Open AccessPatching the gaps towards the 90–90–90 targets: outcomes of Nigerian children receiving antiretroviral treatment who are co‐infected with tuberculosis
Author(s) -
Chamla Dick D,
Asadu Chukwuemeka,
Davies Abiola,
de Wagt Arjan,
Ilesanmi Oluwafunke,
Adeyinka Daniel,
Adejuyigbe Ebun
Publication year - 2015
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.18.7.20251
Subject(s) - medicine , tuberculosis , hazard ratio , pediatrics , isoniazid , retrospective cohort study , human immunodeficiency virus (hiv) , antiretroviral treatment , antiretroviral therapy , medical record , tb treatment , malnutrition , multivariate analysis , viral load , family medicine , confidence interval , pathology
Nigeria has a high burden of children living with HIV and tuberculosis (TB). This article examines the magnitude of TB among children receiving antiretroviral treatment (ART), compares their ART outcomes with their non‐TB counterparts and argues that addressing TB among children on ART is critical for achieving the 90–90–90 targets. Methods This was a facility‐based, retrospective analysis of medical records of children aged <15 years who were newly initiated on ART between 2011 and 2012. Structured tools were used to collect data. STATA software was used to perform descriptive, survival and multivariate analyses. Results A total of 1142 children with a median age of 3.5 years from 20 selected facilities were followed for 24 months. Of these, 95.8% were assessed for TB at ART initiation and 14.7% had TB. Children on ART were more likely to have TB if they were aged 5 years or older ( p< 0.01) and had delayed ART initiation ( p< 0.05). The cotrimoxazole and isoniazid prophylaxes were provided to 87.9 and 0.8% of children, respectively. The rate of new TB cases was 3 (2.2–4.0) per 100 person‐years at six months and declined to 0.2 (0.06–1.4) per 100 person‐years at 24 months. TB infection [adjusted hazard ratio (aHR): 4.3; 2.3–7.9], malnutrition (aHR: 5.1; 2.6–9.8), delayed ART initiation (aHR: 3.2; 1.5–6.7) and age less than 1 year at ART initiation (aHR: 4.0; 1.4–12.0) were associated with death. Additionally, patients with TB (aHR: 1.3; 1.1–1.6) and children below the age of 1 at ART initiation (aHR: 2.9; 1.7–5.2) were more likely to be lost to follow‐up (LFU). Conclusions Children on ART with TB are less likely to survive and more likely to be LFU. These risks, along with low isoniazid uptake and delayed ART initiation, present a serious challenge to achieving the 90–90–90 targets and underscore an urgent need for inclusion of childhood TB/HIV in global plans and reporting mechanisms.