Effect of antiretroviral therapy care interruptions on mortality in children living with HIV: cohort study from Southern Africa.

OBJECTIVE

To evaluate the characteristics and outcomes of HIV-infected children that have care interruptions, during which the child's health status and use of medication is unknown.

DESIGN

We included data on children initiating ART between 2004 and 2016 at <16 years old at 16 International Epidemiologic Databases to Evaluate AIDS Southern Africa cohorts. Children were classified as loss to follow up (LTFU) if they had not attended clinic for >180 days. Children had a care interruption if they were classified as LTFU, and subsequently returned to care. Children who died within 180 days of ART start were excluded.

METHODS

The main outcome was all cause mortality. Two exposed groups were considered: those with a first care interruption within the first six months on ART, and those with a first care interruption after six months on ART. Adjusted hazard ratios were determined using a Cox regression model.

RESULTS

Among 53,674 children included, 23,437 (44%) had a care interruption, of which 10,629 (20%) had a first care interruption within six months on ART and 12,808 (24%) had a first care interruption after six months on ART. Increased mortality was associated with a care interruption within six months on ART (adjusted hazard ratio (AHR) = 1.52, 95% CI 1.12-2.04) but not with a care interruption after six months on ART (AHR = 1.05, 95% CI 0.77-1.44).

CONCLUSIONS

The findings suggest that strengthening retention of children in care in the early period after ART initiation is critical to improving paediatric ART outcomes.