Pediatric HIV Care Cascade in Southern Mozambique: Missed Opportunities for Early ART and Re-engagement in Care. Issue 5 (May 2020) - Fernández-Luis, Sheila
Abstract : Background: There are 170, 000 children living with HIV in 2017 in Mozambique. Scaling-up HIV care requires effective retention along the cascade. We sought to evaluate the pediatric cascade in HIV care at the Manhiça District Hospital. Methods: A prospective cohort of children <15 years was followed from enrollment in HIV care (January 2013 to December 2015) until December 2016. Loss to follow-up (LTFU) was defined as not attending the HIV hospital visits for ≥90 days following last visit attended. Results: From the 438 children included {median age at enrollment in care of 3, 6 [interquartile range (IQR): 1.1–8.6] years}, 335 (76%) were antiretroviral therapy (ART) eligible and among those, 263 (78%) started ART at enrollment in HIV care. A total of 362 children initiated ART during the study period and the incidence rate of LTFU at 12, 24, and 36 months post-ART initiation was 41 [95% confidence interval (CI): 34–50], 34 (95% CI: 29–41), and 31 (95% CI: 27–37) per 100 children-years, respectively. Median time to LTFU was 5.8 (IQR: 1.4–12.7) months. Children 5–9 years of age had a lower risk of LTFU compared with children <1 year [adjusted subhazard ratio 0.36 (95% CI: 0.20–0.61)]. Re-engagement in care (RIC) was observed in 25% of the LTFU children. Conclusions: The high LTFU found in this study highlights the special attention that should be given to younger children during the first 6 months post-ART initiation to prevent LTFU. Once LTFU, only a quarter of those children return to the health unit. Elucidating factors associated with RIC could help to fine tune interventions which promote RIC. Abstract : Supplemental Digital Content is available in the text.