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Determinants of Survival among HIV Positive Children on Antiretroviral Therapy in Public hospitals, Addis Ababa, Ethiopia

Abaya Mulugeta, Henok Assefa, Tsegaye Tewelde, Lamessa Dube

Background: Human Immunodeficiency Virus (HIV) infection rapidly progresses in children. If not put on a treatment nearly half of them would be dead by the second year of infection. Highly Active Antiretroviral Treatment (HAART) consistently improved survival of children infected with the virus and contributed to prevent new infections. Baseline factors that envisage survival could permit for their possible amendment in order to improve pediatric HIV care and decrease HIV-related mortality among children on the treatment. However, there are inconsistencies of finding by fragmented studies about predictors of survival among children on HAART in Ethiopia. Resolving these inconsistencies of the predictors of survival among children after initiation of HAART is important to improve the effectiveness of HAART on child survival. Therefore, this study was conducted to identify the predictors of the survival among children after initiation of ART and also rectify the inconsistency via multihospital based and longer period of follow up.

Method: A retrospective study was conducted on 757 children who started antiretroviral therapy from January 1, 2008 to December 31, 2010 and followed up until December 31, 2015 at selected public hospitals in Addis Ababa. Cox regression model was fitted to identify independent predictors of survival.

Results: The median survival times after initiation of antiretroviral therapy for children who died and censored were 9 months and 72 months respectively. The overall mortality rate was 12.4 deaths per 1000 child-year. Advanced clinical stages, low hemoglobin level and CD4 cell count at initiation of the treatment were found to be significantly associated with risk of mortality among children on HAART.

Conclusion: The study demonstrated that survival rate among HAART children showed that country’s ART program has been successful in increasing longevity of life among HIV infected children. While advanced clinical stages, presence of anemia and low CD4 cell count demonstrated higher mortality among children. The study finding has important policy implications for HAART programme in the country. This claims for the need to identify and treat eligible HIV infected children at an early stage. Therefore, attention is needed to ensure an early diagnosis, enrollment into HAART and improving the quality of existing services like nutritional evaluation.