Predictors of mortality among children and adolescents living with hiv on antiretroviral therapy in western kenya

Abstract

Background:

Antiretroviral therapy (ART) has decreased HIV-attributable deaths; however, children and adolescents continue to have high HIV-associated mortality. Setting:

We determined the predictors of death among children and young adolescents living with HIV (CALWH) who died while in care in Western Kenya. Methods:

This retrospective case-control study used electronically abstracted data of 6234 CALWH who received care in Academic Model Providing Access to Healthcare (AMPATH) HIV clinics in Western Kenya between January 2002 and November 2022. The cases comprised CALWH who were reported dead by November 2022, while the controls constituted of matched CALWH who were alive and in care. Independent predictors of mortality were determined using univariable and multivariable Cox proportional hazard regression models. Kaplan-Meier analysis ascertained survival. Results:

Of the 6234 participants enrolled, slightly over half were male (51.7%). The mean [SD] age at the start of ART was significantly lower in the cases than in controls at 6.01 [4.37] and 6.62 [4.11] (p<0.001). An age of ≥11 years at start of ART (aHR: 8.36 [3.60-19.40]), both parents being alive (aHR: 3.06 [1.67-5.60], underweight (aHR:1.82 [(1.14-2.92], WHO stages 3 (aHR: 2.63 [1.12-6.18]) and 4 (aHR: 2.20 [0.94-5.18]) increased mortality; while, school attendance (aHR: 0.12 [0.06-0.21]), high CD4+ counts >350cells/mm3 (aHR:0.79 [0.48-1.29]), and low first viral load <1000copies/ml (aHR: 0.24 [0.14-0.40]) were protective. Conclusion:

Independent predictors of mortality were age ≥11 years at the start of ART, orphan status, underweight, and advanced HIV disease. Beyond the provision of universal ART, care accorded to CALWH necessitates optimization via tackling individual predictors of mortality.