Abstract:
Objectives: To describe the characteristics and outcomes of children registered for care
in a large HIV care programme in Western Kenya.
Design: A retrospective descriptive study.
Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district
hospitals; Moi Teaching and Referral Hospital in Western Kenya.
Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics
in Western Kenya.
Interventions: Paediatric HIV diagnosis and care including treatment and prevention
of opportunistic infections and provision of combination antiretroviral therapy
(CART).
Main outcome measures: Diagnosis, clinical stage and immune status at enrollment
and follow-up; hospitalisation and death. Descriptive statistical analyses and chi
square tests were performed
Results: Four thousand and seventeen HIV-infected children seen between June 2002
and April 2008. Median age at enrollment was four years (0-14.2 years), 51% girls, 25%
paternal orphans, 10% total orphans and 13% maternal orphans. At enrollment, 25% had
weight-for-Age Z scores (WAZ)> -1 and 21% had WAZ scores < 3. Orphaned children had
worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO
clinical stage 3 and 4, 56% were WHO clinical stages 1 and 2 with 19% missing clinical
staging at enrollment. Cough (25%), gastroenteritis (21%), fever (15%), pneumonia (10%)
were the commonest presenting features. Twenty six per cent had been diagnosed with
tuberculosis and only 25% started on cotrimoxazole preventive therapy (CPT). Median
CD4% at enrollment was 16% (0-64%); latest recorded values were 22% (0-64). Sixty four
per cent were on cART (cART+), median age at start was 5.4 (014.4 years).The median
initial CD4% among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART
(cART-). Median CD4% for cART+ improved to 22% (0-59); whereas cART- was 23% (0-
64) at last appointment. During the period of follow-up, one fifth (19%) of children on
cART were lost to follow-up compared to slightly over one third (37%) for those not on
cART. Thirty four percent were hospitalised; 41% diagnosed with pneumonia. Six per
cent of 4017 were confirmed dead.
Conclusions: HIV -infected children were enrolled in care early in childhood. Orphan-
hood was prevalent in these children as were gastroenteritis, fever, pneumonia and
advanced immuno-suppression. Orphans were more likely to be severely malnourished.
Only a quarter of children were put on cotrimoxazole preventive therapy. Children
commenced on cART late but responded well to treatment. Loss to follow-up was less
prevalent among those on cART