Incidence of mortality and its predictors among HIV-infected children receiving antiretroviral therapy in Amhara region: a multicenter retrospective follow-up study

Abstract

BACKGROUND: Evidence shows that earlier access to Antiretroviral Therapy (ART) helps to increase the survival of children by delaying the progression to advanced stages of HIV-related diseases. However, the effect of testing and treatment strategies on mortality among children receiving ART has remained a limited study in Ethiopia. This study aimed to assess the incidence of mortality and its predictors among HIV-infected children receiving ART in Amhara Region Specialized Hospitals, after the test and treat strategy. METHODS: A multicenter facility-based retrospective follow-up study was conducted on 475 HIV-infected children receiving ART at Amhara Region Comprehensive Specialized Hospitals from June 10, 2014, to February 28, 2022. A simple random sampling technique was used to select the study participants. Data were collected using national antiretroviral intake and follow-up forms via the KoBo Toolbox. Data analysis was done using STATA version 17. Descriptive analyses were summarized using the Kaplan-Meier curve, and a log-rank test was used to estimate and compare. Both bivariable and multivariable Weibull regression model were fitted to identify predictors of mortality. Finally, an adjusted hazard ratio with 95% CI was computed, and variables having a p-value < 0.05 were considered as statistically significant predictors of mortality. RESULTS: Among the 461 (97.1%) records included in the final analysis [42], 9.11% of the individuals died within the follow-up period. In this study, the overall mortality rate was found to be 2.53 per 100 child-year observations (95% Confidence Interval (CI): 1.87, 3.43). HIV-infected children presenting with opportunistic infections (OIs) other than tuberculosis infection (adjusted hazard ratio (AHR): 3.81, 95% CI: 1.66, 8.72), tuberculosis (AHR: 7.14, 95% CI: 2.86, 17.79), wasting (AHR: 2.83, 95% CI: 1.44, 5.56), and advanced disease staging (AHR: 4.02, 95% CI: 1.84, 8.78) were at higher risk of mortality. CONCLUSION: In this study, the mortality rate was high after the test-and-treat strategy. HIV-infected children presenting with OIs, advanced disease staging, and wasting were at higher risk of mortality. Therefore, to increase the survival rate for HIV-positive children, clinicians should place a strong emphasis on early screening, controlling OIs, and optimizing nutritional supplements.