Survival time and its predictors among HIV-infected children after antiretroviral therapy in public health facilities of Arba Minch town, Gamo Gofa Zone, Southern Ethiopia

 Abstract

Background: Antiretroviral therapy is a drug treatment that plays a great role in reduction of mortality among children infected with human immunodeficiency virus. Studies in Africa have shown that there is short survival time among children receiving antiretroviral therapy. Factors that contribute to low survival probability have been poorly described in sub-Saharan Africa, particularly in Ethiopia.

Objective: The study was conducted to estimate the survival time and identify associated factors among HIV-infected children after initiation of antiretroviral therapy.

Methods: Institution-based retrospective cohort study was conducted among 421 children enrolled on antiretroviral therapy from January 2009 to December 2016 in public health facilities in Arba Minch town, Gamo Gofa zone, Southern Ethiopia. Cox proportional-hazard regression model was used to determine independent predictors of survival time.

Results: Two hundred and sixty one (62%) children were alive; 43 (10.2%) were lost to follow-up; 52 (12.4%) were transferred out to other facilities and 65 (15.4%) were reported to have died. The probability of survival of children on antiretroviral therapy was 73.9% after 96 months and overall mean survival time was 82.3 (95% CI= 79.48 - 85.14) months. Multivariate analysis showed that low hemoglobin level (AHR =3.3, 95% CI=1.83-6.04), absolute CD4 count below threshold (AHR=2.1, 95% CI=1.15-3.77), fair and poor adherence to antiretroviral therapy (AHR=2.17, 95% CI=1.12-4.79), (AHR=2.1, 95% CI=1.02-4.13), Isoniazid prophylaxis (AHR=0.4, 95%, CI=0.22 -0.68) and Cotrimoxazole prophylactic therapy (AHR=0.3, 95% CI=0.15-0.46) were independent predictors of the survival time.

Conclusions: Survival time was very low among children below 1 year and 5-14 years olds as compared to those aged between 1-4 years. The main predictors for this variation were nutritional status, poor adherence to antiretroviral therapy, absolute CD4 below threshold, and absence of Isoniazid and Cotrimoxazole prophylaxes. Therefore, children living with HIV should be encouraged to adhere to the antiretroviral therapy, take Cotrimoxazole and isoniazid preventive therapies.

Key Words: Antiretroviral therapy, Co-trimoxazole preventive therapy, isoniazied preventive therapy, children, Ethiopia