Attrition among HIV positive children enrolled under integrated HIV care programme in Myanmar: 12 years cohort analysis

Aung Chan Minn, Nang Thu Thu Kyaw, Thet Ko Aung, Ohn Mar Mon, Thurain Htun, Myo Minn Oo, July Moe, Aye Aye Mon, Srinath Satyanarayana, Htun Nyunt Oo, Aung Chan Minn, Nang Thu Thu Kyaw, Thet Ko Aung, Ohn Mar Mon, Thurain Htun, Myo Minn Oo, July Moe, Aye Aye Mon, Srinath Satyanarayana, Htun Nyunt Oo

Abstract

Background: In Myanmar, HIV seropositive children are being enrolled in an integrated HIV care (IHC) Program for HIV treatment and care since 2005.

Objectives: To assess the: (a) attrition (death or loss-to-follow-up) rates among children (aged ≥ 18 months to < 15 years) enrolled into the programme before and after initiation of anti-retroviral therapy (ART) (pre-ART and ART periods); (b) demographic and clinical factors associated with attrition during these two periods.

Methods: Children enrolled in IHC Programme and their status (death, lost to follow-up, regular follow-up or transferred out) was assessed as on 30 June 2017. Attrition rates (per 100 person-years) at pre - ART and ART periods were calculated and the association between demographic and clinical characteristics with attrition was assessed using Cox proportional hazards model.

Results: Among 2,736 children enrolled, pre-ART attrition rate was 19 per 100 person-years of follow-up (95% CI: 17-21) and ART attrition rate was 4 per 100 person-years of follow-up (95% CI: 3-4) with higher levels during the initial few months of enrolment. The 36-month retention rates during pre-ART period was 75% (95% CI: 72-78) and during ART period was 87% (95% CI: 86-88). The children 'at enrolment' with relatively lower levels of haemoglobin, immune deficiency, underweight for age, higher WHO clinical stages, presence of hepatitis B infection had higher hazards of attrition in both periods.

Conclusion: The attrition rates are high particularly among children with relatively poorer clinical, nutritional profiles at enrolment. The study suggests the urgent need for improving adherence counselling especially during the initial few months of enrolment and early ART initiation.

Keywords: Attrition; HIV; SORT-IT; children; death; lost to follow up; retention.

Figures

Figure 1.
Figure 1.
Flow diagram of the study participants and outcomes in children (aged 18 months –

Figure 2.

The smoothened ‘hazard function’ for…

Figure 2.

The smoothened ‘hazard function’ for pre-ART attrition in a cohort of HIV positive…

Figure 2.
The smoothened ‘hazard function’ for pre-ART attrition in a cohort of HIV positive children (aged 18 months to

Figure 3.

The smoothened ‘hazard function’ for…

Figure 3.

The smoothened ‘hazard function’ for attrition during ART period in a cohort of…

Figure 3.
The smoothened ‘hazard function’ for attrition during ART period in a cohort of HIV positive children (aged 18 months to

Figure 4.

Nelson Aalen Cumulative Hazard graph…

Figure 4.

Nelson Aalen Cumulative Hazard graph for Pre-ART attrition in children (aged 18 months…

Figure 4.
Nelson Aalen Cumulative Hazard graph for Pre-ART attrition in children (aged 18 months –

Figure 5.

Nelson Aalen Cumulative Hazard graph…

Figure 5.

Nelson Aalen Cumulative Hazard graph for ART attrition in children (aged 18 months…

Figure 5.
Nelson Aalen Cumulative Hazard graph for ART attrition in children (aged 18 months –
Similar articles
Cited by
References
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Data 2017. Geneva (Switserland); 2017. Available from: http://www.unaids.org/en/resources/documents/2017/2017_data_book
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Regional HIV Statistics 2016. Geneva (Switzerland); 2017. Available from: http://www.unaids.org/en/resources/fact-sheet
    1. Peacock-Villada E, Richardson BA, John-Stewart GC.. Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries. Pediatrics. 2011;127:e423–11. - PMC - PubMed
    1. Vermund SH, Blevins M, Moon TD, et al. Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement. PLoS One. 2014;9:e110116. - PMC - PubMed
    1. Abuogi LL, Smith C, McFarland EJ. Retention of HIV-infected children in the first 12 months of anti-retroviral therapy and predictors of attrition in resource limited settings: a systematic review. PLoS One. 2016;11:e0156506. - PMC - PubMed
Show all 26 references
Publication types
MeSH terms
Substances
Related information
Grant support
The training programme and open access publications costs were funded by the Department for International Development (DFID), UK and La Fondation Veuve Emile Metz-Tesch (Luxembourg). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Figure 2.
Figure 2.
The smoothened ‘hazard function’ for pre-ART attrition in a cohort of HIV positive children (aged 18 months to

Figure 3.

The smoothened ‘hazard function’ for…

Figure 3.

The smoothened ‘hazard function’ for attrition during ART period in a cohort of…

Figure 3.
The smoothened ‘hazard function’ for attrition during ART period in a cohort of HIV positive children (aged 18 months to

Figure 4.

Nelson Aalen Cumulative Hazard graph…

Figure 4.

Nelson Aalen Cumulative Hazard graph for Pre-ART attrition in children (aged 18 months…

Figure 4.
Nelson Aalen Cumulative Hazard graph for Pre-ART attrition in children (aged 18 months –

Figure 5.

Nelson Aalen Cumulative Hazard graph…

Figure 5.

Nelson Aalen Cumulative Hazard graph for ART attrition in children (aged 18 months…

Figure 5.
Nelson Aalen Cumulative Hazard graph for ART attrition in children (aged 18 months –
Similar articles
Cited by
References
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Data 2017. Geneva (Switserland); 2017. Available from: http://www.unaids.org/en/resources/documents/2017/2017_data_book
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Regional HIV Statistics 2016. Geneva (Switzerland); 2017. Available from: http://www.unaids.org/en/resources/fact-sheet
    1. Peacock-Villada E, Richardson BA, John-Stewart GC.. Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries. Pediatrics. 2011;127:e423–11. - PMC - PubMed
    1. Vermund SH, Blevins M, Moon TD, et al. Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement. PLoS One. 2014;9:e110116. - PMC - PubMed
    1. Abuogi LL, Smith C, McFarland EJ. Retention of HIV-infected children in the first 12 months of anti-retroviral therapy and predictors of attrition in resource limited settings: a systematic review. PLoS One. 2016;11:e0156506. - PMC - PubMed
Show all 26 references
Publication types
MeSH terms
Substances
Related information
Grant support
The training programme and open access publications costs were funded by the Department for International Development (DFID), UK and La Fondation Veuve Emile Metz-Tesch (Luxembourg). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Figure 3.
Figure 3.
The smoothened ‘hazard function’ for attrition during ART period in a cohort of HIV positive children (aged 18 months to

Figure 4.

Nelson Aalen Cumulative Hazard graph…

Figure 4.

Nelson Aalen Cumulative Hazard graph for Pre-ART attrition in children (aged 18 months…

Figure 4.
Nelson Aalen Cumulative Hazard graph for Pre-ART attrition in children (aged 18 months –

Figure 5.

Nelson Aalen Cumulative Hazard graph…

Figure 5.

Nelson Aalen Cumulative Hazard graph for ART attrition in children (aged 18 months…

Figure 5.
Nelson Aalen Cumulative Hazard graph for ART attrition in children (aged 18 months –
Similar articles
Cited by
References
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Data 2017. Geneva (Switserland); 2017. Available from: http://www.unaids.org/en/resources/documents/2017/2017_data_book
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Regional HIV Statistics 2016. Geneva (Switzerland); 2017. Available from: http://www.unaids.org/en/resources/fact-sheet
    1. Peacock-Villada E, Richardson BA, John-Stewart GC.. Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries. Pediatrics. 2011;127:e423–11. - PMC - PubMed
    1. Vermund SH, Blevins M, Moon TD, et al. Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement. PLoS One. 2014;9:e110116. - PMC - PubMed
    1. Abuogi LL, Smith C, McFarland EJ. Retention of HIV-infected children in the first 12 months of anti-retroviral therapy and predictors of attrition in resource limited settings: a systematic review. PLoS One. 2016;11:e0156506. - PMC - PubMed
Show all 26 references
Publication types
MeSH terms
Substances
Related information
Grant support
The training programme and open access publications costs were funded by the Department for International Development (DFID), UK and La Fondation Veuve Emile Metz-Tesch (Luxembourg). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Figure 4.
Figure 4.
Nelson Aalen Cumulative Hazard graph for Pre-ART attrition in children (aged 18 months –

Figure 5.

Nelson Aalen Cumulative Hazard graph…

Figure 5.

Nelson Aalen Cumulative Hazard graph for ART attrition in children (aged 18 months…

Figure 5.
Nelson Aalen Cumulative Hazard graph for ART attrition in children (aged 18 months –
Similar articles
Cited by
References
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Data 2017. Geneva (Switserland); 2017. Available from: http://www.unaids.org/en/resources/documents/2017/2017_data_book
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Regional HIV Statistics 2016. Geneva (Switzerland); 2017. Available from: http://www.unaids.org/en/resources/fact-sheet
    1. Peacock-Villada E, Richardson BA, John-Stewart GC.. Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries. Pediatrics. 2011;127:e423–11. - PMC - PubMed
    1. Vermund SH, Blevins M, Moon TD, et al. Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement. PLoS One. 2014;9:e110116. - PMC - PubMed
    1. Abuogi LL, Smith C, McFarland EJ. Retention of HIV-infected children in the first 12 months of anti-retroviral therapy and predictors of attrition in resource limited settings: a systematic review. PLoS One. 2016;11:e0156506. - PMC - PubMed
Show all 26 references
Publication types
MeSH terms
Substances
Related information
Grant support
The training programme and open access publications costs were funded by the Department for International Development (DFID), UK and La Fondation Veuve Emile Metz-Tesch (Luxembourg). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 5.
Figure 5.
Nelson Aalen Cumulative Hazard graph for ART attrition in children (aged 18 months –

References

    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Data 2017. Geneva (Switserland); 2017. Available from:
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Regional HIV Statistics 2016. Geneva (Switzerland); 2017. Available from:
    1. Peacock-Villada E, Richardson BA, John-Stewart GC.. Post-HAART outcomes in pediatric populations: comparison of resource-limited and developed countries. Pediatrics. 2011;127:e423–11.
    1. Vermund SH, Blevins M, Moon TD, et al. Poor clinical outcomes for HIV infected children on antiretroviral therapy in rural Mozambique: need for program quality improvement and community engagement. PLoS One. 2014;9:e110116.
    1. Abuogi LL, Smith C, McFarland EJ. Retention of HIV-infected children in the first 12 months of anti-retroviral therapy and predictors of attrition in resource limited settings: a systematic review. PLoS One. 2016;11:e0156506.
    1. Phelps BR, Ahmed S, Amzel A, et al. Linkage, initiation and retention of children in the antiretroviral therapy cascade: an overview. AIDS. 2013;27(Suppl 2):S207–13.
    1. McNairy ML, Lamb MR, Carter RJ, et al. Retention of HIV-infected children on antiretroviral treatment in HIV care and treatment programs in Kenya, Mozambique, Rwanda, and Tanzania. J Acquir Immune Defic Syndr. 2013;62:e70–81.
    1. Hsiao N-Y, Stinson K, Myer L. Linkage of HIV-infected infants from diagnosis to antiretroviral therapy services across the Western Cape, South Africa. South Africa PLoS One. 2013;8:e0055308.
    1. Fox MP, Rosen S. Systematic review of retention of pediatric patients on HIV treatment in low and middle-income countries 2008–2013. AIDS. 2015;29:493–502.
    1. Joint United Nations Programme on HIV/AIDS(UNAIDS) Country factsheets: Myanmar 2016. UNAIDS; 2016. p. 1–6. Available from:
    1. Oo MM, Gupta V, Aung TK, et al. Alarming attrition rates among HIV-infected individuals in pre-antiretroviral therapy care in Myanmar, 2011-2014. Glob Health Action. 2016;9:31280.
    1. Sabapathy K, Ford N, Nyein Chan K, et al. Treatment outcomes from the largest antiretroviral treatment program in Myanmar (Burma). JAIDS J Acquir Immune Defic Syndr. 2012;60:e53–e62.
    1. Mburu G, Paing AZ, Myint NN, et al. Retention and mortality outcomes from a community-supported public-private HIV treatment programme in Myanmar. J Int AIDS Soc. 2016;19:20926.
    1. Sienaert A, Schneider C, Rab H, et al. MYANMAR ECONOMIC MONITOR Alexandra Drees-Gross Senior Financial Specialist Finance and Markets. 2015. Available from:
    1. Department of Population, Ministry of Immigration and Population The 2014 Myanmar Population and Housing Census The Union Report. Nay Pyi Taw (Myanmar); 2014. Available from:
    1. World Health Orgranization Progress Report on HIV in the WHO South-East Asia Region. India; 2016.
    1. World Health Organization Antiretroviral Thereapy of HIV Infection In Infants And Children: Towards Universal Access. Recommendations for a public health approach (2006 revision). Geneva (Switzerland); 2006. Available from:
    1. Myanmar National AIDS Program Guidelines for clinical management of HIV infection in children in Myanmar 2010. 3rd ed. 2010Available from:
    1. Myanmar National AIDS Program Guidelines for clinical management of HIV infection in Myanmar 2014(4th edition). 2014. Available from:
    1. Khadilar V, Khadilkar A. Growth charts: a diagnostic tool. Indian J Endocrinol Metab. 2011;15:S166–S171.
    1. Yu JK-L, Chen S-C-C, Wang K-Y, et al. True outcomes for patients on antiretroviral therapy who are “lost to follow-up” in Malawi. World Health Organization. 2007;85:550–554.
    1. Schöni-Affolter F, Keiser O, Mwango A, et al. Estimating loss to follow-up in HIV-infected patients on antiretroviral therapy: the effect of the competing risk of death in Zambia and Switzerland. PLoS One. 2011;6:2–8.
    1. World Health Orgranization Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva (Switzerland); 2011. Available from:
    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) Ending AIDS Progress Towards the 90-90-90Targets. Geneva (Switzerland); 2017. Available from:
    1. Blevins M, José E, Bilhete FR, et al. Two-year death and loss to follow-up outcomes by source of referral to HIV care for HIV-infected patients initiating antiretroviral therapy in rural Mozambique. AIDS Res Hum Retroviruses. 2015;31:198–207.
    1. National AIDS Program Ministry of Health Myanmar Guidelines for the Clinical Management of HIV infection in Myanmar. Nay Pyi Taw (Myanmar); 2017. Available from:

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する