Increasing numbers of children are requiring long-term HIV care and antiretroviral treatment (ART) in public ART programs in Africa but temporal trends and long-term outcomes in care remain poorly understood. Analysis was done on infants and children up to 10 enrolling in a public tertiary ART center in Zimbabwe over an eight year period from 2004-2012. It was found that initially there was a drop out rate of up to 33% within the first three months of enrollment. Following implementation of revised guidelines in 2009, decentralization of care and increased access to PMTCT services, there was and increase in infants and children of up to 68% remaining in care for more than three months. Long term retention in care also improved with decreasing risk of loss from care at 36 months. ART eligibility at enrollment was a significant predictor of long-term retention in care. Delayed ART initiation after five years resulted in failure to fully reconstitute CD4 counts to age-appropriate levels despite prolonged ART.
Significant improvements have been made in engaging and retaining children in care in public ART programs in Zimbabwe. Guideline and policy changes that increase access and eligibility will likely continue to support improvement in pediatric HIV outcomes.
Authors: Tariro Makadzange, Leanne Dougherty, Rutendo Birri, Gillian Kupakuwana, Janneke van Dijk, Mutsa Dangarembizi, Nomvuyo Mothobi, Benjamin Phelps, Bisola Ojikutu, Chiratidzo Ndhlovu
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