Trends of severe HIV disease and mortality among children in rural Tanzania

Abstract

Objective: To assess trends of severe HIV disease (SHD) and mortality/loss to follow-up (LTFU) among children living with HIV in rural Tanzania. Methods: Among children aged 0–14 years living with HIV enrolled in the prospective Kilombero & Ulanga Antiretroviral Cohort in January 2005–December 2023, we determined WHO-defined SHD prevalences at enrolment, mortality/LTFU incidence during follow-up using Kaplan–Meier methods, and associated factors using regression models. Results: At enrolment, among 1089 children [567 (52%) males, 587 (54%) aged <5 years and 530 (49%) with a HIV WHO stage III/IV], 112/332 (34%) had CD4 cell count <200 cells/μL among those aged 5–14 years. In children aged 5–14 years, SHD was diagnosed in 265/502 (53%) with a prevalence of 35–94% declining after 2013. Among children aged <5 years, 374/587 (64%) had SHD with no change over time. Male gender [adjusted odds ratio = 1.45; 95% confidence interval: 1.10–1.90], age <5 years versus older (1.64; 1.13–2.37), hospitalization versus outpatients (6.72; 3.35–13.5), antiretroviral treatment (ART) start within 30 days versus later (2.18; 1.52–3.13), and enrolment during 2013–2016 versus before (2.29; 1.54–3.41) were associated with SHD. After a median follow-up of 3.3 years [interquartile ratio: 0.8–7.8], 130 (12%) children died and 359 (35%) were LTFU. Predictors of mortality/LTFU were SHD [adjusted hazard ratio (aHR) = 1.54; 95% CI: 1.26–1.89], age <5 years versus older (1.28; 1.01–1.66), hospitalization versus outpatients (1.93; 1.42–2.63), living ≥50 km versus ≤1 km away (1.72; 1.37–2.16) and delayed ART initiation versus within 30 days (3.40; 2.70–4,27), while enrolment 2017–2023 versus before (0.51; 0.37–0.70) was protective. Conclusions: The persisting high prevalence of paediatric SHD and high mortality/LTFU underscores the need for early diagnosis and care.