Antiretroviral treatment program retention among HIV-infected children in the Democratic Republic of Congo.

BACKGROUND: Retaining patients with HIV infection in care is still a major challenge in sub- Saharan Africa, particularly in the Democratic Republic of Congo (DRC) where the antiretroviral treatment (ART) coverage is low. Monitoring retention is an important tool for evaluating the quality of care. METHODS AND FINDINGS: A review of medical records of HIV-infected children was performed in three health facilities in the DRC: the Amo-Congo Health center, the Monkole Clinic in Kinshasa, and the HEAL Africa Clinic in Goma. Medical records of 720 children were included. Kaplan Meier curves were constructed with the probability of retention at 6 months, 1 year, 2 years and 3 years. Retention rates were: 88.2% (95% CI: 85.1%-90.8%) at 6 months; 85% (95% CI: 81.5%-87.6%) at one year; 79.4% (95%CI: 75.5%-82.8%) at two years and 74.7% (95% CI: 70.5%-78.5%) at 3 years. The retention varied across study sites: 88.2%, 66.6% and 92.5% at 6 months; 84%, 59% and 90% at 12 months and 75.7%, 56.3% and 85.8% at 24 months respectively for Amo-Congo/Kasavubu, Monkole facility and HEAL Africa. After multivariable Cox regression four variables remained independently associated with attrition: study site, CD4 cell count <350 cells/µL, children younger than 2 years and children whose caregivers were member of an independent church. CONCLUSIONS: Attrition remains a challenge for pediatric HIV positive patients in ART programs in DRC. In addition, the low coverage of pediatric treatment exacerbates the situation of pediatric HIV/AIDS

Retention rates for children on ART by age categories in three different programs and sites in the Democratic Republic of Congo.

<p>Retention rates for children on ART by age categories in three different programs and sites in the Democratic Republic of Congo.</p

Risk factors associated with LTFU and death among children in three study sites.

<p>HR: Hazard Ratio; CI: Confidence Interval.</p><p>Risk factors associated with LTFU and death among children in three study sites.</p

Children's characteristics in three different programs and sites in the Democratic Republic of Congo.

<p>*At the start of antiretroviral treatment.</p><p>Children's characteristics in three different programs and sites in the Democratic Republic of Congo.</p

Characteristics of the child's caregiver in three different programs and sites in the Democratic Republic of Congo.

<p>Characteristics of the child's caregiver in three different programs and sites in the Democratic Republic of Congo.</p

Overall retention rates for children on ART in three different HIV treatment centers in the Democratic Republic of Congo.

<p>Overall retention rates for children on ART in three different HIV treatment centers in the Democratic Republic of Congo.</p

Risk factors for attrition in three different programs and sites in the Democratic Republic of Congo.

<p>HR: Hazard Ratio; CI: Confidence Interval;</p><p>P-value from Cox-regression model adjusted for all factors in final model, including site as a fixed effect.</p><p>Risk factors for attrition in three different programs and sites in the Democratic Republic of Congo.</p

Study flow of participants in three different HIV treatment centers in the Democratic Republic of Congo.

<p>Study flow of participants in three different HIV treatment centers in the Democratic Republic of Congo.</p