Abstract:
HIV has emerged as one of the leading causes of childhood mortality and morbidity in sub Saharan Africa. But, the attention given to HIV-infected children in terms of providing ART had so far taken a second rank. This was because primary concern is about adults. The study had the objectives to assess the relationship of explanatory variables to survival time, estimate the survival duration and identify predictors that have significant impact on the survival status of HIV infected children who received antiretroviral treatment and care in Gondar University Hospital, Gondar, Ethiopia. The data used in the study was based on secondary data from hospital records of HIV infected children aged below 15 years who started ART between 2008 and 2013 were included and followed until April 2015 in Gondar University Hospital, Gondar, Ethiopia. Kaplan-Meier survival curves and Log-Rank test are used to compare the survival experience of different category of children, and Multivariable Cox proportional model was fitted to identify factors affecting survival of children after initiation of ART. The estimation of the model parameters was done by partial maximum likelihood procedures. A total of 269 records were included in the analysis. The median survival time was found to be 55 months. At the end of the follow up, 46 (17.1%) children died due to the disease, the remaining 223 (82.9%) were alive and loss to follow-up. The multivariate analysis of Cox regression model gives that age of a patient (for age < 1.5 years HR: 3.590 ; 95% CI: 1.439, 8.953; P = 0.006 and for age 1.5-5 years HR: 2.632; 95% CI: 1.350, 5.130; P = 0.004), Baseline hemoglobin level (for hemoglobin level < 7g/dl HR: 6.286; 95% CI: 2.328, 16.973; P=0.000 and for hemoglobin level 7-8.5g/dl HR: 5.592; 95% CI: 1.903, 16.436; P = 0.002), WHO clinical stage (For stage III HR: 0.308 ; 95% CI: 0.150, 0.630; P = 0.001) and baseline CD4 count(HR: 0.180 ; 95% CI: 0.084, 0.388; P = 0.000) are significant risk factors of survival of HIV infected children during the 92 months of follow up. Therefore, special attention should be given to younger children in ART; patients with low CD4 cell count, patients with advanced WHO clinical staging (stage III and IV) and patients with low hemoglobin level are necessary in order to improve the survival of HIV infected children treated with ART.
