J Acquir Immune Defic Syndr

BackgroundRetention of children in HIV care is essential for prevention of disease progression and mortality.MethodsRetrospective cohort of children (0 to 6 months. Cumulative incidence of ascertained survival and retention after ART initiation was estimated through 24 months using Kaplan-Meier methods. Factors associated with LTF and death were assessed using Cox proportional hazard modeling.Results17,712 children initiated ART at 192 facilities: median age was 4.6 years (IQR: 1.9\u20138.3), median CD4 was 15% (IQR: 10\u201320) for children < 5 years and 265 cells/uL (IQR: 111\u2013461) for children 65 5 years. At 12 and 24 months, 80% and 72% of children were retained with 16% and 22% LTF and 5% and 7% known deaths respectively. Retention ranged from 71\u201395% and 62\u201393% at 12 and 24 months across countries, and was lowest for children < 1 year (51% at 24 months). LTF and death were highest in children < 1 year of age and children with advanced disease.ConclusionRetention was lowest in young children and differed across country programs. Young children and those with advanced disease are at highest risk for LTF and death. Further evaluation of patient- and program-level factors is needed to improve health outcomes.U2G PS001537/PS/NCHHSTP CDC HHSUnited States/5U2GPS001537-03/PHS HHSUnited States