Effect of antiretroviral therapy care interruptions on mortality in children living with HIV: cohort study from Southern Africa.

OBJECTIVE To evaluate the characteristics and outcomes of HIV-infected children that have care interruptions, during which the child's health status and use of medication is unknown. DESIGN We included data on children initiating ART between 2004 and 2016 at 180 days. Children had a care interruption if they were classified as LTFU, and subsequently returned to care. Children who died within 180 days of ART start were excluded. METHODS The main outcome was all cause mortality. Two exposed groups were considered: those with a first care interruption within the first six months on ART, and those with a first care interruption after six months on ART. Adjusted hazard ratios were determined using a Cox regression model. RESULTS Among 53,674 children included, 23,437 (44%) had a care interruption, of which 10,629 (20%) had a first care interruption within six months on ART and 12,808 (24%) had a first care interruption after six months on ART. Increased mortality was associated with a care interruption within six months on ART (adjusted hazard ratio (AHR) = 1.52, 95% CI 1.12-2.04) but not with a care interruption after six months on ART (AHR = 1.05, 95% CI 0.77-1.44). CONCLUSIONS The findings suggest that strengthening retention of children in care in the early period after ART initiation is critical to improving paediatric ART outcomes