Table of Contents
ISRN AIDS
Volume 2014 (2014), Article ID 852489, 13 pages
http://dx.doi.org/10.1155/2014/852489
Research Article

Factors Determining Survival and Retention among HIV-Infected Children and Adolescents in a Community Home-Based Care and a Facility-Based Family-Centred Approach in Kampala, Uganda: A Cohort Study

1Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
2St. Raphael of St. Francis Hospital (Nsambya Hospital), Kampala, Uganda
3Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda
4Infectious Diseases Research Collaboration, Mulago Hospital Complex, Kampala, Uganda
5Department of Global Health Sciences, University of California San Francisco, 50 Beale Street, 12th Floor, San Francisco, CA 94105, USA
6University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein 2000, Johannesburg, South Africa
7Department of Global Heath and Population, Harvard University School of Public Health, Boston, MA, USA
8Santa Chiara Hospital, Via Largo Gold Medals 9, 38122 Trento, Italy
9Department of Pathology, Johns Hopkins School of Medicine 600 N. Wolfe Street/Carnegie 43 Baltimore, MD 21287, USA
10Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda

Received 21 December 2013; Accepted 1 April 2014; Published 1 April 2014

Academic Editors: R. Ansari and L. Sarmati

Copyright © 2014 W. Massavon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We describe factors determining retention and survival among HIV-infected children and adolescents engaged in two health care delivery models in Kampala, Uganda: one is a community home-based care (CHBC) and the other is a facility-based family-centred approach (FBFCA). This retrospective cohort study reviewed records from children aged from 0 to 18 years engaged in the two models from 2003 to 2010 focussing on retention/loss to follow-up, mortality, use of antiretroviral therapy (ART), and clinical characteristics. Kaplan Meier survival curves with log rank tests were used to describe and compare retention and survival. Overall, 1,623 children were included, 90.0% (1460/1623) from the CHBC. Children completed an average of 4.2 years of follow-up (maximum 7.7 years). Median age was 53 (IQR: 11–109) months at enrolment. In the CHBC, retention differed significantly between patients on ART and those not (log-rank test, adjusted, ). Comparing ART patients in both models, there was no significant difference in long-term survival (log-rank test, , adjusted, ), while retention was higher in the CHBC: 94.8% versus 84.7% in the FBFCA (log-rank test, , adjusted ). Irrespective of model of care, children receiving ART had better retention in care and survival.