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<title xml:lang="en">Outcomes of antiretroviral therapy in children in Asia and Africa: a comparative analysis of the IeDEA pediatric multiregional collaboration</title>
<author>
<name sortKey="Leroy, Valeriane" sort="Leroy, Valeriane" uniqKey="Leroy V" first="Valeriane" last="Leroy">Valeriane Leroy</name>
<affiliation>
<nlm:aff id="A1">Inserm, U897, Epidemiologie-Biostatistiques-Bordeaux France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Institut de Santé Publique, Epidémiologie et Développement (ISPED), Bordeaux Segalen University, Bordeaux, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Malateste, Karen" sort="Malateste, Karen" uniqKey="Malateste K" first="Karen" last="Malateste">Karen Malateste</name>
<affiliation>
<nlm:aff id="A1">Inserm, U897, Epidemiologie-Biostatistiques-Bordeaux France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Institut de Santé Publique, Epidémiologie et Développement (ISPED), Bordeaux Segalen University, Bordeaux, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Rabie, Helena" sort="Rabie, Helena" uniqKey="Rabie H" first="Helena" last="Rabie">Helena Rabie</name>
<affiliation>
<nlm:aff id="A3">Tygerberg Academic Hosp., Stellenbosch University, Cape Town, South Africa</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Lumbiganon, Pagakrong" sort="Lumbiganon, Pagakrong" uniqKey="Lumbiganon P" first="Pagakrong" last="Lumbiganon">Pagakrong Lumbiganon</name>
<affiliation>
<nlm:aff id="A4">Khon Kaen University, Thailand</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ayaya, Samuel" sort="Ayaya, Samuel" uniqKey="Ayaya S" first="Samuel" last="Ayaya">Samuel Ayaya</name>
<affiliation>
<nlm:aff id="A5">Moi Teaching and Referral Hosp., Eldoret Kenya</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dicko, Fatoumata" sort="Dicko, Fatoumata" uniqKey="Dicko F" first="Fatoumata" last="Dicko">Fatoumata Dicko</name>
<affiliation>
<nlm:aff id="A6">Hop Gabriel Touré, Bamako, Mali</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Davies, Mary Ann" sort="Davies, Mary Ann" uniqKey="Davies M" first="Mary-Ann" last="Davies">Mary-Ann Davies</name>
<affiliation>
<nlm:aff id="A7">Center for Infectious Diseases Epidemiology and Research, School of Public Health and Family Med., University of Cape Town, South Africa</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kariminia, Azar" sort="Kariminia, Azar" uniqKey="Kariminia A" first="Azar" last="Kariminia">Azar Kariminia</name>
<affiliation>
<nlm:aff id="A8">National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Wools Kaloustian, Kara" sort="Wools Kaloustian, Kara" uniqKey="Wools Kaloustian K" first="Kara" last="Wools-Kaloustian">Kara Wools-Kaloustian</name>
<affiliation>
<nlm:aff id="A9">Indiana Univ. School of Medicine, Indianapolis, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Aka, Edmond" sort="Aka, Edmond" uniqKey="Aka E" first="Edmond" last="Aka">Edmond Aka</name>
<affiliation>
<nlm:aff id="A10">Centre de Prise en Charge, de Recherche et de Formation, CePReF, Abidjan, Côte d'Ivoire</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Phiri, Samuel" sort="Phiri, Samuel" uniqKey="Phiri S" first="Samuel" last="Phiri">Samuel Phiri</name>
<affiliation>
<nlm:aff id="A11">Lighthouse Clinic, Lilongwe, Malawi</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Aurpibul, Linda" sort="Aurpibul, Linda" uniqKey="Aurpibul L" first="Linda" last="Aurpibul">Linda Aurpibul</name>
<affiliation>
<nlm:aff id="A12">Chiang Mai University, Thailand</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Yiannoutsos, Constantin" sort="Yiannoutsos, Constantin" uniqKey="Yiannoutsos C" first="Constantin" last="Yiannoutsos">Constantin Yiannoutsos</name>
<affiliation>
<nlm:aff id="A13">Hopital Albert Royer, Dakar, Sénégal</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Signate Sy, Haby" sort="Signate Sy, Haby" uniqKey="Signate Sy H" first="Haby" last="Signaté-Sy">Haby Signaté-Sy</name>
<affiliation>
<nlm:aff id="A14">Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children,
<italic>Eunice Kennedy Shriver</italic>
National Institute of Child Health and Human Development, National Institutes of Health, Rockville, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mofenson, Lynne" sort="Mofenson, Lynne" uniqKey="Mofenson L" first="Lynne" last="Mofenson">Lynne Mofenson</name>
</author>
<author>
<name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="François" last="Dabis">François Dabis</name>
<affiliation>
<nlm:aff id="A1">Inserm, U897, Epidemiologie-Biostatistiques-Bordeaux France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Institut de Santé Publique, Epidémiologie et Développement (ISPED), Bordeaux Segalen University, Bordeaux, France</nlm:aff>
</affiliation>
</author>
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<idno type="pmid">23187940</idno>
<idno type="pmc">3556242</idno>
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<idno type="RBID">PMC:3556242</idno>
<idno type="doi">10.1097/QAI.0b013e31827b70bf</idno>
<date when="2013">2013</date>
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<analytic>
<title xml:lang="en" level="a" type="main">Outcomes of antiretroviral therapy in children in Asia and Africa: a comparative analysis of the IeDEA pediatric multiregional collaboration</title>
<author>
<name sortKey="Leroy, Valeriane" sort="Leroy, Valeriane" uniqKey="Leroy V" first="Valeriane" last="Leroy">Valeriane Leroy</name>
<affiliation>
<nlm:aff id="A1">Inserm, U897, Epidemiologie-Biostatistiques-Bordeaux France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Institut de Santé Publique, Epidémiologie et Développement (ISPED), Bordeaux Segalen University, Bordeaux, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Malateste, Karen" sort="Malateste, Karen" uniqKey="Malateste K" first="Karen" last="Malateste">Karen Malateste</name>
<affiliation>
<nlm:aff id="A1">Inserm, U897, Epidemiologie-Biostatistiques-Bordeaux France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Institut de Santé Publique, Epidémiologie et Développement (ISPED), Bordeaux Segalen University, Bordeaux, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Rabie, Helena" sort="Rabie, Helena" uniqKey="Rabie H" first="Helena" last="Rabie">Helena Rabie</name>
<affiliation>
<nlm:aff id="A3">Tygerberg Academic Hosp., Stellenbosch University, Cape Town, South Africa</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Lumbiganon, Pagakrong" sort="Lumbiganon, Pagakrong" uniqKey="Lumbiganon P" first="Pagakrong" last="Lumbiganon">Pagakrong Lumbiganon</name>
<affiliation>
<nlm:aff id="A4">Khon Kaen University, Thailand</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Ayaya, Samuel" sort="Ayaya, Samuel" uniqKey="Ayaya S" first="Samuel" last="Ayaya">Samuel Ayaya</name>
<affiliation>
<nlm:aff id="A5">Moi Teaching and Referral Hosp., Eldoret Kenya</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dicko, Fatoumata" sort="Dicko, Fatoumata" uniqKey="Dicko F" first="Fatoumata" last="Dicko">Fatoumata Dicko</name>
<affiliation>
<nlm:aff id="A6">Hop Gabriel Touré, Bamako, Mali</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Davies, Mary Ann" sort="Davies, Mary Ann" uniqKey="Davies M" first="Mary-Ann" last="Davies">Mary-Ann Davies</name>
<affiliation>
<nlm:aff id="A7">Center for Infectious Diseases Epidemiology and Research, School of Public Health and Family Med., University of Cape Town, South Africa</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kariminia, Azar" sort="Kariminia, Azar" uniqKey="Kariminia A" first="Azar" last="Kariminia">Azar Kariminia</name>
<affiliation>
<nlm:aff id="A8">National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Wools Kaloustian, Kara" sort="Wools Kaloustian, Kara" uniqKey="Wools Kaloustian K" first="Kara" last="Wools-Kaloustian">Kara Wools-Kaloustian</name>
<affiliation>
<nlm:aff id="A9">Indiana Univ. School of Medicine, Indianapolis, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Aka, Edmond" sort="Aka, Edmond" uniqKey="Aka E" first="Edmond" last="Aka">Edmond Aka</name>
<affiliation>
<nlm:aff id="A10">Centre de Prise en Charge, de Recherche et de Formation, CePReF, Abidjan, Côte d'Ivoire</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Phiri, Samuel" sort="Phiri, Samuel" uniqKey="Phiri S" first="Samuel" last="Phiri">Samuel Phiri</name>
<affiliation>
<nlm:aff id="A11">Lighthouse Clinic, Lilongwe, Malawi</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Aurpibul, Linda" sort="Aurpibul, Linda" uniqKey="Aurpibul L" first="Linda" last="Aurpibul">Linda Aurpibul</name>
<affiliation>
<nlm:aff id="A12">Chiang Mai University, Thailand</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Yiannoutsos, Constantin" sort="Yiannoutsos, Constantin" uniqKey="Yiannoutsos C" first="Constantin" last="Yiannoutsos">Constantin Yiannoutsos</name>
<affiliation>
<nlm:aff id="A13">Hopital Albert Royer, Dakar, Sénégal</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Signate Sy, Haby" sort="Signate Sy, Haby" uniqKey="Signate Sy H" first="Haby" last="Signaté-Sy">Haby Signaté-Sy</name>
<affiliation>
<nlm:aff id="A14">Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children,
<italic>Eunice Kennedy Shriver</italic>
National Institute of Child Health and Human Development, National Institutes of Health, Rockville, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Mofenson, Lynne" sort="Mofenson, Lynne" uniqKey="Mofenson L" first="Lynne" last="Mofenson">Lynne Mofenson</name>
</author>
<author>
<name sortKey="Dabis, Francois" sort="Dabis, Francois" uniqKey="Dabis F" first="François" last="Dabis">François Dabis</name>
<affiliation>
<nlm:aff id="A1">Inserm, U897, Epidemiologie-Biostatistiques-Bordeaux France</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A2">Institut de Santé Publique, Epidémiologie et Développement (ISPED), Bordeaux Segalen University, Bordeaux, France</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Journal of acquired immune deficiency syndromes (1999)</title>
<idno type="ISSN">1525-4135</idno>
<idno type="eISSN">1944-7884</idno>
<imprint>
<date when="2013">2013</date>
</imprint>
</series>
</biblStruct>
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<profileDesc>
<textClass></textClass>
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<front>
<div type="abstract" xml:lang="en">
<sec id="S1">
<title>Background</title>
<p id="P1">We investigated 18-month incidence and determinants of death and loss-to-follow-up of children after antiretroviral therapy (ART) initiation in a multiregional collaboration in lower-income countries.</p>
</sec>
<sec id="S2">
<title>Methods</title>
<p id="P2">HIV-infected children (positive PCR <18 months or positive serology ≥18 months) from IeDEA cohorts, <16 years, initiating ART were eligible. A competing risk regression model was used to analyze the independent risk of two failure types: death and loss-to-follow-up (>6 months).</p>
</sec>
<sec id="S3">
<title>Findings</title>
<p id="P3">Data on 13611 children, from Asia (N=1454), East-Africa (N=3114), Southern-Africa (N=6212) and West-Africa (N=2881) contributed 20,417 person-years of follow-up. At 18 months, the adjusted risk of death was 4.3% in East-Africa, 5.4% in Asia, 5.7% in Southern-Africa and 7.4% in West-Africa (
<italic>P</italic>
=0.01). Age<24 months, WHO stage 4, CD4<10%, attending a private sector clinic, larger cohort size and living in West-Africa were independently associated with poorer survival. The adjusted risk of loss-to-follow-up was 4.1% in Asia, 9.0% in Southern-Africa, 14.0% in East-Africa, and 21.8% in West-Africa (
<italic>P</italic>
<0.01). Age<12 months, non NNRTI-based ART regimen, WHO stage 4 at ART start, ART initiation after 2005, attending a public sector or a non-urban clinic, having to pay for laboratory tests or antiretroviral drugs, larger cohort size, and living in East or West-Africa were significantly associated with higher loss-to-follow-up.</p>
</sec>
<sec id="S4">
<title>Conclusion</title>
<p id="P4">Findings differed substantially across regions but raise overall concerns about delayed ART start, low access to free HIV-services for children, and increased workload on program retention in lower-income countries. Universal free access to ART services and innovative approaches are urgently needed to improve pediatric outcomes at program level.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article">
<pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-journal-id">100892005</journal-id>
<journal-id journal-id-type="pubmed-jr-id">21821</journal-id>
<journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id>
<journal-id journal-id-type="iso-abbrev">J. Acquir. Immune Defic. Syndr.</journal-id>
<journal-title-group>
<journal-title>Journal of acquired immune deficiency syndromes (1999)</journal-title>
</journal-title-group>
<issn pub-type="ppub">1525-4135</issn>
<issn pub-type="epub">1944-7884</issn>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">23187940</article-id>
<article-id pub-id-type="pmc">3556242</article-id>
<article-id pub-id-type="doi">10.1097/QAI.0b013e31827b70bf</article-id>
<article-id pub-id-type="manuscript">NIHMS425417</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Article</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Outcomes of antiretroviral therapy in children in Asia and Africa: a comparative analysis of the IeDEA pediatric multiregional collaboration</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Leroy</surname>
<given-names>Valeriane</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Malateste</surname>
<given-names>Karen</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Rabie</surname>
<given-names>Helena</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Lumbiganon</surname>
<given-names>Pagakrong</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ayaya</surname>
<given-names>Samuel</given-names>
</name>
<xref ref-type="aff" rid="A5">5</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dicko</surname>
<given-names>Fatoumata</given-names>
</name>
<xref ref-type="aff" rid="A6">6</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Davies</surname>
<given-names>Mary-Ann</given-names>
</name>
<xref ref-type="aff" rid="A7">7</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kariminia</surname>
<given-names>Azar</given-names>
</name>
<xref ref-type="aff" rid="A8">8</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Wools-Kaloustian</surname>
<given-names>Kara</given-names>
</name>
<xref ref-type="aff" rid="A9">9</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Aka</surname>
<given-names>Edmond</given-names>
</name>
<xref ref-type="aff" rid="A10">10</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Phiri</surname>
<given-names>Samuel</given-names>
</name>
<xref ref-type="aff" rid="A11">11</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Aurpibul</surname>
<given-names>Linda</given-names>
</name>
<xref ref-type="aff" rid="A12">12</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Yiannoutsos</surname>
<given-names>Constantin</given-names>
</name>
<xref ref-type="aff" rid="A13">13</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Signaté-Sy</surname>
<given-names>Haby</given-names>
</name>
<xref ref-type="aff" rid="A14">14</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Mofenson</surname>
<given-names>Lynne</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dabis</surname>
<given-names>François</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author">
<collab>for the International IeDEA Pediatric Working Group
<xref rid="FN2" ref-type="author-notes">*</xref>
</collab>
</contrib>
</contrib-group>
<aff id="A1">
<label>1</label>
Inserm, U897, Epidemiologie-Biostatistiques-Bordeaux France</aff>
<aff id="A2">
<label>2</label>
Institut de Santé Publique, Epidémiologie et Développement (ISPED), Bordeaux Segalen University, Bordeaux, France</aff>
<aff id="A3">
<label>3</label>
Tygerberg Academic Hosp., Stellenbosch University, Cape Town, South Africa</aff>
<aff id="A4">
<label>4</label>
Khon Kaen University, Thailand</aff>
<aff id="A5">
<label>5</label>
Moi Teaching and Referral Hosp., Eldoret Kenya</aff>
<aff id="A6">
<label>6</label>
Hop Gabriel Touré, Bamako, Mali</aff>
<aff id="A7">
<label>7</label>
Center for Infectious Diseases Epidemiology and Research, School of Public Health and Family Med., University of Cape Town, South Africa</aff>
<aff id="A8">
<label>8</label>
National Centre in HIV Epidemiology and Clinical Research, Sydney, Australia</aff>
<aff id="A9">
<label>9</label>
Indiana Univ. School of Medicine, Indianapolis, USA</aff>
<aff id="A10">
<label>10</label>
Centre de Prise en Charge, de Recherche et de Formation, CePReF, Abidjan, Côte d'Ivoire</aff>
<aff id="A11">
<label>11</label>
Lighthouse Clinic, Lilongwe, Malawi</aff>
<aff id="A12">
<label>12</label>
Chiang Mai University, Thailand</aff>
<aff id="A13">
<label>13</label>
Hopital Albert Royer, Dakar, Sénégal</aff>
<aff id="A14">
<label>14</label>
Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and Children,
<italic>Eunice Kennedy Shriver</italic>
National Institute of Child Health and Human Development, National Institutes of Health, Rockville, USA</aff>
<author-notes>
<corresp id="FN1">Corresponding author: Valériane Leroy; MD, PhD, Centre de Recherche INSERM U897, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Bordeaux Segalen, Case 11, 146, rue Léo Saignat, 33076 Bordeaux Cedex, FranceTel: 33 (0) 5. 57.57.12.58 (Direct) or 33 (0) 5. 34.57.05.44, Fax: 33 (0) 5. 57.57.45.28,
<email>Valeriane.Leroy@isped.u-bordeaux2.fr</email>
, Web:
<ext-link ext-link-type="uri" xlink:href="http://www.isped.u-bordeaux2.fr">http://www.isped.u-bordeaux2.fr</ext-link>
</corresp>
<fn id="FN2">
<label>*</label>
<p>See the International Epidemiologic Databases to Evaluate AIDS (IeDEA) composition in the
<xref rid="APP1" ref-type="app">Appendix</xref>
</p>
</fn>
</author-notes>
<pub-date pub-type="nihms-submitted">
<day>9</day>
<month>1</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="ppub">
<day>1</day>
<month>2</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>01</day>
<month>2</month>
<year>2014</year>
</pub-date>
<volume>62</volume>
<issue>2</issue>
<fpage>208</fpage>
<lpage>219</lpage>
<abstract>
<sec id="S1">
<title>Background</title>
<p id="P1">We investigated 18-month incidence and determinants of death and loss-to-follow-up of children after antiretroviral therapy (ART) initiation in a multiregional collaboration in lower-income countries.</p>
</sec>
<sec id="S2">
<title>Methods</title>
<p id="P2">HIV-infected children (positive PCR <18 months or positive serology ≥18 months) from IeDEA cohorts, <16 years, initiating ART were eligible. A competing risk regression model was used to analyze the independent risk of two failure types: death and loss-to-follow-up (>6 months).</p>
</sec>
<sec id="S3">
<title>Findings</title>
<p id="P3">Data on 13611 children, from Asia (N=1454), East-Africa (N=3114), Southern-Africa (N=6212) and West-Africa (N=2881) contributed 20,417 person-years of follow-up. At 18 months, the adjusted risk of death was 4.3% in East-Africa, 5.4% in Asia, 5.7% in Southern-Africa and 7.4% in West-Africa (
<italic>P</italic>
=0.01). Age<24 months, WHO stage 4, CD4<10%, attending a private sector clinic, larger cohort size and living in West-Africa were independently associated with poorer survival. The adjusted risk of loss-to-follow-up was 4.1% in Asia, 9.0% in Southern-Africa, 14.0% in East-Africa, and 21.8% in West-Africa (
<italic>P</italic>
<0.01). Age<12 months, non NNRTI-based ART regimen, WHO stage 4 at ART start, ART initiation after 2005, attending a public sector or a non-urban clinic, having to pay for laboratory tests or antiretroviral drugs, larger cohort size, and living in East or West-Africa were significantly associated with higher loss-to-follow-up.</p>
</sec>
<sec id="S4">
<title>Conclusion</title>
<p id="P4">Findings differed substantially across regions but raise overall concerns about delayed ART start, low access to free HIV-services for children, and increased workload on program retention in lower-income countries. Universal free access to ART services and innovative approaches are urgently needed to improve pediatric outcomes at program level.</p>
</sec>
</abstract>
<kwd-group>
<kwd>antiretroviral therapy</kwd>
<kwd>children</kwd>
<kwd>cohort studies</kwd>
<kwd>HIV infection</kwd>
<kwd>mortality</kwd>
<kwd>loss to follow-up</kwd>
<kwd>low income countries</kwd>
<kwd>Asia</kwd>
<kwd>Africa</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>

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