Predictors of Loss to Follow-Up After Engagement in Care of HIV-Infected Children Ineligible for Antiretroviral Therapy in an HIV Cohort Study in India

Introduction: Previous studies performed in low- and middle-income countries have shown that nearly half of HIV-infected adults not eligible for antiretroviral therapy (ART) at the time of enrolment in care are lost to follow-up (LTFU). However, data about the attrition from enrolment in care to ART eligibility of HIV-infected children are scarce, especially outside sub-Saharan Africa. Methods: This is a retrospective study about the attrition before ART eligibility of 282 children ineligible for ART at enrolment in care in a cohort study in India. Multivariate analysis was performed using competing risk regression. Results: During 5695 child-months of follow-up, three children died, 36 were LTFU and 144 became ART eligible. The cumulative incidence of attrition (mortality and LTFU) was 15.6% (95% confidence interval [CI], 11.3–20.5) at five years, and the attrition rate was higher during the first year after enrolment in care. The cumulative incidence of LTFU and mortality was 14.4% (95% CI, 10.2–19.2) and 1.2% (95% CI, 0.3–3.3) at five years, respectively. Children with a 12-month AIDS risk 4%. Those children whose father had died had a lower risk of LTFU (SHR 0.26, 95% CI 0.09–0.75) than those whose parents were alive and were living in a rented house. Children aged 10–14 had a lower risk of LTFU (SHR 0.12, 95% CI 0.03–0.55) than those aged 5–9 years. Conclusions: In our setting, a substantial proportion of children ineligible for ART are lost to follow-up before ART eligibility, especially those with younger age, less severe immunosuppression or living with parents in poor socio-economic conditions. These findings can be used by HIV programmes to design interventions aimed at reducing the attrition of pre-ART care of HIV-infected children in India.