Background: To reduce HIV-related morbidity and mortality among children living with HIV (CLHIV), continuity of treatment is critical. We sought to understand how aging out among CLHIV in Kenya impacts estimates of treatment continuity.
Methods: A retrospective cohort analysis was performed on deidentified individual-level data from the Kenya National Data Warehouse for all clients who initiated and/or received antiretroviral therapy between the periods of October 2018 and September 2022 [US Government fiscal years (FYs) 2019-2022]. CLHIV previously on treatment and those newly initiating treatment were included in the analysis. Outcomes included aging out of childhood (turning 15 years old), interruption in treatment, return to treatment and remaining active on treatment.
Results: The number of active CLHIV on treatment at the end of FY 2019 was 44,628. This changed to 48,218, 48,262 and 44,780 representing 8%, 0% and -7% cohort growth/reduction at the end of FYs 2020, 2021 and 2022, respectively. Among those who were on treatment at the beginning of each FY, aging out of childhood accounted for 53%, 61% and 72% of the total cohort reductions for the periods 2020, 2021 and 2022, respectively. Interruptions in treatment accounted for proportions ranging from 5% to 9% among those active on treatment, while those who aged out of childhood ranged between 11% and 13%. Among those who returned to treatment in each FY, the proportions who remained active at the end of the FY varied from 72% to 76%.
Conclusions: Accounting for aging out of childhood can improve program estimates of their true rates of interruptions of treatment in children, as they work to achieve epidemic control among CLHIV.
Keywords: HIV; HIV care continuum; aging out; care and treatment; pediatrics.
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