Trends of severe HIV disease and mortality among children in rural Tanzania

L S Moshi; J Okuma; E Luoga; A V Kalinjuma; G J Mollel; G Sigalla; L Wilson; E Dotto; T Glass; F Vanobberghen; M Weisser; KIULARCO study group

doi:10.1111/hiv.70015

Trends of severe HIV disease and mortality among children in rural Tanzania

HIV Med. 2025 Mar 25. doi: 10.1111/hiv.70015. Online ahead of print.

Authors

L S Moshi^{1

2}, J Okuma^{3

4}, E Luoga^{1

2}, A V Kalinjuma^{1

5}, G J Mollel^{1

2}, G Sigalla^{1

2}, L Wilson¹, E Dotto¹, T Glass^{3

4}, F Vanobberghen^{3

4}, M Weisser^{1

3

6}; KIULARCO study group

Collaborators

KIULARCO study group:
Aschola Asantiel, Farida Bani, Manuel Battegay, Theonestina Byakuzana, Joyce Claud, Adolphina Chale, Elizabeth Dotto, Gideon Francis, Tracy R Glass, Yvonne Haridas, Speciosa Hwaya, Getruda Julius, Aneth V Kalinjuma, Andrew Katende, Yassin Kisunga, Olivia Kitau, Bernard Kivuma, Thomas Klimkait, Juma Kupewa, Ezekiel Luoga, Jerome Lwali, Edgar Enzigard Martin, Swalehe Masoud, Mohammed Mbaruku, Geofrey Mbunda, Josephine Mhina, Slyakus Mlembe, Teddy Mlumba, Mengi Mkulila, Margareth Mkusa, Fransisca Alfred Mmbando, Lina Mnunga, Alpha Mninje, Dorcas K Mnzava, Getrud J Mollel, Lilian Moshi, Germana Mossad, Rejina Mponji, Dolores Mpundunga, Athumani Mtandanguo, Ummu-Kulthum Mwaliga, Elizabeth Mwambashi, Selerine Myeya, Sanula Nahota, Sharifa Nakapala, Regina Ndaki, Robert C Ndege, Suzan Ngahyoma, Agatha Ngulukila, Alex John Ntamatungiro, Vaileth Nyaenza, Emmanuel Nyenza, Amina Nyuri, James Okuma, Daniel H Paris, Martin Rohacek, Petro Togolani Sabuni, Leila Samson, Elizabeth Senkoro, George Sigalla, Jamali B Siru, Jenifa Tarimo, Emmy Temba, Juerg Utzinger, Fiona Vanobberghen, Maja Weisser, John Wigay, Lulu Wilson

Affiliations

¹ Ifakara Health Institute, Ifakara, Tanzania.
² St. Francis Regional Referral Hospital, Ifakara, Tanzania.
³ Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
⁴ University of Basel, Basel, Switzerland.
⁵ School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁶ Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland.

PMID: 40134127
DOI: 10.1111/hiv.70015

Abstract

Objective: To assess trends of severe HIV disease (SHD) and mortality/loss to follow-up (LTFU) among children living with HIV in rural Tanzania.

Methods: Among children aged 0-14 years living with HIV enrolled in the prospective Kilombero & Ulanga Antiretroviral Cohort in January 2005-December 2023, we determined WHO-defined SHD prevalences at enrolment, mortality/LTFU incidence during follow-up using Kaplan-Meier methods, and associated factors using regression models.

Results: At enrolment, among 1089 children [567 (52%) males, 587 (54%) aged <5 years and 530 (49%) with a HIV WHO stage III/IV], 112/332 (34%) had CD4 cell count <200 cells/μL among those aged 5-14 years. In children aged 5-14 years, SHD was diagnosed in 265/502 (53%) with a prevalence of 35-94% declining after 2013. Among children aged <5 years, 374/587 (64%) had SHD with no change over time. Male gender [adjusted odds ratio = 1.45; 95% confidence interval: 1.10-1.90], age <5 years versus older (1.64; 1.13-2.37), hospitalization versus outpatients (6.72; 3.35-13.5), antiretroviral treatment (ART) start within 30 days versus later (2.18; 1.52-3.13), and enrolment during 2013-2016 versus before (2.29; 1.54-3.41) were associated with SHD. After a median follow-up of 3.3 years [interquartile ratio: 0.8-7.8], 130 (12%) children died and 359 (35%) were LTFU. Predictors of mortality/LTFU were SHD [adjusted hazard ratio (aHR) = 1.54; 95% CI: 1.26-1.89], age <5 years versus older (1.28; 1.01-1.66), hospitalization versus outpatients (1.93; 1.42-2.63), living ≥50 km versus ≤1 km away (1.72; 1.37-2.16) and delayed ART initiation versus within 30 days (3.40; 2.70-4,27), while enrolment 2017-2023 versus before (0.51; 0.37-0.70) was protective.

Conclusions: The persisting high prevalence of paediatric SHD and high mortality/LTFU underscores the need for early diagnosis and care.

Keywords: advanced HIV diseases; mortality; paediatric HIV; prospective study; severe HIV disease.