Same day ART initiation does not reduce 12-month retention among HIV-infected children in Uganda

1. Same day ART initiation does not reduce 12-month retention among HIV-infected children in Uganda Adeodata Kekitiinwa, Peter Elyanu, Esther Nazziwa, Grace P. Kisitu, Rogers N. Ssebunya, Cordelia Katureebe, Grace Namayanja, Ivan Lukabwe, Eleanor N. Magongo, Alice Namale, Patricia Nahirya Ntege, Michelle Adler

2. Conflict of interest No disclosures

3. Background • 2015 WHO recommended ART should be initiated in all children and adolescents living with HIV, regardless of WHO clinical stage or CD4 cell count • Uganda has implemented test and treat guidelines for children which included same day initiation since 2014 • However, there was limited guidance on how soon after diagnosis ART should be initiated without jeopardizing retention • This study provides a unique opportunity to examine the impact of same day initiation on 12 month retention in children

4. Study objective We compared the 12-month probability of retention in HIV-infected children aged <15yrs initiated on ART on the same day of diagnosis versus 2-14 days or >14 days from diagnosis in Uganda

5. Methods I Study design: Retrospective cohort study Study setting: 42 health facilities in Uganda • Regional hospitals(13) • General Hospitals(13) • Health centres(16) Study population • HIV infected children(<15yrs) newly initiated on ART between June 2014-March 2015

6. Methods II Sampling: • Purposive selection (42 facilities) • Representing 80% of children in care Data collection: • Data was abstracted from patient charts • All existing charts of children in care were included

7. Methods III Independent variable: • Time from HIV diagnosis to ART initiation ( same day vs 2-14 days vs >14 days) Outcome: • Retention: alive and on ART at the site (not dead, not LTFU, not Transferred Out)

8. Statistical analysis • 899 charts abstracted, 115 (12.8%) were dropped from analysis because of missing date of diagnosis • Summarized baseline characteristics using proportions and median for categorical and continuous variables respectively • Used Kaplan-Meier estimates to compute the 12-month probability of retention & log rank test to compare groups • Stratified by time from diagnosis to ART initiation (same day vs 2-14 days vs >14days).

9. Results Of the 784: 713 (91%) remained in care, 15(2%) died and 56(7%) were lost to follow-up

10. 12-month retention stratified by age at ART initiation

11. 12-month retention (95%CI) by health facility level

12. 12-month retention (95%CI) by age at ART diagnosis

13. Conclusion • Starting ART in children on the same day of diagnosis does not reduce 12-month retention among HIV infected children initiated on treatment • Our findings support the inclusion of children in the 2016 WHO test and treat guidance • While 91% 12-month retention is very promising, we suggest further evaluation to determine reasons for attrition to ensure universal treatment for children

14. Recommendation • Improve data quality through onsite mentorships and use of standard operating procedures • Make on site data use a culture so that the HW may also realise the gaps in their own data as they try to use it • Emphasise and supervise on site monthly data validation

15. Acknowledgements • We acknowledge all children living with HIV whose data was used in this study • We thank CDC and PEPFAR for the financial and technical support • Appreciation goes to Ministry of Health, district health teams, and all health facility staffs involved in the study