HIV infection among children and adolescents in Burundi, Cameroon, and the Democratic Republic of Congo
Evidence demonstrates a substantial HIV epidemic among children and adolescents in countries with long-standing generalized HIV epidemics, where availability of prevention of mother-to-child transmission services has historically been limited. The objective of this research was to explore factors associated with antiretroviral therapy (ART) initiation and morbidity among HIV-infected surviving children 2-17 years of age attending HIV programs in Central Africa. Programmatic data from 404 children attending HIV programs in Burundi, Cameroon, and the Democratic Republic of Congo (DRC) were included in our evaluation. Children were followed prospectively from 2008 to 2011 according to each clinic's standard of care. Diagnosis at a reference hospital was significantly associated with not having initiated ART (adjusted odds ratio, AOR=0.40; 95% confidence interval, CI, 0.24-0.67). Being seen at a clinic in Cameroon (AOR=0.45; 95%CI=0.24-0.85) and being in school were associated with decreased risk (AOR=0.55; 95%CI=0.31-0.96). Being ART-naive (AOR=1.88; 95%CI=1.20-2.94) and being diagnosed at a reference hospital (AOR=2.39; 95%CI=1.29-4.41) or other testing facility (AOR=2.86; 95%CI=1.32-6.18) were associated with increased risk of having a morbid event at the initial visit. In longitudinal analysis of incident morbidity, we found a decreased risk associated with attending clinics in Cameroon (adjusted hazard ratio, AHR=0.23; 95%CI=0.11-0.46) and the DRC (AHR=0.46; 95%CI=0.29-0.74), and an increased risk associated with being ART-naive (AHR=1.83; 95%CI=1.12-2.97). We found a high burden of HIV-related health problems among children receiving care in this setting. Children face significant barriers to accessing HIV services, and the HIV epidemic among surviving children in the Central African region has not been adequately evaluated nor addressed.