Social and clinical features of HIV infection in older children and adolescents in Zimbabwe
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Introduction HIV infection has had a devastating effect on morbidity and mortality of children and adolescents, particularly in low- income settings. Zimbabwe has been at the epicentre of the HIV epidemic since mid-1990. This study serves to describe the clinical and sociodemographic features of children aged 6-15 years at time of HIV diagnosis and describe their clinical outcomes at 18 months post diagnosis. Methods A prospective cohort study was performed from January 2013-June 2016 in seven primary care clinics in Harare, Zimbabwe. Children found to be newly diagnosed with HIV were offered enrolment and HIV treatment as per national guidelines. Their clinical events and outcomes over the course of 18 month follow up were documented. Results In total, 385 children were enrolled. The median age was 11 years (interquartile range 8-13). Median CD4 count at diagnosis was 375 cells/mm3. 95% had acquired HIV perinatally. A high proportion of chronic illness was noted at time of diagnosis particularly respiratory tract illness. Disclosure of their HIV status to children by their caregiver at time of diagnosis was low. Although a low hospitalisation and mortality was noted at 18 months, virological outcomes were poor with only two- thirds of children achieving virological suppression one year post antiretroviral therapy commencement. Conclusion HIV testing strategies need to be improved for older children to ensure earlier identification of infection and so treatment can be initiated before onset of chronic illness. Methods to support caregivers and healthcare providers to discuss HIV with children need to be enhanced in Zimbabwe’s national HIV program. Adherence to treatment is a challenge in this age group that needs to be urgently addressed as we move towards an AIDS free generation.