Identifying Demographic, Social, and Environmental Determinants of Treatment Failure among HIV-Infected Children in Uganda

BACKGROUND: Of the 1.8 million children (0–14 y.o.) living with HIV worldwide, over 80% live in sub-Saharan Africa. Children’s access to antiretroviral treatment (ART) remains low (est. 63% in east/central Africa), and even with access, long-term adherence is difficult. Uganda has been upheld as a model country for its response to HIV, and therefore offers an ideal place to assess children’s adherence. OBJECTIVES: Identify early indicators of treatment failure for children on ART to facilitate health care worker intervention to improve adherence prior to clinical indicators of treatment failure. METHODS: Chart review of 188 case files of children living with HIV in Uganda; systematic univariate and multivariate analysis of demographic, social, and environmental variables which correlate with HIV treatment failure among reintegrated children; semi-structured interviews with staff, caregivers, and children about predictors of treatment failure. RESULTS: HIV-positive children present late to the program with a mean enrollment age of 9.7 years [n = 137]. Of the HIV-positive children enrolled in the program, one in five (20% [28/137]) had died and 10% [14/137] had rebounded to the center due to treatment failure. Of children who had begun attending school, 14% [13/95] had since dropped out of school. No statistically significant predictors of treatment failure were identified, primarily due to incomplete case files. However, program staff identified several factors not traditionally associated with treatment adherence, including home sanitation, personal hygiene, and children’s behavior (especially respect for adults). CONCLUSION: Well-integrated comprehensive support structures to monitor home sanitation, personal hygiene, children’s behavior, and other factors not traditionally associated with adherance, have the potential to be early indicators of treatment failure. DISCLOSURES: All authors: No reported disclosures.