Abstract

Background: The use of highly active antiretroviral therapy reduces Human immunodeficiency virus related morbidity and mortality dramatically. Despite this, late initiation of highly active anti-retroviral therapy among pediatric patients poses poor treatment outcome. However, information related to the magnitude of late antiretroviral therapy initiation among children is scarce in Ethiopia.

Objective: To assess late antiretroviral therapy initiation and associated factors among children on Antiretroviral Therapy at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2017.

Method: An institution based cross-sectional study was conducted among 422 children on antiretroviral therapy between January/2007 to December 2016. The data were collected from March 28, 2017 to April 13, 2017. Simple random sampling technique was used to select study participant records. Data were collected using pretested and structured data abstraction tool. Multivariable binary logistic regression model was fitted and adjusted odds ratios with 95% confidence interval were computed to determine the strength of association between each variable with late antiretroviral therapy initiation. Variables with P-value < 0.05 was considered as statistically significant.

Result: A total of 422 child records were reviewed. Of which 402 (95.3%) were included in the study. The overall proportion of late antiretroviral therapy initiation among 402 children on antiretroviral therapy was found to be 53.2% (95% CI: 48.5%-58.4%). The mean age of children at the time of antiretroviral therapy initiation was 74.2 months. Age of children below 5 years  [AOR: 2.165 (95% CI: 1.341,3.495)], rural resident [AOR: 1.825 (95% CI: 1.052, 3.166)], any medication taken other than ART [AOR: [2.237 (95%CI,1.212, 4.130)], presence of past opportunistic infection [AOR: 2.548 (95%CI,1.554, 4.178)], unmarried caregiver [AOR: 1.618 (95%CI, 1.023, 2.559)], male caregiver [AOR: 1.903 (95%CI,1.026-3.527)] and mothers with no antenatal visits [AOR: 1.721(95% CI,1.077, 2.752)] were factors associated with late ART initiation among children on ART.

Conclusion and recommendation: The proportion of late anti-retroviral therapy initiation in this study was found to be high. Therefore, early diagnosis, early enrolling HIV diagnosed children into care and prompt initiation of antiretroviral therapy is recommended.

Keywords: Antiretroviral therapy; Children; Ethiopia; Hospital; Late initiation