High prevalence of late presentation of ART-naïve perinatally infected children for care in Pune, India

ABSTRACT

Delayed presentation to care of perinatally infected children in India continues to be a hindrance to achieving the “end pediatric HIV by 2020” goal. In this study, we characterize this issue by describing the prevalence, risk factors and temporal trends of delayed presentation to care of perinatally infected, antiretroviral therapy (ART) – naïve children using programmatic data from a tertiary care center in western India. Delayed presentation was defined as children presenting in moderate or severe WHO immunodeficiency categories. Of 269 children eligible for inclusion in the analysis, the median age at presentation was 4 years (IQR: 3–6 years) and prevalence of delayed presentation was 52%. Multivariable logistic regression identified domicile distance ≥20km from the ART center (OR: 2.2, 95% CI: 1.02–4.7) to be a risk factor for delayed presentation. An inverse association with increasing age (OR: 0.8, 95% CI: 0.7–0.9) was also seen. The proportion of children with delayed presentation between 2006 and 2016 remained unchanged (p = 0.36), although the median age at presentation over the same time period increased significantly (p < 0.001). Our results indicate the urgency of identifying strategies to improve linkage of perinatally infected ART-naïve children to care, earlier than what is currently observed.

KEYWORDS:

• Delayed presentation
• perinatal HIV infection
• pediatrics
• India

Acknowledgements

We would like to thank NACO, the staff at the ART center of BJGMC & SGH and counselors (Suhasini Surwase, and Kanta Zarekar) who were involved in data collection. We also extend our gratitude to Katie McIntire who helped with language editing services for this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work is supported by NIH/ Eunice Kennedy Shriver National Institute of Child Health & Human Development Foundation for AIDS Research (amfAR), supported by funds from the US National Institutes of Health (NIH) for contributions to the International Epidemiologic Databases to Evaluate AIDS (IeDEA), a project of the NIH National Institutes of Allergy and Infectious Diseases (NIAID) (U01AI069907), and the National Institutes of Health funded Johns Hopkins Baltimore-Washington-India Clinical Trials Unit for NIAID Networks BWI CTU [UM1AI069465].