Predictors of Loss To Follow Up and Mortality Among Children ≤12 Years Receiving Anti Retroviral Therapy during the First Year at a Referral Hospital in Bali

Stefanie Juergens , Anak Agung Sagung Sawitri, Ketut Dewi Kumara Wati, I Wayan Gede Artawan Eka Putra, Tuti Parwati Merati

Stefanie Juergens
Universitas Udayana. Email:

Anak Agung Sagung Sawitri
Universitas Udayana

Ketut Dewi Kumara Wati
Universitas Udayana

I Wayan Gede Artawan Eka Putra
Universitas Udayana

Tuti Parwati Merati
Universitas Udayana
Online First: December 01, 2016 | Cite this Article
Juergens, S., Sawitri, A., Wati, K., Putra, I., Merati, T. 2016. Predictors of Loss To Follow Up and Mortality Among Children ≤12 Years Receiving Anti Retroviral Therapy during the First Year at a Referral Hospital in Bali. Public Health and Preventive Medicine Archive 4(2): 101-106. DOI:10.15562/phpma.v4i2.65

Background and purpose: Many HIV-infected children in Bali have started antiretroviral therapy (ART), but loss to follow up (LTFU) is a continuing concern, and the issue of childhood adherence is more complex compared to adults.

Methods: This was a retrospective study among cohort of 138 HIV+ children on ART in Sanglah General Hospital, Denpasar, Bali from January 2010 to December 2015. Kaplan-Meier analysis was used to describe incidence and median time to LTFU/mortality and Cox Proportional Hazard Model was used to identify predictors. Variables which were analysed were socio-demographic characteristics, birth history, care giver and clinical condition of the children.

Results: Mean age when starting ARV therapy was 3.21 years. About 25% experienced LTFU/death by 9.1 month resulting in an incidence rate of 3.28 per 100 child month. The higher the WHO stage, the higher the risk for LTFU/mortality along with low body weight (AHR=0.90; 95%CI: 0.82-0.99).

Conclusion:  Clinical characteristics were found as predictors for LTFU/mortality among children on ART.


UNAIDS. UNAIDS -Indonesia HIV/AIDS estimates (2013) [Internet]. 2013. Available from:

WHO. HIV/AIDS Fact sheet No360 [Internet]. 2014. Available from: factsheets/fs360/en/

Schilkowsky LB, Portela MC, de Castilho Sa M. Factors associated with HIV/AIDS treatment dropouts in a special care unit in the City of Rio de Janeiro, RJ, Brazil. Rev Bras Epidemoil [Internet]. 2011;14(2):187–97. Available from: http://www.

Blutinger E, Solomon S, Srikrischna A, Thamburaj E, Ganescha A, Solomon S. Dropout from care among HIV-infected patients enrolled in care at a tertiary HIV care center in Chennai, India. AIDS Care [Internet]. 2014;26(12):1500–5. Available from:

Fenner L, Brinkhof MWG, Keisser O, Weigel R, Cornell M. Early Mortality and Loss to Follow-up in HIV-Infected Children starting Antiretroviral Therapy in Southern Africa. Acquir Immune Defic Syndr [Internet]. 2010;54(5):524–32. Available from: pmc/articles/


Sengayi M, Dwane N, Marinda E, Sipambo N, Failie L, Moultuer H. Predictors of loss to follow-up among children in the first and second years of antiretroviral treatment in Johannesburg, South Africa. Glob Heal Action [Internet]. 2013;6. Available from: pubmed/23364098

WHO. Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision. Geneva; 2010.

Hansudewechakul R, Sirisanthana V, Kurniati N, Puthanakit T, Lumbiganon P, Saphonn V, et al. Antiretroviral therapy outcomes of HIV-infected children in the TREAT Asia pediatric HIV observational database. J Acquir Immune Defic Syndr [Internet]. 2010;55(4):503–9. Available from: PMC2975064/ pdf/nihms237367.pdf

Miller T, Evans S, Orav E, McIntosh K, Winter H. Growth and body composition in children infected with the human immunodeficiency virus-1. Am J Clin Nutr. 1993;57:588–92.

McKinney R, Robertson R, Duke Pedriatric AIDS Clinical Trial Unit. Effect of human immunodeficiency virus infection on the growth of young children. J Pediatr. 1993;123:579–82.

Nuetzenadel W. Failure to thrive in childhood. Dtsch Arztebl Int. 2011;108(38):643–9.

Newell M, Coovadia H, M C-B, Rollins N, Gaillard P, Dabis F, et al. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet. 2004;364(9441):1236–43.

AIDS INFO Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection [Internet]. 2015. Available from: contentfiles/lvguidelines/pediatricguidelines.pdf

Phelps B, Rakhmanina N. Antiretroviral drugs in pediatric HIV-infected patients: pharmacokinetic and practical challenges. Paediatr Drugs. 2011;13(3):175–92.

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