Quantifying the risk and associated factors for mortality among children and young adolescents on HIV treatment and effects of early sexual debut on new HIV infections

Abstract

Estimating mortality risk among children and young adolescents who have received antiretroviral therapy (on-ART) is crucial for shaping health policies aimed at reducing mortality in this vulnerable group. Additionally, understanding factors for HIV infections in adolescents and young adults is key to preventing these infections. While several studies have examined on-ART mortality in certain regions, a global and systematic estimation using comprehensive data has not been conducted. Moreover, while the link between early sexual debut and HIV risk in adolescents and young adults has been studied, its association with new HIV infections remains unexplored. Chapter 1 of this dissertation presents a systematic review and meta-analysis of on-ART mortality in children and young adolescents, focusing on CD4 category, age, duration since ART initiation, and geographical differences. It compiles global data sources available to provide the most comprehensive estimates of pediatric ART mortality thus far. Chapter 2 assesses the influence of modifiable risk and protective factors on ART mortality in this demographic, quantifying the impact of these factors linked to mortality. Chapter 3 examines the relationship between early sexual debut and recent HIV infection among adolescents and young adults across 11 African countries using Population-Based HIV Impact Assessment (PHIA) surveys. We have conducted extensive sensitivity analyses to strengthen the research findings. We have also calculated the population attributable fractions to quantify the proportion of HIV infections that could be reduced if early sexual debut were prevented. This research provides a comprehensive overview of the mortality risks associated with children and young adolescents on ART, taking into account various factors such as age, time since ART initiation, geography, and the dynamic of CD4 counts. Furthermore, the findings from this study provide compelling evidence that targeted health interventions, such as increased vaccine coverage of PCV and hepatitis B can significantly reduce mortality risks in pediatric HIV patients. In addition, the results of this study provide substantial support for the hypothesis that early sexual debut is associated with an increased risk for HIV infection among adolescents and young adults. The study results could be useful in shaping future health policies and strategies aimed at reducing mortality and improving the overall health outcomes of children and young adolescents living with HIV/AIDS.