Supplementary MaterialsAdditional file 1: Figure S1. of this research is to describe treatment outcomes, measure mortality rates and assess predictors of mortality among children receiving ART. Methods Using a retrospective cohort study design, we abstracted routinely collected clinical data from medical records of children from birth to 15?years old, SB-568849 who had received ART for at least 6?months at Livingstone Central Hospital in Southern Province Zambia, between January 2003 and June 2015. The primary outcome was death. Cause of death was ascertained from medical records and death certificates. Distribution of survival times RNF66 according to baseline covariates were estimated using Kaplan Cox and Meier Proportional Hazards methods. Results Overall, 1039 children were commenced on ART through the scholarly study period. The median age group at treatment initiation was 3.6?years (IQR: 1.3C8.6) and 520 (50%) kids were female. Of the, 71 (7%) passed away, 164 (16%) had been dropped to follow-up, 210 (20%) moved and 594 (56%) had been positively on treatment. After 4450 person years, mortality price was 1.6/100 (95% CI: 1.4C1.8). Mortality was highest through the 1st 3?weeks of treatment (11.7/100 (95% CI: 7.6C16.3). In multivariable proportional risks regression, the modified hazards of loss of life had been highest among children aged ?1?year (aHR?=?3.1 (95% CI: 1.3C6.4), compared to those aged 6C15?years, WHO stage 4 (aHR =4.8 (95% CI: 2.3C10), compared to WHO stage 1 and 2. In the sensitivity analysis to address bias due to loss to follow-up, mortality increased 5 times when we assumed that all the children who were lost to follow up died within 90?days of their last visit. Conclusion We observed low attrition due to mortality among children on ART. Loss to follow-up was high (16%). Mortality was highest during the first 3?months of treatment. SB-568849 Children aged less than one year and those with advanced WHO disease stage had higher mortality. We recommend effective interventions to improve retention in care and early diagnosis of HIV in children. Electronic supplementary material The online version of this article (10.1186/s12889-019-6444-7) contains supplementary material, which is available to authorized users. strong class=”kwd-title” Keywords: HIV, Pediatrics, Therapeutics, Treatment outcome, Survival Background The availability of Antiretroviral Therapy (ART) for children living with HIV and implementation of universal treatment of all pregnant and breastfeeding women living with HIV (Option B+) is a game changer in the global fight against HIV . In 2017, about 1.8 million children were living with HIV globally and 90% of these children lived in sub-Saharan Africa [2, 3]. Although progress has been reported in the scale-up of access to treatment for children, only 52% of children living with HIV received lifesaving ART and only 51% of HIV-exposed infants were tested for HIV by the age of 2?months as recommended by the World Health Organization (WHO) guidelines . These estimates fall short of the UNAIDS 90C90-90 treatment targets, a strategy to end the global HIV epidemic. This strategy aims to achieve the following by 2020: 1) 90% of people living with HIV will know their status, 2) 90% of all diagnosed people will be on ART, 3) 90% of people SB-568849 on ART will be virally suppressed . Although some milestones have been achieved in the provision of ART, access to early HIV diagnosis and ART among infants and children remains a challenge in high HIV burden settings [2, 5]. Similarly, the pediatric HIV program in Zambia has made tremendous progress with over 64% of children living with HIV accessing ART by the end of 2017 . With a population of 17 million people and an estimated HIV prevalence of 12.9%, 72,000 were children SB-568849 living with HIV and 8900 were newly infected in 2017 [6, 7]. This scenario creates a large pool of children living with HIV in need of treatment. An early study done in routine care settings in Zambia exhibited that children were diagnosed at older ages with advanced WHO stage 3 or 4 4 disease. The same study reported that 57% of deaths occurred within the first 90?days of treatment initiation and loss to follow-up was high . Early mortality was consistently associated with lower CD4 count, younger age, low pounds for anemia and elevation at Artwork initiation [8C10]. Recent studies claim that routine care configurations in.