**Acknowledgements**

*Nutrition and HIV/AIDS - Implication for Treatment, Prevention and Cure*

might also be associated with increased access to ART services.

of the study conducted in Northwest Ethiopia (52.3–70.4%), and the difference

The cumulative probability of survival of children on ART in our study was 82.9% after 5 years (95% CI: 78.2–86.7%). This was comparable with the report of a study conducted in Felege Hiwot Referral Hospital, Bahir Dar, Northern Ethiopia (83%) [27] and another one in Northwest Ethiopia (83%) [20]. However the cumulative survival probability from our study was much lower than that of the reports from Adama Referral Hospital and Medical College, Central Ethiopia (91.6%) [19], and Wolaita zone health facilities, Southern Ethiopia (92%) [20]. These variations between our study and those from central and Southern Ethiopia may have something to do with the variation in the quality of care provided at different institutions. In this study we found that having CD4 cell count below the threshold level was significantly associated with an increased probability of having short duration of survival among the children. This concurs with the findings of different studies previously done in Ethiopia [20, 28]. The similarity might be related to the fact that children, in our series, with absolute CD4 counts below the threshold level are more prone to OIs like TB. Another possible explanation could be ART was initiated in an advanced HIV stage (stages III and IV) where immunity of the children was already compromised. Another covariate that had a significant effect on survival time was adherence to ART. The HR for poor adherence was 2.1 times, and the HR for fair adherence was 2.2 times more likely to result in short duration of survival compared to children with good adherence. This finding was supported by studies conducted in Northwest Ethiopia [28] and Wolaita zone health facilities [20]. The poor adherence

might be due to insufficient counseling and education of caregiver/patient.

children on ART, thereby improving their survival.

prophylactic therapy (IPT) prevented the occurrence of TB.

The initiation of CTZ and INH at the start of ART in our cohort was associated with a longer duration of survival. This finding concurred with that of the studies conducted in Felege Hiwot Referral Hospital, Northern Ethiopia [20], and rural Mozambique [29]. The possible reason for higher risk of shorter survival time among children who did not receive CTZ at ART initiation could be due to occurrence of OIs such as *Pneumocystis pneumonia*, toxoplasmosis, bacterial pneumonia, sepsis, and diarrhea. Co-trimoxazole prophylaxis should be given at the initiation of ART to reduce OI and associated short duration survival among HIV-positive

The hazards of short survival time for children on INH prophylaxis was 0.38, which means that, in those children who take INH prophylaxis, the hazard of short duration of survival was reduced by 62%. This finding corroborates the finding of the study conducted in Mizan-Aman General Hospital, in Southern Ethiopia [26], and that of a double blinded, placebo-controlled trial on INH efficacy among HIV children infected in Cape Town, South Africa [30]. A possible reason could be INH

There are some strengths and limitations of this study. The strengths of this study

In general, this study showed that the probability of survival of children on ART was 73.9% after 96 months and the overall mean survival time was 82.3 months.

are the use of standard measurements which enabled to make the comparison of findings with other national and international literatures to be valid. In addition, considering long duration of follow-up period of children on ART and the inclusion of important predictors like CTZ, INH and nutritional status also add to the strength to this study. Since our study is retrospective based on available records, excluding those with incomplete information, survival time might be underestimated.

**10**

**9. Conclusion**

We would like to say thank you very much to the health facilities administrator of the hospital and health center, health professionals, and data collectors who contributed to this work.
