**1. Introduction**

Acquired immune deficiency syndrome (AIDS) is a disease caused by a retrovirus known as human immunodeficiency virus (HIV) [1]. HIV/AIDS remains one of the world's most significant public health challenges, particularly in low- and middle-income countries [2]. Children constitute a segment of the population affected by the virus. HIV contributes to illness and death of children and is the commonest cause for pediatric hospital admission [3].

Of the total 1.8 million children living with HIV, an estimated 110,000 die of AIDS-related illnesses each year which means 290 children die of AIDS-related illnesses every day. Nearly 90% of HIV-infected children live in sub-Saharan Africa (SSA) [4]. In Ethiopia it is estimated that 65,088 children are living with HIV. In 2016, over 3100 children died due to AIDS-related illness [5].

The introduction of antiretroviral therapy (ART) presented an enormous opportunity in terms of reducing morbidity and mortality due to AIDS, worldwide. Ethiopia has been engaged in the scale-up of ART access to its people since 2005 [6]. It has been shown that the improvement in access to ART improves the quality of life and survival of children [7, 8].

Studies show that early access to ART could prevent 25% of HIV-related deaths [7–9]. Therefore, to reduce child mortality attributed to HIV/AIDS, the provision of comprehensive treatment, care, and support for HIV-infected children is very important.

Ethiopia has adopted the World Health Organization's (WHO) recommendations for ART where "regardless of their CD4 cell count, all HIV-infected individuals should start treatment to reduce morbidity and mortality associated with HIV infection" [3]. The number of sites providing ART service in Ethiopia, including both public and private facilities, has increased from 3 to over 1000, and persons initiated on treatment has increased from 24,000 to 308,000 during the period 2006–2016 with more than 23,400 children under the age of 15 taking antiretroviral drugs [10].

Survival of HIV-positive children in Ethiopia and other similar settings has improved as a result of increased access to ART; however, it is still low in the first 6 months after initiation of ART [11]. Reports from Kenya, Zambia, and Malawi show that death among HIV-positive children following ART initiation remains high, ranging from 7.5 to 15% [12–14]. This contrasts the substantially higher survival probability among HIV-positive children initiated on ART in developed countries [15]. Findings from other studies elsewhere in Africa and other low-income countries show that ART programs have resulted in decreased mortality among children on ART [16–18]. Available evidences also depicted that the survival of the children is not only affected by the care delivered by ART programs but also more fundamentally influenced by low CD4 count, advanced disease according to WHO staging, low hemoglobin (Hgb) level, and opportunistic infections (OIs) like bacterial pneumonia and tuberculosis [19–21]. However, as far as our search of the available literature has revealed, little is known about the effect of factors like viral load, nutritional status, cotrimoxazole (CTZ) preventive therapy (CPT), and isoniazid (INH) preventive therapy (IPT) on survival status of children below 15 years of age. Therefore, this study intended to estimate the survival time and identify associated factors by including viral load, nutritional status, CPT, and IPT among HIV-infected children initiated on ART in public health facilities in Arba Minch town, Southern Ethiopia.

**3**

*Nutritional Status and Its Effect on Treatment Outcome among HIV-Infected Children Receiving…*

*Study area and period*: We conducted the study in Arba Minch town from March 20, 2017 to April 10, 2017. Arba Minch town is located about 495 km southwest of the capital city Addis Ababa and about 275 km from Hawassa, the capital of the Southern Nations, Nationalities, and Peoples' Region (SNNPR). Arba Minch town has one general hospital and one public health center, which provide ART service. Arba Minch Hospital was among the first few public hospitals to start ART in Ethiopia in August 2003. Arba Minch Health Center started ART service at the end of 2007. According to the Gamo Gofa Zone Health Department (ZHD) report, the Arba Minch Hospital and Arba Minch Health Center provide HIV/AIDS interventions, including free diagnostic, treatment, and monitoring services. Since August 2003, ART has been provided to children living with HIV regardless of CD4 count and WHO clinical stage, with financial support from the Norwegian Lutheran Mission. Data from ZHD show that a total of 664 children with HIV/AIDS were enrolled on chronic HIV care at the hospital and the health center since January 2009, but only 608 started ART (460 children at Arba Minch General Hospital and

*DOI: http://dx.doi.org/10.5772/intechopen.85851*

148 children at Arba Minch Health Center) [22].

ART at the center and who fulfill the inclusion criteria.

*Study design*: A health facility-based retrospective cohort study.

**Source populations**: All children living with HIV who were enrolled on first-

**Inclusion criteria**: Those who were aged <18 years and enrolled on first-line ART and have follow-up at Arba Minch General Hospital and Health Center. *Sample size determination*: The sample size was calculated by applying a two-population proportion formula using Epi-Info version 7. Co-trimoxazole preventive therapy, tuberculosis (TB) co-infection at baseline, and anemia were considered, and taking the most significant predictors of the three variables, anemia was used [17] with the following assumptions: 95% CI, power 80%, ratio of unexposed to exposed 1:1, parameter outcome in exposed hemoglobin (Hgb) < 10 gm/dl = 14.7%, outcome in unexposed Hgb ≥ 10 gm/dl = 5.8%, and hazard ratio (HR) = 2.5. This resulted in sample size of 412 children. As there were a total of 421 children in the study area who fulfilled the inclusion criteria, we

*Sampling procedure and sampling technique*: A total of 608 children who started ART during the study period were identified in the two ART clinics. Charts were organized according to the hospital card number, in a chronological order, with each chart representing one child. As some of the charts in the hospital were not arranged in numerical order, the investigator assigned new numbers for all those registered between 2009 and 2016, starting from 1 to 608. Of these, the investigator drew 421 samples which fulfilled the inclusion criteria after reviewing the information transcribed to the pre-structured data abstraction form; 187 individuals did not fulfill the inclusion criteria; therefore, those charts were excluded from the study. Children ≤14 years of age and on ART registered for chronic care at public health institutions of Arba Minch town from 1 January 2009 to 30 December 2016 were included in the study. Those whose cards were incomplete with information on baseline CD4 count, WHICH staging and date of ART start and current status were

**Study populations**: All children living with HIV who were enrolled on first-line

**2. Main body**

**2.1 Patients and methods**

line ART at the center.

included all 421 in this study.

excluded from the study.

*Nutritional Status and Its Effect on Treatment Outcome among HIV-Infected Children Receiving… DOI: http://dx.doi.org/10.5772/intechopen.85851*
