BACKGROUND: Although mortality is higher among HIV positive infants compared to those without HIV, optimized pediatric antiretroviral treatment (ART) has improved survival. We explored the causes of death (COD) and survival-time by HIV status among deceased infants in Zambia from 2020-2021.
METHODS: We analyzed the Zambian Ministry of Health mortality surveillance data from 2020-2021. Verbal autopsies (VA) are conducted on persons who die in the community or within 48 hours of arrival at health facilities in 27 districts representing ~50% of Zambia’s population. Trained officers collect past medical history and circumstances proximal to death from close relatives/associates using a standardized World Health Organization questionnaire. Responses are analyzed by a validated algorithm that assigns probable CODs. We analyzed CODs and survival-time by HIV status among infants (<1 year old) using R.
RESULTS: VAs were conducted for 2,446 infants from 2020-2021. Sixty-six (2.7%) infants were HIV positive (with 50% on ART), 1,372 (56.1%) were HIV negative and 1,008 (41.2%) had unknown HIV status. Among HIV positive and negative infants, the probable CODs were mainly indeterminate or infectious. Birth asphyxia, prematurity and neonatal sepsis were the leading probable CODs among infants with unknown HIV status, who died younger than those with known HIV status (median days: 2 vs. 136; p<0.01). Survival-time did not differ for HIV positive compared to HIV negative infants (median days: 136.5 vs 136; p=0.45). Among HIV positive infants, survival-time did not differ by ART status (p=0.74).


CONCLUSIONS: The lack of difference in survival-time among deceased infants by HIV status could be because other infectious diseases highly affect this age group. Infants with unknown HIV status died younger from complications of pregnancy and delivery. Improved neonatal care, diagnostics for the indeterminate COD and management of infectious diseases can improve infant outcomes. Prompt ART initiation can also improve survival of HIV positive infants.

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