{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T10:51:53Z","timestamp":1770893513137,"version":"3.50.1"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"International AIDS Society Mark Wainberg Fellowship Program (IAS-MWF) supported by ViiV Healthcare as outlined in an agreement signed by both parties on 1 November 2021"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-026-36433-1","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T05:26:03Z","timestamp":1769145963000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Baseline characteristics associated with mortality among children living with HIV initiating ART at a rural district HIV clinic of Mozambique"],"prefix":"10.1038","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0617-9609","authenticated-orcid":false,"given":"Edy","family":"Nacarapa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Maddalozzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahomed-Yunus S.","family":"Moosa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Abecasis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"36433_CR1","unstructured":"UNAIDS, M. O. Z. A. M. B. I. Q. U. E. 2022 | HIV and AIDS Estimates | children aged 14 and under living with HIV, UNAIDS. Accessed: 30, 2023. [Online]. Available: https:\/\/www.unaids.org\/en\/regionscountries\/countries\/mozambique"},{"key":"36433_CR2","unstructured":"UNAIDS, U. N. A. I. D. S. | 2025 AIDS TARGET: The 10s \u2013 The 95s \u2013 The Integration, UNAIDS. Accessed: 30, 2023. [Online]. Available: https:\/\/aidstargets2025.unaids.org\/#section-targets"},{"key":"36433_CR3","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1097\/INF.0000000000001259","volume":"35","author":"CA Teasdale","year":"2016","unstructured":"Teasdale, C. A. et al. Outcomes among children enrolled in HIV care in Mozambique 2009\u20132013. Pediatr. Infect. Dis. J. 35, 10, 1117\u20131125. https:\/\/doi.org\/10.1097\/INF.0000000000001259 (2016).","journal-title":"Pediatr. Infect. Dis. J."},{"key":"36433_CR4","doi-asserted-by":"publisher","unstructured":"Nacarapa, E. et al. Predictors of attrition among adults in a rural HIV clinic in Southern mozambique: 18-year retrospective study. Sci. Rep. 11 (1, 17897, ). https:\/\/doi.org\/10.1038\/s41598-021-97466-2 (2021).","DOI":"10.1038\/s41598-021-97466-2"},{"key":"36433_CR5","doi-asserted-by":"publisher","unstructured":"Nacarapa, E. et al. Extrapulmonary tuberculosis mortality according to clinical and point of care ultrasound features in Mozambique. Sci. Rep. 12 (1, 16675, ). https:\/\/doi.org\/10.1038\/s41598-022-21153-z (2022).","DOI":"10.1038\/s41598-022-21153-z"},{"key":"36433_CR6","doi-asserted-by":"publisher","first-page":"e25762","DOI":"10.1002\/jia2.25762","volume":"24","author":"D MacKellar","year":"2021","unstructured":"MacKellar, D. et al. Annual home-based HIV testing in the Ch\u00f3kw\u00e8 health demographic surveillance System, Mozambique, 2014 to 2019: serial population-based survey evaluation. J. Int. AIDS. Soc. 24, 7, e25762. https:\/\/doi.org\/10.1002\/jia2.25762 (2021).","journal-title":"J. Int. AIDS. Soc."},{"key":"36433_CR7","doi-asserted-by":"publisher","unstructured":"Feldblum, J. et al. HIV prevalence and incidence in a cohort of women at higher risk for HIV acquisition in Ch\u00f3kw\u00e8, Southern Mozambique. PloS One. 9 (5, e97547, ). https:\/\/doi.org\/10.1371\/journal.pone.0097547 (2014).","DOI":"10.1371\/journal.pone.0097547"},{"key":"36433_CR8","unstructured":"Governo do Distrito de Ch\u00f3kw\u00e8. Localizacao geogr\u00e1fica - Governo do Distrito de Ch\u00f3kw\u00e8, Governo do Distrito de Ch\u00f3kw\u00e8. Accessed: 30, 2023. [Online]. Available: https:\/\/www.gaza.gov.mz\/por\/Ver-Meu-Distrito\/Chokwe\/O-Distrito\/Localizacao-Geografica"},{"key":"36433_CR9","unstructured":"CHC -. Carmelo Hospital of Ch\u00f3kw\u00e8, Hospital Carmelo de Ch\u00f3kw&#232."},{"key":"36433_CR10","doi-asserted-by":"publisher","unstructured":"Moon, T. D. et al. Tuberculosis treatment outcomes among children in rural Southern mozambique: A 12-Year retrospective study, https:\/\/doi.org\/10.1097\/INF.0000000000002435","DOI":"10.1097\/INF.0000000000002435"},{"key":"36433_CR11","doi-asserted-by":"publisher","unstructured":"Nacarapa, E. et al. Effect of Xpert MTB\/RIF testing introduction and favorable outcome predictors for tuberculosis treatment among HIV infected adults in rural Southern Mozambique. A retrospective cohort study, (2020). https:\/\/doi.org\/10.1371\/journal.pone.0229995","DOI":"10.1371\/journal.pone.0229995"},{"key":"36433_CR12","doi-asserted-by":"publisher","unstructured":"Skrivankova, V. W. et al. Strengthening the reporting of observational studies in epidemiology using Mendelian randomisation (STROBE-MR): explanation and elaboration. BMJ (Clinical Res. ed.). 375 (2233). https:\/\/doi.org\/10.1136\/bmj.n2233 (2021).","DOI":"10.1136\/bmj.n2233"},{"key":"36433_CR13","doi-asserted-by":"publisher","unstructured":"Bursac, Z., Gauss, C. H., Williams, D. K. & Hosmer, D. W. Purposeful selection of variables in logistic regression. Source Code Biol. Med. 3, 17, https:\/\/doi.org\/10.1186\/1751-0473-3-17 (2008).","DOI":"10.1186\/1751-0473-3-17"},{"key":"36433_CR14","doi-asserted-by":"publisher","unstructured":"Ebonyi, A. O. et al. Predictors of mortality in a clinic cohort of HIV-1 infected children initiated on antiretroviral therapy in Jos, Nigeria. J. AIDS Clin. Res. 5 (12). https:\/\/doi.org\/10.4172\/2155-6113.1000403 (2014).","DOI":"10.4172\/2155-6113.1000403"},{"key":"36433_CR15","doi-asserted-by":"publisher","unstructured":"Alebel, A. et al. Mortality rate among HIV-positive children on ART in Northwest ethiopia: a historical cohort study. BMC public. Health. 20 (1, 1303, ). https:\/\/doi.org\/10.1186\/s12889-020-09418-6 (2020).","DOI":"10.1186\/s12889-020-09418-6"},{"key":"36433_CR16","doi-asserted-by":"publisher","first-page":"e22706","DOI":"10.1371\/journal.pone.0022706","volume":"6","author":"BC Zanoni","year":"2011","unstructured":"Zanoni, B. C., Phungula, T., Zanoni, H. M., France, H. & Feeney, M. E. Risk factors associated with increased mortality among HIV infected children initiating antiretroviral therapy (ART) in South Africa. PloS One. 6, 7, e22706. https:\/\/doi.org\/10.1371\/journal.pone.0022706 (2011).","journal-title":"PloS One"},{"key":"36433_CR17","doi-asserted-by":"publisher","unstructured":"Weldemariam, S. A., Dagnew, Z., Tafere, Y., Bereka, T. M. & Bitewa, Y. B. Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya Liyu zone, Amhara region, ethiopia: a retrospective cohort study. BMC Pediatr. 22 (1, 5, ). https:\/\/doi.org\/10.1186\/s12887-021-03072-6 (2022).","DOI":"10.1186\/s12887-021-03072-6"},{"key":"36433_CR18","doi-asserted-by":"publisher","unstructured":"Alemu, G. G., Nigussie, Z. M., Amlak, B. T. & Achamyeleh, A. A. Survival time and predictors of death among HIV infected under five children after initiation of anti -retroviral therapy in West Amhara referral Hospitals, Northwest Ethiopia. BMC Pediatr. 22 (1, 670, ). https:\/\/doi.org\/10.1186\/s12887-022-03693-5 (2022).","DOI":"10.1186\/s12887-022-03693-5"},{"key":"36433_CR19","doi-asserted-by":"publisher","unstructured":"Simon, A. K., Hollander, G. A. & McMichael, A. Evolution of the immune system in humans from infancy to old age., Proceedings. Biological sciences, 282, 1821, 20143085, (2015). https:\/\/doi.org\/10.1098\/rspb.2014.3085","DOI":"10.1098\/rspb.2014.3085"},{"key":"36433_CR20","doi-asserted-by":"publisher","first-page":"e0260941","DOI":"10.1371\/journal.pone.0260941","volume":"16","author":"D Os\u00f3rio","year":"2021","unstructured":"Os\u00f3rio, D. et al. Mother-to-child transmission of HIV infection and its associated factors in the district of Bilene, Gaza Province-Mozambique. PloS One. 16, 12, e0260941. https:\/\/doi.org\/10.1371\/journal.pone.0260941 (2021).","journal-title":"PloS One"},{"key":"36433_CR21","doi-asserted-by":"publisher","unstructured":"Biyazin, Y., Wondwossen, K., Wubie, A. B., Getachew, M. & Gebremichael, B. Survival and predictors of mortality among HIV-positive children on antiretroviral therapy in public hospitals. J. Pharm. Policy Pract. 15 (1, 48, ). https:\/\/doi.org\/10.1186\/s40545-022-00448-6 (2022).","DOI":"10.1186\/s40545-022-00448-6"},{"issue":"4","key":"36433_CR22","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1093\/ajcn\/nqaa182","volume":"112","author":"R Karunaratne","year":"2020","unstructured":"Karunaratne, R., Sturgeon, J., Patel, R. & Prendergast, A. J. Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis. Am. J. Clin. Nutr. 112 (4), 1069\u20131079. https:\/\/doi.org\/10.1093\/ajcn\/nqaa182 (2020).","journal-title":"Am. J. Clin. Nutr."},{"key":"36433_CR23","doi-asserted-by":"publisher","unstructured":"De Schacht, C. et al. Access to HIV prevention and care for HIV-exposed and HIV-infected children: a qualitative study in rural and urban Mozambique. BMC public. Health. 14 (1240). https:\/\/doi.org\/10.1186\/1471-2458-14-1240 (2014).","DOI":"10.1186\/1471-2458-14-1240"},{"issue":"4","key":"36433_CR24","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1002\/JLB.4MR1019-189R","volume":"107","author":"X Yang","year":"2020","unstructured":"Yang, X. et al. Incomplete immune reconstitution in HIV\/AIDS patients on antiretroviral therapy: challenges of immunological non-responders. J. Leukoc. Biol. 107 (4), 597\u2013612. https:\/\/doi.org\/10.1002\/JLB.4MR1019-189R (2020).","journal-title":"J. Leukoc. Biol."},{"issue":"3","key":"36433_CR25","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1111\/hiv.12567","volume":"19","author":"OT Stirrup","year":"2018","unstructured":"Stirrup, O. T. et al. Predictors of CD4 cell recovery following initiation of antiretroviral therapy among HIV-1 positive patients with well-estimated dates of seroconversion. HIV Med. 19 (3), 184\u2013194. https:\/\/doi.org\/10.1111\/hiv.12567 (2018).","journal-title":"HIV Med."},{"key":"36433_CR26","unstructured":"M. de S. M. DNAM - Direc\u00e7\u00e3o Nacional de Assist\u00eancia M\u00e9dica, COMIT\u00c9 TARV: MISAU, Mozambique. Accessed: 20, 2022. [Online]. Available: https:\/\/comitetarvmisau.co.mz\/"},{"issue":"8","key":"36433_CR27","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.5588\/ijtld.10.0538","volume":"15","author":"S Bakeera-Kitaka","year":"2011","unstructured":"Bakeera-Kitaka, S. et al. Tuberculosis in human immunodeficiency virus infected Ugandan children starting on antiretroviral therapy. Int. J. Tuberculol. Lung Dis. 15 (8), 1082\u20131086. https:\/\/doi.org\/10.5588\/ijtld.10.0538 (2011).","journal-title":"Int. J. Tuberculol. Lung Dis."},{"issue":"1","key":"36433_CR28","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1093\/cid\/ciac765","volume":"76","author":"A Kay","year":"2023","unstructured":"Kay, A. et al. Optimal timing of antiretroviral therapy initiation in children and adolescents with human immunodeficiency Virus-Associated pulmonary tuberculosis. Clin. Infect. Dis. 76 (1), 10\u201317. https:\/\/doi.org\/10.1093\/cid\/ciac765 (2023).","journal-title":"Clin. Infect. Dis."},{"key":"36433_CR29","doi-asserted-by":"publisher","unstructured":"Hashim, H. Morbidity and mortality in tuberculosis associated immune reconstitution inflammatory syndrome in children living with HIV: A narrative review. J. Clin. Tuberculosis Other Mycobact. Dis. 33, 100392, https:\/\/doi.org\/10.1016\/j.jctube.2023.100392 (2023).","DOI":"10.1016\/j.jctube.2023.100392"},{"key":"36433_CR30","doi-asserted-by":"publisher","unstructured":"Navis, A. et al. Immune reconstitution inflammatory syndrome in the central nervous system: limitations for diagnosis in resource limited settings. J. Neurol. Sci. 416, 117042, https:\/\/doi.org\/10.1016\/j.jns.2020.117042 (2020).","DOI":"10.1016\/j.jns.2020.117042"},{"issue":"6","key":"36433_CR31","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s11908-013-0378-5","volume":"15","author":"N Bahr","year":"2013","unstructured":"Bahr, N. et al. Central nervous system immune reconstitution inflammatory syndrome. Curr. Infect. Dis. Rep. 15 (6), 583\u2013593. https:\/\/doi.org\/10.1007\/s11908-013-0378-5 (2013).","journal-title":"Curr. Infect. Dis. Rep."},{"key":"36433_CR32","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1183\/16000617.0042-2016","volume":"26","author":"R Gopal","year":"2017","unstructured":"Gopal, R., Rapaka, R. R. & Kolls, J. K. Immune reconstitution inflammatory syndrome associated with pulmonary pathogens. Eur. Respiratory Rev. : Official J. Eur. Respiratory Soc. 26, 143. https:\/\/doi.org\/10.1183\/16000617.0042-2016 (2017).","journal-title":"Eur. Respiratory Rev. : Official J. Eur. Respiratory Soc."},{"issue":"03","key":"36433_CR33","doi-asserted-by":"publisher","first-page":"301","DOI":"10.4236\/wja.2014.43035","volume":"04","author":"C Adawaye","year":"2014","unstructured":"Adawaye, C. et al. Immunovirologic evaluation of triomune (Lamivudine, stavudine and Nevirapine) antiretroviral therapy in first line HIV-1 adult patients in N\u2019Djamena, Chad. World J. AIDS. 04 (03), 301\u2013305. https:\/\/doi.org\/10.4236\/wja.2014.43035 (2014).","journal-title":"World J. AIDS"},{"issue":"6","key":"36433_CR34","doi-asserted-by":"publisher","first-page":"583","DOI":"10.2217\/hiv.09.40","volume":"3","author":"BG Brenner","year":"2009","unstructured":"Brenner, B. G. & Coutsinos, D. The K65R mutation in HIV-1 reverse transcriptase: genetic barriers, resistance profile and clinical implications. HIV Therapy. 3 (6), 583\u2013594. https:\/\/doi.org\/10.2217\/hiv.09.40 (2009).","journal-title":"HIV Therapy"},{"key":"36433_CR35","unstructured":"Antiviral, A. (2012)."},{"key":"36433_CR36","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1056\/NEJMoa011157","volume":"345","author":"SL Gortmaker","year":"2001","unstructured":"Gortmaker, S. L. et al. Effect of combination therapy including protease inhibitors on mortality among children and adolescents infected with HIV-1. N. Engl. J. Med. 345, 21, 1522\u20131528. https:\/\/doi.org\/10.1056\/NEJMoa011157 (2001).","journal-title":"N. Engl. J. Med."},{"key":"36433_CR37","unstructured":"World Health Organization. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach (WHO. Geneva, 2013)."},{"key":"36433_CR38","doi-asserted-by":"publisher","unstructured":"Njom, A. E. et al. Outcomes of protease inhibitor-based antiretroviral therapy amongst children and associated-factors in Yaound\u00e9. Cameroon PloS One. 14, 3, (e0213900). https:\/\/doi.org\/10.1371\/journal.pone.0213900 (2019).","DOI":"10.1371\/journal.pone.0213900"},{"key":"36433_CR39","doi-asserted-by":"publisher","unstructured":"Chi, B. H. et al. Comparative outcomes of tenofovir-based and zidovudine-based antiretroviral therapy regimens in Lusaka, Zambia., Journal of acquired immune deficiency syndromes 58, 5, 475\u201381, 2011, (1999). https:\/\/doi.org\/10.1097\/QAI.0b013e31823058a3","DOI":"10.1097\/QAI.0b013e31823058a3"},{"key":"36433_CR40","unstructured":"MISAU PNC ITS-HIV\/SIDA Normas Clinicas Actualizadas para o seguimento do paciente HIV Positivo, Comite TARV Mozambique. Accessed: 14, 2023. [Online]. Available: https:\/\/comitetarvmisau.co.mz\/docs\/orientacoes_nacionais\/Circular_Normas_Cl\u00ednicas_Actualizadas_29_11_19.pdf"},{"key":"36433_CR41","unstructured":"MISAU PNCT ITS-HIV\/SIDA Gui\u00e3o de manejo do paciente com doen\u00e7a avan\u00e7ada por HIV \u2013\u20092022, Minist\u00e9rio da Sa\u00fade de Mo\u00e7ambique. Accessed: 15, 2023. [Online]. Available: https:\/\/www.misau.gov.mz\/index.php\/guioes-de-prevencao-e-de-cuidados-e-tratamento?download=1352:guiao-de-manejo-do-paciente-com-doenca-avancada-por-hiv-2022"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-36433-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-36433-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-36433-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T10:00:48Z","timestamp":1770890448000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-36433-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["36433"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-36433-1","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"assertion":[{"value":"29 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The Mozambican National Bioethics Committee for Health (\n                      Comit\u00e9 Nacional de Bio\u00e9tica para a Sa\u00fade\n                      , 25\/CNBS\/2019) approved this analysis. Analysis was performed on de-identified, aggregated patient level data, and no individual informed consent was obtained. The need for written informed consent was explicitly waived.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"We performed analysis on routine administrative data, consent for publication is not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"6051"}}