HIV incidence and death among orphaned and non-orphaned children and adolescents living in family-based settings in western Kenya: a prospective cohort analysis

Dorothy Apedaile, University of Toronto, Canada
Allison DeLong, Brown University, USA
Edwin Sang, Academic Model Providing Access to Healthcare (AMPATH), Kenya
David Ayuku, Moi University, Kenya
Lukoye Atwoli, Aga Khan University
Omar Galárraga, Brown University, USA
Joseph Hogan, Brown University, USA
Paula Braitstein, University of Toronto, Canada


Objectives: To compare the incidence of HIV, death, and abuse among orphaned children to non-orphaned children living in households caring for orphaned children in western Kenya.

Study design: A random sample was taken of 300 households caring for at least one orphaned child in Uasin Gishu County, Kenya. All orphaned and non-orphaned children in each selected household were enrolled in a prospective cohort study between 2010 and 2013. A total of 1488 children (487 double orphans, 743 single orphans, 258 non-orphans) were followed annually until 2019. Survival analysis was used to estimate hazard ratios and 95% confidence intervals of the association between the number of parents the child had lost (none, 1, or 2), and HIV incidence, death, combined HIV incidence or death, and incident abuse.

Results: Among 1488 children enrolled, 52% of participants were female, 23 were HIV-positive, and the median age was 10.4 years. Over course of the study, 16 orphaned children died and 11 acquired HIV. No deaths or incident HIV infections were observed among the non-orphaned children. Among children who were HIV-negative at enrollment, loss of a parent was strongly associated with incident HIV (aHR 2.21 per parent lost, 95% CI: 1.03-4.73) and HIV or death (aHR 2.46 per parent, 95% CI: 1.37-4.42). There were no significant associations between orphan level and abuse.

Conclusions: In similar households, orphaned children experience a higher risk of HIV and death than non-orphaned children. Both orphaned children and the families caring for them need additional support to prevent adverse health outcomes.