Abstract
IntroductionThere are limited data on paediatric HIV care and treatment programmes in low-resource settings.MethodsA standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap).ResultsA total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult–paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4–6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common.ConclusionsIn general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented.
Highlights
There are limited data on paediatric HIV care and treatment programmes in low-resource settings
UNAIDS estimates that 3.4 million children under the age of 15 years are currently living with HIV infection; 91% of these children reside in sub-Saharan Africa [1]
The median upper age limit of children attending the clinic ranged from 14 years at participating sites in East Africa to 18 years in Asia and Southern Africa
Summary
There are limited data on paediatric HIV care and treatment programmes in low-resource settings. There are multiple bottlenecks that limit paediatric treatment, including poor access to early HIV diagnosis in infants, lack of health care centres and providers equipped to deliver paediatric treatment, limited availability of paediatric drug formulations and the high cost of such formulations, the complexity of adjusting dosing as a child ages and weak systems for patient retention. Understanding the availability of clinical management resources as well as the application of prevention, diagnosis and treatment standards is necessary to provide a context for observational cohort studies. Such studies are necessary to optimize programme development, and to improve patient access and outcomes. Large data gaps on the numbers of children living with HIV and those who meet criteria for treatment initiation [8] make it even more difficult to project the level of additional resources needed to deliver paediatric HIV care
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