Missed opportunities of inclusion in a cohort of HIV-infected children to initiate antiretroviral treatment before the age of two in West Africa, 2011 to 2013.

Désiré L Dahourou,Vic Arendt,Valériane Leroy,Marguerite Timite-Konan,Nicolas Meda,Divine Avit-Edi,Madeleine Amorissani-Folquet,Clarisse Amani-Bosse,Diarra Ye,Malik Coulibaly,Roger Salamon,Philippe Lepage

doi:10.7448/ias.19.1.20601

Abstract

IntroductionThe World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso.MethodsAll children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. We used logistic regression to identify correlates of inclusion.ResultsAmong the 217 children screened and referred to the MONOD centres, 161 (74%) were included and initiated on EART. The main reasons of non-inclusion were fear of father's refusal (48%), mortality (24%), false-positive HIV infection test (16%) and other ineligibility reasons (12%). Having previously disclosed the child's and mother's HIV status to the father (adjusted odds ratio (aOR): 3.20; 95% confidence interval (95% CI): 1.55 to 6.69) and being older than 12 months (aOR: 2.05; 95% CI: 1.02 to 4.12) were correlates of EART initiation. At EART initiation, the median age was 13.5 months, 70% had reached WHO Stage 3/4 and 57% had a severe immune deficiency.ConclusionsFear of stigmatization by the father and early competing mortality were the major reasons for missed opportunities of EART initiation. There is an urgent need to involve fathers in the care of their HIV-exposed children and to promote early infant diagnosis to improve their future access to EART and survival.

Highlights

The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age
Among the 208 HIV-infected children confirmed eligible for treatment, 77% were initiated on early antiretroviral therapy (EART) (95% confidence interval: 71% to 83%) (Figure 1)
Characteristics of eligible children according to their inclusion in the EART therapeutic cohort (N 0208) Table 1 provides the baseline characteristics of the children according to their inclusion in the MONOD cohort

Summary

Introduction

The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Cote d’Ivoire, and Ouagadougou, Burkina Faso. Methods: All children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. In 2011, 67% and 29% of HIV-positive women received the PMTCT intervention in Burkina Faso [2] and Cote d’Ivoire [4], respectively, with a growing HIV paediatric epidemic. In the absence of any intervention, the mortality of HIV-infected children remains high, reaching 50% at the age of two [5]

Methods

Results

Discussion

Conclusion