Abstract
BackgroundIn areas where adult HIV prevalence has reached hyperendemic levels, many infants remain at risk of acquiring HIV infection. Timely access to care and treatment for HIV-infected infants and young children remains an important challenge. We explore the extent to which public sector roll-out has met the estimated need for paediatric treatment in a rural South African setting.MethodsLocal facility and population-based data were used to compare the number of HIV infected children accessing HAART before 2008, with estimates of those in need of treatment from a deterministic modeling approach. The impact of programmatic improvements on estimated numbers of children in need of treatment was assessed in sensitivity analyses.FindingsIn the primary health care programme of HIV treatment 346 children <16 years of age initiated HAART by 2008; 245(70.8%) were aged 10 years or younger, and only 2(<1%) under one year of age. Deterministic modeling predicted 2,561 HIV infected children aged 10 or younger to be alive within the area, of whom at least 521(20.3%) would have required immediate treatment. Were extended PMTCT uptake to reach 100% coverage, the annual number of infected infants could be reduced by 49.2%.ConclusionDespite progress in delivering decentralized HIV services to a rural sub-district in South Africa, substantial unmet need for treatment remains. In a local setting, very few children were initiated on treatment under 1 year of age and steps have now been taken to successfully improve early diagnosis and referral of infected infants.
Highlights
Within the broader global HIV epidemic, paediatric HIV infection remains a major cause for concern
We have previously estimated the number of children likely to be eligible for treatment in South Africa up to end of 2003 using a novel model [5]; of the 758,595 children estimated to have acquired HIV infection between 1993–2003, approximately half were predicted to be alive and in need of HAART at the time of widespread treatment roll-out
Whilst initially based in the district hospital, the service is decentralised to a community healthcare centre (CHC) and all primary health care centres (PHCs) within the wider Hlabisa sub-district [8]
Summary
Within the broader global HIV epidemic, paediatric HIV infection remains a major cause for concern. UNAIDS estimates that only accounting for approximately 6% of all HIV infected individuals, children under 16 years of age account for 12% of new infections and 13% of HIV related deaths [1]. We have previously estimated the number of children likely to be eligible for treatment in South Africa up to end of 2003 using a novel model [5]; of the 758,595 children estimated to have acquired HIV infection between 1993–2003, approximately half were predicted to be alive and in need of HAART at the time of widespread treatment roll-out. In areas where adult HIV prevalence has reached hyperendemic levels, many infants remain at risk of acquiring HIV infection. Access to care and treatment for HIV-infected infants and young children remains an important challenge. We explore the extent to which public sector roll-out has met the estimated need for paediatric treatment in a rural South African setting
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