title: Need for timely paediatric HIV treatment within primary health care in rural South Africa.
abstract: BACKGROUND
  In 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.
  
  
  METHODS
  Local 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.
  
  
  RESULTS
  In 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%.
  
  
  CONCLUSIONS
  Despite 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.
authors.affiliation: Africa Centre for Health and Population Studies, University of KwaZulu-Natal, KwaZulu-Natal, South Africa. gcooke@africacentre.ac.za
authors.forename: Graham S
authors.initials: GS
authors.lastname: Cooke
authors.forename: Kirsty E
authors.initials: KE
authors.lastname: Little
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Bland
authors.forename: Hilary
authors.initials: H
authors.lastname: Thulare
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases; D005260:Female; D005380:Financing, Government; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D010372:Pediatrics / Q000379:methods; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population; D013019:South Africa