title: Programmatic impact of the evolution of WHO pediatric antiretroviral treatment guidelines for resource-limited countries (Tukula Fenna Project, Uganda).
abstract: BACKGROUND
  World Health Organization (WHO) recommendations for the initiation of antiretroviral therapy (ART) in children were revised in 2010, but the programmatic impact has had limited study.
  
  
  METHODS
  We used a cohort of 985 Ugandan children followed since 2003 by the Tukula Fenna project to model the differential impact of the 2006, 2008, and 2010 WHO pediatric ART inititation criteria on the proportion of children eligible for ART at enrollment and over time.
  
  
  RESULTS
  Using the WHO 2006, 2008, and 2010 ART criteria, 40%, 57%, and 66% of children, respectively, would have been eligible for ART at enrollment and 76%, 84%, and 88% 2 years later. Evaluating the entire cohort followed for 6 years using the 2006, 2008, and 2010 guidelines, the proportion in need of ART was found to be 70%, 82%, and 87%, respectively. Between 2006 and 2008, the proportions of eligible children starting ART within 6 and 12 months were 39% and 50%, respectively; after this, the proportions starting within 6 and 12 months were 50% and 52%. Before 2008, the most common criterion met in children who did not start ART was WHO clinical stage (odds ratio = 2.0, CI 95% = 1.2 to 3.2); after the 2008 recommendations, the most common eligibility criterion in children who did not start ART was age <12 months (odds ratio = 10.5, CI 95% = 3.8 to 31.1).
  
  
  CONCLUSIONS
  An overall increase of 17% (from 70% to 87%) in children in need of ART was observed in our cohort comparing the 2006 and 2010 guidelines; this increase was primarily driven by the introduction of universal treatment for infants <12 months in 2008.
authors.affiliation: Department of Paediatrics, University of Padua, Padua, Italy. martina.penazzato@gmail.com
authors.forename: Martina
authors.initials: M
authors.lastname: Penazzato
authors.forename: Siobhan
authors.initials: S
authors.lastname: Crowley
authors.forename: Lynne
authors.initials: L
authors.lastname: Mofenson
authors.forename: Genny
authors.initials: G
authors.lastname: Franceschetto
authors.forename: Maria-Musoke
authors.initials: MM
authors.lastname: Nannyonga
authors.forename: Antonio
authors.initials: A
authors.lastname: Mazza
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
mesh_terms: D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D014454:Uganda; D014944:World Health Organization
chemical_list: D044966:Anti-Retroviral Agents