title: Scaling up pediatric HIV care and treatment in Africa: clinical site characteristics associated with favorable service utilization.
abstract: BACKGROUND
  To improve pediatric enrollment and retention in HIV treatment programs in Africa, we examined factors associated with service utilization within the Elizabeth Glaser Pediatric AIDS Foundation program in Côte d'Ivoire, Mozambique, South Africa, Tanzania and Zambia.
  
  
  METHODS
  We retrospectively reviewed characteristics of clinical sites providing HIV treatment services within our program. For each site, favorable pediatric program outcomes were defined as a cumulative number or percentage of pediatric enrollment in care or antiretroviral therapy (ART) more than the pooled median value or an attrition rate less than 10%. We compared proportions of sites with favorable outcomes among those with or without selected characteristics. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were determined using logistic regression analyses, accounting for potential confounding factors.
  
  
  RESULTS
  Over 4 years, 33,331 children were enrolled, including 18,255 on ART, across 220 sites. Characteristics associated with favorable pediatric enrollment were nutritional support (aOR = 8.9; CI: 2.8 to 28.4), linkages with associations of people living with HIV (aOR = 4.2; CI: 1.8 to 9.5), early infant diagnosis (aOR = 3.3; CI: 1.5 to 7.1), and on-site prevention of mother-to-child transmission services (aOR = 3.1; CI: 1.0 to 11.1). Similarly, linkages with people living with HIV, early infant diagnosis, and prevention of mother-to-child transmission were associated with high proportion of children on ART younger than 2 years of age. Home-based care was associated with low pediatric attrition rates (aOR = 2.9; CI: 1.4 to 5.8).
  
  
  CONCLUSIONS
  Certain site characteristics were associated with favorable pediatric enrollment and retention in our program. Expanding these characteristics to improve pediatric HIV treatment in Africa warrants further evaluation.
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Los Angeles, CA, USA.
authors.forename: Georgette
authors.initials: G
authors.lastname: Adjorlolo-Johnson
authors.forename: Andrea
authors.initials: A
authors.lastname: Wahl Uheling
authors.forename: Shobana
authors.initials: S
authors.lastname: Ramachandran
authors.forename: Susan
authors.initials: S
authors.lastname: Strasser
authors.forename: Joseph
authors.initials: J
authors.lastname: Kouakou
authors.forename: Denis
authors.initials: D
authors.lastname: Tindyebwa
authors.forename: Cathrien
authors.initials: C
authors.lastname: Alons
authors.forename: Tshiwela
authors.initials: T
authors.lastname: Neluheni
authors.forename: Stephen
authors.initials: S
authors.lastname: Lee
authors.forename: Richard
authors.initials: R
authors.lastname: Marlink
mesh_terms: D000293:Adolescent; D000349:Africa; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D016903:Drug Monitoring