title: The needs for HIV treatment and care of children, adolescents, pregnant women and older people in low-income and middle-income countries.
abstract: OBJECTIVE
  Success in diagnosing and treating HIV-infected adults has, where HIV care and treatment is available, turned HIV into a chronic, rather than life-limiting disease. Progress meeting the needs of HIV-infected children, perinatally and horizontally infected adolescents, pregnant women and older people has lagged behind. We review the special needs and barriers to scaling up care and antiretroviral therapy (ART) coverage in these populations.
  
  
  METHODS
  A literature review combined with personal views and operational experience specifically from countries covered by the Evidence for Action programme.
  
  
  RESULTS
  Challenges include logistics of diagnosis and treatment in pregnancy, difficulties in early infant diagnosis, availability of appropriate paediatric formulations, management of adolescents, and comorbidities in older people.
  
  
  CONCLUSIONS
  Priorities for development need to focus upon the simplification of HIV care to allow provision for all ages at the primary healthcare level. Specific priorities include focused use of virological testing in infants, ongoing development of dispersible and scored fixed-dose ART combinations suitable for use across ages, development of 'adolescent-friendly' HIV services catering for perinatally and horizontally infected adolescents to improve adherence and reduce onward transmissions, simplification of referral pathways to ensure all pregnant women are tested for HIV and commenced on ART, and education of healthcare workers on the specific needs of HIV care in older patients. Each priority will be reviewed and potential solutions discussed.
authors.affiliation: Clinical Trials Unit, Medical Research Council, and Department of Infectious Diseases and Microbiology, Institute of Child Health, University College London, 30 Guilford St., London, UK. jmk@ctu.mrc.ac.uk
authors.forename: Julia
authors.initials: J
authors.lastname: Kenny
authors.forename: Veronica
authors.initials: V
authors.lastname: Mulenga
authors.forename: Susan
authors.initials: S
authors.lastname: Hoskins
authors.forename: Francien
authors.initials: F
authors.lastname: Scholten
authors.forename: Diana M
authors.initials: DM
authors.lastname: Gibb
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D000328:Adult; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D019380:Anti-HIV Agents