title: Retention in care of HIV-infected children from HIV test to start of antiretroviral therapy: systematic review.
abstract: BACKGROUND
  In adults it is well documented that there are substantial losses to the programme between HIV testing and start of antiretroviral therapy (ART). The magnitude and reasons for loss to follow-up and death between HIV diagnosis and start of ART in children are not well defined.
  
  
  METHODS
  We searched the PubMed and EMBASE databases for studies on children followed between HIV diagnosis and start of ART in low-income settings. We examined the proportion of children with a CD4 cell count/percentage after after being diagnosed with HIV infection, the number of treatment-eligible children starting ART and predictors of loss to programme. Data were extracted in duplicate.
  
  
  RESULTS
  Eight studies from sub-Saharan Africa and two studies from Asia with a total of 10,741 children were included. Median age ranged from 2.2 to 6.5 years. Between 78.0 and 97.0% of HIV-infected children subsequently had a CD4 cell count/percentage measured, 63.2 to 90.7% of children with an eligibility assessment met the eligibility criteria for the particular setting and time and 39.5 to 99.4% of the eligible children started ART. Three studies reported an association between low CD4 count/percentage and ART initiation while no association was reported for gender. Only two studies reported on pre-ART mortality and found rates of 13 and 6 per 100 person-years.
  
  
  CONCLUSIONS
  Most children who presented for HIV care met eligibility criteria for ART. There is an urgent need for strategies to improve the access to and retention to care of HIV-infected children in resource-limited settings.
authors: Division of International and Environmental Health, Institute of Social and Preventive Medicine, University of Bern, Switzerland.
authors: Catrina
authors: C
authors: Mugglin
authors: Gilles
authors: G
authors: Wandeler
authors: Janne
authors: J
authors: Estill
authors: Matthias
authors: M
authors: Egger
authors: Nicole
authors: N
authors: Bender
authors: Mary-Ann
authors: MA
authors: Davies
authors: Olivia
authors: O
authors: Keiser
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000008:administration & dosage; D023241:Antiretroviral Therapy, Highly Active; D001208:Asia; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006678:HIV / Q000302:isolation & purification* / Q000472:pathogenicity; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000821:virology; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology*; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010342:Patient Acceptance of Health Care; D039781:PubMed; D015996:Survival Rate
chemical_list: D019380:Anti-HIV Agents