title: Delivering pediatric HIV care in resource-limited settings: cost considerations in an expanded response.
abstract: If children are to be protected from HIV, the expansion of PMTCT programs must be complemented by increased provision of paediatric treatment. This is expensive, yet there are humanitarian, equity and children's rights arguments to justify the prioritization of treating HIV-infected children. In the context of limited budgets, inefficiencies cost lives, either through lower coverage or less effective services. With the goal of informing the design and expansion of efficient paediatric treatment programs able to utilize to greatest effect the available resources allocated to the treatment of HIV-infected children, this article reviews what is known about cost drivers in paediatric HIV interventions, and makes suggestions for improving efficiency in paediatric HIV programming. High-impact interventions known to deliver disproportional returns on investment are highlighted and targeted for immediate scale-up. Progress will carry a cost - increased funding, as well as additional data on intervention costs and outcomes, will be required if universal access of HIV-infected children to treatment is to be achieved and sustained.
authors.affiliation: aBaylor College of Medicine Children's Foundation - Tanzania, Bugando Medical Centre, Mwanza, Tanzania bUnited States Agency for International Development, Washington, DC, USA cDevelopment Pathways to Health Research Unit, University of Witwatersrand, Johannesburg dClinton Health Access Initiative eUnited Nations Children's Fund (UNICEF), New York, New York fPartnership for Supply Chain Management, Arlington, Virginia, USA gBaylor College of Medicine Children's Foundation-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi hWorld Health Organization, Geneva, Switzerland iManagement Sciences for Health, Cambridge, Massachusetts, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Tolle
authors.forename: B Ryan
authors.initials: BR
authors.lastname: Phelps
authors.forename: Chris
authors.initials: C
authors.lastname: Desmond
authors.forename: Nandita
authors.initials: N
authors.lastname: Sugandhi
authors.forename: Chinyere
authors.initials: C
authors.lastname: Omeogu
authors.forename: David
authors.initials: D
authors.lastname: Jamieson
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.forename: Elan
authors.initials: E
authors.lastname: Reuben
authors.forename: Lulu
authors.initials: L
authors.lastname: Muhe
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kellerman
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use; D057191:Capacity Building; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000458:organization & administration / Q000592:standards / Q000600:supply & distribution; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000600:supply & distribution; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D016730:Program Development
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents