title: Missed opportunities for early access to care of HIV-infected infants in Burkina Faso.
abstract: OBJECTIVE
  The World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIV-infected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso.
  
  
  METHODS
  We conducted a cross-sectional survey in 2011 in all health care facilities involved in PMTCT and pediatric HIV care in Ouagadougou. We assessed them according to their coverage in pediatric HIV care and WHO standards, through a desk review of medical registers and a semi-structured questionnaire administered to health-care workers (HCW).
  
  
  RESULTS
  In 2011, there was no offer of care in primary health care facilities for HIV-infected children in Ouagadougou. Six district hospitals and two university hospitals provided pediatric HIV care. Among the 67 592 pregnant women attending antenatal clinics in 2011, 85.9% were tested for HIV. The prevalence of HIV was 1.8% (95% Confidence Interval: 1.7%-1.9%). Among the 1 064 HIV-infected pregnant women attending antenatal clinics, 41.4% received a mother-to-child HIV transmission prevention intervention. Among the HIV-exposed infants, 313 (29.4%) had an early infant HIV test, and 306 (97.8%) of these infants tested received their result within a four-month period. Among the 40 children initially tested HIV-infected, 33 (82.5%) were referred to a health care facility, 3 (9.0%) were false positive, and 27 (90.0%) were initiated on ART. Although health care facilities were adequately supplied with HIV drugs, they were hindered by operational challenges such as shortage of infrastructures, laboratory reagents, and trained HCW.
  
  
  CONCLUSIONS
  The PMTCT cascade revealed bottle necks in PMTCT intervention and HIV early infant diagnosis. The staffing in HIV care and quality of health care infrastructures were also insufficient in 2011 in Ouagadougou.
authors.affiliation: Projet MONOD ANRS 12206, Centre de Recherche Internationale pour la Santé, Site ANRS Burkina, Université de Ouagadougou, Ouagadougou, Burkina Faso.
authors.forename: Malik
authors.initials: M
authors.lastname: Coulibaly
authors.affiliation: Projet MONOD ANRS 12206, Centre de Recherche Internationale pour la Santé, Site ANRS Burkina, Université de Ouagadougou, Ouagadougou, Burkina Faso; Centre Muraz, Bobo Dioulasso, Burkina Faso.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.affiliation: Service de Pédiatrie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
authors.forename: Caroline
authors.initials: C
authors.lastname: Yonaba
authors.affiliation: Service de Pédiatrie Médicale, CHU Charles de Gaulle, Ouagadougou, Burkina Faso.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Ouedraogo
authors.affiliation: Laboratoire de Bactériologie - Virologie CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
authors.forename: Malika
authors.initials: M
authors.lastname: Congo
authors.affiliation: Service de laboratoire, CHU Charles de Gaulle, Ouagadougou, Burkina Faso.
authors.forename: Mamoudou
authors.initials: M
authors.lastname: Barry
authors.affiliation: Projet MONOD ANRS 12206, Centre de Recherche Internationale pour la Santé, Site ANRS Burkina, Université de Ouagadougou, Ouagadougou, Burkina Faso.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Thio
authors.affiliation: Projet MONOD ANRS 12206, Centre de Recherche Internationale pour la Santé, Site ANRS Burkina, Université de Ouagadougou, Ouagadougou, Burkina Faso.
authors.forename: Issa
authors.initials: I
authors.lastname: Siribié
authors.affiliation: Service de Pédiatrie Médicale, CHU Charles de Gaulle, Ouagadougou, Burkina Faso.
authors.forename: Fla
authors.initials: F
authors.lastname: Koueta
authors.affiliation: Service de Pédiatrie Médicale, CHU Charles de Gaulle, Ouagadougou, Burkina Faso.
authors.forename: Diarra
authors.initials: D
authors.lastname: Ye
authors.affiliation: Service de Pédiatrie, CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Kam
authors.affiliation: Groupe hospitalier Necker- Enfants malades, Paris, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Blanche
authors.affiliation: Inserm U1058, Université Montpellier 1, Montpellier, France.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Van De Perre
authors.affiliation: Inserm, U897, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université de Bordeaux, Bordeaux, France.
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D002050:Burkina Faso / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy
chemical_list: D019380:Anti-HIV Agents