title: Delays in Initiation of Antiretroviral Therapy Among HIV-infected Children in Rural Zambia.
abstract: BACKGROUND
  Although care and treatment are available to many HIV-infected children, barriers remain that delay initiation of antiretroviral therapy (ART). Minimizing these barriers is critical to starting ART at earlier ages.
  
  
  METHODS
  Reasons for delay were evaluated among 200 children younger than 15 years of age initiating treatment in an HIV clinic in rural Zambia from 2011 to 2013.
  
  
  RESULTS
  The median age of children at ART eligibility was 2.9 years, and 49% were male. After being determined eligible, 60% of children delayed ART initiation for a median of 28 days (interquartile range: 14, 75). Primary reasons for delay included waiting for test results, adherence issues and concurrent treatment for tuberculosis. When reasons for delay were categorized by type, 36% of children had family-related delays, 32% had delays because of clinic logistics, 27% had health-related delays and 6% had other or no identified reasons for delay. The median time between eligibility and ART initiation was shortest for children with delays because of clinic logistics (median: 18 days; interquartile range: 14, 35). Children with family-related delays tended to be older and orphaned, whereas children with delays because of clinic logistics tended to be younger, and children with health-related delays tended to have more advanced disease. In the first year of ART, no association was found between adherence and type of delay. CD4 T-cell percentages and weight-for-age Z scores were lower for children with health-related delays.
  
  
  CONCLUSIONS
  Strategies to reduce delays in ART initiation will need to address a diverse set of issues, so children can benefit from earlier treatment.
authors.affiliation: From the *Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; †Macha Research Trust, Macha Hospital, Choma, Zambia; and ‡Department of Immunology and Infectious Diseases, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Sutcliffe
authors.forename: Janneke H
authors.initials: JH
authors.lastname: van Dijk
authors.forename: Mathias
authors.initials: M
authors.lastname: Muleka
authors.forename: Jeridy
authors.initials: J
authors.lastname: Munsanje
authors.forename: Philip E
authors.initials: PE
authors.lastname: Thuma
authors.forename: William J
authors.initials: WJ
authors.lastname: Moss
mesh_terms: D000293:Adolescent; D000359:Aftercare; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012424:Rural Population; D016896:Treatment Outcome; D015024:Zambia / Q000453:epidemiology