title: Missed opportunities of inclusion in a cohort of HIV-infected children to initiate antiretroviral treatment before the age of two in West Africa, 2011 to 2013.
abstract: BACKGROUND
  The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso.
  
  
  METHODS
  All children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. We used logistic regression to identify correlates of inclusion.
  
  
  RESULTS
  Among the 217 children screened and referred to the MONOD centres, 161 (74%) were included and initiated on EART. The main reasons of non-inclusion were fear of father's refusal (48%), mortality (24%), false-positive HIV infection test (16%) and other ineligibility reasons (12%). Having previously disclosed the child's and mother's HIV status to the father (adjusted odds ratio (aOR): 3.20; 95% confidence interval (95% CI): 1.55 to 6.69) and being older than 12 months (aOR: 2.05; 95% CI: 1.02 to 4.12) were correlates of EART initiation. At EART initiation, the median age was 13.5 months, 70% had reached WHO Stage 3/4 and 57% had a severe immune deficiency.
  
  
  CONCLUSIONS
  Fear of stigmatization by the father and early competing mortality were the major reasons for missed opportunities of EART initiation. There is an urgent need to involve fathers in the care of their HIV-exposed children and to promote early infant diagnosis to improve their future access to EART and survival.
authors.affiliation: MONOD Project, ANRS 12206, Centre de Recherche Internationale pour la Santé, Ouagadougou, Burkina Faso.|Inserm, U1219, Institut de Santé Publique, Epidémiologie et Développement, University of Bordeaux, Bordeaux, France.|Centre Muraz, Bobo-Dioulasso, Burkina Faso; ddahourou@gmail.com; ddahourou@gmail.com.
authors.forename: Désiré L
authors.initials: DL
authors.lastname: Dahourou
authors.affiliation: PACCI Programme, Site ANRS, Projet Monod, Abidjan, Côte d'Ivoire.|Pediatric Department, CHU of Cocody, Abidjan, Côte d'Ivoire.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Amorissani-Folquet
authors.affiliation: MONOD Project, ANRS 12206, Centre de Recherche Internationale pour la Santé, Ouagadougou, Burkina Faso.|Inserm, U1219, Institut de Santé Publique, Epidémiologie et Développement, University of Bordeaux, Bordeaux, France.
authors.forename: Malik
authors.initials: M
authors.lastname: Coulibaly
authors.affiliation: PACCI Programme, Site ANRS, Projet Monod, Abidjan, Côte d'Ivoire.
authors.forename: Divine
authors.initials: D
authors.lastname: Avit-Edi
authors.affiliation: MONOD Project, ANRS 12206, Centre de Recherche Internationale pour la Santé, Ouagadougou, Burkina Faso.|Centre Muraz, Bobo-Dioulasso, Burkina Faso.|University of Ouagadougou, Ouagadougou, Burkina Faso.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.affiliation: Pediatric Department, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, Côte d'Ivoire.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Timite-Konan
authors.affiliation: Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg.
authors.forename: Vic
authors.initials: V
authors.lastname: Arendt
authors.affiliation: University of Ouagadougou, Ouagadougou, Burkina Faso.|Pediatric Department, CHU Charles de Gaulle, Ouagadougou, Burkina Faso.
authors.forename: Diarra
authors.initials: D
authors.lastname: Ye
authors.affiliation: PACCI Programme, Site ANRS, Projet Monod, Abidjan, Côte d'Ivoire.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Amani-Bosse
authors.affiliation: Inserm, U1219, Institut de Santé Publique, Epidémiologie et Développement, University of Bordeaux, Bordeaux, France.
authors.forename: Roger
authors.initials: R
authors.lastname: Salamon
authors.affiliation: Pediatric Department, Hôpital Universitaire des Enfants de la Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lepage
authors.affiliation: Inserm, U1027, Université Toulouse, Toulouse, France.
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
mesh_terms: D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; West Africa; acceptability; access to care; children; early antiretroviral therapy; linkage to care