title: Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings.
abstract: Introduction Increasing access to HIV-related care and treatment for children aged 0-18 years in resource-limited settings is an urgent global priority. In 2011-2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of results to facilities; (6) community leader and health worker advocacy at creches, schools, religious centres to increase uptake of HIV testing and dispel fatalistic beliefs about HIV; (7) use of mobile communication technology (m-health) and peer/community supporters to maintain contact with patients. Discussion and Conclusion We propose that this package of facility, community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free survival.
authors: Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa. Ameena.Goga@mrc.ac.za.|Department of Paediatrics, University of Pretoria, Private bag X20, Hatfield, Pretoria, 0028, South Africa. Ameena.Goga@mrc.ac.za.
authors: Ameena Ebrahim
authors: 0000-0002-2394-6486
authors: AE
authors: Goga
authors: Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa.
authors: Yagespari
authors: Y
authors: Singh
authors: Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa.
authors: Michelle
authors: M
authors: Singh
authors: Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa.
authors: Nobuntu
authors: N
authors: Noveve
authors: Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa.
authors: Vuyolwethu
authors: V
authors: Magasana
authors: Health Systems Research Unit, South African Medical Research Council, Francie van Zyl Drive, Parrowvallei, Cape Town, 7505, South Africa.
authors: Trisha
authors: T
authors: Ramraj
authors: South African National AIDS Council, Pretoria, South Africa.
authors: Fareed
authors: F
authors: Abdullah
authors: Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors: Ashraf H
authors: AH
authors: Coovadia
authors: United Nations Childrens Fund, Pretoria, South Africa.
authors: Sanjana
authors: S
authors: Bhardwaj
authors: Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|National Institute of Communicable Diseases, National Health Laboratory Services, Modderfontein Road, Sandringham, Johannesburg, South Africa.
authors: Gayle G
authors: GG
authors: Sherman
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D003906:Developing Countries / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D010355:Patient Identification Systems / Q000592:standards; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents
keywords: ARV coverage; ARV uptake; Adolescent; Continuity of care; PMTCT effectiveness; Paediatric ART access; Paediatric HIV; Paediatric HIV treatment access; SAPMTCTE