title: Costs of Care of HIV-Infected Children Initiating Lopinavir/Ritonavir-Based Antiretroviral Therapy before the Age of Two in Cote d'Ivoire.
abstract: OBJECTIVE
  To access the costs of care for Ivoirian children before and after initiating LPV/r-based antiretroviral therapy (ART) before the age of two.
  
  
  METHODS
  We assessed the direct costs of care for all HIV-infected children over the first 12 months on LPV/r-based ART initiated <2 years of age in Abidjan. We recorded all drug prescriptions, ART and cotrimoxazole prophylaxis delivery, medical analyses/examinations and hospital admissions. We compared these costs to those accrued in the month prior to ART initiation. Costs and 95% confidence intervals (95%CI) were estimated per child-month, according to severe morbidity.
  
  
  RESULTS
  Of the 114 children screened, 99 initiated LPV/r-based ART at a median age of 13.5 months (IQR: 6.8-18.6); 45% had reached World Health Organization stage 3 or 4. During the first 12 months on ART, 5% died and 3% were lost to follow-up. In the month before ART initiation, the mean cost of care per child-month reached $123.39 (95%CI:$121.02-$125.74). After ART initiation, it was $42.53 (95%CI:$42.15-$42.91); 50% were ART costs. The remaining costs were non-antiretroviral drugs (18%) and medical analyses/examinations (14%). Mean costs were significantly higher within the first three months on ART ($48.76, 95%CI:$47.95-$49.56) and in children experiencing severe morbidity ($49.76, 95%CI:$48.61-50.90).
  
  
  CONCLUSIONS
  ART reduces the overall monthly cost of care of HIV-infected children < 2 years. Because children were treated at an advanced HIV disease stage, the additional costs of treating severe morbidity on ART remain substantial. Strategies for treating HIV-infected children as early as possible must remain a priority in Côte d'Ivoire.
authors.affiliation: Inserm, U1219, Bordeaux University, Bordeaux, France.|Institut de Sante Publique, d'Epidemiologie et de Developpement, Bordeaux University, Bordeaux, France.|Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
authors.forename: Sophie
authors.initials: S
authors.lastname: Desmonde
authors.affiliation: Programme PACCI, Site ANRS, Abidjan, Cote d'Ivoire.
authors.forename: Divine
authors.initials: D
authors.lastname: Avit
authors.affiliation: Institut de Sante Publique, d'Epidemiologie et de Developpement, Bordeaux University, Bordeaux, France.
authors.forename: Junie
authors.initials: J
authors.lastname: Petit
authors.affiliation: Programme PACCI, Site ANRS, Abidjan, Cote d'Ivoire.|Service de Pediatrie, Centre Hospitalier Universitaire (CHU) de Cocody, Abidjan, Cote d'Ivoire.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Amorissani Folquet
authors.affiliation: Programme PACCI, Site ANRS, Abidjan, Cote d'Ivoire.
authors.forename: Francois Tanoh
authors.initials: FT
authors.lastname: Eboua
authors.affiliation: Programme PACCI, Site ANRS, Abidjan, Cote d'Ivoire.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Amani Bosse
authors.affiliation: Service de Pediatrie, Centre Hospitalier Universitaire (CHU) de Cocody, Abidjan, Cote d'Ivoire.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Dainguy
authors.affiliation: Programme PACCI, Site ANRS, Abidjan, Cote d'Ivoire.
authors.forename: Véronique
authors.initials: V
authors.lastname: Mea
authors.affiliation: Programme PACCI, Site ANRS, Abidjan, Cote d'Ivoire.|Service de Pediatrie, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, Cote d'Ivoire.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Timite-Konan
authors.affiliation: Centre de Prise en charge, de recherche et de Formation (CePReF), Service Enfant, Yopougon, Abidjan, Cote d'Ivoire.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Ngbeché
authors.affiliation: Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.|Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ciaranello
authors.affiliation: Inserm Unit 1027, University of Toulouse 3, Toulouse, France.
authors.forename: Valeriane
authors.initials: V
authors.lastname: Leroy
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D007560:Cote d'Ivoire; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D061466:Lopinavir / Q000627:therapeutic use*; D059012:Lost to Follow-Up; D008297:Male; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D019438:Ritonavir / Q000627:therapeutic use*; D015996:Survival Rate
chemical_list: D019380:Anti-HIV Agents; D061466:Lopinavir; D019438:Ritonavir