title: Characteristics of HIV-Infected Children at Enrollment into Care and at Antiretroviral Therapy Initiation in Central Africa.
abstract: BACKGROUND
  Despite the World Health Organization (WHO) regularly updating guidelines to recommend earlier initiation of antiretroviral therapy (ART) in children, timely enrollment into care and initiation of ART in sub-Saharan Africa in children lags behind that of adults. The impact of implementing increasingly less restrictive ART guidelines on ART initiation in Central Africa has not been described.
  
  
  METHODS
  Data are from the Central Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) pediatric cohort of 3,426 children (0-15 years) entering HIV care at 15 sites in Burundi, DRC, and Rwanda. Measures include CD4 count, WHO clinical stage, age, and weight-for-age Z score (WAZ), each at enrollment into HIV care and at ART initiation. Changes in the medians or proportions of each measure by year of enrollment and year of ART initiation were assessed to capture potential impacts of changing ART guidelines.
  
  
  RESULTS
  Median age at care enrollment decreased from 77.2 months in 2004-05 to 30.3 months in 2012-13. The median age at ART initiation (n = 2058) decreased from 83.0 months in 2004-05 to 66.9 months in 2012-13. The proportion of children ≤24 months of age at enrollment increased from 12.7% in 2004-05 to 46.7% in 2012-13, and from 9.6% in 2004-05 to 24.2% in 2012-13 for ART initiation. The median CD4 count at enrollment into care increased from 563 (IQR: 275, 901) in 2004-05 to 660 (IQR: 339, 1071) cells/μl in 2012-13, and the median CD4 count at ART initiation increased from 310 (IQR:167, 600) in 2004-05 to 589 (IQR: 315, 1113) cells/μl in 2012-13. From 2004-05 to 2012-13, median WAZ improved from -2 (IQR: -3.4, -1.1) to -1 (IQR: -2.5, -0.2) at enrollment in care and from -2 (IQR: -3.8, -1.6) to -1 (IQR: -2.6, -0.4) at ART initiation.
  
  
  CONCLUSIONS
  Although HIV-infected children ≤24 months of age accounted for half of all children enrolling in care in our cohort during 2012-13, they represented less than a quarter of all those who were initiated on ART during the same period. Further research is needed to identify barriers to timely diagnosis, linkage to care, and initiation of ART among children with HIV infection.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America.
authors.forename: Adebola
authors.identifier: http://orcid.org/0000-0002-8012-9124
authors.initials: A
authors.lastname: Adedimeji
authors.affiliation: Department of Epidemiology, The University of North Carolina, Chapel Hill, North Carolina, United States of America.
authors.forename: Andrew
authors.initials: A
authors.lastname: Edmonds
authors.affiliation: Department of Statistics, Rutgers University, New Brunswick, New Jersey, United States of America.
authors.forename: Donald
authors.initials: D
authors.lastname: Hoover
authors.affiliation: Department of Epidemiology and Community Health, New York Medical College, Valhalla, New York, United States of America.
authors.forename: Qiuhu
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Division of Research and Clinical Education, The Rwanda Military Hospital, Kanombe, Kigali Rwanda.
authors.forename: Jean d'Amour
authors.initials: JD
authors.lastname: Sinayobye
authors.affiliation: Department of Pediatrics, University Hospital of Kamenge, Faculty of Medicine, University of Burundi, Bujumbura, Burundi.
authors.forename: Martin
authors.initials: M
authors.lastname: Nduwimana
authors.affiliation: Kalembe Lembe Pediatric Hospital, Kinshasa, The Democratic Republic of Congo.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lelo
authors.affiliation: Epidemiology and Biostatistics Program at the City University of New York School of Public Health, New York, New York, United States of America.
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America.|Department of Medicine, Montefiore Medical Center, Bronx, New York, United States of America.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
authors.affiliation: College of Public Health, Division of Epidemiology, The Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Marcel
authors.initials: M
authors.lastname: Yotebieng
mesh_terms: D000293:Adolescent; D000350:Africa, Central / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002063:Burundi / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012432:Rwanda / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents