title: Understanding the Influence of Socioeconomic Environment on Paediatric Antiretroviral Treatment Coverage: Towards Closing Treatment Gaps in Sub-Saharan Africa.
abstract: Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets.
  
  
  
  Ecological analyses of paediatric ART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage.
  
  
  
  Factors associated with paediatric ART coverage included adult literacy (r=0.6, p=0.004), effective governance (r=0.6, p=0.003), virology testing by 2 months of age (r=0.9, p=0.001), density of healthcare workers per 10,000 population (r=0.6, p=0.007), and government expenditure on health (r=0.5, p=0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, p<0.001) and gender inequality index (r=-0.6, p=0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices.
  
  
  
  Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals.
authors.affiliation: National AIDS and STIs Control Programme, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Adeyinka
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
authors.forename: Meirion R
authors.initials: MR
authors.lastname: Evans
authors.affiliation: National AIDS and STIs Control Programme, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria.
authors.forename: Chamberline E
authors.initials: CE
authors.lastname: Ozigbu
authors.affiliation: Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.|Public Health Directorate, National Health Service, Highland, Inverness, UK.
authors.forename: Hugo
authors.initials: H
authors.lastname: van Woerden
authors.affiliation: Department of Nursing, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
authors.forename: Esther F
authors.initials: EF
authors.lastname: Adeyinka
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.|Centre for Community Health Care, Research and Development, Abuja, Nigeria.
authors.forename: Olanrewaju
authors.initials: O
authors.lastname: Oladimeji
authors.affiliation: Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.|College of Medicine, University of Ibadan, Ibadan, Nigeria.
authors.forename: Chris
authors.initials: C
authors.lastname: Aimakhu
authors.affiliation: National AIDS and STIs Control Programme, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria.
authors.forename: Deborah
authors.initials: D
authors.lastname: Odoh
authors.affiliation: Health Section, UNICEF, New York, USA.
authors.forename: Dick
authors.initials: D
authors.lastname: Chamla
mesh_terms: D000293:Adolescent; D017954:Africa South of the Sahara / Q000453:epidemiology; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: HIV infections; antiretroviral agents; child; delivery of health care; socioeconomic factors; sub-Saharan Africa