Global HIV prevention, care and treatment services for children: a cross-sectional survey from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium
Valériane Leroy,
Pagakrong Lumbiganon,
Steven Brown,
Mary-Ann Davies,
Kara Wools-Kaloustian,
Rachel C Vreeman,
Michael Scanlon,
Roxanne Martin,
Carolyn Bolton-Moore,
Constantin T Yiannoutsos,
Nik Khairulddin Nik Yusoff,
C William Wester,
Andrew Edmonds,
Susan Ofner,
Regina Célia de Menezes Succi,
Christella Twizere,
Ounoo Elom Takassi
Affiliations
Valériane Leroy
Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France
Pagakrong Lumbiganon
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Steven Brown
Department of Biostatistics and Health Data Science, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, Indiana, USA
Mary-Ann Davies
Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
Kara Wools-Kaloustian
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
Rachel C Vreeman
Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York, USA
Michael Scanlon
Indiana University Center for Global Health, Indianapolis, Indiana, USA
Roxanne Martin
Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York, USA
Carolyn Bolton-Moore
Center for Infectious Disease Research in Zambia, Lusaka, Zambia
Constantin T Yiannoutsos
Department of Biostatistics and Health Data Science, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, Indiana, USA
Nik Khairulddin Nik Yusoff
Department of Paediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
C William Wester
Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
Andrew Edmonds
Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
Susan Ofner
Department of Biostatistics and Health Data Science, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, Indiana, USA
Regina Célia de Menezes Succi
Department of Pediatrics, Universidade Federal de São Paulo, Sao Paulo, Brazil
Christella Twizere
Centre National de Référence en Matière de VIH/SIDA, Bujumbura, Burundi
Ounoo Elom Takassi
Département de Pédiatrie, Université de Lomé, Lomé, Togo
Objectives To assess access children with HIV have to comprehensive HIV care services, to longitudinally evaluate the implementation and scale-up of services, and to use site services and clinical cohort data to explore whether access to these services influences retention in care.Methods A cross-sectional standardised survey was completed in 2014–2015 by sites providing paediatric HIV care across regions of the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We developed a comprehensiveness score based on the WHO’s nine categories of essential services to categorise sites as ‘low’ (0–5), ‘medium’, (6–7) or ‘high’ (8–9). When available, comprehensiveness scores were compared with scores from a 2009 survey. We used patient-level data with site services to investigate the relationship between the comprehensiveness of services and retention.Results Survey data from 174 IeDEA sites in 32 countries were analysed. Of the WHO essential services, sites were most likely to offer antiretroviral therapy (ART) provision and counselling (n=173; 99%), co-trimoxazole prophylaxis (168; 97%), prevention of perinatal transmission services (167; 96%), outreach for patient engagement and follow-up (166; 95%), CD4 cell count testing (126; 88%), tuberculosis screening (151; 87%) and select immunisation services (126; 72%). Sites were less likely to offer nutrition/food support (97; 56%), viral load testing (99; 69%) and HIV counselling and testing (69; 40%). 10% of sites rated ‘low’, 59% ‘medium’ and 31% ‘high’ in the comprehensiveness score. The mean comprehensiveness of services score increased significantly from 5.6 in 2009 to 7.3 in 2014 (p<0.001; n=30). Patient-level analysis of lost to follow-up after ART initiation estimated the hazard was highest in sites rated ‘low’ and lowest in sites rated ‘high’.Conclusion This global assessment suggests the potential care impact of scaling-up and sustaining comprehensive paediatric HIV services. Meeting recommendations for comprehensive HIV services should remain a global priority.
