antiretroviral treatment

In 2012, there were an estimated 2 million children in need of antiretroviral therapy (ART) in the world, but ART is still reaching fewer than 3 in 10 children in need of treatment. As more HIV-infected children are identified early and universal treatment is initiated in children under 5 regardless of CD4, the success of pediatric HIV programs will depend on our ability to link children into care and treatment programs, and retain them in those services over time. In this review, we summarize key individual, institutional, and systems barriers to diagnosing children with HIV, linking them to care and treatment, and reducing loss to follow-up. We also explore how linkage and retention can be optimally measured so as to maximize the impact of available pediatric HIV care and treatment services.

Although antiretroviral treatment (ART) has reduced the incidence of HIV-related opportunistic infections among children living with HIV, access to ART remains limited for children, especially in resource-limited settings. This paper reviews current knowledge on the contribution of opportunistic infections and common childhood illnesses to morbidity and mortality in children living with HIV, highlights interventions known to improve the health of children, and identifies research gaps for further exploration.

Treatment 2.0 is an initiative launched by UNAIDS and WHO in 2011 to catalyze the next phase of treatment scale-up for HIV. The initiative defines strategic activities in 5 key areas--drugs, diagnostics, commodity costs, service delivery and community engagement--in an effort to simplify treatment, expand access and maximize program efficiency. For adults, many of these activities have already been turned into treatment policies. The recent WHO recommendation to use a universal first line regimen regardless of gender, pregnancy and TB status is a treatment simplification very much in line with Treatment 2.0. But despite that fact that Treatment 2.0 encompasses all people living with HIV, we have not seen the same evolution in policy development for children. In this paper we discuss how Treatment 2.0 principles can be adapted for the pediatric population.

As of 2012, only 34% of treatment eligible children in low- and middle-income countries were receiving antiretroviral treatment (ART) despite proven benefits of early initiation of antiretroviral treatment (ART) on child survival. We reviewed routine EID (early infant diagnosis) laboratory and paediatric ART patient records to determine missed opportunities for optimizing EID and current status of linkage between EID entry points to paediatric ART initiation in Tanzania, Uganda, and Zimbabwe. These are three countries with EID coverage of 22, 11 and 14%, respectively and ART coverage rates of 18, 16 and 32%, respectively. This article examines the most likely delivery points for collection of blood samples for EID testing for infant and young children and the most likely referral points for ART initiation of HIV-infected children in these three countries. This data provides evidence of consistent missed opportunities for linking HIV-infected children identified during EID to early ART treatment. We also argue for expanding the provision of EID to other service delivery points beyond PMTCT platform and provide suggestions for better linkages from EID to care and treatment.

Roughly 70% of infected children are not receiving live-saving HIV care and treatment. Strengthening case finding through improved diagnosis strategies and actively linking identified HIV-infected children to care and treatment are essential to ensuring that these children benefit from the care and treatment available to them. This article summarizes the challenges of identifying HIV-infected infants and children, reviews currently available evidence and guidance, describes promising new strategies for case finding, and makes recommendations for future research and interventions to improve identification of HIV-infected infants and children.

This study assessed the effects of facility-based interventions using existing resources to improve overall patient attendance and adherence to antiretroviral therapy (ART) at ART-providing facilities in Uganda. Patients’ adherence was improved with low-cost and easily implemented interventions using existing health facilities’ resources. We recommend that such interventions be considered for scale-up at national levels as measures to improve clinic attendance and ART adherence among patients in Uganda and other low-resource settings in sub-Saharan Africa.

Increasing coverage of isoniazid preventive therapy and cotrimoxazole preventive therapy reduced risk of TB among HIV patients who started treatment. All people living with HIV should be screened for TB, but for patients who have advanced disease (WHO clinical stage III/IV, bedridden, and with hemoglobin level of 10 mg/dl), intensified screening is highly recommended during treatment follow-up.

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