Abstract:
INTRODUCTION : Increasing access to HIV-related
care and treatment for children aged 0–18 years in
resource-limited settings is an urgent global priority. In
2011–2012 the percentage increase in children accessing
antiretroviral therapy was approximately half that of adults
(11 vs. 21 %). We propose a model for increasing access
to, and retention in, paediatric HIV care and treatment in
resource-limited settings. METHODS : Following a rapid
appraisal of recent literature seven main challenges in
paediatric HIV-related care and treatment were identified:
(1) lack of regular, integrated, ongoing HIV-related diagnosis;
(2) weak facility-based systems for tracking and
retention in care; (3) interrupted availability of dried blood
spot cards (expiration/stock outs); (4) poor quality control
of rapid HIV testing; (5) supply-related gaps at health
facility-laboratory interface; (6) poor uptake of HIV testing,
possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure
and weak systems for social support, resulting in
poor retention in care. RESULTS : To increase sustained access
to paediatric HIV-related care and treatment, regular
updating of Policies, review of inter-sectoral Plans (at
facility and community levels) and evaluation of Programme
implementation and impact (at national, subnational,
facility and community levels) are non-negotiable
critical elements. Additionally we recommend the intensified
implementation of seven main interventions: (1)
update or refresher messaging for health care staff and
simple messaging for key staff at early childhood development
centres and schools; (2) contact tracing, disclosure
and retention monitoring; (3) paying particular attention to
infant dried blood spot (DBS) stock control; (4) regular
quality assurance of rapid HIV testing procedures; (5)
workshops/meetings/dialogues between health facilities
and laboratories to resolve transport-related gaps and to
facilitate return of results to facilities; (6) community leader
and health worker advocacy at creches, schools, religious
centres to increase uptake of HIV testing and dispel
fatalistic beliefs about HIV; (7) use of mobile communication
technology (m-health) and peer/community supporters
to maintain contact with patients. DISCUSSION AND CONCLUSION : We propose that this package of facility,community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free
survival.
