Goga, Ameena EbrahimSingh, YagespariSingh, MichelleNoveve, NobuntuMagasana, VuyolwethuRamraj, TrishaAbdullah, FareedCoovadia, Ashraf H.Bhardwaj, SanjanaSherman, Gayle G.2016-08-312016-08-312017Goga, AE, Singh, Y, Singh, M, Noveve, N, Magasana, V, Ramraj, T, Abdullah, F, Coovadia, AH, Bhardwaj, S & Sherman, GG. Enhancing HIV treatment access and outcomes amongst HIV infected children and adolescents in resource limited settings. Maternal and Child Health Journal (2017) 21(1): 1–8. doi:10.1007/s10995-016-2074-1.1092-7875 (print)1573-6628 (online)10.1007/s10995-016-2074-1http://hdl.handle.net/2263/56526INTRODUCTION : 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.en© The Author(s) 2016. This article is published with open access at Springerlink.com.AdolescentPaediatric ART accessPaediatric HIVARV uptakeARV coveragePaediatric HIVContinuity of carePaediatric HIV treatment accessPMTCT effectivenessSAPMTCTEHuman immunodeficiency virus (HIV)Antiretroviral treatment (ART)Article