Decentralization of Pediatric HIV Care and Treatment in Five Sub-Saharan African Countries

AbstractObjectiveTo examine the availability of nutritional support services in HIV care and treatment sites across sub-Saharan Africa.DesignIn 2008, we conducted a cross-sectional survey of sites providing antiretroviral therapy (ART) in nine sub-Saharan African countries. Outcomes included availability of: (i) nutritional counselling; (ii) micronutrient supplementation; (iii) treatment for severe malnutrition; and (iv) food rations. Associations with health system indicators were explored using bivariate and multivariate methods.SettingPresident's Emergency Plan for AIDS Relief-supported HIV treatment and care sites across nine sub-Saharan African countries.SubjectsA total of 336 HIV care and treatment sites, serving 467 175 enrolled patients.ResultsOf the sites under study, 303 (90 %) offered some form of nutritional support service. Nutritional counselling, micronutrient supplementation, treatment for severe acute malnutrition and food rations were available at 98 %, 64 %, 36 % and 31 % of sites, respectively. In multivariate analysis, secondary or tertiary care sites were more likely to offer nutritional counselling (adjusted OR (AOR): 2·2, 95 % CI 1·1, 4·5). Rural sites (AOR: 2·3, 95 % CI 1·4, 3·8) had increased odds of micronutrient supplementation availability. Sites providing ART for >2 years had higher odds of availability of treatment for severe malnutrition (AOR: 2·4, 95 % CI 1·4, 4·1). Sites providing ART for >2 years (AOR: 1·6, 95 % CI 1·3, 1·9) and rural sites (AOR: 2·4, 95 % CI 1·4, 4·4) had greater odds of food ration availability.ConclusionsAvailability of nutritional support services was high in this large sample of HIV care and treatment sites in sub-Saharan Africa. Further efforts are needed to determine the uptake, quality and effectiveness of these services and their impact on patient and programme outcomes.

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Scaling Up Pediatric HIV Care and Treatment in Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182706401 ◽

2013 ◽

Vol 62 (1) ◽

pp. e7-e13 ◽

Cited By ~ 12

Author(s):

Georgette Adjorlolo-Johnson ◽

Andrea Wahl Uheling ◽

Shobana Ramachandran ◽

Susan Strasser ◽

Joseph Kouakou ◽

...

Keyword(s):

Scaling Up ◽

Pediatric Hiv ◽

Hiv Care ◽

Care And Treatment ◽

Pediatric Hiv Care

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Hospital admissions from a pediatric HIV care and treatment program in Malawi

BMC Pediatrics ◽

10.1186/s12887-016-0556-3 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 1

Author(s):

Carl A. Nosek ◽

W. Chris Buck ◽

Alison C. Caviness ◽

Abbie Foust ◽

Yewo Nyondo ◽

...

Keyword(s):

Treatment Program ◽

Hospital Admissions ◽

Pediatric Hiv ◽

Hiv Care ◽

Care And Treatment ◽

Pediatric Hiv Care

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Growing Up with HIV/AIDS

Childhood Studies ◽

10.1093/obo/9780199791231-0213 ◽

2019 ◽

Author(s):

Stephanie Shiau ◽

Lindsey Reif

Keyword(s):

High Risk ◽

Hiv Infection ◽

Hiv Infections ◽

Pediatric Hiv ◽

Sub Saharan Africa ◽

Hiv Care ◽

Close Monitoring ◽

Sub Saharan ◽

Pediatric Hiv Care ◽

Living With Hiv

Largely due to increased success in prevention of mother-to-child transmission, new HIV infections among children globally have declined by 47 percent since 2010, from 300,000 in 2010 to 160,000 in 2016. However, the epidemic continues. In 2016 2.1 million children under fifteen years old were estimated to be living with HIV globally, with 85 percent living in sub-Saharan Africa. Without access to HIV care and antiretroviral therapy (ART), infants and younger children living with HIV are at high risk for mortality, with a mortality rate of about 30 percent by the first year of life and 50 percent by their second year. Therefore, prompt diagnosis and adherence to effective ART is critical. Early infant diagnosis is becoming more widely available globally, allowing for earlier identification of infection close to birth and opportunities to start treatment early in infants and the potential for cure strategies. With effective treatment, pediatric HIV infection has been transformed from a fatal disease to a lifelong chronic disease. Much of pediatric HIV care focuses on co-morbidities related to long-term HIV infection and its treatment. In addition, children living with HIV require close monitoring as they age into adolescence, a high-risk period when they navigate mental, physical, and emotional development. As adolescents become independent from parents or guardians and face choices regarding relationships, sexual behavior, and alcohol and drug use, they are at high risk for poor adherence to ART.

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Implementation of differentiated service delivery for paediatric HIV care and treatment: opportunities, challenges and experience from seven sub-Saharan African countries

Family Medicine and Community Health ◽

10.1136/fmch-2020-000393 ◽

2020 ◽

Vol 8 (3) ◽

pp. e000393

Author(s):

Rebecca Abelman ◽

Catharina Alons ◽

Jeni Stockman ◽

Ivan Teri ◽

Anna Grimsrud ◽

...

Keyword(s):

Service Delivery ◽

Children And Adolescents ◽

Care Delivery ◽

Hiv Care ◽

Differentiated Service ◽

Viral Load Suppression ◽

African Countries ◽

Care And Treatment ◽

Sub Saharan ◽

Living With Hiv

Differentiated service delivery (DSD) models for HIV often exclude children and adolescents. Given that children and adolescents have lower rates of HIV diagnosis, treatment and viral load suppression, there is a need to use DSD to meet the needs of children and adolescents living with HIV. This commentary reviews the concept of DSD, examines the application of DSD to the care of children and adolescents living with HIV, and describes national guidance on use of DSD for children and adolescents and implementation of DSD for HIV care and treatment in children and adolescents in Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)–supported programmes in seven sub-Saharan countries between 2017 and 2019. Programme descriptions include eligibility criteria, location and frequency of care delivery, healthcare cadre delivering the care, as well as the number of EGPAF-supported facilities supporting each type of DSD model. A range of DSD models were identified. While facility-based models predominate, several countries support community-based models. Despite significant uptake of various DSD models for children and adolescents, there was variable coverage within countries and variability in age criteria for each model. While the recent uptake of DSD models for children and adolescents suggests feasibility, more can be done to optimise and extend the use of DSD models for children and adolescents living with HIV. Barriers to further DSD uptake are described and solutions proposed. DSD models for children and adolescents are a critical tool that can be optimised to improve the quality of HIV care and outcomes for children and adolescents.

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