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Global HIV prevention, care and treatment services for children: a cross-sectional survey from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium

Vreeman RC 1 , Yiannoutsos CT 2 , Yusoff NKN 3 , Wester CW 4 , Edmonds A 5 , Ofner S 2 Show all authors , Davies MA 6 , Leroy V 7 , Lumbiganon P 8 , de Menezes Succi RC 9 , Twizere C 10 , Brown S 2 , Bolton-Moore C 11 , Takassi OE 12 , Scanlon M 13 , Martin R 14 , Wools-Kaloustian K 15 , IeDEA

Affiliations 

  • 1 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 [email protected]
  • 2 Department of Biostatistics and Health Data Science, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, Indiana, USA
  • 3 Department of Paediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
  • 4 Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
  • 5 Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  • 6 Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  • 7 Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France
  • 8 Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • 9 Department of Pediatrics, Universidade Federal de São Paulo, Sao Paulo, Brazil
  • 10 Centre National de Référence en Matière de VIH/SIDA, Bujumbura, Burundi
  • 11 Center for Infectious Disease Research in Zambia, Lusaka, Zambia
  • 12 Département de Pédiatrie, Université de Lomé, Lomé, Togo
  • 13 Indiana University Center for Global Health, Indianapolis, Indiana, USA
  • 14 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
  • 15 Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
BMJ Open, 2023 Mar 13;13(3):e069399.
PMID: 36914183 DOI: 10.1136/bmjopen-2022-069399

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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