A survey of paediatric HIV programmatic and clinical management practices in Asia and sub‐Saharan Africa—the International epidemiologic Databases to Evaluate AIDS (IeDEA)

• Published in: Journal of the International AIDS Society Vol. 16; no. 1; pp. 17998 - n/a
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01.01.2013; John Wiley & Sons, Inc
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - diagnosis; Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - epidemiology; Acquired Immunodeficiency Syndrome - prevention & control; Adolescent; Africa; Africa South of the Sahara - epidemiology; AIDS; AIDS treatment; AIDS/HIV; Analysis; Asia; Asia - epidemiology; Breast feeding; Care and treatment; Child; Child Health Services - organization & administration; Child, Preschool; Children; Children & youth; Clinics; cohort; Collaboration; Data collection; Disease susceptibility; Disease transmission; Diseases; Drug therapy; Economic aspects; Female; Health aspects; Health care; Health Services Administration; Health Services Research; HIV; HIV (Viruses); HIV infection in children; Hospitals; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Laboratories; Male; Maternal-fetal exchange; Mortality; observational; paediatric HIV; Pediatrics; Pregnancy; Prevention; Preventive medicine; Resource availability; Risk factors; Short Report; Surveys and Questionnaires; Testing; Urban areas; Africa South of the Sahara; Asia; Africa; Sub-Saharan Africa; Benin; Zambia; Ghana; Mozambique; Gambia; Senegal; Southern Africa; West Africa; Zimbabwe; South Africa; France; Central Africa; East Africa; paediatric HIV; cohort; observational; Asia; Africa
• ISSN: 1758-2652; 1758-2652
• DOI: 10.7448/IAS.16.1.17998

Introduction There are limited data on paediatric HIV care and treatment programmes in low‐resource settings. Methods A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia‐Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web‐based software program (REDCap). Results A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult–paediatric clinics (N=36, 57%). Prevention of mother‐to‐child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4–6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid‐fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow‐up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow‐up (N=45, 71%) were common. Conclusions In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented.