Article

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

1ICAP, Columbia University Mailman School of Public Health, New York, United States 2 Dept. of Epidemiology, Columbia University Mailman School of Public Health, New York, United States 3ICAP- Mozambique, Maputo, Mozambique 4ICAP-Lesotho, Maseru, Lesotho 5ICAP-Kenya, Nairobi, Kenya 6QED Group LLC, Centers for Disease Control and Prevention, Yaounde, Cameroon 7ICAP-Tanzania, Dar es Salaam, United Republic of Tanzania.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 01/2013; 62(5). DOI: 10.1097/QAI.0b013e3182869558
Source: PubMed

ABSTRACT BACKGROUND:: In resource-limited settings, decentralization of HIV care and treatment is a cornerstone of universal care and rapid scale-up. We compared trends in pediatric enrollment and outcomes at primary (PHF) versus secondary/tertiary health facilities (SHFs). METHODS:: Using aggregate program data reported quarterly from 274 public facilities in Kenya, Lesotho, Mozambique, Rwanda and Tanzania from January 2008- March 2010 we examined trends in number of children < 15 years of age initiating antiretroviral treatment (ART) by facility type. We compared clinic-level lost to follow-up (LTFU) and mortality per 100 person years (PYs) on ART during the period by facility type. RESULTS:: During the two year period, 17,155 children enrolled in HIV care and 8,475 initiated ART in 182 (66%) PHFs and 92(34%) SHFs. PHFs increased from 56 to 182, while SHFs increased from72 to 92 sites. SHFs accounted for 71% of children initiating ART; however, the proportion of children initiating ART each quarter at PHFs increased from 17% (129) to 44% (463) in conjunction with an increase in PHFs during observation period. The average LTFU and mortality rates for children on ART were 9.8/100PYsand 5.2/100PYs, respectively at PHFs and 20.2/100PYs and 6.0/100PYs at SHFs. Adjusted models show PHFs associated with lower LTFU (Adjusted Rate Ratio, ARR=0.55; p=0.022) and lower mortality (ARR=0.66; p=0.028). CONCLUSION:: The expansion of pediatric services to PHFs has resulted in increased numbers of children on ART. Early findings suggest lower rates of LTFU and mortality at PHFs. Successful scale-up will require further expansion of pediatric services within PHFs.

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