Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2013 Apr 15;62(5):e124-30.
doi: 10.1097/QAI.0b013e3182869558.

Decentralization of pediatric HIV care and treatment in five sub-Saharan African countries

Ruby N Fayorsey  1 , Suzue Saito, Rosalind J Carter, Eduarda Gusmao, Koen Frederix, Emily Koech-Keter, Gilbert Tene, Milembe Panya, Elaine J Abrams
Affiliations
Comparative Study

Decentralization of pediatric HIV care and treatment in five sub-Saharan African countries

Ruby N Fayorsey et al. J Acquir Immune Defic Syndr. .

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 (PHFs) vs 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 to March 2010, we examined trends in number of children younger than 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 2-year period, 17,155 children enrolled in HIV care and 8475 initiated ART in 182 (66%) PHFs and 92(34%) SHFs. PHFs increased from 56 to 182, whereas SHFs increased from 72 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 9.8/100 PYs and 5.2/100 PYs, respectively, at PHFs and 20.2/100 PYs and 6.0/100 PYs, respectively, at SHFs. Adjusted models show PHFs associated with lower LTFU (adjusted rate ratio = 0.55; P = 0.022) and lower mortality (adjusted rate ratio = 0.66; P = 0.028).

Conclusions: 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.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Number and proportion of children aged younger than 15 years (N = 8475) initiating ART per quarter at 274 primary and secondary health facilities in Rwanda, Tanzania, Mozambique, Kenya, and Lesotho between January 2008 and March 2010.
See this image and copyright information in PMC

References

    1. WHO. Towards Universal access: scaling up priority HIV/AIDS interventions in the health sector. Progress Report; 2010. [Accessed on January 15, 2012]. Available at: http://whqlibdoc.who.int/publications/2010/9789241500395_eng.pdf.
    1. UNAIDS. Global Report: UNAIDS report on the global AIDS epidemic. [Accessed December 23, 2012];2012 Available at: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiolo....
    1. WHO. [Accessed on January 15, 2012];Antiretroviral therapy of HIV infection in infants and children: towards universal access: recommendations for a public health approach-2010 revision. 2010 Available at: http://whqlibdoc.who.int/publications/2010/9789241599801_eng.pdf. - PubMed
    1. WHO, UNICEF, UNAIDS. Global HIV/AIDS response: epidemic update and health sector progress towards universal access. Progress Report; 2011. [Accessed May 13, 2012]. Available at: http://www.who.int/hiv/pub/progress_report2011/hiv_full_report_2011.pdf.
    1. De Baets A, Bulterys M, Abrams E, et al. Care and treatment of HIV-infected children in Africa: issues and challenges at the district hospital level. Pediatr Infect Dis J. 2007;26:163–173. - PubMed

Publication types

Substances