Monday, March 28, 2016

Missed Opportunities of Inclusion of HIV-Infected Children to Initiate Antiretroviral Treatment Before the Age of Two in West Africa, 2011 to 2013

The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso.

All children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. We used logistic regression to identify correlates of inclusion.

Among the 217 children screened and referred to the MONOD centres, 161 (74%) were included and initiated on EART. The main reasons of non-inclusion were fear of father's refusal (48%), mortality (24%), false-positive HIV infection test (16%) and other ineligibility reasons (12%). Having previously disclosed the child's and mother's HIV status to the father (adjusted odds ratio (aOR): 3.20; 95% confidence interval (95% CI): 1.55 to 6.69) and being older than 12 months (aOR: 2.05; 95% CI: 1.02 to 4.12) were correlates of EART initiation. At EART initiation, the median age was 13.5 months, 70% had reached WHO Stage 3/4 and 57% had a severe immune deficiency.

Fear of stigmatization by the father and early competing mortality were the major reasons for missed opportunities of EART initiation. There is an urgent need to involve fathers in the care of their HIV-exposed children and to promote early infant diagnosis to improve their future access to EART and survival.

Below:  Cohort profile ofthe ANRS 12206 MONOD study, Abidjan, Ouagadougou, May 2011 to February 2013

Full article at:

  • 1MONOD Project, ANRS 12206, Centre de Recherche Internationale pour la Santé, Ouagadougou, Burkina Faso.
  • 2Inserm, U1219, Institut de Santé Publique, Epidémiologie et Développement, University of Bordeaux, Bordeaux, France.
  • 3Centre Muraz, Bobo-Dioulasso, Burkina Faso;;
  • 4PACCI Programme, Site ANRS, Projet Monod, Abidjan, Côte d'Ivoire.
  • 5Pediatric Department, CHU of Cocody, Abidjan, Côte d'Ivoire.
  • 6Centre Muraz, Bobo-Dioulasso, Burkina Faso.
  • 7University of Ouagadougou, Ouagadougou, Burkina Faso.
  • 8Pediatric Department, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, Côte d'Ivoire.
  • 9Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg.
  • 10Pediatric Department, CHU Charles de Gaulle, Ouagadougou, Burkina Faso.
  • 11Pediatric Department, Hôpital Universitaire des Enfants de la Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
  • 12Inserm, U1027, Université Toulouse, Toulouse, France. 
  •  2016 Mar 23;19(1):20601. doi: 10.7448/IAS.19.1.20601.

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