%0 Journal Article
%T Access to antiretroviral therapy in HIV-infected children aged 0每19 years in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium, 2004每2015: A prospective cohort study
%A Andrew Edmonds
%A Azar Kariminia
%A Catherine McGowan
%A Constantin Yiannoutsos
%A Elom Takassi
%A Fatoumata Dicko
%A Franck Tanser
%A Jorge Pinto
%A Kara Wools-Kaloustian
%A Karen Malateste
%A Marcel Yotebieng
%A Mary-Ann Davies
%A Mwangelwa Mubiana-Mbewe
%A Pagakrong Lumbiganon
%A Rachel Vreeman
%A Sophie Desmonde
%A Val谷riane Leroy
%A for the International Epidemiology Databases to Evaluate AIDS (IeDEA) Pediatric Working Group
%J -
%D 2018
%R 10.1371/journal.pmed.1002565
%X Introduction Access to antiretroviral therapy (ART) is a global priority. However, the attrition across the continuum of care for HIV-infected children between their HIV diagnosis and ART initiation is not well known. We analyzed the time from enrollment into HIV care to ART initiation in HIV-infected children within the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium.   Methods and findings We included 135,479 HIV-1-infected children, aged 0每19 years and ART-naˋve at enrollment, between 1 January 2004 and 31 December 2015, in IeDEA cohorts from Central Africa (3 countries; n = 4,948), East Africa (3 countries; n = 22,827), West Africa (7 countries; n = 7,372), Southern Africa (6 countries; n = 93,799), Asia-Pacific (6 countries; n = 4,045), and Latin America (7 countries; n = 2,488). Follow-up in these cohorts is typically every 3每6 months. We described time to ART initiation and missed opportunities (death or loss to follow-up [LTFU]: last clinical visit >6 months) since baseline (the date of HIV diagnosis or, if unavailable, date of enrollment). Cumulative incidence functions (CIFs) for and determinants of ART initiation were computed, with death and LTFU as competing risks. Among the 135,479 children included, 99,404 (73.4%) initiated ART, 1.9% died, 1.4% were transferred out, and 20.4% were lost to follow-up before ART initiation. The 24-month CIF for ART initiation was 68.2% (95% CI: 67.9%每68.4%); it was lower in sub-Saharan Africa〞ranging from 49.8% (95% CI: 48.4%每51.2%) in Central Africa to 72.5% (95% CI: 71.5%每73.5%) in West Africa〞compared to Latin America (71.0%, 95% CI: 69.1%每72.7%) and the Asia-Pacific (78.3%, 95% CI: 76.9%每79.6%). Adolescents aged 15每19 years and infants <1 year had the lowest cumulative incidence of ART initiation compared to other ages: 62.2% (95% CI: 61.6%每62.8%) and 66.4% (95% CI: 65.7%每67.0%), respectively. Overall, 49.1% were ART-eligible per local guidelines at baseline, of whom 80.6% initiated ART. The following children had lower cumulative incidence of ART initiation: female children (p < 0.01); those aged <1 year, 2每4 years, 5每9 years, and 15每19 years (versus those aged 10每14 years, p < 0.01); those who became eligible during follow-up (versus eligible at enrollment, p < 0.01); and those receiving care in low-income or lower-middle-income countries (p < 0.01). The main limitations of our study include left truncation and survivor bias, caused by deaths of children prior to enrollment, and use of enrollment date as a proxy for missing data on date of HIV diagnosis, which
%K HIV diagnosis and management
%K Africa
%K Antiretroviral therapy
%K HIV
%K Adolescents
%K Children
%K HIV epidemiology
%K Consortia
%U https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002565