Maximising opportunities for increased antiretroviral treatment in children in an existing HIV programme in rural South Africa

Problem Infants and young children infected with HIV as a result of mother to child transmission are not being identified or started with antiretroviral treatment (ART) in line with HIV guidelines in resource limited settings. Design Retrospective analysis of data from a paediatric cohort before and after an intervention strategy. Setting Rural public HIV treatment programme in the province of KwaZulu-Natal, South Africa. Key measures for improvement Increase in the number of HIV infected infants and children who start HIV treatment each year; increase in the proportion of children starting ART with less immune suppression, shown by higher CD4 counts and less advanced World Health Organization clinical stages for HIV. Strategies for change Late 2008: training in paediatric HIV for all staff in contact with mothers and children; campaigns for increased HIV testing at immunisation and clinics; routine testing of children with tuberculosis and malnutrition for HIV, and HIV testing of all children admitted to hospital. The establishment of a family HIV clinic in late 2007. Effects of change The number of children (1 year to <= 15 years) starting ART each year increased from 43 in 2004 to 254 in 2011; the corresponding number of infants (<1 year) starting treatment increased from 2 to 59. A trend towards increasing CD4 counts at the start of treatment was found. Lessons learnt It is possible to improve the identification of HIV infected children and ensure a prompt start on ART where needed with relatively simple measures and limited implications for staffing and budgets.