Scaling up pediatric HIV care and treatment in Africa: clinical site characteristics associated with favorable service utilization.

Background: To improve pediatric enrollment and retention in HIV treatment programs in Africa, we examined factors associated with service utilization within the Elizabeth Glaser Pediatric AIDS Foundation program in Cote d'Ivoire, Mozambique, South Africa, Tanzania and Zambia. Methods: We retrospectively reviewed characteristics of clinical sites providing HIV treatment services within our program. For each site, favorable pediatric program outcomes were defined as a cumulative number or percentage of pediatric enrollment in care or antiretroviral therapy (ART) more than the pooled median value or an attrition rate less than 10%. We compared proportions of sites with favorable outcomes among those with or without selected characteristics. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were determined using logistic regression analyses, accounting for potential confounding factors. Results: Over 4 years, 33,331 children were enrolled, including 18,255 on ART, across 220 sites. Characteristics associated with favorable pediatric enrollment were nutritional support (aOR = 8.9; CI: 2.8 to 28.4), linkages with associations of people living with HIV (aOR = 4.2; CI: 1.8 to 9.5), early infant diagnosis (aOR = 3.3; CI: 1.5 to 7.1), and on-site prevention of mother-to-child transmission services (aOR = 3.1; CI: 1.0 to 11.1). Similarly, linkages with people living with HIV, early infant diagnosis, and prevention of mother-to-child transmission were associated with high proportion of children on ART younger than 2 years of age. Home-based care was associated with low pediatric attrition rates (aOR = 2.9; CI: 1.4 to 5.8). Conclusions: Certain site characteristics were associated with favorable pediatric enrollment and retention in our program. Expanding these characteristics to improve pediatric HIV treatment in Africa warrants further evaluation.