Understanding the Influence of Socioeconomic Environment on Paediatric Antiretroviral Treatment Coverage: Towards Closing Treatment Gaps in Sub-Saharan Africa.

Objective: Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets. Methods: Ecological analyses of paediatricART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage. Results: Factors associated with paediatric ART coverage included adult literacy (r =0.6, p = 0.004), effective governance (r =0.6, p =0.003), virology testing by 2 months of age (r=0.9, p = 0.001), density of healthcare workers per 10,000 population (r=0.6, p = 0.007), and government expenditure on health (r=0.5, p = 0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, p <0.001) and gender inequality index (r=-0.6, p= 0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices. Conclusions: Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals.