Quantifying pediatric patient need for second- and third-line HIV treatment: A tool for decision-making in resource-limited settings

Autoři: Perry Mohammed aff001;  Andrea Linden aff002;  Maura Reilly aff002
Působiště autorů: Global Public Health, Johnson & Johnson, High Wycombe, Hertfordshire, United Kingdom aff001;  Rabin Martin, New York, New York, United States of America aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224226


As national HIV programs across the world mature and continue to scale up towards UNAIDS’ 90-90-90 targets, it is increasingly important to accurately estimate HIV treatment needs in pediatric patient populations to prepare for anticipated increases in demand. This is particularly vital in sub-Saharan Africa, where the bulk of the global pediatric HIV burden remains concentrated, and for treatment-experienced populations, for which data are severely limited. This article discusses the conceptual framework behind and application of a five-year country-level quantification and decision-making tool aimed at providing national HIV programs and their partners with a better understanding of their evolving national HIV treatment and programming needs for second-and third-line pediatric populations. The conceptual framework of the algorithm which undergirds the tool is the patient pathway, along which key influencing factors that determine whether pediatric HIV patients are linked to care, remain in treatment, and are appropriately switched to later lines of treatment are accounted for quantitatively. Excel-based and arithmetic, the algorithm is designed to use available national, regional, and global data for factors impacting patient estimates including treatment coverage; routine viral load testing; viral load non-suppression; confirmed treatment failure; and patient loss to follow up—outcomes for which data are generally very limited in this patient population. The ultimate output of the tool is an estimate of the aggregate annual number of patients by treatment line. Given the limitations in available data for pediatric HIV, particularly for patients on second- and third-line treatments, this tool may help fill a data gap by providing a mechanism for policymakers to scenario plan, thus aiding resource allocation decisions for pediatric HIV program scale-up. The tool may be used to streamline national antiretroviral procurement of later lines of treatment, especially in resource-limited settings, and may also be used to add value to broader HIV policy and planning processes at the national level.

Klíčová slova:

Death rates – HIV epidemiology – Children – Kenya – Pediatric infections – Pediatrics – Viral load


1. Joint United Nations Programme on HIV/AIDS (UNAIDS). AIDSinfo Database [Internet]. Geneva: UNAIDS; 2019 [cited 2019 Sep 30]. Available from: http://aidsinfo.unaids.org/#.

2. Lecher S, Williams J, Fonjungo PN, Kim AA, Ellenberger D, Zhang G, et al. Progress with scale-up of HIV viral load monitoring—Seven Sub-Saharan African countries, January 2015–June 2016. MMWR Morb Mortal Wkly Rep. 2016 Dec 2;65(47): 1332–1335. doi: 10.15585/mmwr.mm6547a2 27906910

3. Moorhouse M, Maartens G, Venter WDF, Moosa M-Y, Steegen K, Jamaloodien K, et al. Third-line antiretroviral therapy program in the South African public sector: Cohort description and virological outcomes. J Acquir Immune Defic Syndr. 2019 Jan 1;80(1): 73–78. doi: 10.1097/QAI.0000000000001883 30334876

4. United Nations International Children’s Fund (UNICEF). Children and AIDS: Statistical update [Internet]. New York (NY): UNICEF; 2017 Dec [cited 2019 April 4]. Available from: https://data.unicef.org/wp-content/uploads/2017/11/HIVAIDS-Statistical-Update-2017.pdf.

5. Meintjes G, Dunn L, Coetsee M, Hislop M, Leisegang R, Regensberg L, et al. Third-line antiretroviral therapy in Africa: effectiveness in a Southern African retrospective cohort study. AIDS Res Ther. 2015;12: 39. doi: 10.1186/s12981-015-0081-8 26628902

6. Corrigan B, Mukui I, Mulenga L, Mthethwa N, Letsie M, Bruno S, et al. Characteristics of treatment-experienced HIV-infected African children and adolescents initiating darunavir and/or etravirine-based antiretroviral treatment. Pediatr Infect Dis J. 2018 Jul;37(7): 669–672. doi: 10.1097/INF.0000000000001843 29140932

7. Lazarus E, Nicol S, Frigati L, Penazzato M, Cotton MF, Centeno-Tablante E, et al. Second- and third-line antiretroviral therapy for children and adolescents: A scoping review. Pediatr Infect Dis J. 2017 May;36(5): 492–499. doi: 10.1097/INF.0000000000001481 28403052

8. Joint United Nations Programme on HIV/AIDS (UNAIDS). Communities at the centre: Defending rights, breaking barriers, reaching people with HIV services [Internet]. Geneva: UNAIDS; 2019 [cited 2019 Sep 30]. Available from: https://www.unaids.org/sites/default/files/media_asset/2019-global-AIDS-update_en.pdf.

9. World Health Organization (WHO). HIV/AIDS data and statistics [Internet]. Geneva: WHO; 2019 [cited 2019 Sep 30]. Available from: https://www.who.int/hiv/data/en/.

10. Penazzato M, Bendaud V, Nelson L, Stover J, Mahy M. Estimating future trends in paediatric HIV. AIDS. 2014 [cited 2019 Apr 4];28: S445–S451. doi: 10.1097/QAD.0000000000000481 25409099

11. Bastard M, Poulet E, Nicolay N, Szumilin E, Balkan S, Pujades-Rodriguez M. Pediatric access and continuity of HIV care before the start of antiretroviral therapy in sub-Saharan Africa. Pediatr Infect Dis J. 2016;35(9): 981–86. doi: 10.1097/INF.0000000000001213 27187757

12. United States Centers for Disease Control and Prevention (CDC). Strategies for identifying and linking HIV-infected infants, children, and adolescents to HIV care and treatment [Internet]. Washington, DC: United States President’s Emergency Plan for AIDS Relief (PEPFAR); 2015 June 23 [cited 2019 Apr 4]. Available from: https://www.pepfar.gov/documents/organization/244347.pdf.

13. Wynberg E, Williams E, Tudor-Williams G, Lyall H, Foster C. Discontinuation of efavirenz in paediatric patients: Why do children switch?. Clin Drug Investig. 2017;38(3): 231–238. doi: 10.1007/s40261-017-0605-1 29181714

14. World Health Organization (WHO), Center for Disease Control and Prevention (CDC), The Global Fund. HIV drug resistance report 2017 [Internet]. Geneva: World Health Organization; 2017 [cited 2019 Apr 4]. Available from: http://apps.who.int/iris/bitstream/handle/10665/255896/9789241512831-eng.pdf?sequence=1.

15. African Society for Laboratory Medicine (ASLM). Laboratory challenges to viral load implementation in resource-limited settings [Internet]. Lusaka (Zambia): International AIDS Society; 2014 May 5 [cited 2019 Apr 4]. Available from: https://www.iasociety.org/Web/WebContent/File/IAS-ILF__3_Lab_Challenges__Peter.pdf.

16. Clinton Health Access Initiative (CHAI). The state of antiretroviral drug market in low- and middle-income countries, 2014–2019: ARV market report [Internet]. New York (NY): CHAI; 2015 [cited 2019 Apr 4]. Available from: https://clintonhealthaccess.org/content/uploads/2015/11/CHAI-ARV-Market-Report-2015_FINAL.pdf.

17. TREAT Asia Pediatric HIV Observational Database (TApHOD) and the International Epidemiologic Databases to Evaluate AIDS (IeDEA) Southern Africa Paediatric Group. A bioregional survey and review of first-line treatment failure and second-line paediatric antiretroviral access and use in Asia and southern Africa. J Int AIDS Soc. 2011;14(17):7.

18. Zwinkels D. An update on the Coordinated Procurement Planning Initiative (CPP): A multi-partner approach to preventing ARV stockouts. In: WHO/AMDS Partners Meeting [Internet]. Geneva: WHO; 2012 Jun 19 [cited 2019 Apr 4]. Available from: http://www.who.int/hiv/events/scms_cpp_dominique.pdf.

19. World Health Organization (WHO). Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy [Internet]. Geneva: World Health Organization; 2017 Jul [cited 2019 Apr 4]. Available from: https://www.who.int/hiv/pub/guidelines/advanced-HIV-disease/en/.

20. World Health Organization (WHO). Guidelines on the public health response to pretreatment HIV drug resistance: Supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Second edition Jun 2016 [Internet]. Geneva: World Health Organization; 2017 Jul [cited 2019 Apr 4]. Available from: https://www.who.int/hiv/pub/guidelines/hivdr-guidelines-2017/en/.

21. United States President’s Emergency Plan for AIDS Relief (PEPFAR) and Children’s Investment Fund Foundation (CIFF). Promising practices and lessons learned from the implementation of the ACT Initiative. Accelerating Children’s HIV/AIDS Treatment [Internet]. Washington, DC.: PEPFAR and CIFF; 2017 Apr [cited 2019 Apr 4]. Available from: http://www.pedaids.org/wp-content/uploads/2017/11/ACT_Report_04_2017_FINAL-digital.pdf.

22. United States President’s Emergency Plan for AIDS Relief (PEPFAR). Kenya country operational plan (COP) 2018 strategic direction summary [Internet]. Washington, DC.: United States President’s Emergency Plan for AIDS Relief (PEPFAR); 2018 Apr 10 [cited 2019 Sep 30]. Available from: http://www.pepfar.gov/documents/organization/285861.pdf.

23. National AIDS & STI Control Programme (NASCOP). National ACT dashboard [Internet]. Nairobi, Kenya: NASCOP. 2016; [cited 2019 Apr 4]. Available from: http://www.nascop.or.ke/wp-content/uploads/2016/07/National-ACT-Dashboard-1.xlsx.

24. National AIDS & STI Control Programme (NASCOP). Viral load system [Internet]. Nairobi, Kenya: NASCOP. 2019; [cited 2019 Apr 4]. Available from: https://viralload.nascop.org/.

25. Habiyambere V. WHO global ARVs and diagnostic use survey in 2015 in low- and middle-income countries [Internet]. Geneva: WHO HIV Department, AIDS Medicines and Diagnostic Service (AMDS), Strategic Information and Planning Unit; 2016 Mar [cited 2019 Apr 4]. Available from: https://www.who.int/hiv/amds/amds2016-ppt-WHO-2015ARVUseSurvey.pdf?ua=1.

26. Mahy M, Penazzato M, Ciaranello A, Mofenson L, Yianoutsos C, Davies M, et al. Improving estimates of children living with HIV from the Spectrum AIDS impact model. AIDS. 2017 [cited 2019 Apr 4];31:S13–S22. doi: 10.1097/QAD.0000000000001306 28301337

27. Clinton Health Access Initiative (CHAI). Simple Pediatric ARV Forecasting Tool [Internet]. Boston (MA): CHAI. 2017; [cited 2019 Apr 4]. Available from: https://childrenandaids.org/sites/default/files/2017-05/PAEDS%203-year%20Simple%20ARV%20forecasting%20tool%20v2016_BLANK.xlsx.

Článek vyšel v časopise


2019 Číslo 11