Delays in Initiation of Antiretroviral Therapy Among HIV-Infected Children in Rural Zambia

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Background: Although care and treatment are available to many HIVinfected children, barriers remain that delay initiation of antiretroviral therapy (ART). Minimizing these barriers is critical to starting ART at earlier ages. Methods: Reasons for delay were evaluated among 200 children younger than 15 years of age initiating treatment in an HIV clinic in rural Zambia from 2011 to 2013. Results: The median age of children at ART eligibility was 2.9 years, and 49% were male. After being determined eligible, 60% of children delayed ART initiation for a median of 28 days (interquartile range: 14, 75). Primary reasons for delay included waiting for test results, adherence issues and concurrent treatment for tuberculosis. When reasons for delay were categorized by type, 36% of children had family-related delays, 32% had delays because of clinic logistics, 27% had health-related delays and 6% had other or no identified reasons for delay. The median time between eligibility and ART initiation was shortest for children with delays because of clinic logistics (median: 18 days; interquartile range: 14, 35). Children with family-related delays tended to be older and orphaned, whereas children with delays because of clinic logistics tended to be younger, and children with health-related delays tended to have more advanced disease. In the first year of ART, no association was found between adherence and type of delay. CD4+ T-cell percentages and weight-for-age Z scores were lower for children with health-related delays. Conclusions: Strategies to reduce delays in ART initiation will need to address a diverse set of issues, so children can benefit from earlier treatment. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Sutcliffe, C. G., van Dijk, J. H., Muleka, M., Munsanje, J., Thuma, P. E., & Moss, W. J. (2016). Delays in initiation of antiretroviral therapy among hiv-infected children in rural zambia: The Pediatric Infectious Disease Journal, 35(4), e107–e112. https://doi.org/10.1097/INF.0000000000001021

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