Missed opportunities of inclusion in a cohort of HIV-infected children to initiate antiretroviral treatment before the age of two in West Africa, 2011 to 2013

Désiré L Dahourou, Madeleine Amorissani-Folquet, Malik Coulibaly, Divine Avit-Edi, Nicolas Meda, Marguerite Timite-Konan, Vic Arendt, Diarra Ye, Clarisse Amani-Bosse, Roger Salamon, Philippe Lepage, Valériane Leroy, Monod Anrs 12206 Study Group, Malik Coulibaly, Désiré Lucien Dahourou, Nicolas Meda, Colette Ouédraogo, Mamadou Sawadogo, Wilfried Somé, Désiré Sondo, Elisabeth Thio, Mamadou Barry, William Hiembo, Fla Kouéta, Adama Ouattara, Moussa Ouédraogo, Rasmata Ouédraogo, Sylvie Ouédraogo, Bernadette Congo, Rose Barry, Diarra Yé, Malika Congo, Edouard Minéné, Marie Coulibaly, Pierre Innocent Guissou Angèle Kalmogho, Ludovic Kam, Emile Ouédraogo, Lassana Sangaré, Caroline Yonaba, Thérèse N'Dri-Yoman, Ramatou W Sawadogo, Divine Avit, Odette Ky-Zerbo, Xavier Anglaret, Clarisse Amani-Bossé, Christine Danel, Serge Eholié, Didier Ekouévi, Eulalie Kanga, Suzanne Kouadio, Séverin Lennaud, Maxime Aimé Oga, Madeleine Amorissani-Folquet, Evelyne Dainguy, Beugre Kouassi, Jean-Claude Kouassi, Gladys Oka, Kader Keita, Jean Yves Lambin, François Eboua Tanoh, Marguerite Timité-Konan, Véronique Mea-Assande, Addi Edmond Aka, Hortense Aka-Dago, Sylvie N'Gbeche, Eugène Messou, Arlette Emieme, Fatoumata Koné, Hervé Menan, Thomas Toni, Vincent Yapo, Kouamé Abo, Irma Ahoba, David Aka, Gbaméné Kouassi, Carine Kodo, Touré Siaka, Pety Touré, Fassinou Ekouevi, Ida Viho, Anthony Richard Tanoh, Olivier Blé, Yaya Coulibaly, Philomène Takouo, Jean Marie Massumbuko, Kouadio Kouakou, Dorothée Koumi, Berté Koné, Sophie Dattez, Sophie Karcher, Jérôme Le Carrou, Valériane Leroy, Karen Malateste, Pierre Touret, Caroline Bouyssou, Geneviève Chêne, Valérie Conte, Sophie Desmonde, Delphine Gabillard, Valérie Journot, Roger Salamon, Vic Arendt, Carole Devaux, Jean-Claude Schmit, Philippe Lepage, Stéphane Blanche, Marie-Laure Chaix-Baudier, Deborah Hirt, Christine Rouzioux, Claire Pressiat, Alain Pruvost, Jean-Marc Treluyer, Saik Urien, Philippe Van de Perre, Elodie Vernoux, Aminata Paré-Karambiri, Zouma Tinto, Adoulaye Cisse, Madikona Dosso, Roger Salamon, Valériane Leroy, Nicolas Meda, Jean-François Delfraissy, Marguerite Timite-Konan, Vic Arendt, Stéphane Blanche, Philippe Lepage, Philippe Van de Perre, François Dabis, Jean-Claude Schmit, Dominique Costagliola, Mark Cotton, Carlo Giaquito, Diana Gibb, Elisabeth Menu, Brigitte Bazin, Marie de Solère, Claire Rekacewicz, Désiré L Dahourou, Madeleine Amorissani-Folquet, Malik Coulibaly, Divine Avit-Edi, Nicolas Meda, Marguerite Timite-Konan, Vic Arendt, Diarra Ye, Clarisse Amani-Bosse, Roger Salamon, Philippe Lepage, Valériane Leroy, Monod Anrs 12206 Study Group, Malik Coulibaly, Désiré Lucien Dahourou, Nicolas Meda, Colette Ouédraogo, Mamadou Sawadogo, Wilfried Somé, Désiré Sondo, Elisabeth Thio, Mamadou Barry, William Hiembo, Fla Kouéta, Adama Ouattara, Moussa Ouédraogo, Rasmata Ouédraogo, Sylvie Ouédraogo, Bernadette Congo, Rose Barry, Diarra Yé, Malika Congo, Edouard Minéné, Marie Coulibaly, Pierre Innocent Guissou Angèle Kalmogho, Ludovic Kam, Emile Ouédraogo, Lassana Sangaré, Caroline Yonaba, Thérèse N'Dri-Yoman, Ramatou W Sawadogo, Divine Avit, Odette Ky-Zerbo, Xavier Anglaret, Clarisse Amani-Bossé, Christine Danel, Serge Eholié, Didier Ekouévi, Eulalie Kanga, Suzanne Kouadio, Séverin Lennaud, Maxime Aimé Oga, Madeleine Amorissani-Folquet, Evelyne Dainguy, Beugre Kouassi, Jean-Claude Kouassi, Gladys Oka, Kader Keita, Jean Yves Lambin, François Eboua Tanoh, Marguerite Timité-Konan, Véronique Mea-Assande, Addi Edmond Aka, Hortense Aka-Dago, Sylvie N'Gbeche, Eugène Messou, Arlette Emieme, Fatoumata Koné, Hervé Menan, Thomas Toni, Vincent Yapo, Kouamé Abo, Irma Ahoba, David Aka, Gbaméné Kouassi, Carine Kodo, Touré Siaka, Pety Touré, Fassinou Ekouevi, Ida Viho, Anthony Richard Tanoh, Olivier Blé, Yaya Coulibaly, Philomène Takouo, Jean Marie Massumbuko, Kouadio Kouakou, Dorothée Koumi, Berté Koné, Sophie Dattez, Sophie Karcher, Jérôme Le Carrou, Valériane Leroy, Karen Malateste, Pierre Touret, Caroline Bouyssou, Geneviève Chêne, Valérie Conte, Sophie Desmonde, Delphine Gabillard, Valérie Journot, Roger Salamon, Vic Arendt, Carole Devaux, Jean-Claude Schmit, Philippe Lepage, Stéphane Blanche, Marie-Laure Chaix-Baudier, Deborah Hirt, Christine Rouzioux, Claire Pressiat, Alain Pruvost, Jean-Marc Treluyer, Saik Urien, Philippe Van de Perre, Elodie Vernoux, Aminata Paré-Karambiri, Zouma Tinto, Adoulaye Cisse, Madikona Dosso, Roger Salamon, Valériane Leroy, Nicolas Meda, Jean-François Delfraissy, Marguerite Timite-Konan, Vic Arendt, Stéphane Blanche, Philippe Lepage, Philippe Van de Perre, François Dabis, Jean-Claude Schmit, Dominique Costagliola, Mark Cotton, Carlo Giaquito, Diana Gibb, Elisabeth Menu, Brigitte Bazin, Marie de Solère, Claire Rekacewicz

Abstract

Introduction: The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso.

Methods: All children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. We used logistic regression to identify correlates of inclusion.

Results: Among the 217 children screened and referred to the MONOD centres, 161 (74%) were included and initiated on EART. The main reasons of non-inclusion were fear of father's refusal (48%), mortality (24%), false-positive HIV infection test (16%) and other ineligibility reasons (12%). Having previously disclosed the child's and mother's HIV status to the father (adjusted odds ratio (aOR): 3.20; 95% confidence interval (95% CI): 1.55 to 6.69) and being older than 12 months (aOR: 2.05; 95% CI: 1.02 to 4.12) were correlates of EART initiation. At EART initiation, the median age was 13.5 months, 70% had reached WHO Stage 3/4 and 57% had a severe immune deficiency.

Conclusions: Fear of stigmatization by the father and early competing mortality were the major reasons for missed opportunities of EART initiation. There is an urgent need to involve fathers in the care of their HIV-exposed children and to promote early infant diagnosis to improve their future access to EART and survival.

Trial registration: ClinicalTrials.gov NCT01127204.

Keywords: HIV; West Africa; acceptability; access to care; children; early antiretroviral therapy; linkage to care.

Figures

Figure 1
Figure 1
Cohort profile ofthe ANRS 12206 MONOD study, Abidjan, Ouagadougou, May 2011 to February 2013.

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