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Delivering pediatric HIV care in resource-limited settings: cost considerations in an expanded response

Tolle, Michael A.a; Phelps, B. Ryanb; Desmond, Chrisc; Sugandhi, Nanditad; Omeogu, Chinyeree; Jamieson, Davidf; Ahmed, Saeedg; Reuben, Elanb; Muhe, Luluh; Kellerman, Scott E.i; The Child Survival Working Group of the Interagency Task Team on the Prevention and Treatment of HIV infection in Pregnant Women, Mothers and Children

doi: 10.1097/QAD.0000000000000105
Supplement Articles

If children are to be protected from HIV, the expansion of PMTCT programs must be complemented by increased provision of paediatric treatment. This is expensive, yet there are humanitarian, equity and children's rights arguments to justify the prioritization of treating HIV-infected children. In the context of limited budgets, inefficiencies cost lives, either through lower coverage or less effective services. With the goal of informing the design and expansion of efficient paediatric treatment programs able to utilize to greatest effect the available resources allocated to the treatment of HIV-infected children, this article reviews what is known about cost drivers in paediatric HIV interventions, and makes suggestions for improving efficiency in paediatric HIV programming. High-impact interventions known to deliver disproportional returns on investment are highlighted and targeted for immediate scale-up. Progress will carry a cost - increased funding, as well as additional data on intervention costs and outcomes, will be required if universal access of HIV-infected children to treatment is to be achieved and sustained.

aBaylor College of Medicine Children's Foundation – Tanzania, Bugando Medical Centre, Mwanza, Tanzania

bUnited States Agency for International Development, Washington, DC, USA

cDevelopment Pathways to Health Research Unit, University of Witwatersrand, Johannesburg

dClinton Health Access Initiative

eUnited Nations Children's Fund (UNICEF), New York, New York

fPartnership for Supply Chain Management, Arlington, Virginia, USA

gBaylor College of Medicine Children's Foundation–Malawi, Kamuzu Central Hospital, Lilongwe, Malawi

hWorld Health Organization, Geneva, Switzerland

iManagement Sciences for Health, Cambridge, Massachusetts, USA.

Correspondence to Michael A. Tolle, MD, MPH, Executive Director, PO Box 5208, Bugando Medical Centre, Mwanza, Tanzania. Tel: +255 689227997; e-mail:

Received 3 October, 2013

Revised 3 October, 2013

Accepted 3 October, 2013

© 2013 Lippincott Williams & Wilkins, Inc.