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Linkage, initiation and retention of children in the antiretroviral therapy cascade: an overview

Phelps, B. Ryana; Ahmed, Saeedb,*; Amzel, Anoukc,*; Diallo, Mamadou O.d,*; Jacobs, Troya,*; Kellerman, Scott E.e,*; Kim, Maria H.f,*; Sugandhi, Nanditag,*; Tam, Melaniea,*; Wilson-Jones, Meganh; The Child Survival Working Group of the Interagency Task Team on the Prevention, Treatment of HIV infection in Pregnant Women, Mothers, Child

doi: 10.1097/QAD.0000000000000095
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In 2012, there were an estimated 2 million children in need of antiretroviral therapy (ART) in the world, but ART is still reaching fewer than 3 in 10 children in need of treatment. [1, 7] As more HIV-infected children are identified early and universal treatment is initiated in children under 5 regardless of CD4, the success of pediatric HIV programs will depend on our ability to link children into care and treatment programs, and retain them in those services over time. In this review, we summarize key individual, institutional, and systems barriers to diagnosing children with HIV, linking them to care and treatment, and reducing loss to follow-up (LTFU). We also explore how linkage and retention can be optimally measured so as to maximize the impact of available pediatric HIV care and treatment services.

aUnited States Agency for International Development, Washington, District of Columbia

bBaylor College of Medicine, Houston, Texas

cUnited States Agency for International Development, Washington, District of Columbia

dCenters for Disease Control and Prevention, Atlanta, Georgia

eManagement Sciences for Health, Washington, District of Columbia

fBaylor College of Medicine, Houston, Texas

gClinton Health Access Initiative, New York, New York

hLiverpool School of Tropical Medicine, UK.

*B. Ryan Phelps, Saeed Ahmed, Anouk Amzel, Mamadou O. Diallo, Troy Jacobs, Scott E. Kellerman, Maria H. Kim, Nandita Sugandhi, and Melanie Tam contributed equally to the writing of the article.

Correspondence to B. Ryan Phelps, Office of HIV/AIDS, United States Agency for International Development, Washington, District of Columbia, USA. Tel: +1 202 712 1363; e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.