Background:  Children are underrepresented among recipients of ART worldwide. The WHO recently estimated that 800,000 children <15 years of age are in immediate need of ART. Approximately 90% of these children live in Sub-Saharan Africa. In partnership with governments, the Baylor International Pediatric AIDS Initiative (BIPAI) is building a global network of clinical centers designed to catalyze the expanded access of children in the developing world to HIV/AIDS care and treatment. 

Methods:  Database information and medical records were reviewed for all HIV-infected children who, by August 2006, had received care from any of 5 BIPAI programs and centers in Africa. These programs and centers are in Botswana (program initiated January 2002, center opened June 2003), Uganda (program initiated January 2004, center scheduled for completion spring 2007), Lesotho (center opened December 2005), Swaziland (center opened February 2006), and Malawi (program initiated September 2005, center opened September 2006). Children are being treated with HAART in an open manner, by prescription, according to national treatment guidelines.

Results:  As of August 2006, the 5 BIPAI centers in Africa had an active pediatric caseload of 9825; 4062 children were receiving HAART. Mean age at enrollment on HAART in the 5 centers ranged from 5.1 to 7.8 years. Between 50 and 92% of treated children had WHO stage 3 or 4 HIV disease at baseline; 47 to 77% of children were in CDC immunologic category 3. The median CD4 percentage for children receiving HAART in the Botswana center increased from 15% at baseline to 27%, 30%, and 32% at 6, 12, and 36 months, respectively. In Uganda, the median CD4 percentage increased from 8% to 18%, 23% and 26% at 6, 12, and 24 months, respectively. In Botswana, the on-treatment plasma HIV RNA concentration was <400 copies/mL in 79%, 81%, and 71% of children at 6, 12, and 36 months, respectively. Also in the Botswana center, the annual pediatric mortality rate declined from 4.7% in 2003 to 2.1%, 1.1%, and 0.3% in 2004, 2005, and 2006, respectively. Approximately 90% of children followed for ≥2 years were alive and on treatment; about 10% had switched to second or third line HAART.

Conclusions:  State-of-the-art HIV/AIDS care and treatment can be administered to large numbers of children in resource-poor African settings with rates of success comparable to those observed in the United States.