Entry into the programmeThe Aconda programme adopted a comprehensive family-based approach. Health-care workers were trained to offer HIV testing to every pregnant woman attending antenatal clinics and to encourage HIV-infected mothers to bring their children and partners with them for testing and counselling. Each pregnant woman with an HIV infection was immediately referred for an adult consultation. She then received PMTCT therapy, either a short regimen or ART depending on her clinical and immunological status, and underwent assessment at both antenatal and adult clinics. 18Children aged ≤ 15 years entered the Aconda programme in one of two ways: (i) after referral for HIV testing at the age of ≥ 6 weeks because their mother had been diagnosed with HIV infection and had received PMTCT therapy, or (ii) after HIV testing at a paediatric clinic following presentation with AIDS-related symptoms, even if they had not been previously classified as exposed to or infected by HIV and even if their parents had not participated in the Aconda programme. Standardized paediatric follow-upThe Aconda paediatric HIV care package included systematic paediatric HIV testing which varied according to the child's age. In those aged ≥ 18 months, the standard serum testing algorithm comprised a series of two rapid HIV assays: the Determine ® HIV-1/2 assay (Inverness Medical, Bedford, United Kingdom of Great Britain and Northern Ireland) followed by the Genie II ® HIV-1/HIV-2 assay (Bio-Rad laboratories, MarneLa-Coquette, France). 19 Children aged < 18 months were diagnosed virologically using a TaqMan HIV-1, ribonucleic acid (RNA), real-time polymerase chain reaction test (Hoffmann-La Roche, Basel, Switzerland) with a threshold of 300 copies/ml. 20 Children were regarded as having HIV-1 infections if, at any age, they tested positive for HIV-1 RNA in plasma at least once or if, at age ≥ 18 months, they were positive for HIV-1 on serum testing. Children who tested negative but who were still breastfeeding were defined as HIV-undetermined and were retested 2 months after the cessation of breastfeeding or at 18 months. A negative diagnosis was regarded as definite if it was made at least 2 months after the cessation of breastfeeding and children with this diagnosis were excluded from the programme.All children with a confirmed HIV infection were seen monthly and had unrestricted free access to antiretroviral drugs and comprehensive care. 21 In all children, whether on ART or not, the CD4+ T lymphocyte (CD4 cell) count and CD4 cell percentage were measured every 6 months. Plasma viral load testing was not performed routinely after the diagnosis of HIV infection, even in children on ART. Pulmonary radiographs were available for children whose history and symptoms suggested tuberculosis.Children initiated ART if they were either at World Health Organization (WHO) HIV/AIDS clinical stage 3 or 4 or at clinical stage 1 or 2 with impaired immunity (i.e. a CD4 cell percentage ≥ 25 at age < 12 months, ≥ 20 at 12-35 months or ≥ 15 at ≥ 36 month...

Once on treatment, the 2-year risk of death is low but the LTFU risk is substantial. ART is still mainly initiated at advanced disease stage in African children, reinforcing the need for early HIV diagnosis, early initiation of ART, and procedures to increase program retention.

No abstract

The incidence of diseases was significantly lower among asymptomatic children than among symptomatic untreated children (p < 0.0001). The morbidity found in symptomatic children who received treatment was similar to that encountered in asymptomatic children. The main reason for death in all of the groups was tuberculosis.

Task-sharing of HIV care and ART initiation with nurses in Côte d'Ivoire is feasible. This pilot illustrates two models of nurse-led HIV care and has informed national policy on nurse-led HIV care in Côte d'Ivoire.