An estimated 90 percent of new pediatric HIV infections occur in sub-Saharan Africa and despite efforts to expand access to HIV care and treatment, only 28 percent of these children receive antiretroviral therapy (ART). Decentralizing HIV care and treatment services to primary health facilities is considered one of the cornerstones of successful HIV scale-up, but there are few published reports assessing the outcomes of children receiving ART at primary health facilities.

The _Journal of Acquired Immune Deficiency Syndromes (JAIDS)_ recently featured a study evaluating the effect of the decentralization of pediatric HIV services at ICAP supported facilities in five sub-Saharan African countries. The authors, which include ICAP’s Ruby Fayorsey, Suzue Saito, and Elaine Abrams, analyzed data routinely collected from 274 facilities in Kenya, Lesotho, Mozambique, Rwanda, and Tanzania, and compared pediatric enrollment and outcomes at primary health facilities (such as health centers and clinics) and secondary/tertiary health facilities (including district hospitals).

The study’s results indicate that, although secondary health facilities accounted for over two- thirds of the children enrolled in HIV services, primary health facilities were associated with lower loss to follow-up and lower mortality among pediatric patients. The findings provide evidence of successful decentralization of pediatric HIV care in five African countries and demonstrate that pediatric HIV care and treatment is feasible in primary health facilities with equally or more effective outcomes than in secondary health facilities. Future programming efforts to improve access to comprehensive care and treatment in resource-limited settings should continue to support primary health facilities.

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