Vreeman, Rachel C.Yiannoutsos, Constantin T.Yusoff, Nik Khairulddin NikWester, C. WilliamEdmonds, AndrewOfner, SusanDavies, Mary-AnnLeroy, ValérianeLumbiganon, Pagakrongde Menezes Succi, Regina CéliaTwizere, ChristellaBrown, StevenBolton-Moore, CarolynTakassi, Ounoo ElomScanlon, MichaelMartin, RoxanneWools-Kaloustian, KaraIeDEA2023-11-152023-11-152023-03-13Vreeman RC, Yiannoutsos CT, Yusoff NKN, et al. Global HIV prevention, care and treatment services for children: a cross-sectional survey from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. BMJ Open. 2023;13(3):e069399. Published 2023 Mar 13. doi:10.1136/bmjopen-2022-069399https://hdl.handle.net/1805/37059Objectives: To assess access children with HIV have to comprehensive HIV care services, to longitudinally evaluate the implementation and scale-up of services, and to use site services and clinical cohort data to explore whether access to these services influences retention in care. Methods: A cross-sectional standardised survey was completed in 2014-2015 by sites providing paediatric HIV care across regions of the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We developed a comprehensiveness score based on the WHO's nine categories of essential services to categorise sites as 'low' (0-5), 'medium', (6-7) or 'high' (8-9). When available, comprehensiveness scores were compared with scores from a 2009 survey. We used patient-level data with site services to investigate the relationship between the comprehensiveness of services and retention. Results: Survey data from 174 IeDEA sites in 32 countries were analysed. Of the WHO essential services, sites were most likely to offer antiretroviral therapy (ART) provision and counselling (n=173; 99%), co-trimoxazole prophylaxis (168; 97%), prevention of perinatal transmission services (167; 96%), outreach for patient engagement and follow-up (166; 95%), CD4 cell count testing (126; 88%), tuberculosis screening (151; 87%) and select immunisation services (126; 72%). Sites were less likely to offer nutrition/food support (97; 56%), viral load testing (99; 69%) and HIV counselling and testing (69; 40%). 10% of sites rated 'low', 59% 'medium' and 31% 'high' in the comprehensiveness score. The mean comprehensiveness of services score increased significantly from 5.6 in 2009 to 7.3 in 2014 (p<0.001; n=30). Patient-level analysis of lost to follow-up after ART initiation estimated the hazard was highest in sites rated 'low' and lowest in sites rated 'high'. Conclusion: This global assessment suggests the potential care impact of scaling-up and sustaining comprehensive paediatric HIV services. Meeting recommendations for comprehensive HIV services should remain a global priority.en-USAttribution-NonCommercial 4.0 InternationalHealth policyHIVAIDSInternational health servicesArticle