Costs Of Care Of Hiv-Infected Children Initiating Lopinavir/Ritonavir-Based Antiretroviral Therapy Before The Age Of Two In Cote D'Ivoire

ObjectivesTo access the costs of care for Ivoirian children before and after initiating LPV/r-based anti-retroviral therapy (ART) before the age of two.MethodsWe assessed the direct costs of care for all HIV-infected children over the first 12 months on LPV/r-based ART initiated <2 years of age in Abidjan. We recorded all drug prescriptions, ART and cotrimoxazole prophylaxis delivery, medical analyses/examinations and hospital admissions. We compared these costs to those accrued in the month prior to ART initiation. Costs and 95% confidence intervals (95% CI) were estimated per child-month, according to severe morbidity.ResultsOf the 114 children screened, 99 initiated LPV/r-based ART at a median age of 13.5 months (IQR: 6.8 - 18.6); 45% had reached World Health Organization stage 3 or 4. During the first 12 months on ART, 5% died and 3% were lost to follow-up. In the month before ART initiation, the mean cost of care per child-month reached $123.39 (95% CI:$121.02-$ 125.74). After ART initiation, it was $42.53 (95% CI:$42.15-$42.91); 50% were ART costs. The remaining costs were non-antiretroviral drugs (18%) and medical analyses/examinations (14%). Mean costs were significantly higher within the first three months on ART ($48.76, 95% CI:$47.95-$49.56) and in children experiencing severe morbidity ($49.76, 95% CI: $48.61-50.90).ConclusionART reduces the overall monthly cost of care of HIV-infected children < 2 years. Because children were treated at an advanced HIV disease stage, the additional costs of treating severe morbidity on ART remain substantial. Strategies for treating HIV-infected children as early as possible must remain a priority in Cote d'Ivoire.