Cohort Profile: The Paediatric Antiretroviral Treatment Programmes in Lower-Income Countries (KIDS-ART-LINC) Collaboration

The Paediatric Antiretroviral Treatment Programmes in Lower-Income Countries (KIDS-ART-LINC) collaboration (see Appendix for details) is an international epidemiological network in sub-Saharan Africa. The paediatric HIV burden is currently estimated at 2.3 million (1.7–3.5 million) children under 15 years of age worldwide, 90% of them living in subSaharan Africa. Anti-retroviral therapy (ART) is an essential part of the overall strategy to fight the HIV pandemic, and has, since 1996, led to substantial reduction in HIV-related morbidity and mortality in children in industrialized nations. However, paediatric HIV care and ART programmes have not reached most resource-poor settings, particularly in Africa. Simplified models, developed to deliver drugs to large numbers of people generally focus on adults and have rarely addressed ART in children. An estimated 780 000 children were in need of ART in 2006 and only 10% of them received it. The World Health Organization (WHO) has recently updated its guidelines for ART use in resource-limited settings with a specific focus on children, stressing the need to build up and share local expertise in managing HIV-infected children. To date, little data is available on paediatric HIV care and treatment in Africa and furthermore, there is a lack of scientifically rigorous evaluation of the limited number of paediatric ART programmes. Evaluating the effectiveness of ART in delaying disease progression and reducing mortality in children outside research settings deserves an urgent and wide-scale, evidence-based assessment. Built to inform health care policy and practice, the KIDS-ART-LINC Collaboration is a joint initiative of the African Network for the Care of Children Affected by HIV/AIDS (ANECCA), the Regional Centre for Quality of Health Care, Kampala, Uganda, and the Institut de Santé Publique et de Développement (ISPED) at the Université Victor Segalen, Bordeaux, France. The organizational structure includes two principal investigators from ANECCA and ISPED, a central coordinating team (project manager, epidemiologist and data manager) and a Steering Committee of representatives from all the participating sites (local principal investigators). In mid-2005, the coordinating team identified potential clinical sites and cohorts treating HIV-infected children with ART in sub-Saharan Africa from the ANECCA database of network members, by performing MEDLINE searches, screening abstracts presented at international conferences and through investigators’ contacts. A request for expression of interest to participate in the collaboration, detailing the objectives, principles and procedures, was sent to all the potential participating sites. Paediatric HIV care cohorts agreeing to participate signed a collaborative agreement. The collaboration was officially constituted in October 2005. This first phase of the KIDS-ART-LINC Collaboration was funded by the US National Institutes of Health (Office of AIDS Research) and USAID/East Africa (Office for Regional Health and HIV/AIDS Programmes), with the recent adjunct of the French Agence Nationale de Recherches sur le Sida et les Hépatites Virales (ANRS). * Corresponding author. INSERM U.593 – ISPED (Case 11), Université Victor Segalen Bordeaux 2, 33076 BORDEAUX Cedex, France. E-mail: Francois.dabis@isped.u-bordeaux2.fr 1 Unité INSERM 593, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen, Bordeaux, France. 2 African Network for the Care of Children Affected by AIDS (ANECCA), Kampala, Uganda. 3 USAID, Nairobi, Kenya. 4 Unité de Prise en charge des enfants Exposé ou Infecté au VIH (UPEIV)/ Hôpital d’Instruction des Armées (HIA), Cotonou, Bénin. 5 CEPREF Enfants, Abidjan, Côte d’Ivoire. 6 Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d’Ivoire. 7 Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, UK and Africa Centre for Health and Population Studies, University of KwaZulu Natal, Somkhele, South Africa. 8 Mailman School of Public Health, Columbia University, New York, NY, USA. 9 Department of Paediatrics and Child Health, Tygerberg Children’s Hospital, Univeristy of Stellenbosch, Cape Town, South Africa. 10 School of Public Health and Family Medicine, University of Cape Town, South Africa. Published by Oxford University Press on behalf of the International Epidemiological Association The Author 2007; all rights reserved. Advance Access publication 12 November 2007 International Journal of Epidemiology 2008;37:474–480 doi:10.1093/ije/dym216