As accumulating evidence revealed lower HIV-associated mortality with early ART initiation, the World Health Organization (WHO) guidelines broadened ART eligibility for children with HIV infection. To understand the lag between guideline development and implementation, as well as the ART coverage gap, CDC assessed national pediatric HIV guidelines and analyzed Joint United Nations Programme on HIV and AIDS data on children aged <15 years with HIV infection and the numbers of these children on ART. The percentage of children with HIV infection receiving ART increased from 24% in 2012 to 44% in 2016. However, although the ART coverage gap decreased steadily during 2012–2016, there were still approximately 750,000 (56%) children with HIV infection not on ART as of 2016.
This report highlights the continuing gaps in pediatric ART coverage in PEPFAR-supported sub-Saharan African countries with high HIV burden, despite expanded ART eligibility criteria. Robust pediatric HIV testing and comprehensive ART programs are needed to ensure that all children with HIV infection are identified and initiated on ART as early as possible.