Treatment support for older children and adolescents living with HIV: A household-randomised trial linked to evaluation of decentralised HIV testing and care in Harare, Zimbabwe.

Contrary to initial assumptions, one third of HIV-infected infants are now known to be long-term survivors able to reach older childhood with untreated HIV infection. In countries with severe HIV epidemics in the 1990s, large numbers of such children are now reaching adolescence. Most cases are still undiagnosed and at risk of developing serious complications such as lung disease and growth failure. Furthermore, this age-group is also at disproportionately high risk of treatment failure and ma y require additional treatment support to ensure good treatment outcomes. The objectives of this study are: 1. To investigate whether or not implementation of routine facility-based PITC for older children attending primary health care services identifies the majority of children living with HIV infection in the clinic catchment areas before the onset of severe immunosuppression, and before major complications have occurred 2. To investigate whether a household-level intervention improves retention in care and treatment outcomes of HIV-infected children; 3. To assess serial lung function and anthropometry in newly diagnosed children in care, in order to investigate the safety of current deferred-start ART guidelines in this age-group (WHO stage 3/4 disease or CD4 count < 350cells/ l), with respect to prevention of chronic lung disease and growth failure