By Alina Haddad
10 JUNE 2008 [MEDIAGLOBAL]: In 2007, children under the age of 15 accounted for 2.1 million of the estimated 33.2 million people living with HIV. In 2007 alone, 420,000 children were infected with HIV and did not receive care or treatment. One third of these children will die by age one and almost half by age two. And 90 percent of children with HIV live in sub-Saharan Africa, the region most affected by the disease.
According to the recently released report by the World Health Organization (WHO), the United Nations Joint Programme on AIDS (UNAIDS), and the UN Children’s Fund (UNICEF), titled Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, an estimated 3 million people in low and middle income countries are now receiving antiretroviral therapy (ART). ART allows those infected to achieve their fullest possible physical and mental health. When given in combination, the antiretroviral drugs delay the deterioration of the immune system and HIV’s replication, in turn improving the quality of life.
According to UNICEF, children are among the greatest beneficiaries of ART’s rapid scale-up distribution. “The number of children receiving antiretroviral treatment in low- and middle-income countries increased from 75,000 in 2005 to nearly 200,000 in 2007, a notable increase of 150 per cent in just 2 years. A total of 5,660 facilities were reported to be providing antiretroviral therapy to children in 2007, more than twice the 2,400 facilities in 2005,” said Patricia Doughty, HIV and AIDS Programme Officer in the Health Section at UNICEF.
This significant augmentation in children’s access to ART is attributed to the increased testing of children. Virological testing through dried blood spots (DBS), specimen collection and transport methods for exposed children has created opportunities to treat HIV-infected children before the disease advances. Testing has been pursued in locations where child infection is likely, which, in turn increases the possibility of treatment. The number of countries using dried blood spots (DBS) for early diagnostic HIV testing increased from 17 in 2005 to 30 in 2007.
Besides child testing, additional efforts have contributed to increased access of ART for children in sub-Saharan Africa. These factors include more coordinated programming efforts, reduced drug prices, approval of fixed-dose generic antiretroviral drug combinations and better forecasting of pediatric drug needs. Additionally, organizations such as The United States President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund, the Clinton Foundation, and UNITAID have made significant financial and technical contributions, scaling up pediatric HIV treatment.
In addition to children, UNICEF is concentrating on treating pregnant women to reduce the number of children born with HIV. “UNICEF and its partners have been working closely with governments to strengthen their health systems’ response to HIV, specifically to ensure that HIV-negative women who are pregnant, or planning to become pregnant, remain HIV-negative, and that HIV-positive women are identified and provided with interventions to prevent them from passing infection onto their babies,” said Doughty.
According to the newly released report, in 2007, 33 percent of the estimated 1.5 million HIV-positive pregnant women living in low and middle-income countries received antiretroviral medicines to prevent the transmission of HIV to their children. This is a substantial increase from an estimated 10 percent in 2004.
In an interview with MediaGlobal, Doughty credited the significant increase in antiretroviral medicines for pregnant women in sub-Saharan Africa to four factors. The first is increased investment from governments and donor agencies. Secondly, the sustained commitment and leadership of national governments to citizens infected with HIV. Consequently, because of designated resources and government commitment, national policies and guidelines have been revised. Revisions are in line with WHO guidance, and include the implementation of provider-initiated HIV testing as well as counseling in generalized epidemic settings. Lastly, Doughty named the decentralization of services for the prevention of mother-to-child transmission and increased capacity development at district and lower levels as an example of mobilization by communities.
“While there has been significant progress made, still too many children living with HIV are still not receiving treatment, and mortality among them remains unacceptably high,” said Doughty. Although three million people now have access to ART treatment, 6.7 million people are still unable to access these live-saving medicines.
In the case of children, Doughty said the biggest challenge to a rapid scale-up in treatment is poor follow-up of babies born to HIV-positive mothers. In 2007, only 8 per cent of babies born to HIV-positive mothers were tested within the first 2 months. Children born to infected mothers need cotrimoxazole preventive therapy (CPT), a highly effective and affordable antibiotic that substantially reduces mortality among children exposed or infected with HIV. However, in 2007, less than 4 per cent of babies born to HIV-positive mothers received CPT.
“To improve on the follow-up of children born to HIV-positive mothers, many countries have started to integrate key interventions into their health systems. Child health cards have been revised in a number of countries such as Cameroon, Malawi, Rwanda, Swaziland, Tanzania and Zimbabwe, to include HIV-related information and allow health care providers to appropriate care and treat infected children,” Doughty explained.