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HIV treatment for children: how programmes are improving diagnosis and retention
Carole Leach-Lemens, 2012-07-27 04:50:00
“It is unacceptable that children at this point in time are not receiving treatment,” René Ekpini of UNICEF told a satellite session supported by UNICEF, IAS-ILF and MSH last Sunday at the 19th International AIDS Conference (AIDS 2012) in Washington DC.
This means, he continued, moving beyond discussion of drug regimens and looking at how the 75% of children in need of treatment – and who remain untreated – can be identified, receive care and treatment, and most importantly, remain in care.
Practical examples presented included the initial implementation on a national scale of Option B+ (giving ART to all HIV-positive women regardless of CD4 count) in Malawi as an alternative to prophylaxis during pregnancy, labour, delivery and after birth and how this has positively affected scale-up; identifying HIV-exposed infants in Zimbabwe; keeping children in care and treatment programmes; to streamlining the best and most appropriate paediatric formulations at the national level.
When asked what she considered key to the success of efforts to increase the number of children receiving treatment, Dr Dorothy Mbori-Ngachi of UNICEF stressed the critical role that community plays throughout the entire process. Examples include peer support, peer mentors, patient advocates and community volunteers accompanying children to the clinics.
This was further illustrated in a presentation on July 26 on the role of community in helping achieve national paediatric treatment targets in rural Kenya, described below.
Malawi is a small country with minimal capacity and resources. Moving beyond Option B+ was the only realistic option for the elimination of mother-to-child transmission (eMTCT) within the Malawian context, Dr. Erik Shouten stated. Adopting Option B+ eliminates the need for CD4 testing; it is simpler than Option A; makes breastfeeding safe; provides protection for uninfected sex partners; reduces TB and improves the health of the mother. There is now one standard for ART and PMTCT within the health system.
Implementation involved obtaining buy-in from all stakeholders, planning, costing, forecasting, development of guidelines, monitoring and evaluation tools and supervisory systems. This was not an easy task. The decision was made to undertake full-scale implementation and not begin with a pilot or scale-up slowly.
Decentralisation of ART services has been accelerated, bringing ART to the lowest levels of the healthcare system. Dr Shouten described Option B+ as a game-changer. While it is not without challenges, implementation has brought a six-fold increase in pregnant and breastfeeding women on ART from 1200 in the second quarter of 2011 to 15,000 in the fourth quarter.
Option B+ is not the sole solution to eMTCT, he added. Challenges include:
Testing: not all women access antenatal care services, and false-negative results mean that women can be lost.
Identification of exposed and infected infants is problematic because not all mothers will access PMTCT services; there is also 1% incidence of HIV in pregnancy.
Acceptance of ART.
Source:1
