Significant advances have been made with regards to managing children living with HIV/AIDS as well as reducing the number of new HIV infections among children in South Africa, with prevention of mother-to-child transmission (PMTCT) one of the major successes.
This is according to Paediatric Medical Advisor at Right to Care, Dr Julia Turner, who says that in just over 10 years, the PMTCT programme, led by the National Department of Health (NDoH), has reduced HIV transmission in babies from around 30% to less than 2%.
Below are the key elements of the improvements in prevention of HIV transmission and of HIV treatment in children.
The significant reduction in HIV transmission in babies by around 28% has been achieved by ensuring that all pregnant or breastfeeding women are regularly tested for HIV. They are started on antiretrovirals (ARVs) if found to be HIV positive. Babies born to HIV-positive mothers are given preventive ARVs for the first weeks of life.
Birth testing and diagnosis
Advances in birth testing has enabled HIV-positive infants to be diagnosed at birth and put on treatment immediately, a dramatic improvement on what was previously a six-week wait. Since its introduction in 2015, birth testing has proven invaluable in ensuring that infected infants receive treatment as soon possible.
The Children with HIV Early Antiretroviral Therapy (CHER) study conducted in South Africa has shown that in infants with HIV, the likelihood of them dying declines by 75% if they are given ARV treatment within the first 12 weeks of life.
ARVs have been in use with children for many years with very good results. However, South Africa only started actively treating babies under a month in 2015. New-born babies require different ARV therapy compared to older babies and children. Previously, only babies from six weeks could be diagnosed and treated, but now they can be treated from birth. This has led to many lives being saved.
A significant development by the National Health Laboratory Service (NHLS) is an advanced database which identifies and provides weekly updates on all infants who tested HIV positive in the previous week. This allows healthcare workers to track vulnerable patients and start life-saving ARV therapy as soon as possible.
Simplified treatment and drug regimens
However, significant challenges remain including maintaining good adherence to treatment. Ensuring that the infant or child takes the ARV medication every day, sometimes more than once a day, can prove to be challenging. Whether it’s the unpalatable taste, or the complicated regimen of drug combinations and doses with an often-intimidating number of pills, it is very difficult for the parent or carer to ensure good adherence.
Consequently, the Right to Care Paediatric and Adolescent programme encourages healthcare workers to simplify treatment and drug regimens while still keeping to the National Consolidated HIV Guidelines.
Another key challenge is disclosure to a child. Revealing and discussing a child’s HIV status with them can be daunting, and many parents and caregivers delay telling a child about their HIV-positive status or may mislead their child about the reason for taking medication.
Adolescent Psychosocial Programme Manager at Right to Care, Dr Marnie Vujovic, says that: “Waiting until children enter adolescence before telling them about their HIV status can be detrimental. Adolescence is the worst time to disclose because a young person is already coming to terms with other rapid changes that are taking place. Disclosure needs to take place well before adolescence.”
“To ensure that children enter adolescence knowing why they are taking medication, the Right to Care Paediatric and Adolescent Programme has developed useful tools to help clinics disclose to their patients and to run adolescent support groups. It also provides training and mentoring, and runs helplines to assist clinics in managing their paediatric and adolescent patients,” continued Dr Vujovic.
HIV in children, adolescents and adults can be so easily controlled if everyone with HIV knows their status and takes ART consistently.