Ending HIV among children a priority

Rumbidzayi Zinyuke
Health Buzz

Over the past decades, Zimbabwe has made good progress in the fight against HIV and is counted among some of the countries which have implemented strategies that have worked.

The country is definitely on course to meet the UNAIDS 95-95-95 goals of containing and controlling the HIV epidemic by 2030.

The target is to ensure 95 percent of the people who are HIV positive know their status, 95 percent of those who are HIV positive are on ART and 95 percent of the people who are HIV positive are virally suppressed by 2030.

To date, nearly 1,3 million people are living with HIV in Zimbabwe and more than 80 000 of these individuals are children under the age of 15.

Current statistics show that among the adult population, 93 percent of people living with HIV know their status and all of them (100 percent) have been initiated on Antiretroviral treatment(ART) while 95 percent of them are now virally suppressed.

However, these targets were supposed to affect all ages of people living with HIV, but a comparison of adults living with HIV to children shows that children are still lagging behind.

The figures for children remain lower.

About 72,5 percent of children living with HIV have been diagnosed and although all of these children have been initiated on ART, only 79,3 percent of them are virally suppressed.

What the numbers are telling us is that an estimated 82 000 children are living with undiagnosed HIV and these definitely need to be found for them to get treated and for the country to fully achieve its targets.

Dr Hilda Bara, a technical advisor with the Elizabeth Glaser Paediatric Aids Foundation recently told journalists that if HIV is not treated, about half of the babies may die before the age of two and the number increases to three quarters by the age of five.

“This tells us that there is a lot of work to be done in terms of making sure that undiagnosed HIV in children is picked up and the ones that are tested positive are initiated on treatment early otherwise we will lose them,” she said.

However, what happens to babies and young children depends on the health seeking behaviours of the adults who are playing the caregiver role in their lives.

This means if the mothers do not take the baby to the clinic, they will not be tested and they will definitely not go under treatment.

To try and address some of these challenges, Zimbabwe has been implementing some strategies to target this vulnerable population with some good results.

Prevention of Mother to Child Transmission

Of note is the PMTCT programme which seeks to stop the spread of HIV from the mother to the child.

According to statistics, at least eight out of 10 children infected with HIV get it from their mothers.

The mother to child transmission rate of HIV in Zimbabwe stands at 8 percent, a figure that may seem small to the uninformed.

But as Dr Bara says “that is a baby that will need to take ART for life and if interventions had been put in place, that transmission could have been avoided.”

The country has targets to reduce the mother to child transmission rate to less than five percent.

So for this to be achieved, activities under the PMTCT programme have to be fully implemented.

The programme is four pronged and speaks to:

1. The need to prevent new HIV infections in women of child bearing age. So all the preventive measures that target that particular population need to be put in place.
2. The need to prevent unintended pregnancies in women living with HIV. This means family planning services should be available to women living with HIV to ensure one who does not want to have a baby does not fall pregnant.
3. The prevention of transmission of HIV from a woman who is HIV positive and pregnant to the baby. Whether the pregnancy is intentional or not, strategies to prevent transmission to the baby are put in place. Activities that speak to this prong need to target the woman during pregnancy, labour and delivery and during breastfeeding.
4. Making sure that women living with HIV have access to treatment, along with their families.

These measures will contribute to the attainment of an HIV-free and AIDS-free generation.

HIV and AIDS free generation

“For us to achieve an HIV-free generation, we are saying there has to be zero new infections. This speaks to the first 95 (UNAIDS targets) where activities that make sure that we prevent new infections in children are implemented. You find that more than 95 percent of new HIV infections in children are transmitted from the mother so we address that. If these activities are implemented properly and widely, then we can see an HIV-free generation,” said Dr Bara.

“When we talk of an AIDS-free generation, this is now speaking of the activities or systems that we need to put in place to make sure that all children, women, adolescents living with HIV have access to treatment and they have access to durable, optimised ART and they take their treatment for life.”

Milestones

While a lot still needs to be done to increase HIV services for children, the Government has done a lot to ensure access to them.

The country has adopted simplified optimised treatment regimens for children to ensure adherence. This has seen children taking one dose of ART once daily from the cocktail of three drugs that used to be taken in the past.

The simplified medicines have also made sure that children don’t find ARVs too difficult to take and they do not get fatigued, especially the older children who can then decide to stop taking their treatment.

Besides the treatment regimens, the Government has integrated HIV services into the child health services, maternal monitoring services and post-natal services.

“This means that when a child comes for one service, they will be able to access all the other relevant HIV services in one visit. Different from what was happening in the past where a child would come in for growth monitoring and come back a week later for ARV supply and then again for their vaccine shot. Synchronising the visits through integration has also encouraged the children, adolescents and young people to continue taking their medication,” said Dr Bara.

Systems have also been put in place to ensure that access to HIV services improves.

Government has widely distributed early infant diagnosis (babies below six months) point of care devices in clinics and hospitals that offer maternity services.

This has ensured that a baby who is born to an HIV positive mother and is considered to be at high risk of HIV infection is tested at birth.

If this is not done, early testing is done, which is when the test is done at the first contact with this baby within six weeks.

EGPAF on its part has played a major role in supporting the Government to ensure that HIV services to children are available.

To date, the organisation has supported the provision of ART to HIV positive women as well as HIV testing for infants and pregnant women nationwide.

Through engagement with communities, they have also increased the knowledge level and even change of attitude towards maternal and child health as well as HIV.

Because the more communities understand the need for children to access HIV services, the more children living with HIV are identified and put under treatment.

That way, we can fully achieve the targets that we as a country have subscribed to.

No child should be left behind in the quest to end HIV!

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