Concern as children left behind in treatment of HIV

Every Friday of the month, Immaculate Mwende*, a community health promoter in Embu, hosts a merry-go-round chama at her house. While the women gather to share their financial burdens and goals, the conversations often veer into intimate exchanges about their children’s welfare, the very issue that brought them together in the first place. Each of the women has a child living with HIV.

At the end of last year, a staggering1.4 million children were living with HIV globally, with 86 per cent residing in Sub-Saharan Africa.

 Approximately 120,000 children newly acquired the virus. This is largely due to stigma and logistical challenges hindering mothers’ access to essential care, including antiretroviral (ARV) therapy. Exacerbating this crisis is a severe shortage of ARVs.

This was revealed in a recent United Nations Programme on HIV/Aids (UNAIDS) progress report. In 2023, there was a significant drop in new HIV infections among adults, having reduced by 65 per cent since the peak of HIV in 1995. A further 77 per cent of adults aged 15 years and older were on HIV treatment in 2023. In Kenya for instance, the number of those receiving treatment has almost doubled, resulting in an almost 90 per cent viral suppression rate among those on treatment. Viral suppression means that the amount of HIV in a person’s blood is so low that it can't be detected by a standard test.

However, experts are concerned that children are still lagging behind in terms of accessing treatment. UNAIDS said that children aged 0-14 years living with HIV “remain considerably less likely than adults to be diagnosed and receive antiretroviral therapy. The 2024 report estimated that about 590,000— 43 per cent of the global total of 1.4 million children living with HIV —  did not receive treatment in 2023 partly due to missing out on timely diagnosis.

There are compounding reasons that include poor testing programmes where conventional testing methods are missing large numbers of people living with HIV, and their mothers not receiving antiretroviral therapy. Further, programmes across the region are missing substantial numbers of pregnant and breastfeeding women living with HIV.  There is poor testing to identify serodiscordant couples and expand HIV screening for pregnant and breastfeeding women and their partners, which can help find the missing pregnant women and young mothers who are living with HIV.

 The ongoing failure to diagnose all children who acquire HIV and provide them with effective treatment claimed the lives of some 76,000 children, accounting for 12 per cent of all AIDS-related deaths. This is even though they only constitute just three per cent of people living with the virus. 

In 2023, 630,000 people died from Aids-related illnesses. While the target for suppressed viral load among children by next year is set at 75 per cent, progress has been slower than anticipated, with only 48 per cent achieved last year. 

Universal ARV coverage for pregnant and breastfeeding women with HIV is currently at 84 per cent; with suppression set target for 95 per cent by next year.

 A key objective of the Kenya Aids Strategic Framework (KASF), which is now in its third year of implementation, was to reduce the rate of HIV transmission from mother-to-child to less than five per cent.

During the midterm review, the country achieved a reduction of 2.2 per cent from 10.8 per cent of HIV infections in 2019 to 8.6 per cent in 2022. On mother-to-child transmission, many counties performed dismally; with Siaya being the only county that achieved its target of less than five per cent transmission. Thirteen counties reported a reduction in transmission rates; while 33 were on the red for a high mother-to-child transmission rate. These include Nairobi, Bomet, Embu, Makueni, Nyeri, Kisii, Kilifi and Tana River.

HIV exposure in an infant or child during pregnancy can occur at delivery and during breastfeeding. Mothers living with HIV can give birth to HIV-negative babies. The World Health Organization (WHO)  recommends being effective in HIV treatment while pregnant, an informed and careful choice between vaginal delivery and caesarean section, not breastfeeding and introducing the baby to anti-HIV drugs (infant PEP)  for a few weeks. 

HIV exposure in an infant or child can occur in the uterus, at labour and delivery and through breast milk. Even though HIV can be transmitted from an HIV-positive mother to the baby during pregnancy, delivery and breastfeeding period, being on ART and having an undetectable viral load during pregnancy and throughout breastfeeding significantly lowers the risk of passing HIV.

In Kenya, all HIV-exposed infants must undergo HIV testing within six weeks of birth or at their first healthcare visit. If the initial test is negative, follow-up testing is crucial at six months and again at twelve months to confirm HIV-negative status. 

The UNAIDS report showed that while the technologies and knowledge needed to end the HIV epidemic in children exist, they are not being used to full effect partly because of health system frailties, piecemeal integration, various structural barriers and inadequate linkages with community systems. 

 “Finding, diagnosing and starting these children on antiretroviral therapy is a challenge, but it is surmountable. It can be done through outpatient testing such as vaccination programmes), family-based index testing and screening as part of other child health services, as is occurring in Mozambique, Nigeria, Uganda and other countries. Closer collaboration with community systems can also help connect these missed children with the services they need,” read an excerpt from the report.

On the flip side, the report shows that Kenya has reached the 95-95 target, which requires a country to ensure that those living with HIV know their status and are receiving life-saving antiretroviral treatment. Kenya has the seventh largest HIV burden globally. 

The report comes out at a time when a new HIV drug, lenacapavir, an injectable medicine taken once every six months, has shown in trials to be 100 per cent effective in preventing HIV. 

“We still have 1.3 million new HIV infections per year. We want this 'miracle' prevention drug to reach all those who need it, now - not in 6 years!” said Winnie Byanyima, the Executive Director of UNAIDS.

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