Declining antiretroviral therapy uptake among children raises concerns
What you need to know:
- In 2021, 2.73 million children aged 0-15 years globally were HIV positive.
- In Kenya, 100,000 children were living with HIV, translating to about 10 per cent of the population.
- Currently, there are 75,000 children aged 0-14 living with HIV in the country.
The number of Kenyan children under 15 on lifesaving antiretroviral therapy (ART) has declined over the past three years, painting a bleak picture of prospects of achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 95 per cent viral suppression.
The latest UNAIDS report on HIV epidemiology and response shows that the rate of children on treatment has dropped by six per cent, from 86 per cent in 2021 to 80 per cent in 2023.
The decline is attributed to late diagnosis, which leads to delayed treatment of HIV infection, as well as ineffective interventions and support for patients. The majority of paediatric infections are transmitted from mother to child due to high viral loads caused by new maternal infection and poor adherence to ART or lack of it during pregnancy and breastfeeding in chronically infected women.
"AIDS used to be seen mainly as a problem of late diagnosis and treatment of HIV infection. These concerns remain, but AIDS is now most common among people who have received antiretroviral therapy and then stopped treatment. This puts their health at risk, increases the risk of HIV transmission and adds to the burden on health systems," the report reads in part.
Globally, 48 per cent of children living with HIV had a suppressed HIV viral load, equivalent to 93 per cent on treatment, against a target of 75 per cent by 2023.
"Children aged 0-14 years living with HIV remain significantly less likely than adults to be diagnosed and to receive antiretroviral therapy. About 43 per cent of the global total of 1.4 million children living with HIV were not receiving treatment in 2023. Children accounted for 12 per cent of all AIDS-related deaths, although they represent only three per cent of people living with HIV," added the report.
According to Dr Ibrahim Osman, a private paediatrician in Kisumu, non-adherence to antiretroviral therapy among children remains a major challenge in HIV/AIDS care and treatment because they are still largely dependent on their caregivers to take their medication.
"Without proper adherence to ART, children face greater risks such as viral resistance to available drugs, treatment failure, immunological decline leading to opportunistic infections, and HIV disease progression," said Dr Osman.
Meanwhile, the number of new infections among the target group in Kenya is projected to decline by 37.7 per cent over the period, from 6,100 in 2021 to 3,800 in 2023, due to increased access to prevention of mother-to-child transmission (PMTCT) services and more pregnant women living with HIV receiving lifelong antiretroviral treatment.
Despite progress in the fight against HIV in children, paediatric HIV remains a global public health concern as children living with HIV have a higher risk of mortality and morbidity than adults living with HIV.
In 2021, 2.73 million children aged 0-15 years globally were HIV positive. In Kenya, 100,000 children were living with HIV, translating to about 10 per cent of the population. Currently, there are 75,000 children aged 0-14 living with HIV in the country.
To address these challenges, Kenya will implement a four-point action plan over the next three years, focusing on addressing the vulnerabilities and inequalities that perpetuate new infections, addressing bottlenecks in the diagnostic system, renewing partnerships and aligning resources with country priorities, and prioritising data and information systems for a comprehensive response.
Kenya has also implemented a HIV testing and treatment strategy to prevent mother-to-child transmission of HIV, whereby infants born to HIV-positive mothers should receive preventive ART within 72 hours of birth and undergo polymerase chain reaction testing within two weeks. Infants who test positive should continue on ART, while those who test negative should continue on infant ARV prophylaxis and be monitored. Confirmatory PCR testing should be performed at the time of ART initiation.
Kenya is also one of the signatories to the Dar es Salaam Declaration, a commitment by 12 high-burden African countries to end childhood AIDS by 2030, because all childhood HIV infections are preventable and no child should die of AIDS.
