Why new infections among children are on the rise
What you need to know:
- Delays to ART initiation could mean high infection rates and death to this young population.
- Also, the high number of undiagnosed and untreated HIV-infected children has led to high mortality rates
- Another problem, he says, emanates from pregnant mothers who deliver at home, thus they can’t get services of qualified health workers, and this increases the chances of transmission during birth.
Despite progress having been made in improving the health outcomes of children living with HIV, Kenya continues to face more challenges in managing paediatric HIV. In what health experts call a public health emergency, the number of new HIV infections among children in the country is on the rise
According to Dr Eliud Mwangi, a public health expert and country director Elizabeth Glaser Paediatric AIDS Foundation, currently, Kenya is recording 5,200 new HIV infections among children every year.
Even worse, a huge percentage of children who have tested positive continue to lag behind in the treatment and suppression cascade compared to other population groups, a gap that is estimated to be slightly above 40 per cent.
“Currently, 41 per cent (33,996) of children living with the virus are not on Antiretroviral therapy (ART) treatment,” he adds.
According to a National AIDS and STI Control Programme (NASCOP) 2021 report, there was a significant drop in ART coverage for children from 76.48 per cent in 2021 to 59.02 per cent in 2022. “We are only able to keep track of 60 per cent of the children on treatment,” explains Dr Mwangi.
Overall, children are performing below the national target of 95 per cent, with those below five years lagging behind in both viral loads done and viral suppression. Further reports indicate that children below two years are performing sub-optimally low in both viral load uptake and suppression. Almost 80 per cent of HIV- positive children are achieving viral suppression, while 12 per cent are not getting it compared to adults who are achieving the 95 per cent suppression rate.
“Delays to ART initiation could mean high infection rates and death to this young population. Also, the high number of undiagnosed and untreated HIV-infected children has led to high mortality rates where a third or up to 35 percent die in the first year of their lives, and 50 per cent in their second birthday,” reveals Dr Mwangi.
He says children’s vulnerability is compounded by their dependence on their caregivers, determining their access to HIV services. “Further, children living with HIV continue to grapple with lack of child-friendly formulations, transition, disclosure, stigma, adherence, and treatment failure among other challenges.”
“The problem could stem out from pregnant mothers who do not go to health facilities during pregnancy, meaning that the HIV infected mothers cannot be identified. The issue of pregnant mothers who go to the hospital late; and mostly after the third trimester, also is a problem considering that one requires at least three months to take ARTs treatment so as to achieve the suppression viral load and prevent mother- to-child transmission.”
Another problem, he says, emanates from pregnant mothers who deliver at home, thus they can’t get services of qualified health workers, and this increases the chances of transmission during birth.
Dr Mwangi also points out the challenge of teen pregnancies as one of the main contributors to high infection rates among children. “Teen pregnant girls face sexual and gender based violence, and high threat to HIV. This is even made worse by stigma, which makes them highly unlikely to adhere to treatment. Due to this, most of them will show up for prenatal care very late, and this exposes the unborn child to HIV if the mother is infected.”
According to Dr Mwangi, there is need to invest more on point of care testing to support early identification and treatment. “Right from the beginning, community workers should ensure that all pregnant mothers receive antenatal care..”
Dr Mwangi says HIV prevention services for children are only available for children between zero to two years, leaving a gap for those between 2-14 years thus putting the child at risk of HIV infection. “For this matter, it is critical to rethink age specific interventions for children aged 2-14 years to avert new HIV infections.”
Dr Mwangi insists on the urgency to address the HIV inequalities for children through early identification, and putting them on child-friendly optimal regimens and strengthening social protection mechanisms to improve their outcomes.