It was a dissonant note in an otherwise largely congratulatory event. The setting was a public discussion this week of the Institute of Medicine’s report on the President’s Emergency Plan For AIDS Relief, and as report committee chair Robert Black had pointed out that morning, PEPFAR has proven that health services can be delivered on a large scale in high burden, low resource countries.
And yet, a Zambian physician pointed out later, while more than 58 percent of adults who need live-saving treatment for HIV are getting it, thanks to PEPFAR, only 28 percent of children living with HIV are receiving the treatment they need. The physician, Dr. Chewe Luo, a pediatrician specializing in tropical child health, raised the point during an afternoon discussion about services and programs for children and adolescents.
It was a deficiency that had been noted in the IOM evaluation, which said: “coverage of pediatric HIV care and treatment remains proportionally much lower than coverage for adults despite the goal in the reauthorization legislation to provide care and treatment services in partner countries to children in proportion to their percentage within the HIV-positive population.”
One reason for that shortfall, an audience member pointed out, is that out of the 10 percent of PEPFAR funding that is set aside for programs to reach orphans and other children considered more “vulnerable” than others, funding for pediatric HIV treatment was removed from those programs several years ago. The program areas continue to include food and nutrition support, shelter and care, health care, psychosocial support, education and vocational training.
A number of developments went into removing the treatment funding, a representative from the U.S. Office of the Global AIDS Coordinator said, including that UNITAID, an international initiative to provide drugs for HIV, malaria and tuberculosis began increasing its efforts to provide treatment for children.
With UNITAID moving away from that role, however, another audience member noted, even bigger gaps in treatment for children, could be on the way. He pointed to reports of pills intended for adults being shaved down so that children could take them.
OGAC staffers responded that the office is working with other organizations to increase treatment access for children and soon will release new guidelines which will align pediatric treatment with adult treatment.
In the meantime, Dr. Luo said she was surprised to see that only 4 percent of the PEPFAR budget is going toward pediatric treatment. “As a pediatrician, I always say we shouldn’t care about cost when it comes to children,” she said.
Dr. Luo also pointed out that the evaluation recommends children living with HIV must be identified very early, as 30 percent of children infected with HIV, but left untreated, die within one year after birth, and 50 percent die by age two. And, she noted, while treatment to prevent mother to child transmission has been successful, only 30 percent of pregnant women living with HIV are on antiretroviral treatment for protection of their own health.
The IOM’s evaluation praises PEPFAR’s work in nonmedical care for orphans and vulnerable children and adolescents affected by HIV.