Elizabeth Chester held up a picture of half a dozen large pills – the daily treatment regimen for a child infected with HIV. She then held up a picture of the child, showing that a child no more than three years old has to do what an adult would have difficulty doing, swallowing down pill after pill and spoon after spoon of bitter-tasting medicine, every day. And that child is one of the lucky few who even have access to HIV treatment, panelists said today at the congressional briefing on the crisis of pediatric and adolescent HIV/AIDS care.
Developing new pediatric formulations is a priority in the global response to pediatric HIV, said Global AIDS Coordinator Dr. Deborah Birx. While adults have had combination drug formulations requiring only 1-2 pills per day for years, children’s drug formulations aren’t as convenient, and as Elizabeth Glaser Pediatric AIDS Foundation Ambassador Martha Cameron explained, doctors in rural parts of Africa still shave down adult pills for children.
“We’re still astounded that in countries where we have over 90 percent prevention of mother-to-child-transmission coverage, there’s a big gap for treatment among children,” Birx said. Of the 3.3 million children living with HIV/AIDS, 2.1 million do not have access to treatment, and children are half as likely as adults to receive treatment, event moderator Lisa Carty of UNAIDS explained, leading to 600 children dying from HIV-related illnesses every day, while an additional 700 become infected daily.
What’s even more alarming is that HIV mortality rates have increased among adolescents while declining among all other age groups over the past decade, panelists said.
Craig McClure of UNICEF said improving HIV service delivery is another priority that must be addressed to achieve an AIDS-free generation. Great strides have been made in immunizing children and delivering services for malaria prevention and treatment, and even in addressing nutrition, but none of that matters if children aren’t getting the HIV treatment they need, he said. “If a child has HIV, he will still get sick,” he said.
Chester, a registered nurse and associate field director for AMPATH, hit that point home by presenting a picture of a child living with HIV who had access to clean water, vaccines, and nutritional support, but still looked very sick before getting access to HIV drugs. After starting antiretroviral therapy, the child looked just like a healthy child should. “HIV drugs are miracle drugs,” she said.
EGPAF CEO Chip Lyons said we’re missing opportunities to link HIV services with other health and development interventions. “We need to make it easy, affordable, and as practical as possible for women to seek care for themselves and their children,” he said.
Building support among communities in Africa and enabling them to care for children affected by HIV is crucial, Cameron said. “We’re missing the opportunity to use the community,” she said. She explained that when she gave birth to her first child in Zambia, her home was full of relatives and neighbors waiting to help her with whatever she needed. “In Africa they’re willing to do anything for children, but it won’t work if they’re not doing the right things,” she said, emphasizing that communities need the proper tools to help families and children, in addition to more trained community health workers.
Birx agreed: “We need support for these families that transcends the biology,” she said, citing psychosocial support as key for supporting mothers and in turn, supporting children. Chester said AMPATH’s mentorship program which partners highly trained community health workers to mentor and not only train mothers but also to offer them economic empowerment programs has been very successful.
Birx said addressing pediatric and adolescent HIV must be a political priority. “We need senior leadership saying this is serious,” she said.
Lyons agreed, saying maintaining robust funding for PEPFAR and other programs is the biggest priority. “The progress we’ve made so far must not be misconstrued as an endpoint success,” he said. “We can succeed if we have multi-year, substantial, robust funding for the next three to five years.”
Read Elizabeth Glaser Pediatric AIDS Foundation CEO Chip Lyon’s open letter to Ambassador Birx here, and the Elizabeth Glazer Pediatric AIDS Foundation blog here. Click here to watch a video on the gaps in addressing pediatric HIV.