Eliminating pediatric HIV and AIDS was high on the agenda on the first day of the sixth International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment, and Prevention in Rome.
Even before delegates had been officially welcomed during the evening’s opening session, my colleagues and I had already attended four satellite sessions focused on the issue of HIV and children.
My organization, the Elizabeth Glaser Pediatric AIDS Foundation, kicked things off with a morning session on the role of community in preventing new HIV infections in infants and children, and keeping their mothers healthy. The Foundation was joined by representatives from CARE, the Regional Psychosocial Support Initiative (REPSSI), the Global Fund, and the London School of Hygiene and Tropical Medicine (LSHTM) in a panel discussion.
The goal of the discussion was to bring together researchers and program implementers to find ways to measure the success of community engagement activities. Ultimately, programs like these can substantially increase success rates to prevent mother-to-child transmission of HIV (PMTCT) and to treat HIV/AIDS.
The discussion was moderated by Dr. Anja Giphart, the Foundation’s Vice President of Program Implementation, and by Linda Richter, from the Global Fund and the Human Sciences Research Council in South Africa. The panel highlighted successful approaches, including the following:
- Using community-based counselors for HIV-positive mothers undergoing PMTCT
- Training traditional birth attendants to help identify infants who have been exposed to HIV
- Integrating community-based psychosocial counseling and support into PMTCT services
- Collaborating with local post offices and community health care workers to identify TB patients who have been lost to follow up
Two representatives from LSHTM presented reviews of the scientific literature and studies on the effectiveness of community-based approaches. They concluded that there is enough evidence to show that community involvement in HIV prevention and treatment is effective, but what’s needed now is implementation science and the processes to put them into practice.
While it’s important to learn from successful examples, they also stressed that these should not be replicated for every situation or country. It’s important to identify challenges to each individual program, and to adapt successful processes to come up with interventions tailored to the situation and local context. There’s no “one-size-fits-all” solution.
An afternoon session looked at the challenges in developing and purchasing new pediatric formulations for antiretroviral drugs. It was sponsored by IAS and its Industry Liaison Forum, UNICEF, WHO, and the Clinton Health Access Initiative (CHAI), and discussed the fact that drugs available for adults are often not suitable for infants and children. The session looked at the challenges to developing child-appropriate formulations, including:
- Developing more pediatric ARVs and making the ones we do have more accessible to children. For example, small children can’t swallow pills, so they need liquids or similarly easy drug formulations to take.
- Overcoming market barriers that prevent the production and purchase of pediatric ARVs. The population of HIV-positive children is much smaller than the adult population, which means there is less opportunity to innovate and less purchasing power to drive down costs.
The panel discussed how to incentivize the production of pediatric drugs for this relatively small patient population, and how to simplify the purchase of drugs for countries that need them.
A third session covered the operation and implementation challenges to scaling up PMTCT, and was also sponsored by IAS’s Industry Liaison Forum. It featured examples of both successes and roadblocks to universal PMTCT access from Zimbabwe and Uganda. Dr. Angela Mushavi, the PMTCT coordinator for Zimbabwe’s ministry of health, spoke about her country’s experience, which has included a longtime partnership with the Elizabeth Glaser Pediatric AIDS Foundation.
Dr. Mushavi detailed Zimbabwe’s decade-long history with PMTCT and maternal health in the context of HIV, and discussed what will be necessary to reach its goal – the virtual elimination of new pediatric HIV infections by 2015.
Among Zimbabwe’s successes:
- Very high PMTCT coverage within health facilities
- Rapidly improving delivery of HIV testing and ARVs to both mothers and infants for PMTCT
- Scaling up of Early Infant Diagnosis of HIV
- Deploying “Point of Care” CD4 machines that can measure pregnant women’s CD4 counts on site, and be used by nurses and other trained health care workers
Some of Zimbabwe’s challenges:
- Improving quality and coverage of PMTCT services
- Increasing community mobilization and generating knowledge and demand for services
- Improving male participation
- Combating persistent stigma and discrimination
- Difficulty in tracking mother-infant pairs after they first receive PMTCT services
“Do we give up,” Dr. Mushavi asked, acknowledging the remaining challenges. Her answer: “A most emphatic no.” She stressed the need to better understand the challenges, and design country and community-specific innovative and creative solutions.
One of the last sessions of the day focused on measuring the effectiveness of national PMTCT programs to reach the goal of the elimination of pediatric AIDS. This discussion was sponsored by WHO and the U.S. Centers for Disease Control and Prevention (CDC), and included the experiences of Mozambique, Swaziland, Kenya, Rwanda, and South Africa.
Like Zimbabwe, each country has its successes and challenges, some shared and others unique. But all countries are striving for the goal of universal access to PMTCT services. In a national survey in South Africa in June, results showed that the rate of mother-to-child transmission of HIV had been reduced to an average of 3.5 percent, approaching the rate found in high-resourced countries.
While the rate varied within the country, South Africa’s Department of Health wants to reduce it in all regions to far less than 2%, and is working with the various provinces to develop an action framework for eliminating pediatric AIDS.
These new numbers show that the momentum is there, and the goal is achievable.
By the end of the day, I had noticed another example of momentum through numbers.
Even though not everyone had arrived in Rome for the conference, all of these sessions were packed with attendees, with few seats available. This shows that more and more people are aware of the unique issues surrounding pediatric HIV and AIDS, and the need for stepping up the political, financial, and research commitment to create a generation born free of HIV.
“It is morally wrong that babies are still being born with HIV when we know how to prevent it,” Michel Sidibe, the Executive Director of UNAIDS, told IAS delegates at the evening’s welcome and opening session.
We couldn’t agree more.
Robert Yule is the Foundation’s Senior Media Relations Manager in Washington, D.C., and is blogging this week from the IAS 2011 conference in Rome.