More than half of children living with HIV still without treatment in high burden, PEPFAR-supported southern African countries

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While a growing number of countries have adopted World Health Organization guidelines recommending antiretroviral treatment for all children with HIV, more than half of children living with the virus in the highest burden countries in sub-Saharan Africa remain untreated, according to a report released today.

The report notes that pediatric HIV treatment coverage nearly doubled between 2012 and 2016 as national policies began to incorporate WHO recommendations to expand pediatric antiretroviral treatment eligibility. Still, data across 20 countries receiving PEPFAR support showed 56 percent of children living with HIV under the age of 15 — an estimated 750,000 children — are not receiving the life-saving treatment that also prevents transmission of the virus.

The report, in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report notes that in addition to greatly reducing death rates among children younger than a year old, early antiretroviral treatment supports growth, neurological development, and long-term care outcomes for older children.

WHO guidelines, which in 2012 recommended antiretroviral treatment for all children with HIV under a year old, have reflected a growing body of knowledge about the benefits of early treatment over the years since. In 2013, the agency recommended that all children with HIV under the age of five receive antiretroviral treatment, a recommendation that was adopted by 30 percent of the countries covered in the report* within that year, and 80 percent by the following year. By 2015, all of the countries had adopted the under-five guidelines, but by then the benefits of immediate treatment upon HIV diagnosis for all ages was demonstrated by the START study. WHO adjusted its guidelines accordingly, and by the end of 2016, 65 percent of the countries covered in the report reflected that guidance in national policies establishing antiretroviral treatment eligibility for all children under 15 living with the virus.

CDC researchers used UNAIDS data to examine the impacts of the policies on actual pediatric treatment coverage, and found it ranged from about 5 percent of children with HIV receiving treatment in South Sudan, to 66 percent in Namibia. In 11 of 18 countries with data available, fewer than half of children living with the virus were receiving treatment in 2016.

The authors note that the findings show that increased case-finding, same-day care-linkage and community-based treatment retention, adherence, and tracking of pediatric patients must accompany prompt adoption of guidelines to improve treatment coverage and outcomes for children with HIV.

*The report covers data and policies from: Angola, Botswana, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe.

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