A concerning reality has emerged from recent estimates. Approximately one in three of the 157,000 children living with HIV in South Africa are not accessing the antiretroviral therapy (ART) they desperately need to maintain their health. This situation highlights the critical importance of improving child HIV treatment. This stark figure, highlighted by Thembisa, the leading mathematical model of HIV in the nation, underscores an urgent need to bolster paediatric HIV care.
Stark Disparities in Child HIV Treatment
While South Africa has made commendable strides in its overall HIV response, children under 15 are notably lagging. Current data indicate that only 65% of children with HIV are on treatment, which is 13 percentage points lower than the 78% coverage for all individuals living with the virus. This disparity extends across the entire HIV care cascade, from diagnosis (85.5% for children versus 95% overall) to treatment initiation among the diagnosed (76% for children versus 81% overall) and viral suppression among those on treatment (77% for children versus 92% overall). Provincial variations further complicate the picture. Regions like the Western and Northern Cape report over 70% treatment coverage for children, while seven other provinces fall below 60%.
Data Dilemmas and Nuances
Experts caution that interpreting these figures requires a nuanced understanding. Dr Leigh Johnson from the University of Cape Town points out the inherent uncertainties in paediatric HIV data, which is less consistent than adult data. This uncertainty impacts the denominator used to calculate ART coverage. Furthermore, lower cross-sectional treatment coverage in children doesn't necessarily mean poorer treatment initiation or retention rates. Children, having lived with HIV for a shorter duration on average than adults, have had less time to be diagnosed and initiated on treatment. However, proxy measures suggest that ART initiation rates might indeed be lower in children. This is a worrying trend given the aggressive nature of HIV in young bodies.
Vulnerability of Young Immune Systems
HIV progresses much faster and more severely in children due to their immature immune systems. Early diagnosis and immediate commencement of ART are therefore paramount to prevent severe illness and long-term organ damage.
Progress Made, Yet Challenges Persist
Despite these challenges, South Africa has seen a remarkable 97% reduction in HIV/AIDS-related deaths in children between 2005 and 2024. This success is mainly due to successful prevention of mother-to-child transmission (PMTCT) programmes and earlier infant diagnosis. However, progress in diagnosing and treating children has recently stagnated. Diagnosis rates hover around 85-86%, and treatment coverage is at 65%.
Key hurdles include missed opportunities for testing older children, as current systems heavily focus on infants. For those diagnosed, maintaining treatment adherence is a significant challenge. Children rely on caregivers, who may face difficulties due to movement, stigma, or lack of support.
Innovations and Support Offer Hope
The introduction of palatable, child-friendly formulations of dolutegravir is hailed as a breakthrough, expected to improve viral suppression rates significantly. However, ensuring consistent access and adherence remains critical. Experts advocate for family-centred care, integrating maternal and child HIV services, and bolstering psychosocial support for caregivers. Community health workers can play a vital role in home-based support.
Unfortunately, recent cuts to international research funding threaten the promise of innovations like long-acting injectable treatments, which could ease the daily burden of medication. This development underscores the need for South Africa to cultivate sustainable, local funding for its crucial HIV research endeavours.
The path forward requires a multi-pronged approach: strengthening testing strategies for all children, improving linkage to care, providing comprehensive support for families, and ensuring continued access to the latest effective treatments. Addressing the treatment gap for children living with HIV is not just a statistic. It's a moral imperative to secure a healthier future for South Africa's youngest generation.