Blow in HIV fight as viral suppression in children remains challenging

Achieving viral load suppression among children still remains a challenge according to health experts. Despite the positive strides made in HIV management in Kenya, children continue to have lower viral load suppression compared to adults living with the virus. Dr Lucy Matu, the director of programmes at Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) told the Standard that a number of reasons lead to this reality. “The biggest challenge with treating children living with HIV lies in keeping them within care, retention and viral suppression,” said Dr Matu. This even as statistics show that only one out of five children who are not on treatment for HIV will survive by the time they are five years. Matu was speaking during the ongoing National HIV Conference 2018 where she noted that most of the children who are yet to be identified living with HIV are because they are being concealed by their parents. “Parents do not want to bring their children for testing because this indirectly means that their status will also be known yet some want to hide and this is mainly because of stigma,” she said. Viral suppression among children on treatment currently stands at 69 per cent which means that about seven out of every ten children on treatment have achieved viral suppression.

 This is lower than suppression among adults which is at about nine out of every ten people on treatment. By the end of 2017, about 105,000 children were living with HIV in Kenya. Out of these 23,000 were yet to be put on treatment. Despite all these, the news is not all that bad because transmission from mother to child has dropped significantly in the past five years. In February this year, Cabinet Secretary for Health, Sicily Kariuki announced that transmission had dropped to just about two out of every fifty children born to parents living with HIV. In 2013, about four children out of fifty were being born with HIV. Dr Matu stated viral load suppression outcomes also differed among children in different age groups. She said, “Those within the age bracket of zero to two years have the least suppression because they mainly depend on caregivers but suppression increases with advance in age because children are able to take charge of their treatment as they continue growing.” The World Health Organisation (WHO) notes that to enable antiretroviral (ARV) prophylaxis to be given to infants as soon as possible after birth, all infants should have their HIV exposure status known at birth. But not all children are tested at birth, nor in the first few months of life mainly due to lack of testing in all pregnant mothers. “As not all mothers are given HIV tests, very few HIV-exposed infants are identified and very few infants are known to be gaining access to early diagnosis, the necessary prerequisite to ‘timely’ initiation of antiretroviral therapy (ART). Currently, only an estimated 15 per cent of HIV-exposed infants needing testing are tested in the first two months of life,” notes WHO.