Paediatric care and treatment
© UNICEF Cambodia/Nicolas Axelrod
HIV is especially aggressive and harmful to children, leaving babies born with the virus to face an uphill battle at the earliest and most fragile stage of their lives. Lack of early treatment and care for HIV-affected infants damages their defence system, making them more prone to pneumonia, malnourishment and other childhood illnesses. Worldwide, an estimated 50 per cent of all infants who acquire HIV from their mothers die before their second birthday.
In Cambodia, roughly 250 infants were born with HIV in 2010, according to government data. However, Cambodia’s challenged public health system and fragmented HIV and AIDS response means that many HIV exposed babies (estimated at 2,000 per year) do not receive the care and treatment they need, reducing their quality of life and, in too many cases, resulting in death, whether HIV infected or not. Furthermore, by the end of 2009, it was estimated that only 68.2 per cent of children (3,638 children) with advanced HIV infection were receiving antiretroviral treatment in comparison to 95.8 per cent of adults. Although this increased to 4,102 children by the end of 2010, children are still lagging behind. Meanwhile, early infant diagnosis testing covers only 40 per cent of HIV exposed infants, with these tests often conducted too late – averaging at five months of age, rather than the required six weeks after birth. Out of 100 infants who tested positive for HIV since 2007, only 33 were alive and on antiretroviral treatment by September 2009, according to a UNICEF-supported government study. Special attention also needs to be paid to assisting adolescents on treatment to transition safely to adulthood and adult care.
UNICEF works with government health agencies to build a safe and supportive environment for HIV-infected children and adolescents that limits the virus’ heavy toll on their lives through access to antiretroviral therapy and improved health care.
What we do
- Assist the government to adopt at scale the newly updated national paediatric antiretroviral therapy guidelines, which promote more effective antiretroviral regimens for children, in accordance with the new World Health Organization recommendations. This will be achieved through training, mentoring and supervision and on-the-job support, and the strengthening of data monitoring systems.
- Support the government to expand the coverage and quality of opportunistic treatment and antiretroviral therapy and other care for children with earlier initiation of treatment,including care for severely malnourished children and childrenliving with HIV. This will be achieved by:
• Strengthening the national programme for screening and treating severely malnourished children, through establishing a better system for staff training and supervision and the refurbishment of paediatric care facilities.
• Developing, printing and disseminating educational materials for use by health care workers and caregivers at home and in health facilities.
• Maintaining support to the expansion of the Ministry of Health’s Early Infant Diagnosis system and the early provision of antiretroviral therapy for confirmed HIV-infected infants.
• Intensifying efforts to improve the quality of care and adherence to treatment for children, especially infants and adolescents, which will help to address the increasing treatment failures and reduce the need for second line treatment.
More infants and children infected by HIV are receiving critical antiretroviral therapy and other relevant care and treatment to help them combat HIV-related disease and infection. By the end of 2010, paediatric HIV care was available at 32 public health facilities providing 4,102 children under the age of 15 with ART and 1,734 children with pre-ART care. Sixty per cent of these facilities were supported by UNICEF. Moreover, a concerted effort to revive paediatric health care as a whole, through strengthened paediatric antiretroviral therapy services has led to the establishment of four new paediatric care sites in 2009 and 2010 with ward and outpatient facilities that focus on HIV-affected infants, but benefit all children with improved palliative, curative and severe malnourishment treatment services. Refresher training courses and on-the-job support for health care providers in early infant diagnosis and treatment and improved quality assurance measures have also ensured that an increasing number of HIV-affected babies receive proper medical attention and treatment as early as possible.