Impact on children: paediatric testing and treatment
Paediatric Testing and Treatment
About 260 children are born HIV positive every day in South Africa and most die before their second birthday. This has made HIV and AIDS the biggest killer of children under five in the country. The high mortality rate stems partly from the fact that until lately, children’s HIV status was rarely diagnosed at an early age (ideally, six weeks), and subsequently, not treated – despite the increasing availability of life-prolonging ARVs that would have helped them survive and lead a relatively healthy life.
AIDS is the main cause of death, accounting for 40% of child mortality in the country. Health workers need to be trained on how to treat infants and children with ARVs.
District institutions, including hospitals and clinics can learn in relative short time how to improve efficiency and effectiveness in delivering essential services, while at community level, grandmothers need to learn quickly how to manage the awesome daily regime of medicines that many children infected and orphaned by AIDS must follow once diagnosed, in order to survive.
Early diagnosis and treatment of HIV-exposed infants
Current HIV testing capacity in South Africa, based on the polymerase chain reaction (PCR) method, is at 30,000 tests (10 per cent of the 300,000 HIV exposed children born every year).
This recent technical innovation has made testing of infants practical – and easier. The dried blood spot (DBS) polymerase chain reaction (PCR) method, instead of liquid blood PCR, allows specimens to be easily collected via a simple heel prick, and more importantly, to be done and stored in rural settings.
In 2005, UNICEF supported both PCR testing and innovative methods of increasing the number of children receiving ARVs. PCR capacity has improved and 13,000 children are receiving ARVs but many more remain untreated.
UNICEF worked to strengthen outreach and down referral services at three paediatric HIV clinic sites in Gauteng Province operated by the University of the Witwatersrand, and at three central hospital units, to improve their systems and share information in district based collaborations. UNICEF supported the purchase of equipment, hiring of additional technical staff to increase laboratory capacity to perform PCR tests and the addition of pharmacists to the paediatric treatment team to improve the pharmaceutical component of the outreach services to children.
Both PCR testing and paediatric treatment will remain key aspects of our response in the new country programme, 2007 - 2011.
ART outreach at Coronation Clinic improves life for Baby Tshepiso*
It’s a sophisticated scientific environment, Coronation Clinic is, but that doesn’t stop children from being children while there.
Squeals of laughter mixed with screams and tears filter up through the quiet and humming of the big machines. But the sound of children puts a smile on the faces of the visitors heading down the stairs to see the little ARV outpatients.
Baby Tshepiso waddles over and grasps the knees of one visitor while her friends, each armed with a teddy bear, doll or mug of juice watch. With her irresistible smile, it’s not long before she is picked up by the UNICEF Goodwill Ambassador.
She perches sullenly on his knee, but is quickly joined by another child who climbs up on to the other knee. Soon, the entire room of some 30 young children, the clinic’s patient quota for one month, huddles around under the watchful eye of Matron.
“She is feeling good today”, says matron, pointing to Baby Tshepiso, another child resting comfortably in her arms. Matron knows and fusses over every one of the children and their mothers who regularly come to spend a day at the clinic for diagnosis and ART treatment.
Matron closely monitors their condition in response to the drugs. Baby Tshepiso is reacting well today.
Coronation Clinic tests from 120 – 150 infants per month on site. Yet, given the prevalence rate of HIV infection in the country, 29.7% according to the most recent ante natal survey figures form the national Department of Health, that’s just a drop in the bucket when the overall need is considered.
Too few children are accessing ARV treatment. Some 37,000 children urgently require the life saving medicine and do not have access to treatment. But there is hope.
Under a landmark government plan of action, some 13,000 children are receiving treatment at virus ART sites around the country. Coronation is doing its part, having treated over 550 infants since April 2004. And the dedicated staff there has also treated some 100 other children up to 14 years old.
“Unfortunately, not enough children can come here,” says Matron. The clinic, a small but state-of-the-art facility, is located at one of the few women’s and children’s hospitals in the country and runs one of the best Prevention of Mother to Child Transmission (PMCT) programmes, including ARVs for pregnant women.
According to HIV experts, it is also one of only a few sites that does infant diagnostic testing for HIV and has the second largest anti retroviral treatment (ARV) rollout for infants in the province of Gauteng.
While UNICEF supports the research conducted by the Wits Paediatric Working Group on HIV at Coronation Clinic, more early diagnostic testing and treatment and down referral clinic sites are still desperately needed for South African children.
* name changed