More than half of the children living with HIV failing to access ARVs

MORE than half of the children living with HIV and Aids are failing to access anti-retroviral drugs despite the pediatric formulations being available, senior health officials have said.

About 150 000 children between the ages of 0 and 14 years are HIV-positive and of these, nearly 89 000 who are in need of the drugs are failing to access them.
National Prevention of Mother to Child Transmission and Pediatric HIV Care and Treatment Co-ordinator in the Ministry of Health and Child Welfare Dr Angela Mushavi said only 45 percent of HIV-positive children in need of the drugs were on ARVs.


Dr Mushavi was speaking on the sidelines of a capacity building workshop for journalists reporting on pediatric infections organised by the Elizabeth Glaser Pediatric Aids Foundation.
"Uptake is still very low. We are not putting enough numbers of children on ARVs," Dr Mushavi said.

She attributed the low uptake to inadequate officials initiating anti-retroviral therapy and the centralisation of laboratories, among other reasons.
In Zimbabwe, a special test, which detects the presence of the virus in children is only done in Harare at the National Microbiology Reference Laboratory and initiation of ARVs is only done by doctors.

Dr Mushavi said Government was in the process of decentralising and was looking forward to opening laboratories in Bulawayo and Mutare.
"When we started in 2007, there were few samples and it was okay to operate with just one laboratory, but now more and more samples are coming in.
"More than 1 000 sites countrywide are sending samples to the laboratory hence the long waiting periods before results are sent back to their site."
It takes about a month for the laboratory to send back results to their original site.

Dr Mushavi said the machine for the Bulawayo laboratory has already been bought and renovations were almost complete.
"We expect that the Bulawayo laboratory will start functioning before the end of this year," she said.
She said Government was yet to buy the machine for the Mutare laboratory, but had already identified where it will be installed.

Dr Mushavi said Government had since trained nurses throughout the country to initiate ART.
"We know that there are few doctors in the country and training nurses to initiate the ART will go a long way in increasing uptake of children on ARVs.
"We have already trained these cadres and hopefully they will soon start initiating treatment in children."

She said they were waiting for the Nurses Council of Zimbabwe to revise the scope of practice for the cadres before they start initiating ARVs.
Dr Mushavi said there was need to train more doctors to be confident in initiating the drugs as most of them were not comfortable and prefer initiation to be done by pediatricians.

For a child to be on the ART, a pediatrician at Harare Hospital, Dr Hilda Mujuru, said HIV-positive children were categorised into two groups, one below the age of two years and the other between two and 14 years.

She said as soon as they know that a child below two years was HIV-positive, they were immediately commenced on cotrimoxazole, an antibiotic responsible for fighting infections.

She said the child was then registered in the hospital book and given an appointment to see the doctor.
"While they are waiting for their appointment date, parents or guardians of the children are counselled to understand their child's condition and tests including tuberculosis, liver function, full blood count are done."

Dr Mujuru said at Harare Hospital, the waiting period to see the doctor might take about a day or a week depending on the condition of the child.
She said if the child did not have TB and was below two years, he or she was immediately put on ART, but if the child had TB he or she was put on TB treatment first.
TB treatment takes two weeks.

"If they have TB, we refer them to either Wilkins or Beatrice Road Infectious Diseases Hospitals for TB treatment," she said.
However, if a child is between two and four years, unlike in adults their CD4 Count is measured in percentages and if it is below 20 percent they are put on ART.
"But for children above five years, they are initiated on ART at the same CD4 Count as adults, which is 350 and below," she said.

This process takes an average of a month if it is done at Harare Hospital, but more if it is done from a provincial or district hospital.
Another health official, Dr Tichaona Nyamundaya, said transport problems at health institutions to send samples to the Harare laboratory were contributing to delays in putting children on ART.

Dr Nyamundaya, a technical officer for programme implementation with Elizabeth Glaser Pediatric Aids Foundation, said some health institutions, especially in rural areas, take an average of two weeks before samples were sent to the laboratory because of transport problems.
According to the new World Health Organisation guidelines on treatment of HIV in children, once an infant below two years of age has been diagnosed of HIV, they should immediately be put on ARVs despite their CD4 Count.

However, in adults, ARVs are prescribed once one's CD4 Count has reached 350 and below.
"In children, HIV multiplies very fast because their immune system is not yet strong compared to adults hence infants who are exposed to HIV should immediately be put on treatment regardless of their CD4 Count," Dr Nyamundaya said.

EGPAF is the major partner of the Ministry of Health and Child Welfare in the Prevention of Mother to Child Transmission programme supporting 60 of the 62 districts in the country.

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