By Sharon Atieno
Though Kenya has made much progress in the HIV care cascade across populations, children and adolescents are still lagging behind.
Dr. Caren Mburu, Elizabeth Glaser Pediatric AIDS Foundation said during a Media for Environment, Science, Health and Agriculture (MESHA) café on pediatric and adolescent HIV and AIDS in Nairobi, Kenya.
Currently, there are 68,000 children (0-14 years) and 88, 853 adolescents (10-19 years) living with HIV, According to the Kenya HIV Estimates 2023.
While there are 95% of adults (aged 15 years and above) on antiretroviral therapy (ART), only 85% of children (0-14 years) are on the same.
Worse still, while 90% of adults (aged 15 years and above) have achieved viral load suppression, only seven out of ten children (about 74%) have achieved this milestone.
Dr. Mburu noted that the country needs to make more effort for positive outcomes in pediatric HIV. This includes addressing missed opportunities in preventing mother-to-child transmission of the virus.
In 2022, some of the causes of new HIV infections among children involved mothers not receiving ART during pregnancy or breastfeeding, mothers stopping ART during pregnancy or breastfeeding, mothers acquiring HIV during pregnancy or breastfeeding and mothers not achieving viral load suppression.
She also observed that drug regimens were posing a tremendous challenge. This is because there is poor availability of suitable dosage forms for children and slow progress with the simplification of treatments. Also, while child-friendly formulations are expensive to make and take long to be accessible, there is inadequate knowledge on dosage and safety among children.
Besides, there are also socio-structural challenges that are making children lag behind in terms of HIV care, Dr. Mburu said.
These include orphanhood which leaves children in the hands of relatives who might not care about the child’s welfare, food insecurity and malnutrition whereby lack of access to nutritional food is driving a quarter of AIDS-related deaths among children, and poor access to health facilities and services where some facilities are not properly equipped with human personnel and commodities while some are also located in very far places.
The widening gap in HIV funding for low- and middle-income countries is also a huge burden. A country like Kenya which has upgraded to the lower middle income cadre can no longer benefit from as much international funding as it used to while in the lower income category. This means that domestic funding has to increase to fill the funding gap left.
“Focused evidence-based interventions, treatments and investments are required for the HIV response towards the elimination of mother-to-child transmission of HIV (eMTCT), and elimination of AIDS in children and adolescents,” Dr. Mburu said.
With stigma, non-disclosure to partners and discrimination contributing to poor retention in care and interruption to ART, she observed that prioritizing stigma and discrimination reduction is crucial. This involves community sensitization and multisectoral engagement.
Dr. Mburu also noted that people-centered approaches and strategic partnerships are key to achieving end AIDS targets in children at both national and international levels. While UNAIDS targets to end AIDS in children by 2030, Kenya’s target is for 2027.