BOX 3
Child-friendly medicines Of the 1.8 million children under the age of 15 who are living with HIV, only half are on ART.58 One persistent problem is that many children remain undiagnosed. Another challenge is that far fewer ART options are safe, tolerable and acceptable for children. For example, only 10 of the 29 antiretroviral medicines approved for use in adults have also been approved for use in children under 2 years old.59 This may be one reason why about 40 per cent of the children on ART globally are on a regimen that is ‘suboptimal’, or low quality in terms of effectiveness, pill burden (number of pills in a regimen) and side effects.60 Finding solutions has been hampered by a lack of research on dosing levels for children.61 Additionally, few generic versions of child-friendly ARVs have been developed, making some existing regimens expensive and often unaffordable.62 Treatment parity with adults is likely to be a long way off. However, recent developments offer hope for the future. In its latest treatment guidelines, released in 2015, WHO added new alternative regimens for children, thereby expanding options in countries that rely on the agency’s guidance.63 Also in 2015, the United States Food and Drug Administration approved a new paediatric formulation of the ARV ritonavir-boosted lopinavir (LPV/r) that can be mixed into a young child’s food; the drug is available as a generic formulation affordable for most countries. Efforts are also underway to provide more, and better, fixed-dose ART combinations for children. One, the Pediatric HIV Treatment Initiative, is a collaborative partnership that works to improve access.64 Another, the Medicines Patent Pool (MPP), negotiates to reduce the cost of patented drugs. For example, in February 2015, MPP reached an agreement with the manufacturer to license the firm’s paediatric formulation of the ARV raltegravir in combination HIV treatment regimens.65
FIGURE 2.10
Routine immunizations provide entry points for early HIV detection
Percentage of infants receiving DPT1 and DPT3 immunizations and HIV testing within two months of birth in selected countries, 2015 DPT1 100% 97%
94%
Early infant diagnosis
93% 88%
92%
80%
Coverage
DPT3
99%
76%
97%
97%
89%
97%
89%
95%
90%
94%
>95%
81% 78%
74%
60%
44% 40% 30%
33%
37%
20%
20% 9% 0%
2% Burundi
3% Chad
Nigeria
Malawi
Ghana
Uganda
Zambia
Kenya
South Africa
Source: DPT1 and DPT3 data are from WHO-UNICEF 2015 Vaccine-preventable Diseases Estimates (June 2016); EID data are based on UNAIDS/UNICEF/WHO Global AIDS Response Reporting and UNAIDS 2016 estimates.
For Every Child, End AIDS | 25