More children are accessing ART, but progress for children lags behind progress for adults In the absence of HIV testing and timely ART initiation, one third of infants living with HIV die before their first birthday, and half die before the age of 2 years.41 Globally, the pace of scale-up of ART for children under 15 years is only half that of adults. For children, an increase in ART access of 14 per cent was registered from 2011 to 2012, compared to an increase of 20 per cent for adults over the same period.42 In low- and middle-income countries, overall ART coverage for children under the age of 15 years has consistently been around half that for adults – 34 per cent compared to 64 per cent for adults in 2012 (see Figure 1.5).43 The CEE/CIS region reports the highest ART coverage for children younger than 15 years: at 85 per cent (80–89 per cent), followed by Latin America and the Caribbean at 67 per cent (50–83 per cent). East Asia and the Pacific reported 53 per cent (41–72 per cent) coverage, whereas South Asia reported 39 per cent (30–49 per cent) coverage. The region with the
FIGURE 1.5 Percentage of adults (aged 15+) and children (aged 0–14) living with HIV receiving antiretroviral therapy in low- and middle-income countries, 2012
64% 34% Adults (aged 15+)
Children (aged 0–14)
Source: Joint United Nations Programme on HIV/AIDS, Global Report: UNAIDS report on the global AIDS epidemic 2013, UNAIDS, Geneva, 2013, pp. A87, A94.
greatest need, Eastern and Southern Africa, reported 40 per cent (35–46 per cent) coverage. The lowest coverage was registered in West and Central Africa, 15 per cent (13–18 per cent), and in the Middle East and North Africa, 7 per cent (4–10 per cent).44 ART coverage for children younger than 15 years in the 22 Global Plan priority countries increased from 29 per cent (500,000 children) in 2011 to 34 per cent (560,000 children) in 2012, but the pace of scale-up across low- and middle-income countries lags behind that of adults.45 Four of the Global Plan priority countries had greater than 50 per cent ART coverage among eligible children – Botswana (>95 per cent), Namibia (88 per cent), South Africa (63 per cent) and Swaziland (54 per cent) – and coverage has doubled in nine other countries in the last three years.46 Other priority countries have very low coverage, and on average, only one in three eligible children have access to ART in the 22 priority countries (see Figure 1.6). A huge effort therefore will be needed to reach the global goal of providing ART to all eligible children by 2015. Providing paediatric ART presents a number of unique and complex challenges. Among them are the limited availability of fixed-dose combinations, poor palatability of currently recommended paediatric drug formulations for infants, and the need to use virological testing to determine HIV infection in children under the age of 18 months. However, new drugs such as granular ’sprinkles‘ and new technologies for performing virological testing at the point of care are expected to help overcome the challenges and may facilitate improved uptake and adherence.
Timely diagnosis of HIV in pregnant women and children is crucial, but coverage of testing varies widely and linkages to treatment and care are still inadequate Significant proportions of pregnant women and children living with HIV remain undiagnosed or, if diagnosed, are not adequately enrolled into care.
11