Doctors ask govt to boost ARV access for HIV-positive kids

As South Africa rolls out anti-AIDS drugs to a growing number of people living with the disease, the number of HIV-positive children on treatment remains disturbingly low. Now a group of South African paediatricians have begun lobbying the government to place more children on antiretroviral (ARV) medication, and are also hoping to work with government to find a faster and more effective way of treating children living with HIV/AIDS. Health Minister Manto Tshabalala-Msimang last week raised concerns about the toxic side effects of ARVs, and the lack of information on the number of people who had died or voluntarily left treatment programmes because of side effects. But findings from a recent study conducted by the Wits Paediatric HIV Unit at the Chris Hani Baragwanath hospital in Soweto have demonstrated the efficacy of the life-prolonging medicines. Monitoring 262 of the over 500 children on treatment, researchers found that although 6.9 percent of the children had died while on treatment, not one of the deaths could be attributed to the ARVs they were taking. Between 30,000 and 45,000 HIV positive children in South Africa need the drugs, but only about 3,000 are currently estimated to be receiving them. Earlier this year doctors from the Wits Paediatric HIV Unit sent a letter to the health department, calling for more children to be tested and placed on treatment, as well as better treatment literacy efforts among health workers. Three months later the group has yet to receive a response. Dr Brian Eley from the Red Cross Children's Hospital in Cape Town, one of the paediatricians who signed the letter, said so far there had been little direct collaboration between the department of health and the country's paediatricians. Ministers and doctors should jointly discuss how to best train healthcare workers, and set national, provincial and local ARV treatment targets. "We need to get the dialogue going ... Willingness to work together is essential [to implementing a successful children's ARV programme]," he added. Unlike adults, children had been marginalised and could not protest that government had failed to make specific policy recommendations for paediatric ARV treatment, Eley told PlusNews. When the health department set the target of enrolling 53,000 people on ARV treatment by March 2005, it did not specify numbers for children, he noted. The government has estimated that about 42,000 HIV-positive people are currently taking the drugs. The group of paediatricians sent the letter "in the hope that government will make children a priority," explained Dr Tammy Meyers, a paediatrician at Chris Hani Baragwanath hospital, because in most clinics and hospitals, "children are the last to be taken care of". Paediatric HIV-care has not been integrated into primary level healthcare in South Africa. Healthcare workers were also bearing the brunt of neglect by policy-makers, as many doctors and nurses lacked technical and clinical expertise in the treatment of children on ARVs. The severe lack of clinic space, staff and resources were further barriers. With the development of the disease in youngsters being more complex, and monitoring drug adherence more difficult, "we often find staff resistant to treating HIV-positive children", Eley pointed out. There was also a tremendous gap in researching how children's bodies reacted to ARV treatment, and a lack of appropriate and affordable drug formulations for children. Not only government, but also the pharmaceutical industry needed to be lobbied, he noted. According to the paediatricians, few hospitals and clinics have been accredited for paediatric treatment, and how many sites the government had actually accredited remained unclear. In addition, not enough children were being tested for HIV, so the group was advocating for greater use of Polymerase Chain Reaction (PCR) tests, which provide accurate test results for children younger than 18 months. "Early diagnosis would make a big and positive difference to care," Eley stressed. PCR tests are expensive and not widely available; Meyers admitted that they were only available at the country's main health centres and, at R180-R200 (US $30-$33) per test, were used sparingly. "PCR is [part of government] policy but it is not [widely] implemented." The issues around paediatric ARV treatment are not specific to South Africa. "Most of the problems that we have in South Africa are the same for the whole of Africa," Eley commented. Eley is part of the African Network for the Care of Children Affected by HIV/AIDS (ANECCA), a recently established group of child health practitioners from 14 African countries that advocates improved care for children.