As Lesotho rolls out anti-AIDS drugs to a growing number of people living with HIV/AIDS, the percentage of HIV-positive children on treatment remains disturbingly low.
Former US President Bill Clinton was in the mountain kingdom on Monday to open a new paediatric HIV/AIDS clinic in the capital, Maseru. The clinic, established with the help of the Clinton Foundation, will make antiretroviral (ARV) treatment available to greater numbers of HIV-positive children.
According to Dr Nyane Letsie, head of family health in the health ministry, "roughly 100 children" were currently receiving ARVs in Lesotho, while about 22,000 are estimated to be living with the virus.
The Clinton Foundation hopes to boost this figure to at least 750 by the end of the year.
"Treating kids is really a problem ... it's one of our biggest challenges," Letsie admitted.
Pharmaceutical companies have not yet developed fixed-dose combination treatments in dosages appropriate for children, and physicians often have to blend changing portions of three separate adult-dose medicines as the child grows.
To determine a correct paediatric dose, caregivers should use the three drugs according to the surface area of the child - a number obtained by a complicated formula of multiplying the child's weight by its length, dividing by 3,600 and then taking the square root of that figure.
This kind of calculation is often impossible in the developing world and simplifying it sometimes results in overdosing HIV-positive children, with increased side effects.
Paediatric formulations were also more expensive than adult treatments, Letsie pointed out. According to international relief agency Medecins Sans Frontieres (MSF), the most popular fixed-dose combination pill for adults costs about US $200 a year, but treating a 14-kg patient with three separate drugs costs roughly $1,300 a year.
"We've only just started because we've been trying to sort ourselves out - you don't want to give children [this type of] medication without having proper follow-up procedures in place," Letsie noted.
Lesotho's mountainous terrain was another obstacle. "We don't want to restrict [ARVs] to children living in Maseru, but it will be difficult to immediately scale up; at the same time, we realise the pandemic has no age barrier and kids must be treated as well," she added.
Nevertheless, most hospitals distributing ARVs and offering prevention of mother-to-child transmission of HIV (PMTCT) services now had trained healthcare professionals and could begin providing the medication to children.