oa South African Health Review - Management of HIV-infected children : child health



Paediatric HIV care has lagged behind that for adults in South Africa. It is estimated that almost 300 000 children are HIV-infected. HIV is responsible for an upswing of child mortality in the country, reversing improvements in child survival. Despite the implementation of a perinatal prevention programme in 2003 and the increasing availability of antiretroviral therapy for children since early 2004, facilities still admit significantly large numbers of HIV-infected children. Little data exist evaluating the outcomes of the prevention of mother-to-child transmission of HIV programme. Postnatal transmission of HIV is elevated despite the availability of replacement feeds as part of the national prevention of mother-to-child transmission of HIV programme. Infant diagnosis rates are low even though guidelines recommend diagnosing infants from 6 weeks of age. Cotrimoxazole prophylaxis is not widely available, this contributes to high morbidity and mortality in HIV-infected infants. The number of children receiving antiretroviral therapy has increased over the past year from roughly 3 000 to more than 14 000, however inequalities exist across the provinces. Challenges for paediatric antiretroviral therapy include lack of sufficiently trained health care personnel, inadequate facilities, complexity of treatment recommendations, as well as drug regimens and formulations. Children are made particularly vulnerable by their circumstances and by frequent change of caregivers. Lack of integration of services results in attrition of patients at each step from prior to delivery through to the initiation of ART. Still relatively few children are benefiting from the services which should be available through the Comprehensive HIV and AIDS, Care, Management and Treatment Plan.


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