Beyond ICASA: Zim needs to spotlight eliminating paediatric HIV

THE International Conference on Aids and STIs in Africa (ICASA) beckons for Zimbabwe. Everything is now in place for the biggest Aids conference on the continent.

As the world descends on the motherland, to take stock of the HIV/AIDS landscape, Zimbabwe is ready!

A lot of progress has been made over the past few decades to fight the epidemic. But statistics are still worrying. According to the World Health Organisation, there were approximately 37,9 million people living with HIV at the end of 2018, with 1,7 million people becoming newly infected in the same year globally.

The WHO African Region is the most affected region and accounts for almost two thirds of the global total of new HIV infections.

In Zimbabwe, nearly 1,3 million people are living with HIV and a good number of these are children under the age of 15.

The country has made significant strides towards ending Aids, being among the first few countries to achieve the UNAIDS 95 95 95 targets.

Current statistics show that among the adult population, 93 percent of people living with HIV know their status and all of them (100 percent) have been initiated on Antiretroviral Treatment(ART) while 95 percent of them are now virally suppressed.

These targets were supposed to be achieved among all age groups of people living with HIV, but a comparison of adults living with HIV to children shows that children are still lagging behind. The figures for children remain lower.

About 72,5 percent of children living with HIV have been diagnosed and although all of these children have been initiated on ART, only 79,3 percent of them are virally suppressed.

What this means is that an estimated 82 000 children are living with undiagnosed HIV and these definitely need to be found for them to get treated and for the country to fully achieve its targets.

Hence, as Zimbabwe takes part in ICASA, the burden of children with HIV still weighs on the country. And it will need to be addressed during and after the premier event.

Ministry of Health and Child Care HIV/ AIDS and STIs deputy director, Dr Tsitsi Apollo acknowledged that the country was lagging behind in linking children with HIV care.

“Generally, we are doing well in terms of progress towards the 95 95 95 for adults,” she said. “But we have seen that children are lagging behind so we need to step up case finding for these children.

“They are somewhere in the communities, so we need to go out and widen testing for these children from the time they are born in facilities and follow them up to bring them services, engaging and working closely even with the Ministry of Education because most of these children are in school.

“We are sure that we can put together some concerted efforts to find these children and once we find them we give appropriate services. We have a package of services for these children.”

While those who are between the ages of zero to 15 will be catered for in the said programming, Zimbabwe also has a robust Prevention of Mother to Child Transmission (PMTCT) programme which still needs to be scaled up.

Over the years, the country has been testing pregnant women for HIV during their antenatal visits. Of late, the Ministry of Health has adopted the triple elimination of mother to child transmission of HIV, Syphilis and viral hepatitis B (EMTCT).

This has helped to ensure that all women who visit the antenatal clinics have access to screening for the three diseases, which if left untreated could prove to be fatal for the child.

“We are committed to the triple elimination of mother to child transmission of HIV, syphilis and viral Hepatitis B. As a country we have a plan already which is a sign of commitment and issues around paediatric ART are also in that plan,” said Dr Apollo.

Of note is the PMTCT programme which seeks to stop the spread of HIV from the mother to the child.

According to statistics, at least eight out of 10 children infected with HIV get it from their mothers. The mother to child transmission rate of HIV in Zimbabwe stands at 8 percent, a figure that may seem small to the uninformed. There is a need to work on these figures. National PMTCT and Paediatric HIV care and treatment co-ordinator Dr Angela Mushavi, says the three diseases need to be targeted holistically to ensure progress.

“Hepatitis B is the new kid on the block in our EMTCT plan and I think it really makes sense to address all of them at one because all of them are sexually transmitted; we know that they cause significant maternal and infant morbidity,” she said.

“For us within the triple EMTCT plan, we are going for gold. The gold tier says we must have at a minimum 95 percent of ANC attendance, 95 percent of HIV testing, syphilis testing and hopefully also hepatitis testing although for hepatitis we have said 90 percent is good enough and we must make sure that at least 95 percent of our women who are positive for either HIV or Syphilis are initiated on treatment.”

For this to happen, there is need for a buy-in from communities to ensure that women visit the antenatal clinics and get screened.

According to Dr Mushavi, leadership can play a major role in ensuring that pregnant women seek health services.

“Leadership in its traditional form, religious form or political form is important. We have seen some of our leadership particularly on the religious side who are reluctant to seek care and bring their children for services and indeed their women for booking,” she said.

Besides the religious objectors, there are other groups of women who may not seek health services in traditional set-ups due to the stigma surrounding their situations.

Public Solutions for Health (PSH) this week launched a programme that will complement the Ministry of Health and Child Care’s interventions to reach the desired levels in access to HIV services.

The Prevent HIV for Sustainable Epidemic Control programme (PREVENT) is a five year programme aimed at supporting the Government to sustain HIV epidemic control with a focus on serving those most at risk for acquiring HIV and those least likely to seek health and HIV prevention care and treatment services in traditional settings.

“So the PREVENT activity is a good opportunity for us to build on those communities that may not have been optimally benefiting from the success that we have realised so far. We will be working with a population base that is considered to be at higher risk, either not accessing services for falling off the treatment cascade, we think we should be able to focus on children of sex workers or children that are born to those communities that are traditionally not optimally served by interventions. These activities will then help us to optimise all these strategies that the Government has put in place,” said Dr Blessing Mutede the PREVENT programme chief of party.

It is, therefore, good to know that the country, while it is still lagging behind, is taking the necessary strides to close the existing gaps.

What is now needed is to ensure that these efforts continue to gain momentum. We cannot relax as a country.

For the country to reach the targets of eliminating AIDS by 2030, it is necessary to continue targeting children in vulnerable communities with services. Access to HIV services means reduced incidents of new HIV infections among children.

With less new infections, only then can we have an HIV free generation.