Deputy Minister Musiiwa

Deputy Minister Musiiwa

Nyemudzai Kakore Review Correspondent
Farai Zvidzayi (not his real name) is an ordinary infant. He plays with his feet, cries when he is hungry or just needs someone to pick him up and his parents have high hopes that when he grows up he will leave a mark on the world through distinguishing himself by acquiring fame or fortune or both.

Or at least they had such high hopes until the 13-month-old boy was diagnosed with HIV some six months ago. Since then the family has been anxiously waiting to complete the process that will allow him to access treatment.

Zvidzayi is now among hundreds of thousands of children living with HIV in Zimbabwe who are failing to access anti-retro viral therapy (ART).

While the country has made great strides in combating the HIV/AIDS pandemic, Government revealed that only 40 percent of children living with HIV have access to anti-retro viral therapy against the targeted 100 percent.

On the other hand ART initiation in adults has reached over 80 percent.

“I was on ART and has followed the advice at the clinic religiously so I was sure that my child was clear. I even breastfed exclusively for six months and weaned him after that,” relates Zvidzayi’s mother.

She says Zvidzayi only got tested after a recurrent cough that lasted more than two months after he was weaned but is still to be initiated on ART.

Health and Child Care Deputy Minister Cde Aldrin Musiiwa said lack of funding has stalled children initiation on ART

Among the reasons are lack of adequate laboratory capacity and shortage of skilled workers.

The country has only three centres receiving “dry blood samples” to test children born of mothers who are living with HIV.

“Challenges remain in many areas of child programming like children’s access to ART which is currently at 40 percent but the desirable being 100 percent,” he said.

As with most other health delivery related challenges, the problem lies with money or rather the lack thereof.

“While Government is committed to the realisation of children’s rights, we are currently experiencing budgetary constraints to fully support children’s programmes,” said Deputy Minister Musiiwa.

Advocacy groups say the push for an AIDS free generation is under threat if children living with HIV continue to fall through the net without getting proper treatment and counselling.

Some children born with HIV are now sexually active and there is concern that if they are undiagnosed and untreated, they may be unwittingly spreading the virus thereby directly negatively impacting on the targets of achieving zero new infections and ultimately raising an HIV-free generation.

Zimbabwe National Network of People Living with HIV (ZNNP+) executive director Muchanyara Mukamuri said Government should speed up the process of the releasing of “dry sample” results, test of children who are born of a mother living with HIV.

She said that with only three centres receiving “dry blood samples”, there are problems in the value chain relating to the availability of the results.

“We are lagging behind in the implementation of Paediatric ART, There is need to strengthen programmes such as the training of health staff who initiate and manage children on ART.”

Mrs Mukamuri said on the other hand parents also need to be proactive in becoming a part of the solution as now they are possibly part of the problem due to social dynamics.

“We need to investigate on claims that most mothers do not want to have their children initiated even though they are on ART themselves.

It could be that they find it difficult to bear news that they have given birth to an infected child to their spouses,” she added.

SOS Children’s Village in Zimbabwe fund development officer Mrs Zvikomborero Zimunya said HIV had caused the disintegration of families.

She said besides initiation into ART more needed to be done, including funding the wellbeing of the children.

“With over 150 000 children (0-14 years) living with HIV and 570 000 children orphaned due to AIDS, greater numbers of children have lost the protection and care of their families and now require alternative care,” she said.

“A greater budgetary support is needed for these children, especially for those needing treatment such as anti-retroviral therapy.

“As the duty bearer, there is an urgent need for Government through the Ministry of Public Service and Social Welfare to respond to this challenge through increased grant allocations to alternative care institutions,” she said

Ministry of Health and Child Care National and Paediatric HIV Care and Treatment (PMTCT) coordinator Dr Angela Mushavi, however, said Government had developed a plan termed Accelerate Anti-retroviral Treatment for Paediatric (AAP) to scale up the initiation of ART in the country.

She said targeted groups would be infants, children and adolescents from the age of 0 to 19 years.

“The AAP strategy will be launched soon but we have started implementing the strategies,” she said.

“The programme involves increased knowledge by adolescents in knowing their HIV status as well as mothers making sure that they are aware of a child’s HIV status.”

She said on the demand side, health care systems were going to be capacitated from medication to the training of more health care workers.

“Training of health care workers is underway, we previously had one laboratory but we have decentralised the testing centres to three labs one in Harare, Mutare, and Bulawayo,” said Dr Mushavi.

Dr Mushavi said some of the strides involved the launch of the Zimbabwe Population-based HIV Impact Assessment (Zimphia), a survey targeting 15 000 households.

The country’s current estimated prevalence rate is at 15 percent for both children and adults with Zimphia expected to give more certain statistics which may or may not alter the picture.

But for now, parents of Zvidzayi and other children like him will have hope that opportunistic infections which prey on people with suppressed immunity will not get their offspring before it is too late.

WHO Paediatric ART Guidelines

When to Start Antiretroviral Therapy in Infants and Children

 

Recommendations:

 

Infants: Initiate ART for all HIV-infected infants diagnosed in the first year of life, irrespective of CD4 count or WHO clinical stage.

 

(Strong recommendation, moderate quality of evidence)

 

Children: Initiate ART for all HIV-infected children between 12 and 24 months of age irrespective of CD4 count or WHO clinical stage.

 

(Conditional recommendation, very low quality of evidence)

 

Initiate ART for all HIV-infected children between 24 and 59 months of age with CD4 count =750 cells/mm3 or %CD4+ =25, whichever is lower, irrespective of WHO clinical stage.

 

(Strong recommendation, very low quality of evidence)

 

Initiate ART for all HIV-infected children more than 5 years of age with CD4 count =350 cells/mm3 (as in adults), irrespective of WHO clinical stage.

 

(Strong recommendation, moderate quality of evidence)

 

Initiate ART for all HIV-infected children with WHO HIV clinical stages 3 and 4, irrespective of CD4 count.

 

(Strong recommendation, low quality of evidence)

 

Initiate ART for any child less than 18 months of age who has been given a presumptive clinical diagnosis of HIV infection.

 

(Strong recommendation, low quality of evidence)

 

Current research demonstrates that the initiation of ART early in infancy and childhood dramatically reduces the risk of death and disease progression.

 

Without effective treatment, an estimated one third of infected infants will have died by one year of age, and about half will have died by two years of age. Given these data, WHO has updated the recommendations on when to begin ART. – guideline.gov

Zimbabwe HIV and AIDS estimates (2014)

Number of people living with HIV

 

1 600 000 (1 500 000-1 600 000)

 

Adults aged 15 to 49 prevalence rate

 

6,7 percent (15,9 percent-17,5 percent)

 

Adults aged 15 and up living with HIV

 

1 400 000 (1 300 000-1 500 000)

 

Women aged 15 and up living with HIV

 

830 000 (780 000-870 000)

 

Children aged 0 to 14 living with HIV

 

150 000 (140 000-160 000)

 

Deaths due to AIDS

 

39 000 (32 000-49 000)

 

Orphans due to AIDS aged 0 to 17

 

570 000 (410 000-1 000 000) – unaids.org