Children lag behind adults in HIV treatment, testing

Key takeaways:

• Children with HIV comprise 15% of AIDS-related deaths.
• Only around half of children with HIV are receiving ART.

Children are falling far behind adults when it comes to testing and treatment for HIV, according to a new study published in Pediatrics.

In 2015, WHO introduced a “Treat All” approach to addressing HIV/AIDS, which called for universal HIV screening and immediately treating people who test positive.

According to the new study, although children account for just 5% of all people living with HIV, they make up 15% of AIDS-related deaths.

The disparity exists “despite new policies that should precipitate immediate linkage to HIV care among diagnosed children,” said Joseph Rosen, PhD, MSPH, assistant scientist in the department of international health at Johns Hopkins Bloomberg School of Public Health and a senior manager at the school’s Center for AIDS Research.

“Whereas over two-thirds of adults living with HIV worldwide are receiving ART, only about half of children are,” Rosen told Healio. “This dramatic disparity prompted us to look at the potential effects of new global policies aiming to close these gaps.”

Rosen and colleagues studied data from the Global AIDS Response Progress Reports —publicly accessible national HIV indicators on pediatric ART coverage and AIDS-related deaths — from 93 countries during 2010 to 2020.

They assessed when and if each of the countries adopted the “Treat All” policy and compared rates of ART and AIDS-related deaths among children before and after the adoption of the policy.
We had initially hypothesized that we would observe significant increases in pediatric ART coverage and significant decreases in AIDS-related deaths following the adoption of ‘Treat All,’” Rosen said. “To our initial surprise, we observed neither.”

On a global scale, the researchers found marked increases in ART in children, with treatment among pediatric patients tripling from 16% in 2010 to 54% in 2020. AIDS deaths among children were more than halved, from 240,000 to 99,000.

However, the researchers found children remained harder to reach for HIV testing and treatment services.

“We suspected that prior policies — for example, lowering CD4-based ART initiation criteria for children — might have attenuated the effect of ‘Treat All’ adoption on pediatric treatment coverage and AIDS mortality,” Rosen said. “Separately, the inclusion of these new policies into national HIV treatment guidelines does not mean that these policies are being implemented consistently or effectively.”

The authors concluded that although progress has been made, more effort is needed to ensure effective implementation of “Treat All” for children, as well as to address structural barriers to pediatric HIV treatment.

“Enhanced linkage to HIV care and follow-up of children diagnosed with HIV is critical to improving their clinical outcomes,” Rosen said. “Family-based HIV services, for example, those integrating HIV prevention and care for parents and their children, are one appropriate and effective approach for closing these gaps. Future studies should investigate the barriers and facilitators of implementing and scaling up ‘Treat All’ policies for pediatric populations, specifically in settings where pediatric HIV treatment outcomes remain suboptimal despite the presence of policies guaranteeing universal access to HIV treatment.”

An accompanying commentary was co-authored by Susan L. Gillespie, MD, PhD, and Gordon E. Schutze, MD, both physicians in the department of AIDS and retrovirology at Texas Children’s Hospital.

“The data from Rosen et al show us that, despite our significant progress, we have plenty of areas where we can improve; but even as we continue to do so, more infections will occur, and more children will die, and that is what is so frustrating and unnecessary,” they wrote. “Now is not the time to slow down because of waning political will and HIV fatigue; now is the time to push for global equity in health care for children so that we can save future generations of children and families.”

References:

Gillespie SL, et al. Pediatrics. 2023;doi: 10.1542/peds.2023-061410.

Rosen J, et al. Pediatrics. 2023;doi:10.1542/peds.2022-059013.