Abstract
It is estimated that almost 300,000 children in South Africa have human immunodeficiency virus (HIV) infection. The disease is responsible for reversing decreases in child mortality. Few data exist evaluating the outcomes of the prevention of mother-to-child transmission of HIV (PMTCT) program, although PMTCT coverage appears to be low. Hospitals are still witnessing large numbers of admissions of HIV-infected children. Postnatal transmission of HIV is high, reflecting poor education of and support for women in their infant feeding choices. Too few infants and children are entering care through early diagnosis, which should be widely available. Cotrimoxazole prophylaxis coverage is inadequate, contributing to high morbidity and mortality in infants. The number of children receiving antiretroviral therapy (ART) is increasing steadily. However, significant inequalities in access to ART exist between and within provinces. Challenges for pediatric ART include a lack of sufficiently trained health care personnel and inadequate facilities, as well as the complexity of drug regimens and formulations. The compartmentalization of the ART rollout program hinders PMTCT and makes it difficult for children to be identified and referred into appropriate services. This article delineates the challenges to pediatric HIV care in South Africa and provides some practical recommendations to improve it.
Highlights
In 2004, 29.5% (95% confidence interval [CI], 28.5%– 30.5%) of women attending public antenatal facilities in South Africa were human immunodeficiency virus (HIV) positive [1]
There are, no reliable data on the national coverage and efficacy of the prevention of mother-to-child transmission of HIV (PMTCT) program, which makes the incidence of HIV infection in children difficult to quantify
Progression to AIDS is more rapid in children than adults, and it is likely that a large proportion of HIV-infected children are urgently in need of access to antiretroviral therapy (ART)
Summary
There are, no reliable data on the national coverage and efficacy of the prevention of mother-to-child transmission of HIV (PMTCT) program, which makes the incidence of HIV infection in children difficult to quantify. The Actuarial Society of South Africa AIDS and Demographic Model (ASSA2003), which provides the most plausible estimates of the prevalence of HIV infection among children in South Africa, estimates that there were 275,000 HIV-infected children in mid-2005, increasing to 293,000 in mid-2006 [2].a The estimated numbers of HIV-infected children in each province range from !3000 in the Northern Cape to nearly 100,000 in KwaZulu-Natal (figure 1) The proportion of these HIV-infected children requiring antiretroviral therapy (ART) is unknown. Reports indicate that nevirapine coverage for HIV-infected pregnant women is no more than 30% (PMTCT Task Team, Concerned Child Health Workers, unpublished report).
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