Addressing and Improving the Continuum of Care for HIV-Affected Children: Challenges and Solutions

Journal Article
  • Scott E. Kellerman
  • Nandita Sugandhi
  • Chewe Luo
  • Craig McClure
  • Ram Yogev
Nov. 2013; 27 (supplement 2): S135-137. DOI: 10.1097/QAD.0000000000000129.

The current elimination strategy has focused primarily on the expansion of HIV testing and counseling of pregnant women and the provision of antiretroviral therapy (ART) to those living with HIV to protect their health and prevent HIV transmission to their infants. Something is missing: despite WHO guidelines calling for 100% treatment coverage for all infected children younger than 5 years, early infant diagnosis and pediatric treatment have thus far been neglected. The primary focus on prevention of maternal-to-child transmission (PMTCT) has inadvertently perpetuated poor access to treatment for those children who still are inevitably acquire HIV. New ideas are needed that can propel programming to diagnose, link, and retain infected children in care, particularly those missed by current PMTCT programming, and provide optimal care for those children who do get diagnosed and linked to care and treatment services. Policy issues such as the unveiling of a Treatment 2.0 approach toward greater simplification of pediatric treatment and the difficulties and challenges on how to finance pediatric HIV programming are critical to consider. Better systems for earlier identification of positive children are an urgent priority, given their high risk for morbidity and mortality. There is also a need to provide comprehensive, integrated programs--HIV is not just a medical disease but a social one.