Scientific view

Beyond medication: Addressing structural barriers in paediatric HIV care

28 Sep, 2023

This article was written by Eleanor Namusoke Magongo, Team Lead Pediatrics and Adolescent HIV Care & Treatment AIDS Control Program, Ministry of Health Uganda. It is taken from Penta’s 2022 Annual Social Report.

When we compare the treatment options that are available for children and adults, we know that there’s a limitation for children. We need to see pharmaceutical companies manufacturing more child-friendly formulations, that will foster treatment adherence. Paediatric dolutegravir (DTG) has changed the treatment landscape in a very positive trajectory.

Children now have a oncea-day treatment option, and this is great! We have started to notice upward trends in the proportions of children with HIV viral load suppression, an indicator which had stagnated for years in some countries. However, we need to remember that even with a good drug like paediatric DTG, we must maintain a holistic approach to care for the children, and also, we need to continue addressing the structural barriers that lead to the interruption of treatment. If we ignore this, we could soon find ourselves where we started before the DTG era, where children did not adhere to their treatment, which led to mutations and subsequent HIV drug resistance.

It is also important for us to ask ourselves this important question: how are we supporting the parents and caregivers to support their children better? We have invested heavily in HIV interventions at facility level; it is now time for us to do the same for community interventions if we are to achieve our goal to end AIDS by 2030. It is in the community, and at household level, that children begin to fail on treatment for various reasons like multiple, and many times, elderly caregivers, non-disclosure of HIV status, lack of transport, gender-based violence in the homes, stigma, and low treatment literacy.

As we work to address the household and community challenges, we need formulations that will work around these structural barriers. We need to dream and work towards a time, when we can have child-friendly formulations and treatment delivery methods that will reduce the frequency of taking antiretroviral treatment from a daily routine to at least once a quarter, or even better, a longer duration. LET US KEEP DREAMING AND WORKING TOWARDS MAKING OUR DREAMS A REALITY!