Aid for AIDS

How to Save a Child: The Program

Each day 1,800 children become infected with HIV world-wide, the vast majority of whom are newborns. The ultimate objective of HOW TO SAVE A CHILD is to eliminate the suffering of children and their families due to HIV, and decrease the number of children dying from AIDS-related causes.

Currently there are more than 50,000 children living with HIV and AIDS in Latin America and the Caribbean (LAC). Each one of these children needs continuous and reliable access to antiretroviral medication and comprehensive healthcare services.

---

Goal I:

Ensure that every child living with HIV and AIDS in Latin America and the Caribbean receives pediatric formulated antiretroviral medication

In the absence of treatment, progression of HIV occurs more rapidly in children, attacking a child’s developing immune system and creating a desperate situation for the child and his or her caregivers.

Without Treatment…
25-30% of children living with HIV will die before their first birthday 50-60% will die before they reach two 80% will die by age five

Pediatric antiretroviral medication has been proven to be highly effective in children in developing countries. Treatment can restore and preserve a child’s fragile immune system, promote normal growth and development, and sustain a child’s life to adulthood.

Goal II:

Complement distribution of ARVs with services offering HIV prevention, medical training, and health education. Collaborate and support established groups and organizations to provide a comprehensive approach to combat the epidemic in children

Utilization of treatment services provides the healthcare provider with the opportunity to reinforce prevention messages and educate patients and their caregivers on adherence and treatment guidelines. In addition, access and availability to treatment and services stimulates the number of individuals seeking HIV testing, counseling, and services. This type of community mobilization can help break the stigma commonly associated with HIV and AIDS.

Opportunistic Infections and Cotrimoxazole

Opportunistic infections attack the weakened immune systems in people living with HIV and are particularly unforgiving on a child’s immature immune defenses. Pneumonia (pneumocystis carinii pneumonia) is the most common opportunistic infection for children with HIV and is among the leading causes of death in infants.

Cotrimoxazole is a widely available antibiotic medication which has been proven to fight off deadly infections and is routinely used to treat opportunistic infections in people living with HIV and AIDS. According to the World Health Organization, UNAIDS, and UNICEF:

“Cotrimoxazole prophylaxis is also a crucial potentially life saving intervention that should be given to all HIV exposed children…”

According to these guidelines, all HIV exposed children and any child identified as HIV-positive should receive cotrimoxazole, especially if antiretroviraltherapy is unavailable. Use of the antibiotic can reduce AIDS-related deaths in children by almost fifty percent and can delay the need to initiate ARV therapy. AID FOR AIDS provides cotrimoxazole as part of a comprehensive treatment package for each child living with HIV and AIDS in Latin America and the Caribbean.

How does AID FOR AIDS accomplish its goals?

Donations from HOW TO SAVE A CHILD allow AID FOR AIDS to acquire antiretroviral (ARV) medication for countries in Latin American and the Caribbean (LAC). In addition, AID FOR AIDS uses donations to support and expand health care services needed to accompany treatment, ensuring the strongest fight against HIV and AIDS in children.

AID FOR AIDS is already collaborating with Health Ministries and organizations throughout LAC and providing pediatric ARVs to countries in this region. In addition, the program is currently providing annual treatment to several thousand adults living with HIV and AIDS in Central America.

Medication donated to each country is distributed through existing systems, channels and controls refined and established by AID FOR AIDS. This program model is respectful of ensuring proper distribution and use of the medication, and requires collaborating countries to provide detailed feedback on medication efficacy and resistance. This information is used for evaluation, statistics, and continual enhancement of the program model.

Once medication has been donated to a country, AID FOR AIDS continues its mission by partnering with and expanding local, regional, and international groups providing comprehensive AIDS-related services to children living with HIV and their families. Some of these services include:

• Supporting nutritional programs that provide food and vitamins to children living with HIV and AIDS.
• Replicating psychological and emotional support programs already operating at several AID FOR AIDS satellite offices.
• Expanding education and prevention programs.
• Arranging training for health care workers on the intricacies of diagnosing and treating HIV in children.
• Sponsoring national efforts to increase the number of pregnant women tested for HIV.

Why focus on Latin America and the Caribbean?

To be successful, the fight against the HIV and AIDS epidemic must be mobilized on a global scale. To date, much of the world’s attention has been focused on the plight of individuals suffering from the epidemic in sub-Saharan Africa. This is a appropriate response, as this region reports the most sever rates of infection and death. However, there are other regions around the world that are also being devastated by this epidemic. In particular, there are countries in Latin America and the Caribbean that report rates of HIV and AIDS nearing those of sub-Saharan Africa.

Every child counts, regardless of geography.

It is foolish to wait until the prevalence rates in LAC equal or surpass those in the most affected regions to focus attention on this region. In addition, AID FOR AIDS has over 10 years of experience working in this region of the world with satellite offices in 9 Latin American countries and countless contacts involved in HIV and AIDS work in this part of the world

Why Focus on Treatment?

Early initiation of treatment in HIV positive children prolongs a child’s life, allowing him or her to live a fruitful life and become a productive member of society. Availability of medication to treat HIV and AIDS can have a powerful impact on a community.

Treatment and care offer hope to individuals living with HIV and AIDS. For children, access to medication means the possibility of reaching adulthood.

Availability of antiretroviral medication increases the number of individuals seeking voluntary HIV testing. More people will request to be tested if treatment is available for them in the case they test positive.

People are more likely to access the health care system and community-based organizations for treatment and care, than for prevention alone. With this in mind, treatment efforts can be paired with prevention messages to improve delivery and acceptance of such messages.

Medication provides benefits and relief not only for the person receiving it, but for the community as a whole. The perspective is not only that of the individual patient, who benefits from a drug, but of the entire community, which will benefit as well, if safe, effective drugs are available to anyone who needs them.

Increased treatment availability, individuals seeking voluntary testing, and prevention efforts can help break the stigma commonly associated with HIV and AIDS. Testing, and the counseling that accompanies it, are crucial steps to stop the spread of the HIV epidemic. Disclosure and discussion are the only ways to lessen stigma.

---

Pediatric Antiretroviral Treatment

According to UNICEF, children are a growing proportion of individuals living with HIV and AIDS. Generally, access to medication for HIV and AIDS has expanded considerably in Latin America and the Caribbean (LAC). However, despite the increase in children living with HIV and AIDS, an average of only 8% of children in the LAC region have access to the necessary antiretroviral medication for HIV and AIDS treatment.

Pediatric antiretroviral therapy is not reaching enough children in developing countries, WHY?

FIRST:Children have to be tested to determine their HIV status Often, parents or caregivers do not know that they themselves are living with the virus, until their child becomes sick. Parents or caregivers are hesitant to have child tested for fear of stigma (both toward the child and toward the parents). Parents or caregivers feel testing and diagnosis are unnecessary because treatment is not available. Testing facilities may be inaccessible due to location or cost.

SECOND:Diagnosing HIV in children has many complexities HIV tests for children under 18 months of age are complicated and expensive. Waiting until 18 months is a risky option, since half of all children with untreated HIV will die before reaching this age. Clinics and hospitals loose contact with parents and caregivers over the 18-month waiting period. By relying on parents and caregivers to bring the child back for testing, healthcare personnel run into the issues discussed above.

Diagnosis based on clinical symptom is possible, but can only be done by trained healthcare professionals, which are in short supply in developing countries. Few healthcare providers have been adequately trained to recognize the signs of HIV infection in children.

THIRD: Treatment of HIV-positive children is complicated Antiretroviral therapy is unavailable in many poor countries, due to lack of financial and human resources.

Pediatric formularies are more expensive than adult medication, sometimes up to four times.

Because infants and young children cannot swallow pills, pediatric medication is often in liquid or powder form.

Powder medication requires mixing with clean water- an issue for many developing countries, especially for individuals living in rural areas.

Liquid medication requires refrigeration (and therefore depends on a reliable electrical supply), has a shorter shelf-life, and occupies more storage space than pills. Families must store the large bottles of liquid medication in often-limited refrigerator space

Liquid and powder forms taste unpleasant and must be taken in high volume. Combination pills of two or three different antiretrovirals into a single dose are now available for adults living with HIV and AIDS. Unfortunately, these fixed-dose combination (FDC) pills have not been approved for use in children. FDCs simplify treatment for HIV, significantly reducing the number of pills required for daily treatment.

Instead, it is common for individuals to crush or divide adult fixed-dose pills, even though it is very difficult to determine exact dosage with broken tablets. Inexact amounts increase the likelihood of over or under dosage. There are no published data on use or effectiveness of divided or crushed adult pills. Lack of healthcare personnel that are trained in pediatric HIV and AIDS: Studies found “less than 10% of health workers providing pediatric care were trained” in this type of care (The Lancet, 2003).

Treatment is technically difficult. Children metabolize drugs differently than adults. Children must be monitored more often than adults. The common tests used to monitor children must be judged differently than in adults.

Drug dosages in children are based in weight and body surface, yet formal guidelines for dosage and testing in children are not standardized.

Adherence: If drugs are not taken routinely, HIV may become resistant to the therapy and it may not work as effectively. For a child starting antiretroviral therapy—it is a commitment for a lifetime. Unpleasant taste of the medication and large dosing requirements deter children from adherence.

Most pediatric medication must be taken with food and/or clean water, which is difficult to guarantee in resource-poor settings. There is a stigma attached to taking medication, especially if children are in school. Adverse side-effects deter children from routinely taking their medication.

Despite these barriers, early diagnosis and treatment of HIV in children is feasible in developing countries and children respond well to antiretroviral therapy.

Adapted from: “Taking Stock: HIV in Children”, published by the WHO, and” HIV Treatment & Children: The Issues”, published by avert.org

HIV is known to progress extremely rapidly in children if untreated “Adherence is one of the most significant challenges to children receiving ARVs”