In 2015, the World Health Organization introduced a “Treat All” approach to addressing HIV/AIDS—universal testing and treatment—making all patients eligible for life-saving antiretroviral therapy (ART). A new study, “Pediatric Antiretroviral Therapy (ART) Coverage and AIDS Deaths in the ‘Treat All’ Era,” in the June 2023 Pediatrics (published online May 17), found that HIV treatment and testing for children is falling far behind adults. Researchers studied data derived from the Global AIDS Response Progress Reports and found globally there were marked increases in the treatment of AIDS in children (16% to 54%) and AIDS mortality among children was more than cut in half (240,000 to 99,000) from 2010 to 2020. However, researchers found children remain harder to reach with HIV testing and treatment services. The reasons include stigma, fear from caregivers, gaps in training, and short supply of pediatric ART regimens. Children living with HIV have a heavier burden of dying from AIDS. They account for fewer than 5% of all people living with HIV but 15% of all AIDS-related deaths. However, the use of ART in children living with HIV was just 52% in 2021, lagging substantially behind adults (76%), which is already below goals. The United Nations Commission on HIV/AIDS has issued a “95-95-95” goal, calling for 95% of people living with HIV to know their status, 95% of people who know their status to receive life-saving ART, and 95% of people on ART to have suppressed viral loads. In the countries studied, pediatric ART coverage did not increase significantly following “Treat All” adoption. Observed declines in pediatric AIDS-related deaths did not vary significantly before and after “Treat All” introduction. The authors provide several interpretations for these findings. For example, a study from Burundi found health care providers were challenged in reaching children who did not live with their biological parents. In a study of women living with HIV in Cameroon, nearly 70% of participants reported that none of their children had received HIV testing before age 5. Without timely diagnosis and treatment, half of perinatally infected children living with HIV will die by age 2. Researchers concluded that while 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.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.