When CHAI began working on pediatric HIV/AIDS in 2005, kids were being left behind. Only one in 40 children in need was on treatment, compared to one in eight adults. The cost of pediatric medications was prohibitively high and the dosing was difficult in part because young children could only use liquid formulations. Infant testing for HIV was almost non-existent. Despite phenomenal progress in scaling up adult treatment and testing, services for children were lagging.
Negotiate Lower Prices
To address the massive disparity between the number of adults and children on treatment, CHAI began by working to bring down the price of pediatric AIDS drugs. By pooling volumes across 34 countries and through our partner UNITAID’s support, we were able to bring down drug prices by 90 percent, from almost $600 per patient per year to just $60 by 2006. Since then, CHAI has worked with drug manufacturers to reduce the price of new pediatric regimens from $745 in 2006 to $103 in 2010, an 87 percent reduction. The dramatic drop in costs has led to a robust annual increase in the number of children on treatment.
By the end of 2011, 340,000 children were on treatment in the 34 CHAI countries, up from about 10,000 in 2005.
Infant Testing and Child-Centered Medicines
Before CHAI got involved, treating children with HIV/AIDS was extremely complex. Beyond higher drug costs, their diagnosis was more difficult, their dosing more nuanced, and their medicines less patient-friendly than those for adults. By the end of 2005, fewer than 200 sites across countries where CHAI worked were equipped to conduct the specialized tests needed to diagnose HIV in children. To overcome this hurdle we worked with governments around the world to rapidly roll out infant testing. We helped establish testing guidelines for infants and equipped thousands of health facilities with the supplies and know-how needed to collect blood samples from babies. By the end of 2009, 4,600 sites were testing infants for HIV in the 34 CHAI-supported countries.
In 2005, pediatric HIV drugs were only offered in liquid formulations, making them difficult to transport, store and dispense. One month of pediatric medicine once consisted of twelve bottles of syrup. Since then, CHAI helped develop formulations so today kids only have to take one pill twice a day.
The number of children now benefitting from this simplified treatment has increased more than 30-fold since 2005.
Quality of Care and Retention
A landmark 2009 CHAI study found that over half of children who test positive for HIV are lost to follow-up before they receive proper treatment. One cause of this was the long period of time that elapsed between taking the test and receiving the diagnosis. Kids were getting lost in the system. Parents had them tested, but because they never got the results, they never knew whether their child was HIV-positive or not. By improving data management systems to monitor retention and equipping both testing sites and labs with SMS printers, we have been able to cut this delay in receiving results by 50 percent. Through these and other steps, such as strengthening the referral system between testing sites and treatment clinics, CHAI is helping countries keep kids who test HIV-positive alive and well.
Building on Success
Ending pediatric AIDS is a dream that we can realize, but only if we take some critically important steps. We must provide universal access to treatment for all children who are living with HIV. This requires earlier identification of exposed and infected infants, especially those who live in hard-to-reach areas. We have nearly reached parity in treatment between adults and children, but any slow-down in momentum puts all of our gains at risk.
We must also redouble our efforts to eliminate mother-to-child transmission of HIV now that the medicines to do this are available. Because, historically, pediatric HIV and prevention of mother-to-child transmission programs have been siloed, children have not had access to an integrated continuum of care. CHAI is now working to align these two critically important services in the countries where we work. While a great deal of work remains, the dramatic progress that we have made since 2005 is evidence that bold efforts can slow the spread of HIV in children and one day may allow it to be eliminated altogether.