Policy Leads to Improved Treatment Access for Adolescents Living with HIV
Children, aged 10 to 14, living with HIV in sub-Saharan Africa are receiving antiretroviral treatment (ART) earlier as countries adopt the World Health Organization’s (WHO) recommendation for immediate treatment of HIV regardless of the severity of their illness. And a new study shows that the change has had a positive impact on this hard-to-reach group.
In the study published in The Journal of Infectious Diseases, researchers Olga Tymejczyk and Ellen Brazier (of CUNY’s Graduate School of Public Health and Health Policy) utilized data from HIV clinics in seven sub-Saharan African countries. Using a regression discontinuity design, the team found that after national adoption of Treat All policies, there were large increases in the proportion of young adolescents who initiated treatment within 30 days of enrolling in HIV care.
“Our findings are clinically important because young adolescents living with HIV in these settings often do not initiate ART until they are at advanced stages of HIV disease,” Tymejczyk said in a news release.
“Getting them on treatment faster after they enroll in HIV care could help lower disproportionately high HIV mortality rates in this age group.”
In 2018, about 599,000 children aged 10 to 14 were living with HIV, with 90% living in sub-Saharan Africa.
In low-resource settings, children living with HIV often start treatment late, due to lack of access to care and ongoing HIV stigma. With that, children often go without treatment until they are very, very sick.
“Young adolescents enrolling in HIV care are often underweight and stunted, and they tend to have lower [white blood] cell counts and more advanced disease than both older adolescents and younger children with HIV diagnosed earlier after perinatal infection,” the researchers note.
Since 2015, an increasing number of countries have adopted WHO’s Treat All policy, which makes all people living with HIV eligible for immediate treatment, regardless of their immunological status or clinical symptoms. This policy has expanded access for many adolescents who were not previously eligible for treatment when they enrolled in HIV care.
Although the researchers view the results as a promising development in the battle against HIV, they believe there is still work to be done.
“We also need to do more to shorten the time from HIV infection to diagnosis and enrollment in HIV care,” Brazier said in the press release. “Most of those enrolling into HIV care between the ages of 10-14 years are thought to have acquired the infection perinatally. While it is encouraging that Treat All has improved their access to HIV treatment, we need to understand and address barriers to timely diagnosis and enrollment in HIV among this age group.”