Expanded access to ART has the potential to avert millions of AIDS orphans in Africa

Universal adult access to antiretroviral therapy compared to current roll-out could prevent over 4 million more children being orphaned because of HIV in the sub-Saharan African countries hardest hit by AIDS, according to published in the online journal AIDS Research and Therapy.

“Results from this study highlight the positive impact that expanded ART [antiretroviral therapy] may have in sub-Saharan countries already burdened with high numbers of AIDS orphans,” comment the investigators. They add, “we found that achieving universal ART uptake among adults may avert over 4 million maternal, paternal and double AIDS orphans over the next 10 years.”

It is estimated that 11.6 million children in sub-Saharan Africa have already lost one or both parents because of HIV.

Orphans have greater material, physical, health-related and psychological need, and there is also evidence that they have higher levels of HIV-related risk behaviour. Moreover, HIV-infected orphans often delay accessing essential care and have poor rates of adherence to HIV therapy.

Antiretroviral therapy has significantly reduced rates of HIV-related illness and death. At the end of 2008, it was estimated that 44% of eligible patients in sub-Saharan Africa were receiving HIV therapy.

Investigators wanted to calculate what impact uptake of antiretroviral therapy would have on the number of HIV orphans over a ten-year period - 2009-2020 - in the ten sub-Saharan African countries hardest hit by HIV and with the largest number of orphans.

They therefore developed a model that took into account demographics, fertility, and the uptake of antiretroviral therapy and its effectiveness.

The researchers modelled two scenarios: the first assumed that 100% of HIV-infected adults would access antiretroviral therapy immediately. The second assumed that uptake of therapy would differ between countries and be based upon clinical eligibility.

Results of the model showed that universal access to antiretrovirals would avert 4.37 million more HIV orphans by 2020 compared to more gradual rollout of HIV treatment. In every single country included in the model, the incidence of orphanage would be reduced substantially with universal access to therapy.

The calculations showed that overall universal access would avert 3.15 million maternal orphans, as well as 1.89 million paternal orphans, and almost 750,000 double orphans.

Countries with the highest number of orphans averted were South Africa (901,705), Nigeria (839,014) and Kenya (717,382).

Current treatment rollout plans were shown to have only a limited impact on the incidence of children being orphaned in several countries, especially Zimbabwe and Uganda.

The investigators believe their findings “have important implications for the health and quality of life for children in sub-Saharan Africa and other HIV-epidemic areas.”

They conclude, “our projection model strongly argues that expanded access to HIV treatment will have immediate preventative impact on the health and welfare of children in sub-Saharan Africa. If we are to make important gains in the livelihood of future generations in Africa, expanding access to ART should be of paramount importance.”