Family-centred clinics can achieve excellent HIV treatment outcomes in children in Africa

A “family-centred” approach to HIV treatment can help achieve excellent treatment outcomes in children receiving antiretroviral therapy in resource-limited countries, according to a letter published in the April 23^rd edition of AIDS.

There is now good evidence showing that it is possible to deliver antiretroviral therapy in Africa and that such treatment has good outcomes. Despite concerns that there would be “antiretroviral anarchy”, some studies have shown that adult Africans have better adherence to antiretroviral treatment than HIV-positive patients in the US.

Preliminary evidence also suggests that antiretroviral-treated children in resource limited settings can have excellent levels of adherence. Investigators from the Sinikithemba HIV/AIDS clinic in South Africa write that 89% of the children receiving care at their clinic had 95% or better adherence to their HIV treatment regimens. Such a high level of adherence meant that 84% of children had a viral load below 50 copies/ml after six months of treatment, with 80% having a viral load below this level after a year of therapy.

The investigators note that studies suggest that only 25% - 50% of antiretroviral-treated children in the US and Europe achieve such impressive outcomes.

Investigators at the Sinikithemba clinic note that approximately half the HIV-positive children treated at their clinic are cared for by an adult who is also infected with HIV. They found that children who received care from an HIV-positive adult were less likely to die than children whose care-giver was HIV-negative or untested.

They therefore hypothesise that “HIV-positive caregivers on HAART at the same treatment site may be able to provide more informed treatment support for their children resulting in better outcomes.”

Instead of thinking about families being “devastated” or “ravaged” by AIDS, the investigators suggest that the provision of antiretrovirals through a family-centred clinic could mean that “those on treatment can instead be sources of unity, continuity and strength for pediatric patients with other HIV-infected family members.”