Johannesburg, 2 November 2010 (PlusNews) - KwaZulu-Natal Province remains the epicentre of South Africa's HIV epidemic but new research reveals that nearly a third of hospitals surveyed had not started a single HIV-positive infant on antiretroviral treatment in several years.

The research, presented at this week's Orphaned and Vulnerable Children (OVC) in Africa Conference in Johannesburg, was conducted by the University of the Witwatersrand's Maternal, Adolescent and Child Health (MatCH) Unit, with the government.

MatCH tracked the number of children under 15 who were put on antiretroviral drugs (ARVs) at 10 major KwaZulu-Natal hospitals near the coastal city of Durban over three years. While data collection is often problematic at these facilities, the survey relied on clinic ARV registers and statistics routinely reported to the provincial government.

The researchers found that three of the hospitals had no record of treating an HIV-positive infant during the period; another two hospitals that they had put 11 infants or fewer on the life-saving drugs.

The study also showed that while treatment initiation was higher among older children, the number of children on ARVs varied greatly from year to year and between facilities.

"Very little efforts have been made to put children on ARVs and this is concerning when we have such a large number of children who require treatment," MatCH researcher Ravikanthi Rapiti told IRIN/PlusNews. He noted that Durban's eThekwini district is estimated to be home to about 93,000 HIV-positive children based on antenatal clinic data.

Dual ARV therapy to prevent mother-to-child HIV transmission (PMTCT), which South Africa adopted in 2008, can reduce the risk of transmission to as little as 5 percent when correctly administered. However, a recent government report charting progress on South Africa's national strategic plan for HIV/AIDS noted that almost 40 percent of infants exposed to HIV were at risk of contracting the virus due to incomplete provision of PMTCT services.

Under recently revised national HIV treatment guidelines, all HIV-positive infants under one are eligible for ARVs. Without treatment, the UN Children's Fund (UNICEF) has said that one-third of HIV-positive babies die in their first year of life.

Testing barriers

According to Rapiti, the research revealed two main barriers standing between HIV-positive children and treatment: health workers' confusion regarding the implementation of national guidelines, and mothers' reluctance to test their children for HIV.

MatCH researchers noted that clinical staff were prone to misunderstanding the criteria for starting ARV treatment as set out by the national guidelines. Rapiti said delays in treatment also arose because health workers struggled to find an appropriate caregiver to involve in the process of initiating the child or infant who could undergo treatment literacy classes.
To address the gaps, MatCH conducted extensive training on the treatment guidelines and created posters to help clinicians and health workers understand the difference between treating adult and paediatric patients. Some health facilities also began holding the three mandatory treatment literacy classes required of caregivers of paediatric ARV patients on a single day, instead of once a week, to save caregivers time and transport costs.

In addition, MatCH and its partners developed ways to train often illiterate older relatives in HIV-positive children's care and treatment, for example by marking syringes or droppers and numbering pill bottles to indicate in what order children should take medication.

Rapiti said counsellors had started approaching mothers in waiting rooms to talk to them about a broad range of infant health issues, including low weight and stunting. They also used these talks to encourage mothers to test their children for HIV.