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ELIUD MWANGI: Working towards a HIV-free generation



It is 24 years since Elizabeth Glaser lost her fight with Aids. Elizabeth, who created the foundation that now bears her name, contracted HIV in a blood transfusion while giving birth to her daughter, Ariel, in 1981. Ariel also contracted the virus, and ultimately lost her battle with Aids in 1988. At the time there were no drugs on the market to treat HIV and prevent transmission. Elizabeth devoted her life to changing that.

We have come a long way since then. The Aids epidemic is not yet over, but the progress we have made is real, and we know that an end is possible. Life-saving antiretroviral therapies (ART) are reaching people who need them. Nearly 60 per cent of the 37 million people around the world living with HIV were on treatment in 2017, but without treatment the remaining 40 per cent remain at high risk of sickness and even death, and the rate of the rollout of treatments is slowing.

In Kenya more than 1.1 million of the 1.5 million people with HIV are on ART. More than three quarters of HIV positive pregnant women now receive ART to prevent mother-to-child transmission of HIV and for their own health. As a result, 11,000 new HIV infections among children were averted in 2017.

We are at a critical moment in the fight against this epidemic. Progress is slowing, and HIV infections are increasingly concentrated in marginalised and harder-to-reach populations. Global new infections declined by 18 per cent over the last seven years, which is not fast enough to meet the UNAIDS’s target of fewer than 500,000 new infections by 2020. New HIV infections are rising in approximately 50 countries.

Perhaps, most worryingly, the gains that we have made in protecting children are not being sustained. While new HIV infections among children have declined by 35 per cent since 2010, only slightly more than half of all children living with HIV have access to treatment. Just as when the Elizabeth Glaser Pediatric Aids Foundation (EGPAF) was founded, children are the forgotten face of HIV/Aids. Without treatment, 50 per cent of HIV-positive children will die before their second birthday, and most will die before they reach the age of five.

In Kenya, 8,000 children were infected with HIV in 2017, because their families lack access to the health services they need to prevent mother-to-child transmission of HIV and 4,300 children died due to Aids. That is 20 new infections and 10 deaths every single day. Each of these new HIV infections and deaths is preventable. That number can come down to zero.

Early HIV testing, prompt return of test results, and rapid initiation of treatment are critical for reducing morbidity and mortality among HIV-infected infants. In Kenya, using the conventional laboratory-based testing approach, where samples need to be transported from where the blood is drawn to the referral laboratory for analysis, it takes a median of 53 days to get children’s HIV test results to the caregiver, which leads to delayed ART initiation.

Point-of-care (PoC) for early infant diagnosis (EID) technology provides a timely solution to this challenge of delayed diagnosis and delayed treatment initiation, which often result in needless deaths. With funding and support from Unitaid, EGPAF is working with ministries of health and key stakeholders to identify the most appropriate health facilities for placement of PoC EID platforms in nine countries, including Kenya.

New-to-market, point-of-care technology ensures that infants are screened on-site and quickly receive their test results so that HIV-positive infants can be rapidly enrolled on lifesaving ART. Through this technology, mothers and caregivers now get HIV test results for their infants immediately. This gives the infected infants a chance to live healthy and productive lives and reduces the anxiety associated with prolonged wait for an infant’s HIV test results. We now need to make sure that these technologies reach the people who need them the most.

The First Lady of the Republic of Kenya recently launched two important documents; an implementation plan for piloting Early Infant Diagnosis for HIV and TB using a multi-disease point-of-care platform, and the national point-of-care testing implementation roadmap in Kenya. These documents provide a roadmap for the scale up of this life-saving technology across the country, which will contribute to achieving the elimination of mother to child transmission agenda. The technology will also help to contribute to the UNAIDS fast-track strategy to end the Aids epidemic by 2030.

Achieving this milestone, and ultimately an Aids-free generation, will require concerted efforts by all partners. Together, we can defeat Aids in children and end the Aids epidemic by 2030.

Country director, Elizabeth Glaser Pediatric Aids Foundation

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Kenyan Digest