Challenges in Providing HIV Care to Paediatric Age Group in India (Commentary) (Human Immunodeficiency Virus) (Report)
Over 90 per cent of the 2 million HIV infected children worldwide, live in developing countries (1). In India, 3.8 per cent (2) (approximately 100,000 (3)) of an estimated 2.5 million persons living with HIV/AIDS (PLHA) are children. As of September 2008, of about 1,77,808 individuals started on antiretroviral therapy (ART) since its launch in April 2004, about 12,116 are children and, over 42,000 are registered in pre-ART programme (personal communication, Rewari BB). Since median duration of progression from HIV to AIDS in children is two years (4), many infected children, particularly infants may not be able to access ART. Paediatric HIV/AIDS Initiative of Government of India comprises Prevention of Parent to Child Transmission (PPTCT) on one hand and co-trimoxazole (CTX) prophylaxis to avert opportunistic infections (OI) and ART, on the other. However, endeavours at scaling up comprehensive care for children living with HIV/AIDS (CLHA) are met with many barriers, such as low access to treatment, difficulty in early diagnosis, diagnosis and management of OI, implementing CTX prophylaxis, need of specific as well as frequently changing drug dosages, trained human resource, etc. One of the greatest challenges to paediatric HIV care and treatment in India is the low coverage of ANC and PPTCT services. Less than 20 per cent of pregnant women (5) in India access public health facilities for delivery, resulting in low utilization rate of PPTCT services. In fact, the reported percentage of estimated HIV-infected pregnant women in India who received anti-retrovirals for PPTCT was only 10 per cent (6).