Original articles

The impact of health programmes to prevent vertical transmission of HIV. Advances, emerging health challenges and research priorities for children exposed to or living with HIV: Perspectives from South Africa

A Goga, A Slogrove, C J Wedderburn, U Feucht, J Wessels, V Ramokolo, A Bhana, N du Plessis, R J Green, Y Pillay, G Sherman

Abstract


Over the past three decades, tremendous global progress in preventing and treating paediatric HIV infection has been achieved. This paper highlights the emerging health challenges of HIV-exposed uninfected (HEU) children and the ageing population of children living with HIV (CLHIV), summarises programmatic opportunities for care, and highlights currently conducted research and remaining research priorities in high HIV-prevalence settings such as South Africa. Emerging health challenges amongst HEU children and CLHIV include preterm delivery, suboptimal growth, neurodevelopmental delay, mental health challenges, infectious disease morbidity and mortality, and acute and chronic respiratory illnesses including tuberculosis, pneumonia, bronchiectasis and lymphocytic interstitial pneumonitis. CLHIV and HEU children require three different categories of care: (i) optimal routine child health services applicable to all children; (ii) routine care currently provided to all HEU children and CLHIV, such as HIV testing or viral load monitoring, respectively, and (iii) additional care for CLHIV and HEU children who may have growth, neurodevelopmental, behavioural, cognitive or other deficits such as chronic lung disease, and require varying degrees of specialised care. However, the translation thereof into practice has been hampered by various systemic challenges, including shortages of trained healthcare staff, suboptimal use of the patient-held child’s Road to Health book for screening and referral purposes, inadequate numbers and distribution of therapeutic staff, and shortages of assistive/diagnostic devices, where required. Additionally, in low-middle-income high HIV-prevalence settings, there is a lack of evidence-based solutions/models of care to optimise health amongst HEU and CLHIV. Current research priorities include understanding the mechanisms of preterm birth in women living with HIV to optimise preventive interventions; establishing pregnancy pharmacovigilance systems to understand the short-, medium- and long-term impact of in utero ART and HIV exposure; understanding the role of preconception maternal ART on HEU child infectious morbidity and long-term growth and neurodevelopmental trajectories in HEU children and CLHIV, understanding mental health outcomes and support required in HEU children and CLHIV through childhood and adolescence; monitoring HEU child morbidity and mortality compared with HIV-unexposed children; monitoring outcomes of CLHIV who initiated ART very early in life, sometimes with suboptimal ART regimens owing to medication formulation and registration issues; and testing sustainable models of care for HEU children and CLHIV including later reproductive care and support.


Authors' affiliations

A Goga, Health Systems Research Unit, South African Research Council, Cape Town, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa; HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa

A Slogrove, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

C J Wedderburn, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK

U Feucht, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa; Tshwane District Health Services, Gauteng Department of Health, Pretoria, South Africa; Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, South Africa; Maternal and Infant Health Care Strategies Research Unit, South African Medical Research Council, Pretoria, South Africa

J Wessels, Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, Faculty of Health Sciences, University of Pretoria, South Africa

V Ramokolo, Health Systems Research Unit, South African Research Council, Cape Town, South Africa

A Bhana, Health Systems Research Unit, South African Research Council, Cape Town, South Africa;Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa

N du Plessis, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa

R J Green, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa

Y Pillay, National Department of Health, Pretoria, South Africa

G Sherman, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Centre for HIV & STI, National Institute for Communicable Diseases, National Health Laboratory Services, Johannesburg, South Africa

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Cite this article

South African Medical Journal 2019;109(11b):77-82. DOI:10.7196/SAMJ.2019.v109i11b.14292

Article History

Date submitted: 2019-12-05
Date published: 2019-12-05

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