Proposal to Ministries of Health for treating children born to HIV-positive mothers

Proposal to Ministries of Health for treating children born to HIV-positive mothers

Some 2.3 million children under the age of 15 are living with HIV worldwide, and the vast majority have no access to any form of care or treatment. These children live and die in obscurity.

The GMC has published a proposal to Ministries of Health for treating children born to HIV-positive mothers.

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Some 2.3 million children under the age of 15 are living with HIV worldwide, and the vast majority have no access to any form of care or treatment. These children live and die in obscurity.

There is one basic, easily delivered intervention that can be the difference between life and death for these children. Cotrimoxazole prophylaxis can prevent children from developing life ending pneumonias that are the leading cause of death in HIV positive children.

Cotrimoxazole is already widely used in all countries and in most it is clearly identified as an essential drug. The WHO has recently developed clear guidelines on its use. It is time to take decisive steps toward making this life saving, low cost antibiotic available to those who most need it.

The Global Movement for Children is calling on Ministers of Health to:

1. Develop a national plan of action for your country with clear targets to ensure that every child known to be HIV-positive and all those born to HIV-positive mothers, have access to a consistent, high quality supply of cotrimoxazole.

2. Ensure that training is provided to health centre staff using the WHO guidelines on the delivery of cotrimoxazole prophylaxis to children in need.

These actions are wholly in line with the commitments which made by African governments in the Abuja Call for Accelerated Action Towards Universal access to HIV and AIDS, TB and Malaria, and Africa's Common Position to the High Level meeting of the UNGASS on AIDS which set ambitious goals for 2010.

Below is basic information on increasing cotrimoxazole access. We also attach a joint statement by UNIADS, WHO and UNICEF on the matter as well as the Guidelines on Co-trimoxazole prophylaxis for HIV-related infections among children, adolescents and adults in resource-limited settings.
Increasing Cotrimoxazole Access – Saving Children’s Lives

A child under 15 dies of an AIDS-related illness every one and a half minutes of every day – 1000 a day in 2006.
Fifty per cent of HIV infected children will die before their second birthday from opportunistic infections, especially pneumonia. Cotrimoxazole can prevent these deaths.

What is Cotrimoxazole?
Cotrimoxazole is a widely available antibiotic that is generally used in the treatment and prevention of infections. This intervention can dramatically reduce mortality in HIV positive children, particularly in the first two years of life.

Who needs Cotrimoxazole?
Over 4 million children need access to contrimoxazole now.
It is now widely agreed that this intervention should be delivered to all children from 4-6 weeks of age who are HIV exposed (children born to HIV infected mothers), until a conclusive diagnosis can be obtained. Additionally, any child identified as HIV-infected or those with clinical signs or symptoms suggestive of HIV, regardless of age.

How should cotrimoxazole be given?
All HIV exposed children need this drug. They should take the prophylaxis until HIV infection has been definitively ruled out and they are no longer breastfeeding
All HIV infected children can benefit from this intervention where ARV treatment is not yet available.
Cotrimoxazole should be delivered free as part of basic health intervention for all HIV positive and HIV exposed children.

What stands in the way?
Currently health workers are not aware of the potential benefits of cotrimoxazole for children – tended to focus on ART as gold-standard and to focus on adult treatment

HIV is difficult to diagnose in children under 18 months – antibody tests used to diagnose HIV in adults cannot be used because of the presence of maternal antibodies

Policy and programme information

It is recommended that:

• National AIDS treatment, care and support policies and strategies include provision of cotrimoxazole prophylaxis
• National ARV treatment guidelines, PMTCT guidelines, and clinical care guidelines include cotrimoxazole prophylaxis for HIV exposed and HIV infected children
• Health providers at all levels are sensitized and trained to provide cotrimoxazole prophylaxis to all HIV-exposed and HIV -infected children
• Countries should supply the cotrimoxazole for children free of charge or at subsidized rates where possible