Home / Episode 13


2008 SERIES

EPISODE 13 - Infants on ARVs

The TeamAdolescents & ARVsHerpes & HIVCelebrities & HIVSero-disordant coupleRelationships & sex Breast, bottle or cup?VCTHate crimesMDR & XDR TBCircumcisionGender violenceInfants on ARVsSexual negotiationsSocial grantsCervical cancerSubstance abusePMTCTFarm workers & HIVPEPTeen pregnancyDisclosureNSPStigma and predjudiceWater and sanitationHuman rights

The gift of life shouldn't be guesswork

Baby being consoled after the administration of the PCR test

 

This episode of Siyayinqoba Beat It! aims to inform us on the best practices and difficulties of administering ARVs to infants. It has been shown that starting new born children on ARVs as soon as they are diagnosed leads to far better results.  Pharmaceutical companies have not yet developed a fixed dose that is a sure-fire across the board measure suitable for infants. Determining the correct pediatric dose is often difficult at understaffed hospitals in South Africa. This leads to hospitals often using a dose that is relative to the child's weight which could lead to over or under dosing.

Joining our support group is Dr Trevor Majoro and we hear about the mandatory PCR DNA test given to infants born to HIV positive mothers. Our first insert sees how these tests are conducted as we travel to McCord Hospital in KZN and see how the test is conducted by extracting blood from the baby's heel. The actual test takes a few minutes and the results are known in a matter of weeks. Back in the studio Dr Majoro explains the PCR test in more detail and other methods of testing for HIV are discussed.

Read the insert & discussion transcript on the PCR test here

We next meet Florence and Neo, a mother and child who are living with HIV. Florence listened to the recommendations of her healthcare practitioner and had Neo tested for HIV as soon as possible. We see how this early testing resulted in Neo's early treatment. Early treatment can literally be a lifesaver and can lead to the baby having a far better chance of a normal life.

Download the transcript of our Florence & Neo interview here

The question of protocol in our treatment guidelines is raised in the studio after seeing how healthy and happy Neo is after going on ARVs early. The message for all of us is clear, early testing and treatment is vital. Our next insert is from Khayelitsha where we talk to Mama Mbovane who has been trained to give ARVs to children.  As mentioned, getting the dosage for children right is a tricky process.  She explains how she has learnt about ARVs and the types she uses while looking after two of the six children in her care that require treatment. We see how difficult it is to administer ARVs to infants because of the combination of tablets and syrups and how vital the correct measurement of the doses needs to be.

Read about Mama Mbovane's experiences here

Back in the studio the question is raised as to why there aren't simpler ways to help these children in terms of dosages. Hopefully this will improve over time.  This episode really highlights the fact that we need to simplify the process of mothers getting their babies tested and ultimately treated in a safe, manageable way.

IT'S A FACT

Neo being given her antiretrovirals

Mama Mbovane makes sure the children in her care take their ARVs

Dr Avy Violari

Florence and CJ Mxo outside Florence's home

 Of the 5.5 million people living with HIV in South Africa, 294 000 are children.  Most of these children are under 5 years of age.
Approximately 64 000 children are born with HIV each year. Of these 38 000 are infected at birth, with 26 000 infected through breast milk.
A child born with HIV who has no access to ARVs (ART) lives on average 2 years.
Most children born with HIV die before the age of 5 (over 90%).
These deaths are entirely unnecessary as infants can have a healthy, relatively normal life on ARVs (ART).
Only 30 000 children in South Africa are on ARVs (ART). The rest are dying unnecessarily. Given good medical management there is no defined limit on the longevity of children on ART.
The National Strategic Plan for HIV and AIDS 2007-2011 commits to starting 40 000 children a year on ART by 2011. If Prevention of Mother-To-Child Transmission services are working properly and the number of infant infections decrease, an uptake of 40 000 children a year will cover most of the children born with HIV.
Children born from mothers with HIV should receive a PCR test 6 weeks after birth. This test checks directly for the virus (it is not an antibody test) and can detect whether or not the child is infected with HIV.
New research has shown that HIV positive children under 1 year of age should be started on ARVs immediately regardless of their CD4 count. This results in a much better overall development for the child and lowers mortality.  This approach simplifies putting infants on ARVs, but has not been put into action by the National Department of Health.
HIV positive children who are over one year old and have not started ARVs usually wait until their CD4 cell count drops to less than 20% of the total white blood cell count.
Administering ARVs to children often involves the mixing of syrups with water. The dosage changes as the child grows. This complicates ART for children and requires a stable, committed and well-trained caregiver.
Communities all over South Africa have shown that it is possible for children to be successfully put on ART despite the difficulties.
All children living with HIV have a right to treatment and a normal life.