HIV activists have called on the Ugandan government to urgently address the rollout of paediatric HIV treatment; just 26 percent of children who need the life-prolonging antiretroviral (ARV) drugs have access to them, compared to 55 percent of adults.
"The 26,000 children who are on ART [antiretroviral treatment] is a very small number. Our stand is very clear. We need everybody, including children who are eligible for ART, to be enrolled on treatment," said Stella Kentutsi, executive director of the National Forum of People Living with HIV/AIDS Networks in Uganda (NAFOPHANU).
"Healthcare workers need to be trained, supervised, and provided with tools to ensure that HIV-exposed or infected children are identified and enrolled into treatment and care," she told IRIN/PlusNews.
According to the Ministry of Health, between 20,000 and 24,000 children are infected with HIV each year.
A severe shortage of trained health workers - just 56 percent of posts in the public sector are filled - and an overall poor quality public health sector are partly responsible for the low number of children on ARVs.
"It's true that the number of children on ART in Uganda is low, and one of our concerns... [is that] we have some challenges in personnel in the country," Christine Ondoa, Uganda's Health Minister, told IRIN/PlusNews.
A shortage of paediatric formulations means children often access ARVs only when they are older and at a more advanced immunological stage. Retention in ART programmes is low, especially in rural areas, where follow-up is often inadequate. In some areas, particularly Karamoja in the northeast, many children suffer from a lack of proper nutrition, which affects their ability to take the drugs.
"It is critical that government accredits more health facilities that will be able to offer paediatric ART services, especially in the rural areas, including new districts that may not have the required environment," said Paul Mayende, public relations coordinator for the Baylor (College of Medicine) International Paediatric AIDS Initiative, which runs a clinical centre of excellence for children in the capital, Kampala.
"The government, given the resources, can designate a 'Futures Fund' to specifically cater for the ART needs of children," he pointed out.
Esther Joan Kilande, administrative and programmes assistant at the Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda, pointed out that "We shall not realize any major change in accessibility, affordability, availability and acceptability of ARVs for HIV-positive children if problems like inadequate training of clinicians... lack of standardized protocol dissemination, lack of follow-up [persist]. Health system problems such as inadequate supply of drugs due to high prices, lack of transport, inadequate supply of clinicians, lack of clinics in rural areas for case-finding, need to be addressed."
|The government, given the resources, can designate a 'Futures Fund' to specifically cater for the ART needs of children|
Ondoa said as part of efforts to scale up the number of children accessing ART services, the government was training more health workers, accrediting more health facilities to provide paediatric health services, and had procured more ARVs.
Activists have expressed concern about the government's ability to meet these commitments, given that just 8 percent of the national budget is spent on health - far below the 15 percent commitment made by African governments at the African Union Summit in Abuja in 2001.
"The government should focus on securing the financial resources needed to facilitate country-level scale-up of paediatric ART, prevention of mother-to-child transmission of HIV, and maternal treatment programmes," said an official of The AIDS Support Organization, who preferred anonymity.
"We should also focus on... including nutrition services, and integrate child and family services with other health services in order to improve survival rates and health outcomes for children, positive mothers and their families."