Children the least covered by HIV/Aids treatment in Kenya

Children are the least covered by HIV/Aids treatment in Kenya, a new survey shows, raising concern that hundreds of them could be dying needlessly.

The preliminary Kenya Population-based HIV Impact Assessment (KENPHIA) 2018 report showed that HIV/AIDs treatment for children aged between 0-14 years stands at 93.2 percent—the lowest among all the clustered age groups of HIV patients under treatment. This means only one in four children living with HIV not on ART.

The survey released Thursday shows that only 67.1 percent of the children on Antiretroviral Therapy (ART) had achieved viral load suppression. Overall, 96 percent of those aged between 15 to 64 years were on ART and 90.6 percent had achieved viral load suppression.

The study, conducted between June 2018 and February 2019 and involving 17,000 households and 34,000 participants, found that there are approximately 139,000 children living with HIV in Kenya.

“Among children living with HIV, 78.9 percent who tested HIV-positive in KENPHIA had known HIV-positive status prior to the survey of whom, 93 percent were on ART. This translates to one in four children living with HIV not on ART” the report stated.

Comparatively, people aged between 15-64 years reported a 96 percent treatment coverage.

The prevention of mother-to- child transmission also registered small wins with study saying that most of the pregnant women had attended Antenatal clinics during the pregnancy.

The study indicates that among women aged 15 to 49 years who gave birth within the 12 months preceding the survey and attended ANC, 96 percent knew their HIV status. Among the pregnant HIV positive women, 92.1 percent reported to attending ANC and receiving ART during their pregnancy.

The Government prioritises preventing of new infections in pregnant and breastfeeding women as one of the ways of cutting down HIV infections among children. Pregnant or breastfeeding women that are positively diagnosed are immediately put on ART treatment as the country targets to eliminate mother-to-child transmission (eMTCT) of HIV by 2021.

The government targets 90 percent antenatal care (ANC) attendance, 90 percent HIV testing among pregnant women, and 90 percent ART among the cluster.

The World Health Organisation (WHO) recommends two ANC visits in the first two trimesters and two more during the last three months. Each visit has a service package as recommended by WHO. The first one takes place within eight to 12 weeks, second at 24 and 26 weeks, the third at 32 weeks and fourth at 36 to 38 weeks.

Each ANC visit involves lessons on postnatal care, infant feeding, birth and emergency plan and it is during this period that ART’s are recommended to mothers carrying the HIV virus - they are also taught on the importance of the Anti-Retroviral Therapy (ART) during pregnancy and after. “While the results that we have seen show impressive progress, the data also show where further efforts are required. Although only four in 100 women attending antenatal care in the year prior to the survey did not learn their HIV status, that is still four too many,” said ministry of Health Chief Administrative Secretary, Dr Rashid Aman.

“Moreover, of those that were HIV positive during pregnancy, 7.9 percent reported they did not receive antiretrovirals. We must find out why.”

Women also remained the most affected by HIV with the data showing that prevalence was highest among women at 6.6 percent compared to men’s 3.1 percent of the 1.3 million adults that are living with HIV in Kenya. The report found that the annual new infections among adults was 0.14 percent, about 36,000 new incidences per year from 106,000 in 2012.“The prevalence of HIV in women is at 6.6 percent, twice that in men at 3.1 percent. This gender disparity in the burden of HIV is even greater than three times in between the ages of 20-34 years,” said Aman.

“This data shows the ever-widening gap from the 2007, to 2012 KAIS surveys that are now showing a significantly higher burden of the disease in women compared to men. The same worrying trend is also emerging in the sub-Saharan region as evidenced by other regional PHIA surveys,” he said.

The worst hit counties with over six percent prevalence include Homa Bay, Kisumu, Siaya Migori, Busia, Turkana and Kisii with a prevalence rate of 19.6, 17.5, 15.3, 13, 9.9, 6.8 and 6.1 percent, respectively.

Garissa County had the lowest incidences of HIV positive at below 0.1 percent prevalence, while Wajir, Tana River, Kiambu, Baringo and Samburu recorded percentage incidence of 0.2, 1.1, 1.1, 1.8 and 1.9 percent, respectively.

The report was commissioned by US Centers for Disease Control and Prevention (CDC) and ICAP at Columbia University with support from the Ministry of Health and financial backing of several stakeholders including US President’s Emergency Plan for AIDS Relief (PEPFAR) the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

The new data is set to help the country to come-up with policy and in tailoring the HIV treatment and response according to regions and in areas like Migori and Turkana counties where there is evidence of an emerging epidemic.

"The KENPHIA preliminary results show just how well HIV response policies and programmes in Kenya are doing to address the epidemic,” Columbia University’s ICAP Principal Investigator and Senior Technical Director.

“We look forward to working with the Ministry of Health and PEPFAR colleagues to use KENPHIA data to strengthen policies and programs to close in on epidemic control by 2030.”