South Sudan

Civil society organizations and networks of persons living with HIV are very crucial in supporting children and adolescents infected and affected by HIV. Therefore, the MoH of South Sudan with support from ANECCA held a three-day sensitization-training workshop for members of CSOs on the importance of providing PSS as part of their interventions and to highlight the importance of coordination and need for synergy between CSOs at community level and health facilities in the care of children and adolescents living with HIV.

“South Sudan had nothing before ANECCA in terms of paediatric and adolescent HIV services and we depend on partners in almost everything. South Sudan is one of the countries with Challenging Operating Environments (COE).

South Sudan is Africa’s youngest republic, having attained independence a little over 5 years ago. The decades-long civil war left over 2 million dead and led to the neglect of the health system, contributing to high rates of morbidity and mortality across the social strata

South Sudan has 1,147 functioning health facilities serving a population believed to be more than 12 million. Infrastructure is poor and health systems are weak. There is a big crisis in availability of health personnel, necessitating task shifting to community health workers and home health promoters. The estimated HIV prevalence for 2015 was 2.7% (40). In the same year, it was estimated that about 180,000 people including 14,000 children were living with HIV. Similar to other sub-Saharan countries, women, particularly in the age groups 20–24 years and 25–29 years, are disproportionately affected due to sociocultural and economic risk factors. By June 2016, only 27 sites across the country were offering comprehensive HIV treatment, care and support to people living with HIV (41). Hence the low coverage: only < 5% of all adults and 3% of all children living with HIV are on treatment.

ART coverage for children and adolescents living with HIV is low compared with adults, where ANECCA implemented a regional project to improve coverage and quality of care.

Catalyzing Access to Quality Services for Children and Adolescent Living with HIV/AIDS

Country  Action Plan for policy review and training needs assessment findings for children and adolescent HIV/AIDS

ANECCA

ANECCA commissioned a team of international and national consultants to conduct rapid assessments of the performance gaps among healthcare workers in the provision of HIV services to children and adolescents in seven countries, including South Sudan that could be addressed through appropriate training and mentorship.

As part of the process, ANECCA conducted a Regional Trainers of Trainers (TOT), where five persons were engaged in an in-depth competence building training, as Regional Trainers, from South Sudan. In a bid to roll out the training in-country, ANECCA together with National Ministry of Health organized the National TOT to build capacity, at greater Equatoria level for health care providers, which later will be conducted in two regions of Upper Nile and Bahr el-Ghazal, so as to sustain this effort.

With a total area of 27,830 km2, Burundi is one of the smallest but most densely populated countries in East and Central Africa. The HIV national prevalence is estimated at 1.4% (17). A disproportionately higher HIV prevalence is seen in the urban than in the rural population (4:1): the capital city, Bujumbura, is estimated to have a HIV prevalence of 4.3% (18).

The last decade has seen progress in the fight against HIV. In 2015, fewer than 300 new HIV infections were reported among children compared with more than 1,600 new infections in 2009 (19). In 2015, 89% of pregnant women living with HIV accessed antiretroviral medicines to prevent mother-to-child transmission (PMTCT). ART coverage for children (0–14 years) increased from 12% in 2009 to 30% in 2015 (19).

However, challenges still remain in increasing coverage of paediatric HIV services—only 2% of infants exposed to HIV received early infant diagnosis and 29% of children living with HIV accessed ART (19). Data is limited for adolescents living with HIV although national programmatic assessments show that about 50% of all new infections occur in persons aged <25 years, with 25% of these related to the transmission of HIV from mother to child (20, 21).

ART coverage for children and adolescents living with HIV is low compared with adults, where ANECCA implemented a regional project to improve coverage and quality of care.

Tanzania

The United Republic of Tanzania national HIV prevalence declined from 7.0% in 2004 to 5.3% in 2012 among adults aged 15–49 years. Despite this improvement, there is great regional variation: Njombe has a HIV prevalence of 14.8% while Zanzibar has less than 1% (42). An estimated 1.4 million people are living with HIV; of these approximately 28% are children (0–14 years) and 11.2% are young people age 15–24 years. Tanzania has the second-largest burden of HIV-positive children who have yet to be initiated on antiretroviral treatment based on the 2010 WHO eligibility criteria. Young females age 15–24 years are three times more likely to contract HIV than boys of the same age (42).

In 2010, about 335,000 people living with HIV were reported to be on ART; of these only 25, 000 were children under 15 years, which represents only a third of the estimated number of children who are in need of ART (43).

In partnership with PEPFAR and the Global Fund, Tanzania placed 34,524 children on ART by the end of 2013, representing 26.5% coverage, based on a UNAIDS estimate of 130,000 children and adolescents in need of treatment. This places Tanzania below the global coverage estimate for paediatric antiretroviral treatment of 34%. A wide disparity exists in ART coverage between adults and children, with an adult ART coverage estimate of 68%. Additionally, only 43% of infants had access to early infant diagnosis (DNA PCR).

ART coverage for children and adolescents living with HIV is low compared with adults, where ANECCA implemented a regional project to improve coverage and quality of care.

Uganda’s population is estimated at 34.9 million.  It has one of the youngest and most rapidly growing populations in the world with 70% of the total population being less than 25 years old and children below 18 years constituting 56.7%. The Uganda AIDS Indicator Survey (2011) estimates HIV prevalence at 7.3% from 6.4% (UAIS, 2004).  The number of persons in the country living with HIV has continued to increase, from 1.4 million in 2013 to 1.56 million in 2015. This rise is attributed to new HIV infections, high enrollment in HIV care and treatment, good retention and reduced HIV-related morbidity.

Uganda has adopted key global strategies to end the HIV epidemic by 2030: “Towards zero new infections, zero HIV/AIDS-related mortality and morbidity and zero discrimination”; the UNAIDS treatment targets of 90-90-90 by 2020; and efforts “Towards an AIDS-free Generation”. The Uganda country report (2015–2016) reported reduction of new infections amongst children living with HIV from 12,000 in 2013 to 3,500 in 2015. In addition, since 2011 new infections among exposed infants have reduced by 86%, the highest reduction in eastern and southern Africa.  Adaptation of Test and Treat for all HIV-positive children has led to increased coverage of children living with HIV, from 54% in 2014 to 66% (60,124 / 92,370) by end of June 2016.

Even with these gains, there are still challenges to be overcome. Among children under 2 years initiated on ART in 2015, 23% were lost to follow up in the first year. For children under 5 years, the viral suppression rates were at 70% compared with 90% for adults. This is coupled with a higher sample rejection rate of 7% compared with 5% for adults.  Only 39% of the health facilities had adolescent-friendly services. This shows that despite scaling up the PMTCT programme and roll-out of HIV services to lower-level health facilities, there are still gaps in paediatric and adolescent HIV testing, linkage, care and treatment and retention on ART.

ART coverage for children and adolescents living with HIV is low compared with adults, where ANECCA implemented a regional project to improve coverage and quality of care.

.