Namibia has rolled out new HIV medication for children, and it is now available to eligible children in all regions. This was announced by Dr Laimi Ashipala, the chief medical officer for the HIV/STI programme within the health ministry. She indicated that the introduction of this new medication is informed by new developments in the HIV field and positive scientific evidence.
“At the beginning when HIV medications became available in the country in 2003, people living with HIV were taking up to three tablets at a time more than once a day. However, with advanced research in the HIV field, newer and better medications and formulations are becoming available, including the Dolutegravir 10mg (for children),” she explained.
In Namibia, just over 6 000 children are living with HIV, but most of these cases are from the pre-ART era and those who became infected during breastfeeding as well as minorities from other modes of transmission like infections during pregnancy.
The paediatric HIV medications exist in different formulations such as tablets, syrup and granules, and Namibia has all these.
Ashipala said syrup and granules are reportedly not palatable as they have an unpleasant taste, and children struggle to swallow them.
“This contributed to some children not achieving viral load suppression, which is the desired outcome when initiating a child on treatment.”
“Although medications in general, including HIV medications, have side-effects, Dolutegravir has mild and bearable side-effects which reportedly resolve within a month of starting treatment, unlike Lopinavir, which had moderate side-effects”, she added.
There are numerous benefits attributable to this new medication: the tablets are easily dissolved in water and are palatable, and have a strawberry flavour, which makes them popular with children.
Dolutegravir has a high genetic barrier, meaning resistance to the medication does not develop easily. Children will achieve viral load suppression quicker when initiated on a Dolutegravir-based regimen in comparison to the older regimens.
“Additionally, the medication is taken once a day, which makes it more efficient with an anticipation that it will improve adherence.”
Dolutegravir can be taken by children aged four weeks and older, and/or those who are 3kg up to 20kg. Older children will continue to take Dolutegravir into adulthood, but the medication strengths differ.
“They will take the 50mg tablets that are also already available in the country. This is good news for our children living with HIV because once stable on medication, they can continue the same medication into adulthood, unless new medication becomes available and is recommended.”
Children mostly acquire HIV infections from their mothers during pregnancy, at birth, or during the breastfeeding period.
Namibia has an effective ‘Prevention of Mother-to-Child Transmission’ programme, which saw a significant reduction of children being born HIV positive. The numbers are so low that the country is about to achieve the elimination level.
Ashipala said cooperation from guardians and parents has been fruitful, with minimal obstacles hampering the administering of HIV medicine to children, something the ministry is observing with keen interest.
“There are a few cases of adults and guardians who are not collecting medication for the children timely or at all, but the majority of them are coming. To address that challenge, there is a system in place that traces patients who miss their appointments, and brings them back into care. This is done by contacting them telephonically, or using the residential address provided at the initiation.”
In addition to the caregiver challenges, there have been strategies and innovations to close the system gaps.
“To compensate for the long distances that some clients need to walk to access healthcare services, the ministry has a differentiated service delivery model, which includes the community dispensing of antiretroviral therapy (ART) at sites where structures are erected in the community and healthcare workers go and deliver the services straight to the people, the dispensing of medication for up to six months to reduce the frequency of clients visiting health facilities, and many others.”
Ashipala thus urged caregivers to go to the nearest health facilities to access Dolutegravir 10mg for their children.
She further encouraged caregivers to get vaccinated for Covid-19, and to continue taking care of these children, in addition to adhering to other Covid-19 infection control measures like the washing of hands, sanitising, wearing masks correctly and consistently as well as observing social distancing.