A child born with HIV in 2009 was only diagnosed in March 2012.
According to his mother, the boy disguised as James has been receiving Nevirapine antiretroviral (ARV) drug for eight years.
She explains that administering Nevirapine to James, now aged 12, was never easy when he was young.
“It was a hard task as my child had difficulties swallowing the drugs since he was too young,” she explains. “Besides, he was required to be taking the tablets twice every day.”
James goes for HIV treatment at Dream Centre in Blantyre, where medical coordinator Dr Sagno Jean Baptiste explains why Nevirapine-based regimen is “a pill burden”.
He states: “Children have to take the tablets twice a day and the tablets are many.
“A child of less than 25 kilogramme takes over six tablets of Nevirapine-based regimen per day. This complicates adherence and compliance,” he adds.
The World Health Organisation (WHO) no longer recommends Nevirapine-based regimens due to the increased risks of drug resistance and inferior clinical outcomes.
In 2018, the organisation recommended optimal paediatric Dolutegravir (DTG) as the preferred first-line treatment for children below four weeks old and three kilogrammes.
UNAids estimates that 74 000 Malawian children aged under 14 years are living with HIV and 45 689 are receiving treatment. DTG has been part of their treatment regimens since January 2019, but was only available in 50 miligramme (mg) pills only given to clients weighing from 20kgs and above.
This means that children below the recommended weight had no access to the optimal ARV drug.
Not any longer. This year, the Ministry of Health rolled out 10mg paediatric DTG for children weighing three to 19.9 kilogrammes.
The ministry’s spokesperson Adrian Chikumbe says the rollout of the new drug started in phases from June this year, targeting facilities with high volume paediatric clients.
Chikumbe says the ministry and its partners have trained and equipped health workers to effectively administer the new drug.
He explains: “The second phase started in August 2021. The third phase was in October 2021 and in this phase, DTG 10mg was distributed to all ART facilities nationwide.
“This represents 100 percent of all children falling within the recommended weight-band, including new initiates.”
From his experience with children on the new treatment, Baptiste notes that DTG is not prone to resistance and has shown to be highly effective on HIV.
“It is child-friendly in terms of doses and taste. It has the capacity to suppress the viral load in just three months if well taken,” he says.
This makes it good for children who struggle to adhere to pill burden.
Unitaid—an international organisation that invests in new ways to prevent, diagnose and treat HIV and Aids, TB and malaria—says the strawberry-flavoured first-line HIV drug is designed to overcome barriers that stop young children from taking their medication well.
“A lack of appropriate paediatric medicines has meant that tablets are often unpalatable to children due to a bitter taste or use of adult formulations being crushed or broken for children,” it reports.
The Southern Africa Aids Dissemination Service (Safaids) champions the use of DTG in Zimbabwe. It is excited because children only have to take paediatric DTG once a day and does not require cooling.
This makes it favourable for low- income countries where cold chain requirements remain a challenge, Safaids states.
New findings from the Odyssey randomised trials in HIV-positive children in Uganda, Zimbabwe and South Africa conducted from 2016 to 2020 confirm that DTG-based regimens are safe, effective and can significantly improve viral load suppression in young children.
Mrs Dimba says her daughter, who is on ART at Dream Centre, has greatly improved since she started taking DTG.
“Her health status has improved tremendously and she no longer spends weeks admitted hospital. My child is now gaining weight, she is also performing well at school,” says the mother.
Elizabeth Glaser Paediatric Aids Foundation (EGPAF) spokesperson Prince Henderson expects DTG to make paediatric HIV treatment significantly cheaper than former ARVs, including Lopinavir/ritonavir (LPV/r) formulations.
“The estimated yearly cost savings of changing a child from LPV/r to 10mg paediatric DTG ranges from $90 to $1 200 per child, inclusive of shipping costs, depending on the LPV/r formulation and dosing weight band,” says Henderson
Baptiste, however, says that although paediatric DTG is working wonders, the main problem remains adherence. He says some children still have high viral load while taking the drugs because of low adherence and non-compliance.
“DTG is not a magic bullet, it is effective when taken well,” he cautions.