Fifteen years old. This is the age when many South African children living with HIV stop benefitting from the free antiretroviral (ARV) treatment provided by the government.
Speaking to Health-e News Sergio Carmona from the National Health Laboratory Service (NHLS) said the “transition from paediatric care to adult care is challenging” and older adolescents, 15 to 19 years of age, do worse on treatment than both adults and younger children.
Worldwide, adolescents “living with HIV have the highest rates of poor medication adherence and treatment failure”, according to a report published by The Joint United Nations Programme on HIV/AIDS (UNAIDS) last week.
But with a new online tool, doctors, nurses and facility managers working in the South African public health sector can track who is, and isn’t, doing well on HIV treatment, in real time. Healthcare workers and policy makers will now have the ability to see which facilities need to pay more attention to children, for example.
According to Carmona a special algorithm was designed for this tool: the first National CD4 / Viral Load Monitoring Dashboard – a software programme that visualises decades of CD4 cell and viral load test results.
Speaking from the launch of the dashboard in Boksburg last Tuesday, he said we’ve already “identified that we could look after children better” and that transitioning into adulthood is a time where many teenagers lose control of the virus. Fifteen to 19-year-olds have the lowest rates of viral load suppression.
Measured with a blood test, a viral load is an indicator of how much virus is present in a person’s blood; while a CD4 count is an indicator of a person’s immunity. Patients taking treatment properly should have a low viral load, and are said to be virally suppressed, indicating the ARVs are working for them.
However, patients taking their ARVs as indicated can also have a high viral load which means the drugs are no longer working to fight the virus. These patients have become resistant to the medication and need to be changed to a different regimen.
Using data from the NHLS and national Department of Health Information Systems, the dashboard can provide access to detailed information about how many patients are virally suppressed – and where.
Healthcare workers need access to a smart phone or laptop with internet access, and a registered email address, to access the dashboard’s information and can see trends on a national, provincial, district, sub-district and individual facility level.
Carmona said that only doctors and nurses treating specific patients will be able to access their individual information which ensures confidentiality and privacy is kept in place.
“Children and adolescents are often overlooked in our response to HIV/Aids. The new system will enable healthcare workers to focus attention on high risk, HIV-infected children and adolescents to improve individual outcomes and meet the 90:90:90 targets,” said Gayle Sherman from Wits University’s Faculty of Health Sciences.
The UNAIDS targets are ambitious: By 2020, 90 percent of people living with HIV should know their status; 90 percent of these people should be on ARVs; and 90 percent of people on treatment should have suppressed viral loads.
According to the NHLS, there are almost 6.75-million people living with HIV in South Africa – with 3.3 million on treatment. Of those who have had their viral loads tested 80 percent are suppressed.
Launched by the NHLS, Department of Health, Boston University, and HIV organisation Right to Care, the dashboard will be rolled out in the nine provinces and is expected to be fully implemented by June 2017.
“As a clinician, when you have this information in front of you making you aware of the gaps you are more likely to act,” said Carmona.
The country only has 36 months to reach the target and according to Right to Care’s Pappie Majuba “we stand a chance”. – Health-e News.
An edited version of this story was published on Health24.com