Pediatric HIV epidemic: Status and prospects in Ethiopia

Abstract

Ethiopia has made encouraging progress towards human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) epidemic control over the past decade.In 2022, the rate of new infections decreased by 59% and the death rate by 52% compared to 2010 figures (1).HIV prevalence remains relatively high in urban areas, a three percent rate compared to under one percent nationally, with much variation by region and sociodemographic characteristics (2,3).The remaining gaps that need to be filled to achieve epidemic control include prevention among priority populations, provision of support services for persons affected by HIV to ensure retention in care, and enhancing pediatric services such as identification of new cases and improving treatment coverage (1-3).The mortality among those on antiretroviral therapy (ART) is high, ranging from 3.2%-22.9%(4,5) with a median survival time of 91.6 months, and 51% of the deaths occur within the first 2 years of treatment (5).Among children 0-14 years of age in Ethiopia, the estimated number of HIV infections dropped from 140,000 in 2003 to 42,000 in 2021 (6,7).This is a remarkable achievement, but much remains to be done.Case identification will continue to pose a huge challenge, given the low HIV prevalence rate of 0.3% in urban Ethiopia among children.This will render early identification of cases difficult, delaying their rapid engagement in care and ART services.Moreover, we need to find innovative ways of overcoming this challenge, while mounting our efforts to fill the existing gaps in ART coverage in this age group, which stands at 48% vs 76% in adults (6,8).As indicated by a report from northern Ethiopia (9) viral suppression is at 73% vs the expected global target of 95% (10).Decades of experience and available evidence have also shown that the HIV epidemic in children (and the youth) is a serious and complex problem.We know that children living with HIV get sicker than adults because of their less developed immune systems, get recurrent infections, and develop severe malnutrition.They are also at risk of developmental and psychosocial