Finally Undetectable

Ausy Thabie* is an 8-year-old girl living in the mountainous nation of Lesotho in southern Africa. Amid the normal play and learning activities of any young girl, Thabie must take antiretroviral medication every day to keep her alive and healthy—as a child living with HIV. The simple task of swallowing medicine had previously been difficult because she had trouble swallowing the medication, and she hated the taste. Fortunately, she was recently transitioned to a treatment regimen that is optimized for children, which makes it much easier for her mother to keep her on treatment.

“Pediatric HIV treatment optimization means using the best possible regimen recommended by the World Health Organization,” says EGPAF-Lesotho Program Director Dr. Lephosa-Likobe.

“The regimen should be safer, have fewer side effects, be palatable, and effectively suppress the HIV viral load faster than other treatments. It should be easy to administer by both children and caregivers and be easy to store. And it should have a higher barrier in terms of [drug] resistance.”

With the support of her mother, Thabie has maintained good adherence of her treatment. Her mother reminds her about taking daily treatment and consistently brings Thabie to the hospital for her peer support group and to have her viral load checked—to ensure that HIV is suppressed.

Updates in HIV Treatment for Children

In the past, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) has supported the Lesotho Ministry of Health in scaling up optimized HIV treatment regimens for children. With updated World Health Organization guidelines, EGPAF is now working with the Ministry to smoothly transition small children living with HIV to the new optimized regimen: a three-drug combination of Abacavir, Lamivudine, and Pediatric Dolutegravir,1 also known as ABC/3TC/pDTG.

“Pediatric Dolutegravir is easier to administer because it is dissolved in water and has sweet taste that enable the child to drink easily,” says Dr. Lephosa-Likobe.

Phase One of pediatric Dolutegravir (pDTG) implementation began in April 2022, at which time the eligibility criteria was limited to newly identified HIV-positive children and children failing on first- and second-line antiretroviral regimens. Phase Two began in June 2022, at which time all children like Thabie with weight equal or less than 20kg became eligible to be transitioned onto the preferred treatment regimen.

To support the transition to this new optimal drug regimen, EGPAF reviewed Lesotho’s 2022 antiretroviral treatment guidelines and mentored health care workers. EGPAF further trained community partners on pDTG to create awareness to their respective communities—especially educating caregivers of children living with HIV so they are informed of best possible treatments. This effort should ensure that all eligible children are receiving optimized regimen by end of 2022.

Psychosocial Support

Currently, Thabie does not know that she is living with HIV, as disclosure can be a difficult topic for caregivers to navigate. However, her health team is working with the family through Ariel Club—a support group for children ages 5-9 living with HIV—to partially disclose Thabie’s HIV-status to her.

“At this stage the facilitator explains to children that there are viruses, which are referred to as insects or bugs—without mentioning HIV. Here, the main focus is on adherence to treatment and staying healthy,” says Pokane Matela, an EGPAF youth ambassador who facilitates Ariel Club. The club is also staffed with counselors and a psychologist who further address the psychological and clinical needs of children—to boost their confidence and adherence to treatment.

Full disclosure of HIV status to children happens after the age of 9, when children join the next level of peer support group.
Thanks to the combination of optimal treatment and psychosocial support, Thabie’s viral load is undetectable, which indicates that HIV is under control in her body. She is living as any other active and adventurous 8-year-old girl.