Review of US PEPFAR programme highlights continued higher infant mortality

On 1 December 2023, the US MMWR included an important review of the positive impact the PEPFAR programme has had globally on the health of children living with HIV.

This included highlighting the disproportionately higher mortality experienced by children younger than five compared to those older.

Across all US PEPFAR sites from October 2020 to September 2022, almost 5% of babies younger than a year old and nearly 3% of children aged 1-4 years on antiretroviral treatment died each year.

We include below the abstract from the report but please see the full online report for full details.

Globally, children aged <5 years, including those living with HIV who are not receiving antiretroviral treatment (ART), experience disproportionately high mortality. Global mortality among children living with HIV aged <5 years receiving ART is not well described.

This report compares mortality and related clinical measures among infants aged <1 year and children aged 1–4 years living with HIV with those among older persons aged 5–14, 15–49, and ≥50 years living with HIV receiving ART services at all clinical sites supported by the U.S. President’s Emergency Plan for AIDS Relief.

During October 2020–September 2022, an average of 11,980 infants aged <1 year and 105,510 children aged 1–4 years were receiving ART each quarter; among these infants and children receiving ART, 586 (4.9%) and 2,684 (2.5%) respectively, were reported to have died annually. These proportions of infants and children who died ranged from four to nine times higher in infants aged <1 year, and two to five times higher in children aged 1–4 years, than the proportions of older persons aged ≥5 years receiving ART.

Compared with persons aged ≥5 years living with HIV, the proportions of children aged <5 years living with HIV who experienced interruptions in treatment were also higher, and the proportions who had a documented HIV viral load result or a suppressed viral load were lower.

Prioritising and optimising HIV and general health services for children aged <5 years living with HIV receiving ART, including those recommended in the WHO STOP AIDS Package, might help address these disproportionately poorer outcomes.

Mortality Among Children Aged <5 Years Living with HIV Who Are Receiving Antiretroviral Treatment — U.S. President’s Emergency Plan for AIDS Relief, 28 Supported Countries and Regions, October 2020–September 2022. MMWR, 72(48);1293–1299. 1 December 2023.
https://www.cdc.gov/mmwr/volumes/72/wr/mm7248a1.htm