ASTMH 2019: In plans to end AIDS impacts on children, an easier trip to the clinic could make all the difference

ASTMH 2019, the 68th annual meeting of the American Society of Tropical Medicine and Hygiene, took place Nov. 20-24 in National Harbor, MD.[/caption] NATIONAL HARBOR, MARYLAND - In Malawi, where more than half the population lives in poverty, the available transportation to a clinic can determine whether a child or adolescent living with HIV gets treatment adequate enough to suppress the virus. At the 68th Annual Meeting of the American Association of Tropical Medicine and Hygiene, where aisles of posters and days of sessions highlight the impacts of neglected diseases endemic in countries of low incomes and limited resources, sessions Friday showed that even as international agencies and national governments tout plans to end the global health threat of HIV, inequities and infrastructure gaps continue to make all the difference. A study of youth getting antiretroviral treatment at the Baylor College of Medicine  Centre of Excellence in Lilongwe, Malawi examined the relationship of factors that included whether patients homes had electricity, a source of drinking water, employed adults, as well as available modes of transportation, to viral suppression. While social determinants of health are acknowledged to play an important role in disease outcomes, Dr. Brian Vonasek of Baylor College if Medicine noted, little has been studied on their impacts among children and adolescents living with HIV. Of outcomes for 308 children and adolescents examined, suppression of the virus eluded nearly two-thirds. Sixteen children were lost to follow up, and fifteen died. Mortality was highest for children under five. Those with access to a personal vehicle of a taxi showed significantly higher rates of viral suppression than those taking a minibus. "Ease of transportation could be a big target to improve viral suppression for children and adolescents living with HIV," Dr. Vonasek said. Answers to the challenge could include cash supplements for transportation and decentralized care, he noted, as well as the continued development and ultimately access to long-acting antiretroviral treatment.