Swaziland has the highest HIV prevalence rate in the world. While progress has been made in preventing transmission from mothers to their children in Swaziland, testing among very young children still remains a huge challenge.

Dr Nduduzo Dube  is the Medical director Aids Help Centre in Mazzini,  Swaziland. He looks at the issues around testing young children with a tight budget.

TESTING BEFORE CHILDREN GET SICK

“Most of the children who are lost here in Swaziland die because they don’t have access to treatment early enough. If testing were routine children would get diagnosed before they got sick – especially children who were exposed to the virus.”

CURRENT STATE OF TESTING

 “Currently the PCR test is only done in referral hospitals. Blood samples are collected and sent to Pretoria (almost 200 miles away). We don’t have any laboratories for doing PCR test locally. The antibody test we use here  isn’t accurate below 18 months of age.”

CHALLENGES

 “Most children who need to be tested are out in rural areas and may be cared for by their grandparents. Transport to urban areas for testing may be expensive for the families.”
“Sometimes children are in a child-headed family so there’s no one to contact about testing.”* 

WHY CHILDREN ARE NOT TESTED EARLIER

“The public aren’t very well informed about testing. Also, there the availability of testing facilities is an issue. If we could do the PCR test in public laboratories it would help a lot.”

THE RISK OF WAITING

 “There are some children in whom the disease progresses rapidly and by the age of two their illness is very advanced or they have already passed away. For children who get test very late, if there are opportunistic infections such as TB involved, the outcome is never good.”

*In some countries an adult guardian needs to be able to give authorization for orphans to be tested for HIV.