The Democratic Republic of the Congo (DRC) has launched a major five-year plan to combat HIV in children. President Félix Tshisekedi announced this initiative in Lualaba province, dedicating US $18 million to stop mother-to-child transmission, expand treatment for young people, and strengthen national health systems.Backed by the United Nations as “a beacon of hope” during global budget cuts, the initiative aims to align the DRC’s domestic efforts with Sustainable Development Goal 3, targeting the end of the AIDS epidemic by 2030.
The Urgency of Pediatric HIV in the DRC
Pediatric HIV in the DRC remains a major issue despite advances in adult treatment. While 91% of HIV-positive adults receive antiretroviral therapy, only about 45% of children have access to this crucial treatment. Annually, around 50,000 children are born with HIV in sub-Saharan Africa, with the DRC having a large share of these cases. High maternal HIV rates, inadequate antenatal care, and logistical challenges in rural areas contribute to high pediatric infection and death rates, among the worst in Africa.
Key Pillars of the Initiative
President Tshisekedi outlined three core strategies to drive the eradication of pediatric AIDS:
- Political Leadership and Accountability
- A Presidential Task Force on Pediatric HIV is set up to manage implementation, reporting directly to the president.
- Yearly public scorecards will monitor progress on crucial indicators like mother-to-child transmission rates, pediatric treatment coverage, and viral suppression in children.
- Health Systems Strengthening
- Invest in primary health centers for on-site HIV testing for pregnant women and infants.
- Train healthcare workers on pediatric ART, infant feeding, and early diagnosis tech.
- Combine HIV services with regular maternal, neonatal, and child health programs to ensure no missed chances for testing and treatment.
- Inclusive Healthcare Access
- Mobile clinics will reach remote areas, providing children and teens with testing, counseling, and ART refills away from cities.
- Collaborate with local organizations to support marginalized groups like orphans, street youth, and children of young mothers who struggle to access clinic care.
Financing and Resource Mobilization
The DRC’s initial $18 million investment is just the beginning, with $120 million needed over five years to complete the program. President Tshisekedi plans to seek support from international donors, health financing bodies, and private philanthropists to cover the shortfall.
- Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM): Efforts are in progress to obtain new GFATM funding dedicated to pediatric HIV initiatives.
- PEPFAR (U.S. President’s Emergency Plan for AIDS Relief): The DRC seeks to expand its agreement to include early infant diagnosis and pediatric treatment in PEPFAR support.
- Private Sector and Philanthropy: A national campaign, “Friends of Child Health,” will encourage Congolese businesses and global foundations to fund local health centers.
Operational Challenges and Mitigation Strategies
Implementing a pediatric HIV eradication program in the DRC is fraught with potential obstacles:
- Geographical Barriers: Long distances and bad roads delay infant diagnosis and ART delivery. Solution: Use motorcycle couriers with solar coolers and test drones for transporting samples.
- Human Resource Constraints: A lack of trained healthcare workers restricts pediatric HIV services. Solution: Implement fast-track training and offer incentives for rural assignments with hardship pay.
- Stigma and Discrimination:HIV stigma stops mothers from getting tested and treated for themselves and their babies. Solution: Start a national multimedia campaign with stories from HIV-positive parents and young ambassadors.
- Data Gaps: Disjointed health data systems hinder precise monitoring of child health cases. Solution: Expand digital record systems with tablet apps linked to a central database for real-time patient outcome tracking.
Global and Regional Context
The DRC’s initiative is crucial for the global HIV fight. International HIV funding has stalled, while other health priorities, like pandemic readiness and managing chronic diseases, have stretched donor budgets. Meanwhile, countries like Uganda and Zambia have reduced new pediatric infections by expanding programs to prevent mother-to-child transmission.
The DRC is dedicating resources and leadership to fight pediatric AIDS, joining countries like Botswana, Namibia, and Eswatini with clear goals to eliminate it. The UN praised the DRC’s strategy as a model for low-income, high-burden nations to maintain progress despite uncertain donor support.
Voices from the Field
- Dr Joel Mbemba, For years, we’ve treated children with HIV complications without a clear way to prevent new cases. This initiative provides us with tools like rapid tests and pediatric ART formulations to change that.
- Marie-Renée Lukongolo,In Haut-Katanga, many mothers in rural areas give birth at home and don’t visit clinics. Our mobile teams will connect these communities to healthcare, ensuring babies receive timely testing and treatment.
- Ms Beatrice Nkunda,The leader of the National Association of People Living with HIV states that stigma is a deadly issue. Beyond medical care, we must tackle the social obstacles that force mothers and children to remain unseen.
Implementation Timeline and Milestones
The initiative’s first year will focus on establishing governance structures, releasing the initial tranche of funds, and piloting mobile outreach in five priority provinces. Key milestones include:
- Year 1 (2025/26): Launch Task Force; train 1,200 healthcare workers; pilot mobile teams in Haut-Katanga, Kwango, and Sankuru.
- Year 2 (2026/27): Scale up community outreach to cover 50 percent of high-burden districts; introduce point-of-care early infant diagnosis machines in 20 facilities.
- Year 3 (2027/28): Achieve 80 percent ART coverage for HIV-positive children under 15; reduce mother-to-child transmission rate below 5 percent.
- Year 4 (2028/29): Integrate adolescent HIV services into 100 percent of district hospitals; expand data-management systems nationwide.
- Year 5 (2029/30): Attain near-elimination benchmarks—fewer than 2 new pediatric infections per 1,000 live births—and transition to a sustainable, domestically funded maintenance phase.
Measuring Success and Accountability
Transparency and accountability are key to the program. Twice a year, public reports will reveal progress on: the number of pregnant women tested and enrolled in PMTCT, the percentage of HIV-exposed infants getting PCR tests by 2 months, ART initiation rates, viral suppression in children and teens, and retention in care at 12 and 24 months after starting treatment. Independent audits by Congolese academic institutions and international partners will check data quality and financial integrity, ensuring taxpayer and donor funds make a real difference.
Looking Ahead: Legacy Beyond 2030
The main goal is to eradicate pediatric AIDS by 2030, but the initiative’s lasting impact might be in its systemic changes. Improved supply chains, digital health systems, and community involvement can enhance responses to other childhood diseases like tuberculosis, malaria, and malnutrition. Additionally, empowering HIV-positive adolescents with specific psychosocial support could create a generation of healthcare equity advocates.
Conclusion
The DRC’s Presidential Initiative to End Pediatric AIDS is a bold national plan to combat a major health issue. It aims to save many young lives by strengthening health systems and ensuring access for all. This initiative shows that countries with high HIV rates can lead the fight against the disease, even with less international support. President Tshisekedi stated, “Our children deserve a future free from AIDS.” With careful execution, clear oversight, and ongoing partnerships, this goal is achievable by 2030.
