Prevalence, incidence, mortality attributed to HIV in children under 5 years of age, and comparative analysis of health expenditure in central Asian countries

Background and Aim: Despite progress in HIV prevention and treatment in many regions, Eastern Europe and Central Asia continue to experience a rising epidemic, with a 20% increase in new HIV cases since 2010. Pediatric HIV remains a significant concern, with 13,000 children (0–14 years) living with HIV in Eastern Europe and Central Asia. Mother-to-child transmission (MTCT) rates in the region stand at 10%, far exceeding the global elimination targets of 2% (for non-breastfeeding mothers) and 5% (for breastfeeding mothers). However, country-specific, age-disaggregated data on pediatric HIV (prevalence, incidence, mortality, and ART coverage) remain scarce, hindering targeted interventions. This study aimed to assess the prevalence, incidence, and mortality of HIV among children under 5 years in Central Asia and evaluate health expenditures related to pediatric HIV treatment in the region. Methods: This descriptive study includes prevalence, incidence of HIV, and all deaths of children under 5 years of age living with HIV, in different regions covered by Central Asia during the years 1990 to 2021. Information was collected from the mortality registration system. Financial data on HIV-related health spending for each country of interest were gathered through the Development Assistance to Health (DAH) database. The model framework was based on the Global Burden of Disease (GBD) protocol. Results: There is a dramatic surge in HIV prevalence across Central Asia, from 4,776 cases in 1990 to over 1.5 million in 2019. Kazakhstan and Uzbekistan faced the most significant increases, while Georgia showed progress in reducing new infections, and Mongolia remained the least affected. Male children consistently had higher rates of HIV-related incidence and mortality. Notably, Uzbekistan experienced a rise in under-5 HIV-related mortality, from 10.06 per 100,000 in 1990 to 11.52 in 2019. Disparities in healthcare spending were evident, with Kazakhstan and Kyrgyzstan demonstrating more substantial investments, in contrast to lower per capita spending in Uzbekistan and Turkmenistan. Conclusion: Overall, the Central Asian region is experiencing a surge in HIV cases among children under 5 years of age, which contrasts with global trends. This may be attributed to disparities in healthcare spending, access to care, prevention efforts, and the stigma associated with HIV in Central Asia.