There are many reasons for the low childhood antiretroviral therapy coverage in western and central Africa. Too few children are being diagnosed in the region—with only 27% of infants exposed to HIV being tested for HIV infection within eight weeks of birth in 2018, there is an urgent need to expand access to early infant diagnosis.

The lack of accessible health services in many countries in the region results in children living with HIV being missed. If a pregnant woman doesn’t interact with antenatal care services, she isn’t tested for HIV, isn’t offered services to prevent vertical (mother-to-child) transmission of HIV and her baby isn’t tested for HIV—without a diagnosis, HIV treatment can’t be provided.

Even if a woman does see a health-care professional, the woman and her child are often lost to follow-up after delivery, with the HIV status of the child remaining unknown. HIV-exposed children need to be tested within two months of delivery and regularly re-tested up to the end of the breastfeeding period. Finding the missing children needs a scale-up of family index testing and HIV testing being offered where children get other health services.

Keeping mothers and children on treatment if they do start taking antiretroviral therapy is also important—far too many mothers and children begin HIV treatment only to later stop it. New and improved HIV treatments for children would also help to increase treatment coverage.

With no progress in recent years in preventing vertical transmission of HIV in the region, it’s no wonder that children living with HIV in western and central Africa are being left behind.