Infants

This key considerations document, developed by UNICEF and WHO, expands on the 2020 “last mile” operational guidance, with specific considerations for countries with lower HIV prevalence. It builds on the experiences of countries that have been validated for EMTCT of HIV and syphilis and translates the valuable lessons and promising practices of these countries into an operational framework for national programmes, consisting of 12 strategies and enablers to guide efforts towards Fast-Tracking EMTCT in lower prevalence countries.

It is based on a review of experiences, key lessons learned and promising practices in implementation of EMTCT interventions in lower prevalence countries, including Sri Lanka and Thailand, which have been validated by WHO for having eliminated vertical transmission of HIV, and three countries with the potential to achieve EMTCT by 2030: the Democratic Republic of the Congo, Ghana and India.

This brief reviews existing resources and analyses potential bottlenecks for the processes in applying for EMTCT/Path to Elimination and to strengthen ongoing PMTCT programmes in such applications. Eight UNICEF priority countries were selected for the review: Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, the Republic of Moldova, Ukraine, and Uzbekistan.

This 2023 framework from WHO and partners guides operationalization of a person-centred and integrated approach to interventions that country programmes can use to effectively scale-up triple elimination efforts and reach targets.

The novel Four Pillars Framework for Triple Elimination Implementation to guide country-led planning and implementation is aligned with the GHSS on HIV, viral hepatitis and sexually transmitted infections 2022−2030. The overarching goal of the framework is to support countries in operationalizing the move from single (HIV) and dual elimination (HIV and syphilis) to triple elimination of HIV, syphilis and HBV. This represents a major revision and modification of the 2002 UN “four-pronged strategy” for the elimination of new HIV infections among children and keeping their mother alive to include two additional conditions − syphilis and HBV − and reflects the significant updates that have been made to WHO’s technical recommendations and guidelines in the past decade.

The Four Pillars Framework focuses on distinct target populations and comprises a minimum package of essential services for each pillar:
(1) primary prevention of infection and vertical transmission
(2) SRH linkages and integration
(3) essential maternal EMTCT services and
(4) infant, child and partner services.

Dolutegravir (DTG)-based HIV treatment regimens are recommended by the World Health Organization for children living with HIV (CLHIV) who weigh at least 3 kg. In 2020, the United States Food and Drug Administration (US FDA) granted tentative approval of paediatric DTG 10 mg scored, dispersible tablets (pDTG) for CLHIV weighing a minimum of 3 kg and at least four weeks of age. In early 2021, national HIV programmes in low- and middle-income countries (LMICs) began to transition CLHIV from treatment regimens containing non-nucleoside reverse transcriptase inhibitor (NNRTI) and lopinavir/ritonavir to pDTG. As of the last quarter of 2022, at least 73 countries have already placed or received orders for pDTG1 and an estimated 130,000 children have transitioned to pDTG. pDTG currently is administered along with optimised backbone antiretrovirals (ARVs) such as abacavir/lamivudine 120/60 mg scored dispersible tablets (pABC/3TC) per the WHO’s 2021 Consolidated HIV Guidelines.

This brief aims to inform the transition from pDTG + pABC/3TC to the new fixed-dose combination (FDC) dispersible tablet of paediatric ABC/3TC/DTG 60/30/5 mg (pALD).

In 2022 an estimated 930,000 children (aged 0-14 years) were living with HIV in Eastern and Southern Africa. Nearly one-third of these children were not receiving lifesaving treatment. Children with HIV need both antiretroviral treatment and viral load suppression if they are to lead long and healthy lives.

UNICEF, in collaboration with governments and partners, supported an updated analysis of laboratory information management systems (LIMS) data in Malawi, Uganda and Zimbabwe from 2017-2020 to better understand viral suppression among children, especially in the context of WHO recommendations for newer, more efficacious drug regimens and the COVID-19 pandemic.

A previous analysis of 2016-2018 LIMS data found that one in every three children was not virally suppressed. The updated study found a steady increase since then in viral load testing, the use of more efficacious and palatable antiretroviral regimen options, and improved viral load suppression. However, children are still falling short of global targets to end AIDS by 2030. The full report describes the methodology, key findings, limitations, and proposes further prioritization and accelerated action to improve treatment outcomes for children with HIV.

This document outlines the fundamentals of PMTCT impact determination and provides considerations for development of pragmatic, streamlined and resource-efficient systems for MTCT estimate generation in high burden settings. The guidance attempts to acknowledge the current reality of PMTCT programme data and the need for reliable MTCT rates while also encouraging a forward-looking approach towards sustainable PMTCT programme data improvements.

Note that this document is intended for countries in sub-Saharan Africa with a high prevalence of HIV among women of reproductive age. Although many of the underlying principles are relevant to settings with a lower burden of HIV, the guidance is not targeted for those programmes.

The tools in appendix 2 can be accessed here.

This review provides a conceptual framework for HIV-sensitive social protection policies and programmes and review the impact of social protection on HIV prevention and treatment outcomes in addition to social and economic care and support. It further provides recommendations for achieving core HIV impacts, comprehensive approaches, and expanding and sustaining HIV-sensitive social protection. 

This research brief defines 'cash plus' interventions, the menu of 'plus' components, and summarizes the evidence on their broad-ranging impacts. It further identifies lessons learned on how to make these integrated interventions work.

‘Cash plus’ interventions combine cash transfers with one or more types of complementary support. Types of complementary support can consist of (i) components that are provided as integral elements of the cash transfer intervention, such as through the provision of additional benefits or in-kind transfers, information or behaviour change communication (BCC), or psychosocial support, and (ii) components that are external to the intervention but offer explicit linkages into services provided by other sectors, such as through direct provision of access to services, or facilitating linkages to services.

Building on previous summaries, this brief summarizes the current evidence and lessons learned from the Transfer Project after more than a decade of research on cash transfers in sub-Saharan Africa.

Since 2009, the Transfer Project has generated rigorous evidence on the impacts of cash transfers in sub-Saharan Africa (SSA) and has supported their expansion. It aims to provide evidence on the effectiveness of cash transfer programmes, inform the development and design of cash transfer policy and programmes, and promote learning across SSA on the design and implementation of research and evaluations on cash transfers. The Transfer Project is a collaborative network comprising UNICEF (Innocenti, Regional and Country Offices), Food and Agriculture Organization of the United Nations (FAO), the University of North Carolina at Chapel Hill, national governments and researchers.