Infants

This governance guidance provides clarity, consistency and detail related to the structure, function, composition and operational duties of validation committees at national, regional and global levels as an extension to what is provided in the Global guidance on the criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis. In addition, this publication describes the standardized methods for country programme review and validation of EMTCT of HIV and syphilis and PTE at these levels.

In the global quest to end the AIDS epidemic as a public health threat by 2030, meeting the HIV-related needs of children, adolescents and pregnant and breastfeeding women represents a critical piece of unfinished business. To inject a sense of urgency in to global efforts to end the epidemic among children, adolescents and young women, global partners joined together in 2015 to launch the Start Free, Stay Free, AIDS Free framework. Unveiled as the global community was embracing a series of 2020 targets intended to Fast-Track the HIV response, Start Free, Stay Free, AIDS Free called for a super-Fast-Track approach to end AIDS as a public health threat among children, adolescents and young women by 2020.

Since the deadline for achieving the targets passed in December 2020, this is the final Start Free, Stay Free, AIDS Free progress report. Although the targets were global, partners identified 23 countries for intensified focus under the framework. This report specifically highlights progress against the targets in focus countries. The only focus countries outside sub-Saharan Africa (India and Indonesia) do not report data on Start Free, Stay Free, AIDS Free targets and are not covered in this report. 

This flyer provides a quick overview of UNICEF's results within HIV and AIDS in 2020. It describes achievements within UNICEF's main programmatic areas: prevention of mother-to-child transmission of HIV, treatment of children and adolescents living with HIV, and HIV prevention in adolescents. 

UNICEF's Global Annual Results Report - Goal Area 1 describes results achieved in more detail from p. 132-150.
 

This document was developed to compile knowledge, insights and recommendations from UNICEF focal points in country offices implementing a project aimed at introducing, scaling up, and integrating point-of-care (POC) diagnostics into national health systems.The project was implemented by UNICEF, CHAI and ASLM with funding from Unitaid in 10 sub-Saharan African countries between 2016-2020. As the project was winding down, we thought it was important to document the lessons learned from those with direct, hands-on experience in project implementation to offer guidance to other countries interested in adopting POC technologies to increase access to diagnostics.

Innovative POC diagnostics can be a game changer in health systems as it enables testing outside the laboratory and closer to patients, can be used for the diagnosis of multiple diseases, addresses key limitations of conventional laboratory networks, and significantly increases access to diagnostic testing in a decentralized fashion. Decentralization of testing also carries an additional benefit as it strengthens elements of the health system around diagnostics (e.g., supply chain management, quality management, connectivity and data management, waste management) that have a broader impact on the health system. The multi-disease testing capacity of POC devices also contributes to pandemic preparedness and response, as has been shown by its use in the Ebola outbreak in West Africa (2014-2016) as well as its widespread use during the COVID-19 pandemic.

The impact of POC diagnostic technologies cannot be overstated. This is particularly important in communities in low-resource settings with limited access to diagnostics as well as patients whose clinical management depends upon quick diagnostic test results – such as children infected with HIV. Without treatment, up to 50 per cent of children living with HIV die by their second birthday, with a peak mortality between two and three months of age. Thus, HIV-exposed infants need to be diagnosed before two months of age using molecular diagnostic methods until recently only available in conventional laboratories. However, such conventional laboratory systems carry inherent limitations that restrict their ability to provide timely results in various settings, particularly low-resource settings. It was this urgent need to diagnose HIV-positive infants and initiate them on treatment as soon as possible that motivated this project. POC diagnostics introduction and scale up allowed faster diagnosis, which in turn increased the number of HIV-infected children diagnosed and initiated on treatment within two months of age.

Although the project was focused on increasing access to early infant diagnosis of HIV through POC testing, it also demonstrated the cost-effectiveness of POC diagnostics and the benefits of multi-disease testing by integrating HIV viral load and TB testing on the same POC diagnostic platforms. In spite of the focus on HIV, the lessons reported here are broadly relevant for other disease programmes. These lessons are organized in seven main topics: (1) Leadership commitment and support; (2) Laboratories and the supply chain; (3) Engagement with civil society organizations(CSOs); (4) Diagnostics network optimization (DNO); (5) Innovative approaches; (6) Transition to national governments and other long-term funding partners; and (7) Grant design and management. These lessons build upon the 'Key Considerations for Introducing New HIV Point-of-Care Diagnostic Technologies in National Health Systems' published in 2017, and 'Lessons Learned from Integrating Point-of-Care testing Technologies for Early Infant Diagnosis of HIV into National Diagnostic Networks' published by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in 2019. Together, these resources offer a comprehensive perspective on the strategies, challenges, and lessons learned in the course of integrating POC diagnostics into national health systems that countries should consider when introducing and/or scaling up POC diagnostics.

 

Accelerating Access to Innovative Point-of-Care HIV Diagnostics

English - French

In the early years, we lay down critical elements for health, well-being and productivity, which last throughout childhood, adolescence and adulthood. Failure to meet a child’s needs during this critical period limits the child’s ability to achieve their full developmental potential and threatens the future of human capital and society in general. This is particularly so for children affected by HIV who experience several interrelated factors that may hinder the achievement of a child’s full developmental potential.

This brief from UNICEF and WHO describes the specific nurturing care components for children affected by HIV as well as facility-level and community-level actions for early childhood development.

The International Workshop on HIV & Pediatrics 2020 took place virtually on 16-17 November. It provided a global update on paediatric HIV and explored pertinent issues through dedicated plenary and oral abstract sessions on prevention of mother-to-child transmission of HIV, paediatric treatment and care, and adolescents and HIV. It also included sessions on COVID-19 in children.

UNICEF and Virology Education have developed a workshop report that summarises highlights and learnings from each session.

Presentations and webcasts (provided speaker's consent) are also publicly available and can be accessed here.

Global and regional epidemiological and response snapshots based on the UNAIDS 2019 HIV estimates.

Community and primary health facility platforms have been recognized as important, but under-utilized entry points to address the large prevention, case detection and treatment gaps faced by young children with TB and/or HIV. In 2014, WHO and UNICEF revised community health worker packages for integrated community case management (iCCM) targeting children under five years of age, to include screening and referral for TB and HIV (TB/HIV iCCM). As part of an integrated, child-centered approach, TB/HIV iCCM is recommended for use in high TB and HIV burden settings.

Developed by UNICEF and Save the Children, Lessons from the Field (Uganda, Nigeria, Malawi) and Guidance (under development) are available for download.

The four investment cases above highlight opportunities for the private sector to engage in the global HIV response for infants, children and adolescents in partnership with UNICEF.

The 'Last Mile' road map draws on the latest scientific research and programmatic evidence to describe and recommend strategies to achieve the elimination of mother-to-child transmission of HIV (EMTCT). It includes a synthesis of evidence and country experiences for reaching EMTCT and recommends clear strategies that can improve the coverage, effectiveness and quality of national programmes for the prevention of mother-to-child transmission (PMTCT). The goal of this document is to provide guidelines for coordinated action so that national programmes address local priority areas to achieve EMTCT in an effective, people-centred, efficient and directed manner.

This document was conceptualized by the United Nations Children’s Fund (UNICEF) and partners including the Start Free working group, the Joint United Nations Programme for HIV/AIDS (UNAIDS) and the World Health Organization (WHO), and it was validated by ministries of health of Botswana, Malawi, Seychelles, Uganda, Zambia and Zimbabwe.