An opportunity to reshape gender norms on sexual and reproductive health in Rwanda: Learning from a pilot project on male partner self-testing for HIV. Rwanda conducted a research study on using self-testing and other means to improve male partner testing and engagement in PMTCT.
HIV testing and treatment remains low among children in West and Central Africa. Various barriers prevent the scale-up of services and improved coverage for children, including limited coverage of early infant diagnostic capacity, limited decentralization of pediatric treatment including task-shifting/sharing from paediatricians to nurses and community actors, as well as prevalent HIV stigma at individual, family and community levels. Family-based HIV index testing has been identified as a game changer that can deliver quick gains for the paediatric HIV response in both high- and low prevalence settings. By using an individual family member living with HIV as an entry point to reaching the entire family unit, several underlying factors can be addressed, which limit access to HIV testing services especially for children.
This operational guidance is meant for use by national programme managers, implementers, advocates and health care providers in collaboration with partners, supported by national, regional and global experts. The guidance draws off the experience in family testing from within and outside West and Central Africa. It combines recommendations from the Dakar Expert consultation, which took place in June 2018, as well as lessons learned from the pilot of the Family Testing Operational Guidance in Liberia in June 2018. It is a living document that will be enriched as evidence on family Testing in the region grows. The use of this guidance will be complemented by a toolkit and a community of practice. It is a regional document drafted for the countries in West and Central Africa to guide country teams to design country-contextualized family HIV testing roll-out.
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.
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.
In partnership with the Global Fund for AIDS, Tuberculosis and Malaria, UNICEF has supported the governments of Botswana and Lesotho to implement targeted programmes for adolescent girls and young women. In Lesotho, a national multi-sectoral referral framework is strengthening community-facility linkages and is catalyzing increased access to HIV/SRH services by guiding adolescent and young people to appropriate services and care. In Botswana, a radio drama series together with peer education components is tackling tough issues adolescents are facing in love, life and relationships. Documentation of both experiences are available for download.
Adolescent and young mothers are a priority population for UNICEF in Eastern and Southern Africa, including those who are affected by HIV. In this region, one in four women aged 20-24 years gives birth before the age of 18 years and 30 per cent of all new HIV infections occur among adolescent girls and young women aged 15-24 years. Studies increasingly show poorer maternal, child and HIV outcomes for this age group as compared to older women. Together with governments and partners, UNICEF has been working to promote differentiated, evidence-based approaches to meet the complex needs of adolescent and young mothers in several countries across the region.
This newly released report describes these efforts in nine countries, highlighting the results achieved and the learning. Key insights include the importance of responsive service delivery and social support as well as working across sectors. Also offered are ways in which policy makers, researchers, programme managers and implementers can strengthen HIV and health services for adolescent and young mothers and their children.
The AGYW Programming & Implementation Repository contains resources relevant to AGYW programming that have been collated to support enhanced implementation and programming of Global Fund Catalytic Funding for HIV prevention among AGYW in Eastern and Southern Africa. Developed in collaboration with Global Fund in response to an identified need from the SEA sub-region, we are confident that you will all find the repository useful in your support of national AGYW programmes.
The repository is housed on Google Drive and is accessible without a Gmail account. The resources are organized in folders by key programming area and are easily searchable through a google sheet. Powerpoint slides have also been developed to help you navigate through the repository.
The spreadsheet and slideshow are available for download above.
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.
This brief summarizes lessons learned from Zimbabwe’s pilot implementation of integrated or multi-disease testing. Partnerships in the country focused on leveraging existing GeneXpert platforms for both TB and HIV testing to improve access to early infant HIV diagnosis and viral load testing. These findings describe the benefits of integrated testing for clients, health providers and the health system and are a resource for other countries scaling up point-of-care integrated testing.
This brief highlights the current scenario of policies and programmes related to point-of-care viral load testing among pregnant and breastfeeding women living with HIV. In many countries, viral load policies are not differentiated for pregnant and breastfeeding women despite evidence that point-of-care viral load testing is helpful for this population. Same-day results for pregnant and breastfeeding women can help ensure timely initiation of ART, improved rates of viral suppression and retention in care to support efforts of preventing vertical transmission of HIV.
