Maternal, newborn and children health

Tuberculosis (TB) is a major contributor to morbidity and mortality in children living with HIV (CLHIV), particularly in TB endemic settings. TB in CLHIV is a
preventable and treatable disease. WHO recommends a cascade of TB services for all CLHIV that begins with routine screening for TB symptoms and/or recent contact with an infectious TB case. It would end with either; 1) diagnosis of active TB disease and prompt initiation of TB treatment, or 2) exclusion of active TB disease and prompt initiation of TB preventive therapy (TPT). Prompt, appropriate treatment for active TB disease is effective in CLHIV.

Similarly, TPT (such as isoniazid preventive therapy) is effective in preventing TB disease and reducing mortality in CLHIV. Effectiveness of both TPT and TB treatment is maximized when CLHIV receive early antiretroviral therapy (ART) to manage HIV infection. However, implementation of these evidence-based interventions to treat and prevent TB in CLHIV remains poor.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more.

Urgent and ambitious 2020 global targets are on the horizon, yet there has been insufficient progress in paediatric and adolescent HIV to date. Scaling up HIV services for all children and adolescents is needed, in alignment with the UNAIDS super-fast-track framework. It’s time to make sure that nobody is left behind.

This series of 12 policy briefs by the Child Survival Working Group (CSWG) looks at scaling up key interventions for children and adolescents living with HIV. They present evidence, policy and monitoring considerations, implementation guidance and tools necessary to scale up 12 key interventions which have proven successful in identifying, linking and supporting children and adolescents to access and remain in quality care and treatment.

They are designed for program managers in government and civil society programs, particularly at country-level, and provide practical information and direction.

Learn more in the Foreword and download the briefs below. 

• Addressing the service delivery needs of children of key populations

• Strategies to improve retention of mother-baby pairs in PMTCT programs

• A child-centred approach for HIV programs

• Providing differentiated service delivery to children and adolescents

• Point-of-care testing as a solution for timely early infant diagnosis

• Complementary and connected: Engaging community and faith-based organizations to deliver PMTCT and pediatric HIV services

• Sensitizing health workers to providing responsive care for adolescents and young people living with HIV

• Family-based index case testing to identify children with HIV

• Meaningful engagement of adolescents and young people in national and local HIV programming

• Scaling up optimal antiretroviral treatment for children: A long overdue intervention

• Preventing and treating tuberculosis among children living with HIV

• Providing peer support for adolescents and young people living with HIV

The West and Central Africa Catch-up Plan provides a framework for political advocacy and accelerated action for countries to adapt and scale up effective approaches and innovations that will reduce inequity in access to HIV treatment. Twelve countries have adapted this regional initiative to their national contexts and developed country catch-up plans, with the support of the World Health Organization (WHO), UNAIDS and UNICEF.

At the 19th International Conference on AIDS and STIs in Africa (ICASA), country representatives and partners took part in a meeting convened by UNICEF and UNAIDS to reflect on the shortfalls within West and Central Africa country catch-up plans and to agree on ways to sharpen acceleration strategies and interventions that will increase access to paediatric ART.

The meeting at ICASA had three high-level strategic objectives:

1. Call greater attention to the gap in paediatric HIV testing, including EID, and paediatric treatment within the West and Central African country catch-up plans
2. Define the priority actions for children in country catch-up plans in 2018, with a focus on: (a) expanding access to paediatric HIV testing through improved EID and rapid testing at other entry points; (b) improving immediate linkages to care and treatment; and (c) task-shifting to enable nurses within maternal, neonatal and child health facilities to treat children
3. Galvanize partnerships in support of country catch-up plans

More information can be found in this meeting report. 

CDC-Atlanta Maternal Child HIV Branch and International Lab Branch, in collaboration with partners, have developed tools to support health care workers and laboratorians to provide services to HIV-exposed infants, including infant virologic testing.

DBS Job Aids for the Clinic: DBS collection, drying, and packaging

Intended audience:
Health care workers who collect specimens for EID on dried blood spots, dry and package specimens for transport.

Summary:
These are visual job aids that are a simplified version of the content provided in the EID video. They cover DBS collection, drying and packaging in the health clinic. They may be displayed on the wall in a health centre for easy reference.

CDC-Atlanta Maternal Child HIV Branch and International Lab Branch, in collaboration with partners, have developed tools to support health care workers and laboratorians to provide services to HIV-exposed infants, including infant virologic testing.

Care of the HIV-Exposed Infant Flipchart

Intended audience:
Health care workers or lay health workers who counsel the caregivers of HEIs.

Summary:
The purpose of this flipchart is to facilitate comprehensive, high quality counseling about the care needs of mothers and HIV-exposed infants to prevent vertical HIV transmission and improve infant health.  The flipchart addresses the importance of maternal health and ART adherence, as well as care and testing for the HIV-exposed infant until the infant’s final HIV diagnosis after the end of breastfeeding.

This flipchart should be printed in large format (A3 or similar), spiral bound and laminated for durable use in health clinics. There are 12 counseling cards total – each card has one side with images for the mother/caregiver and the other side with notes for the counsellor.

Topics include: basics of vertical HIV transmission, maternal health during pregnancy and breastfeeding, safe delivery, infant testing, infant medications – cotrimoxazole and ARV prophylaxis, routine infant care -- growth monitoring and immunizations, infant feeding, family planning, signs of acute child illness, and planning for mother and infant follow up.

UNICEF Learning Collaborative,Summary of Selected Research Articles
January - March 2018

‘Walking in our shoes; Perspectives of pregnant and breastfeeding women living with HIV on access to and retention in care in Malawi, Uganda and Zambia’ highlights the key factors that facilitate retention in care for women living with HIV and calls for increased focus on rights and dignity in care.

The report, presents the findings of community-led research related to the viewpoints and experiences of women who were initiated on antiretroviral treatment during pregnancy or breastfeeding and explores their perspectives on factors that have enabled them to successfully adhere to their treatment and retain in care.