The WHO 2018 guideline update promotes the use of optimal treatment regimens in all populations. Though new, more effective and better tolerated options with a higher genetic barrier to resistance are now available for adults, optimized treatment options for children lag significantly behind.

This fifth edition of the Optimal Formulary and Limited-use List supports the transition to optimal WHO-recommended regimens for infants and children, while giving due consideration to the rapidly evolving treatment landscape and the risks inherent in the uncertain timelines for paediatric drug development.

The International Treatment Preparedness Coalition developed the Key Population Activist Toolkit on PrEP, to equip community activists with the knowledge and skills they need to demand pre-exposure prophylaxis (PrEP).

Community-led demand efforts can influence the success of PrEP programming, including influencing how accessible PrEP services are to the community, whether people actually choose to take PrEP, and whether these services are being offered in a way that is suited to the needs of PrEP users.

The Toolkit aims to:

• Equip community activists with the knowledge and skills that they need around PrEP, advocacy, and community mobilization so that they are able to mobilize their communities to demand PrEP
• To enable community PrEP activists to advocate with their governments and service providers to allow key populations access to PrEP services
• To ensure that these services are provided in a manner that is affordable, appropriate to their needs, and addresses access barriers.

The toolkit is intended for individuals, organizations and networks – particularly those representing key populations – wanting to:

• Learn more about PrEP
• Contribute to preventing the spread of HIV in their communities
• Gain the knowledge and skills that they need to mobilize their communities and advocate with community leaders and decision makers for access to PrEP

WHO recommends peer support, including peer counseling, for adolescents and young people living with HIV age 10-24 years (AYPLHIV). Peer support enables providers, programs and services to be more responsive, acceptable, sustainable and relevant, encouraging AYPLHIV to seek and remain engaged in care.

Peer support activities range from support groups to peer-to-peer counseling and treatment buddy programs. Generally, AYPLHIV are formally or informally engaged as peer supporters at health facilities or in communities to provide care for and promote the health and well-being of their peers. A peer supporter can be a peer, or a near-peer (someone a few years older who understands the needs of AYPLHIV). In all cases, the aim is to ensure a source of empathic support and share positive coping strategies.

Studies show that peer support can improve AYPLHIV linkage, adherence, viral suppression, retention and psychosocial well-being. Peer support models can also provide young peer supporters with opportunities for leadership development, capacity-building and youth-led advocacy, helping to combat the negative effects of self-stigma and peer pressure.

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.

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.

To achieve an AIDS-free generation, optimal treatment options for all infants and young children living with HIV must be available, tolerable and most importantly, effective. Since 2013, the WHO has recommended that all infants and children under three years initiate ritonavir-boosted lopinavir (LPV/r)-based regimens. However, the transition to preferred pediatric regimens has been slow, and one-third of children remain on a sub-optimal regimen of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP).

Only 20 percent receive the WHO preferred regimen despite resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) becoming a major concern for infants and young children. While efavirenz (EFV) is increasingly used, NVP-based regimens are also very common in children older than three years. As a result, overall virological suppression reported in program settings continues to be sub-optimal and particularly poor in young children below five years.

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.

Adolescents and young people (AYP) (10-24 years) are being left behind in the HIV response, with high levels of new infections, and lower levels of diagnosis and treatment coverage than adults. National and local programming adapted to their specific needs is critical to ensuring their well-being and to reaching global targets to end AIDS by 2030.

AYP, including those living with HIV and from young key populations, are not just beneficiaries of programs, but are important stakeholders and agents of change. AYP leadership and partnership is an essential component of the design, delivery and evaluation of programs that affect them, leading to better decisions and policies. In accordance with principles of the greater involvement of people living with HIV, AYP have the capacity to identify approaches and solutions that best respond to their needs, making programs more effective and helping to ensure increased uptake of services and better outcomes.

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.

Paediatric HIV treatment coverage is stagnating. The most recent estimates suggest that only 46% of children living with HIV are on treatment, well below the AIDS Free target of 1.6 million by the end of 2018. A key challenge is to identify children who are living with HIV that have been missed through routine testing services.

For children in the 0-14 year age group, over 95% of HIV infections are acquired as a result of vertical transmission. As a result, historical approaches to pediatric diagnosis have tended to focus on early infant diagnosis (EID) within the context of prevention of mother-to-child-transmission (PMTCT) programs.

Testing the family of adult or child ‘index’ cases can serve as an entry point for identification of children living with HIV not identified through PMTCT program
testing. This type of family-based approach to HIV testing and service delivery enables parents and their children to access care as a unit. Such approaches may improve retention and offer a convenient service for families affected by HIV.

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 95-95-95 targets will only be achieved with zero discrimination, including within healthcare settings. Health worker attitudes, including those of professional and lay providers, are essential in establishing the culture of a health service. Protecting confidentiality and treating adolescents and young people living with HIV (AYPLHIV) with respect are key elements of adolescent and youth-friendly health services (AYFHS). However, AYPLHIV report stigmatizing and unsupportive health worker practices, including imposed moral values, discrimination, shame and scolding and violations of confidentiality. To ensure health workers are equipped to deliver appropriate services, training and sensitization are required. While the importance of sensitization is increasingly acknowledged, a gap remains in documented interventions and models.

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. 

To reach global pediatric HIV targets, efforts must extend beyond clinic doors. Community-based organisations (CBOs), faith-based organisations (FBOs) and places of worship can play a pivotal role in accelerating and expanding services. However, for their contribution to be amplified, they must be engaged as integral implementing partners in service delivery and effectively linked to the health system. A systematic approach is required to formally establish and resource these linkages, as well as embed them in district planning and coordination.

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.