Despite remarkable progress in prevention of mother-to-child transmission of HIV (PMTCT), 160,000 children were newly infected with HIV in 2016. Less than half of HIV-exposed infants (HEI) received early infant diagnosis (EID) within 6 weeks of life, a major challenge for early antiretroviral therapy for HIV-positive infants. Although introduction of dried blood spot (DBS) has increased EID access, conventional laboratory networks have relatively long (22-60 days) turnaround time, resulting in low proportions of results returned and missed opportunities for ART initiation. The WHO conditionally recommends introduction of point-of-care (POC)/ near-POC nucleic acid testing (NAT) for EID.

Recent encouraging evidence for POC/ near-POC EID warrants consideration of rapid adoption and strategic scale-up of this solution complementing the existing laboratory network.

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. 

Children and adolescents living with HIV (CALHIV) have a lifetime of antiretroviral therapy (ART) ahead of them. An estimated 95% of HIV service delivery is currently facility-based, largely undifferentiated for individual need. Differentiated service delivery (DSD) is a client-centred approach, simplifying and adapting services to better meet the needs of people living with HIV and reducing unnecessary burdens on the health care system. Differentiated ART delivery for clinically stable children and adolescents is supported by global agencies, and a growing body of evidence highlights how differentiated ART provides a significant opportunity to improve treatment adherence among children and adolescents living with HIV. However, CALHIV are still often not prioritized when scaling up differentiated ART delivery.

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.

As part of their basic human rights, children need access to the best health care possible, safe water to drink, nutritious food, and a clean and safe environment to grow and develop to their full potential. Optimal health, learning and behavior outcomes stem from laying healthy foundations early in life through exposure to the right health care, nutrition, relationships and environment. Whether because of exposure, infection and/or drug effects, HIV impacts health, nutritional, learning and development outcomes. HIV programs need to design and foster approaches that address the multidimensional needs of children living with and/or affected by HIV, recognizing that both exposure and infection carry risks that may affect survival, growth and development for children of different ages.

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. 

Approximately half of HIV infections among children take place during breastfeeding. While there has been success in retaining pregnant women on antiretroviral therapy (ART) during pregnancy, there has been inadequate focus on retention support to
mother-baby pairs (MBPs) during the breastfeeding period.

Literature shows that the majority of MBPs not retained in prevention of mother-to-child transmission (PMTCT) programs are due to loss to follow-up (LTFU) rather than death. These children are at higher risk of vertical acquisition of HIV compared to breastfeeding infants who remain in care. Current postpartum LTFU rates limit successful implementation of PMTCT programs in sub-Saharan Africa. Cumulative sub-Saharan Africa PMTCT LTFU rates in 2011 were estimated to range from 20-28% during antenatal care, then sharply increase to 70% at four months postpartum and reach approximately 81% six months after birth.

Given these staggering statistics, the quality and effectiveness of PMTCT services should include an assessment of the proportion of MBPs retained in care and early infant diagnosis (EID) rates.

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.

Motherhood is common among female sex workers (FSWs) and many have at least one biological child. People who inject drugs (PWID), men who have sex with men (MSM) and transgender people (TG) are also part of families and have at-risk spouses and children in their households. Stigma and discrimination towards key populations (KP) can negatively impact their children’s access to health, education and protection services. Program data from Cameroon, Ethiopia and Tanzania reflect positivity rates of 4-6 per cent when children of FSWs are tested for HIV.  Access to early infant diagnosis (EID), HIV testing and treatment and other critical health, social and economic strengthening interventions for children of KP and their families must be improved as a priority.

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. 

Social Protection and HIV: Research Implications for Policy by UNICEF, the Eastern and Southern Africa Regional Inter-Agency Task Team on Children Affected by AIDS (RIATT-ESA) and the Coalition for Children Affected by AIDS contain the following six briefs:

1: How can Social Protection reduce adolescent HIV-risk?

2: Combination Social Protection improves adolescent ART-adherence

3: Combination Social Protection reduces HIV-risk in adolescents

4: Social Protection: potential for improving HIV outcomes among adolescents

5: Social Protection and the Sustainable Development Goals

6: Combination Social Protection lowers unprotected sex in HIV-positive adolescents

HIV-sensitive Social Protection: With focus on creating linkages between social cash transfer programmes and HIV services describes an intervention aiming to strengthen the linkages between HIV services and national social protection programmes and provides lessons learned from implementing the intervention in four countries. The focus of the programme is on families with children and adolescents, vulnerable to, or affected by HIV and AIDS. The programme, funded by the Government of the Netherlands, is now being implemented in Malawi, Mozambique, Zambia and Zimbabwe in close collaboration with national, provincial and district level governments.

Building on the collaborative effort that resulted in tremendous progress in scaling up lifesaving anti-retroviral treatment and preventing mother-to-child transmission of HIV in Eastern and Southern Africa region (ESAR), UNAIDS and UNICEF launched a campaign titled All In to End Adolescent AIDS (All In) in 2015 in Nairobi, Kenya.

This report highlights how All In mobilized partners, engaged adolescents and young people and influenced policies and programmes in the 14 high-burden HIV countries in ESAR. The report documents the progress made in a few short years on adolescent HIV, and offers suggestions and recommendations on how to strengthen strategic information, apply evidence-based programming and mobilize resources for adolescents in the HIV response. 

This publication shares the perspectives of women from all over the world, including policymakers and researchers, doctors and campaigners who are helping lead the HIV response for women and children. Their testimonies illuminate and personalize the data and the narrative in the rest of the report.