Infants

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. 

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.

Many millions of people around the world are affected by emergencies, the majority of whom are women and children. Among them are many who are known to be living with HIV and others who may not know their HIV status.

The purpose of this document is to provide operational guidance on HIV and infant feeding in emergencies. It is intended to be used to complement emergency and sectoral guidelines on health, nutrition and HIV, including specifically infant feeding, prevention of mother-to-child transmission of HIV and paediatric antiretroviral treatment.

The envisaged target audience consists of decision makers, policymakers, national and subnational government managers and planners, managers of refugee camps and similar settlements for displaced persons, and managers and planners in United Nations agencies, nongovernmental organizations and other groups responding to humanitarian situations.

This operational guidance is based on a consultation convened by the WHO, UNICEF and the Emergency Nutrition Network in Geneva in September 2016, which brought together a cross-section of senior-level participants from United Nations agencies, government, nongovernmental organizations, academia, and other agencies working in nutrition and HIV in emergencies. This document sets out basic principles related to HIV and infant feeding in emergency settings, and the actions that government and other stakeholders can take to prepare for emergencies.

This progress report presents highlights of the first year of implementation (through December 2016) of the Start Free, Stay Free, AIDS Free initiative, which focuses on accelerating country-level progress toward ending new HIV infections among children, identifying children and adolescents living with HIV, ensuring their right to access life-saving treatment and quality care, and stopping the cycle of new infections among adolescents and young women. See the 2016 Framework to read more about the Three Frees. 

This qualitative rapid appraisal study from researchers at the South African Medical Research Council and partners explores how community cadres provide links to health facilities and supports HIV client support. The study maps the roles taken by the community cadres as well as challenges and opportunities.

This presentation from IAS 2016 highlights a promising practice to improve retention of HIV-exposed infants (HEI) in the postnatal care continuum. The pilot integrated infant defaulter tracing into the Malawi's Option B+ programme. Description of the intervention and initial results are included here.

This poster presented at ICASA 2017 highlights a promising intervention to improve client retention in HIV programmes. Beginning in 2015 in Malawi, a collaboration between the Ministry of Health, UNICEF, and UNC-Project Malawi introduced a community-based Expert Client (EC) intervention with a particular focus on HIV-exposed infants and mothers enrolled in the national PMTCT programme.

This promising practice reviews the rationalization process and a coordination and planning workshop conducted by OHTA and Ministry of Health representatives for partners working on HIV prevention and PMTCT within certain health zones in the Democratic Republic of the Congo (DRC). Outcomes of the programme, key lessons learned and considerations for scale up are included in this report.