Children

This is the first report on progress towards the triple elimination of mother-to-child transmission (EMTCT) of HIV, syphilis and hepatitis B virus (HBV) across 23 countries in the Middle East and North Africa/ Eastern Mediterranean (MENA/EM) region.

Countries included in this report: Algeria, Afghanistan, Bahrain, Djibouti, Egypt, the Islamic Republic of Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, State of Palestine, Saudi Arabia, Somalia, Sudan, the Syrian Arab Republic, Tunisia, United Arab Emirates, Yemen.

To support countries in the region to achieve triple elimination goals, this report collects and assesses national policies and key indicators on EMTCT efforts against WHO criteria for validation of the EMTCT of HIV, syphilis and HBV. Based on analysis and consultations with national policymakers, the report provides a Road Map  for countries at different stages of readiness to follow towards triple elimination goals. The report also provides a set of recommendations for all countries to prioritize EMTCT policy and programming actions over the short, medium, and long term.

Despite global progress in HIV treatment for children, the gap between adult and paediatric treatment coverage continues to widen. This gap is driven primarily by barriers to HIV diagnosis in children, but in the past decade those barriers have shifted.

Scaling-up HIV case-finding efforts for children presents several challenges, including limited access to testing services, lack of provider preparedness to offer testing to children, stigma and discrimination, policy barriers related to age of consent, and inadequate health systems. The aim of this technical brief is to offer countries a guide to address these challenges and enhance HIV case-finding for children to improve testing coverage for children at risk for HIV. This technical brief focuses primarily on how programmes can identify those children who may have missed out on EID testing, who were never tested after breastfeeding or whose mothers were not enrolled in care.

Dolutegravir (DTG)-based HIV treatment regimens are recommended by the World Health Organization for children living with HIV (CLHIV) who weigh at least 3 kg. In 2020, the United States Food and Drug Administration (US FDA) granted tentative approval of paediatric DTG 10 mg scored, dispersible tablets (pDTG) for CLHIV weighing a minimum of 3 kg and at least four weeks of age. In early 2021, national HIV programmes in low- and middle-income countries (LMICs) began to transition CLHIV from treatment regimens containing non-nucleoside reverse transcriptase inhibitor (NNRTI) and lopinavir/ritonavir to pDTG. As of the last quarter of 2022, at least 73 countries have already placed or received orders for pDTG1 and an estimated 130,000 children have transitioned to pDTG. pDTG currently is administered along with optimised backbone antiretrovirals (ARVs) such as abacavir/lamivudine 120/60 mg scored dispersible tablets (pABC/3TC) per the WHO’s 2021 Consolidated HIV Guidelines.

This brief aims to inform the transition from pDTG + pABC/3TC to the new fixed-dose combination (FDC) dispersible tablet of paediatric ABC/3TC/DTG 60/30/5 mg (pALD).

In this viewpoint Getting back on track to ending AIDS in Children: It could just be easier than you think, published in the Journal of the International AIDS Society on World Children's Day, 20 November 2023, UNICEF reviews the global inequities faced by children and adolescents living with HIV and highlights three strategies to end AIDS in children by 2030.