Brief

This brief highlights the current scenario of policies and programmes related to point-of-care viral load testing among pregnant and breastfeeding women living with HIV. In many countries, viral load policies are not differentiated for pregnant and breastfeeding women despite evidence that point-of-care viral load testing is helpful for this population. Same-day results for pregnant and breastfeeding women can help ensure timely initiation of ART, improved rates of viral suppression and retention in care to support efforts of preventing vertical transmission of HIV.

Les tests de diagnostic décentralisés réalisés au moyen de plates-formes présentes sur les lieux de soins ou à proximité peuvent considérablement améliorer les soins prodigués aux patients en élargissant l’accès à des services de diagnostic essentiels, en réduisant les délais d’obtention des résultats et en améliorant l’intégration aux soins.

Decentralized diagnostic testing using point-of-care (POC) or near-POC platforms can significantly improve patient care by expanding access to critical diagnostic services, reducing result turnaround time (TAT), and improving linkage to care.

Led by UNICEF and WHO, the Global Breastfeeding Collective is a partnership of more than 20 prominent international agencies calling on donors, policymakers, philanthropists and civil society to increase investment in breastfeeding worldwide. The Collective’s vision is a world in which all mothers have the technical, financial, emotional and public support they need to breastfeed. The Collective advocates for smart investments in breastfeeding programmes, assists policymakers and NGOs in implementing solutions, and galvanizes support to get real results to increase rates of breastfeeding, thereby benefiting mothers, children and nations.

Download the advocacy brief on breastfeeding and HIV above. Learn more at unicef.org/breastfeeding.

Experiences from Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda

This report documents several promising practices focused on community engagement for PMTCT implemented under the Optimizing HIV Treatment Access for Pregnant and Breastfeeding Women (OHTA) Initiative. OHTA, a UNICEF-supported initiative with funding from the Governments of Norway and Sweden, aimed to accelerate access to Option B+ for the elimination of mother-to-child transmission in Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda.

In an effort to strengthen cross-country learning about effective community engagement activities and inform future PMTCT programming, this report includes implementation details, outcomes, factors for success, and considerations for scale-up and sustainability based on the OHTA Initiative’s experiences. The information and data included in this report were collected by project staff in partnership with the Johns Hopkins Center for Communication Programs (CCP) through a desk review of existing OHTA Initiative documents, including annual reports, partner reports, and presentations. CCP and project staff also made site visits to each country to conduct interviews and focus group discussions with the implementing organisations, programme participants, and Ministries of Health (MOHs).

Five promising practices for the elimination of mother-to-child transmission were identified based on the collective experiences in all four countries: male engagement, community client tracing, Community Mentor Mothers, Health Advisory Committees (HACs), and rationalization of implementing partners and services. This report first provides an overview of the HIV/AIDS epidemic in the four countries supported by the OHTA Initiative and of the five promising practices as implemented under the OHTA Initiative. It then follows with a detailed description of each promising practice, including similarities and differences with implementation in each country, outcomes of the promising practice, factors for success, and essential programme elements. Download the country reports of the promising practices here. 

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.

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.