Improving HIV Service Delivery for Infants, Children and Adolescents: Towards a framework for collective action

In June 2019, UNICEF convened a group of about 40 global experts from 24 organizations and institutions to advance the collective thinking on paediatric HIV service delivery. The aim of this “think tank” consultation was to build consensus on the specific programme interventions that need to be scaled up to improve the quality of HIV treatment services and reach more infants, children and adolescents with these lifesaving medicines.

Participating organizations included:

Aidsfonds
Africaid-Zvandiri
African Network for the Care of Children Affected by HIV/AIDS
(ANECCA)
Baylor College of Medicine
Centers for Disease Control and Prevention (CDC)
Clinton Health Access Initiative (CHAI)
Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)
ELMA Philanthropies
Health Innovations Kenya
FHI 360
ICAP at Columbia University
Joint United Nations Programme on HIV/AIDS (UNAIDS)
Kenya Ministry of Health
Office of the Global AIDS Coordinator (OGAC)
Pact
Pediatric-Adolescent Treatment Africa (PATA)
Positive Action for Children Fund (PACF) / ViiV Healthcare
Réseau Enfants et VIH en Afrique (EVA)
United Nations Children’s Fund (UNICEF)
University of Nairobi
United States Agency for International Development (USAID)
World Health Organization (WHO)
World Council of Churches – Ecumenical Advocacy Alliance (WCC–EAA)
Yale University

Experts addressed the gaps in the continuum of care which are causing children to be missed before they are tested, before they are given their test results and before they are provided with lifelong treatment and care. Read more about the evidence base and the call for action in the brief above.

Paediatric Service Delivery Framework

The paediatric service delivery framework presents strategies to address bottlenecks across the continuum of care for each population: infants, children and adolescents. This includes keeping mothers who receive interventions for the prevention of mother-to-child HIV transmission (PMTCT) and their infants in care; locating missing infants, children and adolescents through family and index testing; linking those diagnosed with HIV to services; treating them with efficacious regimens and retaining them on treatment to achieve viral suppression. It describes comprehensive and targeted service delivery models, which emphasize strong linkages between testing, treatment and care, and between communities and facilities.

The framework was developed by a group of global experts who were convened by UNICEF in June 2019 to advance the collective thinking on paediatric HIV service delivery. The partnership's analysis of current evidence and specific programme interventions that need to be scaled up to improve the quality of HIV treatment services and reach more infants, children and adolescents with these lifesaving medicines is presented here.

The full framework, policy briefs and supporting worksheets are available for download (updated July 2020).

CROI Summary 2017 (Mar 2017)

A total of 105 participants from Uganda, Nepal, Iran, Zimbabwe, South Africa, Kenya, and many other countries attended the webinar on March 9th which featured new research on PMTCT and pediatric treatment presented at CROI 2017.

The links to the webinar, presentations, and webinar summary are below:

Content Bottom

Presented on March 9, 2017

Global standards for quality health-care services for adolescents: Standards and criteria

Global initiatives are urging countries to prioritize quality as a way of reinforcing human rights-based approaches to health. Yet evidence from both high- and low-income countries shows that services for adolescents are highly fragmented, poorly coordinated and uneven in quality. Pockets of excellent practice exist, but, overall, services need significant improvement and should be brought into conformity with existing guidelines.

The WHO/UNAIDS global standards for quality health-care services for adolescents aim to assist policy-makers and health service planners to improve the quality of health-care services, so that adolescents find it easier to obtain the health services that they need to promote, protect, and improve their health and well-being, according to their needs. 

This publication presents global standards for quality health-care services for adolescents, as well as an implementation guide and monitoring tools.

The adolescent health indicators recommended by the Global Action for Measurement of Adolescent Health

This document is an interactive guide for the uniform collection, compilation, reporting, and use of adolescent health data.

Adolescence is a critical stage in life for physical, cognitive and emotional development, shaping future health and well-being. Comprehensive measurement of adolescent health is essential to prioritize health issues, guide interventions and track progress. However, global, regional and national adolescent health measurement has historically been inconsistent and incomplete.

The Global Action for Measurement of Adolescent health (GAMA) Advisory Group has been established by the World Health Organization (WHO) in collaboration with United Nations partners to support efforts to focus adolescent health measurement on the most important issues and to improve alignment across different measurement initiatives.

The indicators are intended to guide policy and programming for adolescents, and to assist in identifying topics in which more detailed health assessments and additional programming are needed. The last chapter in this guidance document describes how this can be done, based on the approach suggested in the Accelerated Action for the Health of Adolescents (AA-HA!) guidance.

This document presents a list of 47 indicators recommended by GAMA for measurement of adolescent health, which are applicable to all adolescent population subgroups and span Well-being Outcomes. 

Ending the AIDS Epidemic Among Young People in the Middle East and North Africa

This advocacy report discusses the HIV epidemic among young people in the Middle East and North Africa (MENA) region, particularly among key populations. The report emphasizes the challenges faced in collecting HIV-related data and the need for comprehensive efforts to address the epidemic, including targeted prevention programmes, improved access to testing and treatment, and addressing social and structural factors. It also discusses the presence of punitive and obstructive laws that contribute to stigma and discrimination and calls for their removal or reform. The report advocates for increased investment in HIV programmes, improved access to sexual and reproductive health services, comprehensive sexuality education, and community engagement. It highlights the importance of community health systems, data collection, and involving young people in the development of HIV and other health programmes.  ​

Technical Brief on Paediatric HIV Case-Finding: Beyond Infant Testing

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.