Paediatric and Adolescent Treatment

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. At the start of the epidemic, the lack of access to virologic testing for HIV-exposed infants was identified as a major hurdle to initiating children on treatment. However, as the quality and efficacy of those programmes has improved, rates of vertical transmission have fallen and so too has the EID testing positivity. There remains a need still to increase access and functional reliability of EID testing, strengthen follow-up of mother-infant pairs, and services for HIV exposed infants; however, 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.

This second edition of AA-HA! guidance to support country implementation builds on the first edition published in 2017. It is a collaborative effort spearheaded by the World Health Organization in collaboration with UNAIDS, UNESCO, UNFPA, UNICEF, UN WOMEN, the World Food Programme and PMNCH.

Building on the solid foundation of the first edition and voices of adolescents and young adults around the world, this multi-agency product has evolved to incorporate valuable learnings from the past six years, including of the COVID-19 pandemic's impacts. Latest estimates of mortality and disease burden, updated evidence, and a broader focus on wellbeing make the second edition a cutting-edge resource for policy makers in the area of adolescent health and well-being.

AA-HA! 2.0 offers insights into the current health and well-being landscape of the world’s over 1.2 billion adolescents, underlining evidence-based solutions and presenting strategies for priority setting, planning, implementing, and evaluating health and well-being programmes. The inclusion of key implementation strategies and real-world case studies make this guide a practical tool for governments in designing and implementing a new generation of adolescent health and well-being programmes.

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).

This brief, the first in UNICEF's new Leveraging the Learning series, sets out to leverage the learnings from holistic, integrated, multisectoral, and age- and gender-responsive approaches to respond to and reduce early and adolescent pregnancy, support young mothers, and improve health and well-being outcomes for adolescent girls and their children. 

Highlighting promising practices for pregnant adolescents living with HIV, the report is relevant for efforts to support all pregnant adolescent girls, regardless of their HIV status.

THIS REPORT IS FORTHCOMING AND WILL BE PUBLISHED JANUARY 2024.

This report examines the HIV epidemic and response among young people, including key populations, in the Middle East and North Africa, using both quantitative and qualitative data. It focuses on marginalized young people who are highly exposed to various health risks but not reached with information, services and tools.

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.