Paediatric and Adolescent Treatment

Children and adolescents living with HIV (CALHIV) have a lifetime of antiretroviral therapy (ART) ahead of them. An estimated 95% of HIV service delivery is currently facility-based, largely undifferentiated for individual need. Differentiated service delivery (DSD) is a client-centred approach, simplifying and adapting services to better meet the needs of people living with HIV and reducing unnecessary burdens on the health care system. Differentiated ART delivery for clinically stable children and adolescents is supported by global agencies, and a growing body of evidence highlights how differentiated ART provides a significant opportunity to improve treatment adherence among children and adolescents living with HIV. However, CALHIV are still often not prioritized when scaling up differentiated ART delivery.

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.

As part of their basic human rights, children need access to the best health care possible, safe water to drink, nutritious food, and a clean and safe environment to grow and develop to their full potential. Optimal health, learning and behavior outcomes stem from laying healthy foundations early in life through exposure to the right health care, nutrition, relationships and environment. Whether because of exposure, infection and/or drug effects, HIV impacts health, nutritional, learning and development outcomes. HIV programs need to design and foster approaches that address the multidimensional needs of children living with and/or affected by HIV, recognizing that both exposure and infection carry risks that may affect survival, growth and development for children of different ages.

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. 

Motherhood is common among female sex workers (FSWs) and many have at least one biological child. People who inject drugs (PWID), men who have sex with men (MSM) and transgender people (TG) are also part of families and have at-risk spouses and children in their households. Stigma and discrimination towards key populations (KP) can negatively impact their children’s access to health, education and protection services. Program data from Cameroon, Ethiopia and Tanzania reflect positivity rates of 4-6 per cent when children of FSWs are tested for HIV.  Access to early infant diagnosis (EID), HIV testing and treatment and other critical health, social and economic strengthening interventions for children of KP and their families must be improved as a priority.

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. 

The West and Central Africa Catch-up Plan provides a framework for political advocacy and accelerated action for countries to adapt and scale up effective approaches and innovations that will reduce inequity in access to HIV treatment. Twelve countries have adapted this regional initiative to their national contexts and developed country catch-up plans, with the support of the World Health Organization (WHO), UNAIDS and UNICEF.

At the 19th International Conference on AIDS and STIs in Africa (ICASA), country representatives and partners took part in a meeting convened by UNICEF and UNAIDS to reflect on the shortfalls within West and Central Africa country catch-up plans and to agree on ways to sharpen acceleration strategies and interventions that will increase access to paediatric ART.

The meeting at ICASA had three high-level strategic objectives:

1. Call greater attention to the gap in paediatric HIV testing, including EID, and paediatric treatment within the West and Central African country catch-up plans
2. Define the priority actions for children in country catch-up plans in 2018, with a focus on: (a) expanding access to paediatric HIV testing through improved EID and rapid testing at other entry points; (b) improving immediate linkages to care and treatment; and (c) task-shifting to enable nurses within maternal, neonatal and child health facilities to treat children
3. Galvanize partnerships in support of country catch-up plans

More information can be found in this meeting report. 

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 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.

In follow-up to the 2017 Continental Summit in October 2017, Pediatric-Adolescent Treatment Africa (PATA) released a summary report with key highlights and recommendations from the meeting. Towards an AIDS Free Africa – Delivering on the frontline was the focus of the 2017 Summit, which brought together over 200 delegates across 15 sub-Saharan African countries along with programme implementers and policy-makers from across the globe. The recommendations provided are centred around three pillars – FIND, TREAT and CARE – that support the UNAIDS superfast-track framework. Attending health facility teams drafted new quality improvement plans and will be commencing 53 projects improving service delivery at the frontline in 2018.

UNICEF Learning Collaborative,Summary of Selected Research Articles
January - March 2018