Paediatric and Adolescent Treatment

A robust monitoring and evaluation (M&E) system is a key component of a strong health system. With the current WHO recommendation of lifelong ART for all pregnant and breastfeeding women living with HIV, outcomes (including maternal survival and final infant HIV status) require monitoring through longitudinal data systems complemented with regular cohort analyses and enhanced monitoring. Additionally, as we move toward the need for more strategic policies and programming to garner system and resource efficiencies, M&E systems need to be designed to be able to inform differences arising from age, sex, and geographic trends as well as identify weaknesses such as sub-optimal commodity supply and testing quality.

Monitoring of individuals on ART is important to ensure treatment efficacy and improved health outcomes. Updated WHO Consolidated ARV Guidelines will be available in December 2015 and include recommendations on routine monitoring and the diagnosis of treatment failure.

WHO recommends initiation of ART for all people living with HIV at any CD4 cell count fixed dose combinations (FDCs) containing TDF/XTC/EFV remain the preferred first line regimen for adults, adolescents and older children For the first time, DTG and EFV400 have been included as alternative first line regimens for adults and adolescents. DRV/r is an alternative option as part of secondline regimens, along with LPV/r and ATV/r.

Differentiated care for HIV requires delivery of different care packages for people based on their needs. As more people start treatment it is important to maximise the quality of care and ensure efficient health services. 

Adolescents face significant barriers accessing and remaining in HIV treatment and care services. WHO guidelines in 2015 support initiation of antiretroviral therapy for all adolescents living with HIV. Adolescent friendly health services should be developed, including support for adherence and retention in care.

The 2016 High-Level Meeting on Ending AIDS will focus the world’s attention on the importance of a Fast-Track approach to the AIDS response over the next five years. The UNAIDS Fast-Track approach aims to achieve ambitious targets by 2020, including:

1. Fewer than 500 000 people newly infected with HIV
2. Fewer than 500,000 people dying from AIDS-related causes
3. Elimination of HIV-related discrimination

Em Moçambique, a pandemia do HIV/SIDA é assumida como um dos desafios de âmbito multissectorial. No que concerne ao Serviço Nacional de Saúde, múltiplas acções integradas têm sido implementadas nos últimos anos pelo Ministério da Saúde (MISAU) com vista a alargar as medidas de prevenção, diagnóstico e o início atempado dos cuidados e tratamento, sendo que em 2013 foi implementado o Plano de Aceleração de Resposta ao HIV e SIDA, que contempla nos seus objectivos a expansão dos Serviços TARV e a melhoria da qualidade assistencial.

This handbook has been written for practitioners working directly with children and adolescents living with HIV and for policy makers and management to help develop services and protocols. To that end, it includes policy and practice guidance for the development of services, practice models and practical examples. The global experience of HIV offers many shared elements and this handbook reflects these, setting out practical guidance and tools that can be used in different settings.

The life course through childhood, adolescence, adulthood and old age affects health, wellbeing and earnings. 

This report discusses how community-facility linkages can be used to support the scale up of lifelong treatment for pregnant and breastfeeding women living with HIV. It offers a conceptual framework and describes eleven promising practices associated with increased service uptake, adherence or retention along the continuum of care.