Guidance

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.

This key considerations document, developed by UNICEF and WHO, expands on the 2020 “last mile” operational guidance, with specific considerations for countries with lower HIV prevalence. It builds on the experiences of countries that have been validated for EMTCT of HIV and syphilis and translates the valuable lessons and promising practices of these countries into an operational framework for national programmes, consisting of 12 strategies and enablers to guide efforts towards Fast-Tracking EMTCT in lower prevalence countries.

It is based on a review of experiences, key lessons learned and promising practices in implementation of EMTCT interventions in lower prevalence countries, including Sri Lanka and Thailand, which have been validated by WHO for having eliminated vertical transmission of HIV, and three countries with the potential to achieve EMTCT by 2030: the Democratic Republic of the Congo, Ghana and India.

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.

This 2023 framework from WHO and partners guides operationalization of a person-centred and integrated approach to interventions that country programmes can use to effectively scale-up triple elimination efforts and reach targets.

The novel Four Pillars Framework for Triple Elimination Implementation to guide country-led planning and implementation is aligned with the GHSS on HIV, viral hepatitis and sexually transmitted infections 2022−2030. The overarching goal of the framework is to support countries in operationalizing the move from single (HIV) and dual elimination (HIV and syphilis) to triple elimination of HIV, syphilis and HBV. This represents a major revision and modification of the 2002 UN “four-pronged strategy” for the elimination of new HIV infections among children and keeping their mother alive to include two additional conditions − syphilis and HBV − and reflects the significant updates that have been made to WHO’s technical recommendations and guidelines in the past decade.

The Four Pillars Framework focuses on distinct target populations and comprises a minimum package of essential services for each pillar:
(1) primary prevention of infection and vertical transmission
(2) SRH linkages and integration
(3) essential maternal EMTCT services and
(4) infant, child and partner services.