Children

Community and primary health facility platforms have been recognized as important, but under-utilized entry points to address the large prevention, case detection and treatment gaps faced by young children with TB and/or HIV. In 2014, WHO and UNICEF revised community health worker packages for integrated community case management (iCCM) targeting children under five years of age, to include screening and referral for TB and HIV (TB/HIV iCCM). As part of an integrated, child-centered approach, TB/HIV iCCM is recommended for use in high TB and HIV burden settings.

Developed by UNICEF and Save the Children, Lessons from the Field (Uganda, Nigeria, Malawi) and Guidance (under development) are available for download.

The four investment cases above highlight opportunities for the private sector to engage in the global HIV response for infants, children and adolescents in partnership with UNICEF.

At a high-level meeting in Dakar, Senegal in January 2019, UNAIDS, UNICEF and WHO urged countries in Western and Central Africa to strengthen their commitments towards EMTCT and universal coverage for paediatric testing and treatment for HIV.

Countries and partners renewed their commitment to the 2015 Dakar Call to Action for Accelerating the Elimination of New HIV Infections in Children and Access to Treatment for Children and Adolescents Living with HIV by 2020.

This toolkit was developed by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) with funding from a consulting agreement with Johnson & Johnson, in support of the New Horizons Advancing Pediatric HIV Care Collaborative. 

The Disclosure of HIV Status Toolkit for Pediatric and Adolescent Populations provides general guidance on disclosure of HIV status in pediatric and adolescent HIV care. This document contains tools for use in clinical practice to build the capacity of health care workers, caregivers, and pediatric and adolescent patients themselves—in assisting with and delivering successful and informed disclosure. It is primarily targeted for use among health care workers.

Specific modules support:

• Health care workers or caregivers to disclose an HIV status to a child or adolescent.
• Horizontally-infected adolescents to disclose their status to their caregivers.
• Adolescents to disclose to their social networks, community, and romantic partners.

Find out more at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) website. 

The WHO 2018 guideline update promotes the use of optimal treatment regimens in all populations. Though new, more effective and better tolerated options with a higher genetic barrier to resistance are now available for adults, optimized treatment options for children lag significantly behind.

This fifth edition of the Optimal Formulary and Limited-use List supports the transition to optimal WHO-recommended regimens for infants and children, while giving due consideration to the rapidly evolving treatment landscape and the risks inherent in the uncertain timelines for paediatric drug development.

Tuberculosis (TB) is a major contributor to morbidity and mortality in children living with HIV (CLHIV), particularly in TB endemic settings. TB in CLHIV is a
preventable and treatable disease. WHO recommends a cascade of TB services for all CLHIV that begins with routine screening for TB symptoms and/or recent contact with an infectious TB case. It would end with either; 1) diagnosis of active TB disease and prompt initiation of TB treatment, or 2) exclusion of active TB disease and prompt initiation of TB preventive therapy (TPT). Prompt, appropriate treatment for active TB disease is effective in CLHIV.

Similarly, TPT (such as isoniazid preventive therapy) is effective in preventing TB disease and reducing mortality in CLHIV. Effectiveness of both TPT and TB treatment is maximized when CLHIV receive early antiretroviral therapy (ART) to manage HIV infection. However, implementation of these evidence-based interventions to treat and prevent TB in CLHIV remains poor.

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.

To achieve an AIDS-free generation, optimal treatment options for all infants and young children living with HIV must be available, tolerable and most importantly, effective. Since 2013, the WHO has recommended that all infants and children under three years initiate ritonavir-boosted lopinavir (LPV/r)-based regimens. However, the transition to preferred pediatric regimens has been slow, and one-third of children remain on a sub-optimal regimen of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP).

Only 20 percent receive the WHO preferred regimen despite resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) becoming a major concern for infants and young children. While efavirenz (EFV) is increasingly used, NVP-based regimens are also very common in children older than three years. As a result, overall virological suppression reported in program settings continues to be sub-optimal and particularly poor in young children below five years.

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.

Paediatric HIV treatment coverage is stagnating. The most recent estimates suggest that only 46% of children living with HIV are on treatment, well below the AIDS Free target of 1.6 million by the end of 2018. A key challenge is to identify children who are living with HIV that have been missed through routine testing services.

For children in the 0-14 year age group, over 95% of HIV infections are acquired as a result of vertical transmission. As a result, historical approaches to pediatric diagnosis have tended to focus on early infant diagnosis (EID) within the context of prevention of mother-to-child-transmission (PMTCT) programs.

Testing the family of adult or child ‘index’ cases can serve as an entry point for identification of children living with HIV not identified through PMTCT program
testing. This type of family-based approach to HIV testing and service delivery enables parents and their children to access care as a unit. Such approaches may improve retention and offer a convenient service for families affected by HIV.

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. 

Urgent and ambitious 2020 global targets are on the horizon, yet there has been insufficient progress in paediatric and adolescent HIV to date. Scaling up HIV services for all children and adolescents is needed, in alignment with the UNAIDS super-fast-track framework. It’s time to make sure that nobody is left behind.

This series of 12 policy briefs by the Child Survival Working Group (CSWG) looks at scaling up key interventions for children and adolescents living with HIV. They present evidence, policy and monitoring considerations, implementation guidance and tools necessary to scale up 12 key interventions which have proven successful in identifying, linking and supporting children and adolescents to access and remain in quality care and treatment.

They are designed for program managers in government and civil society programs, particularly at country-level, and provide practical information and direction.

Learn more in the Foreword and download the briefs below. 

• Addressing the service delivery needs of children of key populations

• Strategies to improve retention of mother-baby pairs in PMTCT programs

• A child-centred approach for HIV programs

• Providing differentiated service delivery to children and adolescents

• Point-of-care testing as a solution for timely early infant diagnosis

• Complementary and connected: Engaging community and faith-based organizations to deliver PMTCT and pediatric HIV services

• Sensitizing health workers to providing responsive care for adolescents and young people living with HIV

• Family-based index case testing to identify children with HIV

• Meaningful engagement of adolescents and young people in national and local HIV programming

• Scaling up optimal antiretroviral treatment for children: A long overdue intervention

• Preventing and treating tuberculosis among children living with HIV

• Providing peer support for adolescents and young people living with HIV