Programmatic and clinical guidance
The impact of the COVID-19 response on the supply chain, availability and cost of generic antiretroviral medicines for HIV in low- and middle-income countries (UNAIDS): This report assesses the situational landscape during mid-May 2020 surrounding the value chain of the production and distribution of generic antiretroviral medicines in LMICs and provides recommendations to governments on mitigating the risks of potential disruptions.
Interim guidance for COVID-19 and PLHIV (AIDSInfo): Review of special considerations for people living with HIV and their health care providers in the United States regarding COVID-19. The guidance offers suggestions on switching ART, appointment postponement, planning for isolation, and HIV SARS-CoV-2 co-infection management. See also interim adult ART guidance from the British HIV Association
PEPFAR Technical Guidance in Context of COVID-19 Pandemic (PEPFAR): Technical note with guidance on a range of HIV-specific, cross-cutting and health systems issues related to PEPFAR's programmes. The document is updated twice per week as the situation evolves globally. See also:
- Draft tips and programmatic considerations for remote case management of orphans and vulnerable children (OVC Taskforce)
- Strategic considerations for mitigating the impact of COVID-19 on key-population-focused HIV programs (PEPFAR, USAID, EpiC)
COVID-19: Considerations for Global Fund Support for HIV (Global Fund): This information note summarizes preliminary messages about the operation of Global Fund-supported HIV programmes and services, and provides guidance on adaptive prevention, testing and treatment programming.
Technical Briefing on HIV and COVID-19 Programming (Frontline AIDS): this working document provides concrete recommendations intended for Frontline AIDS partners, but useful for other stakeholders, who are mitigating the impact of COVID-19 on their HIV programmes and addressing the secondary impact of COVID-19 in communities most impacted by AIDS. Available in English, Spanish and French.
Maintaining and prioritizing HIV prevention services in the time of COVID-19 (Global HIV Prevention Working Group): This brief outlines several critical actions and temporary modifications that can be considered to ensure continued effective HIV prevention and related services in the time of COVID-19.
Condoms and lubricants in the time of COVID-19. Sustaining supplies and people-centred approaches to meet the need in low- and middle-income countries (Global Condom Working Group): This brief for country condom programme managers and experts provides a summary of relevant actions to sustain supplies of male condoms, female condoms and lubricants, and to adjust approaches for condom promotion during the time of COVID-19.
PrEP during COVID-19 (CDC): US-based guidance for providing PrEP as an essential service when facility-based services and in-person patient-clinician contact is limited.
Models of COVID-19 impacts on HIV
Potential effects of disruption to HIV programs in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models (Jewell et al.): This paper published in The Lancet combines all five models used to estimate the impacts of COVID-19 related service disruptions on HIV (Goals, Optima HIV, HIV Synthesis, Imperial College London, EMOD). It provides projections for a six month disruption on PMTCT, ART programmes, condom programming and VMMC. See previous press release from a modelling group convened by WHO and UNAIDS.
The Potential Impact of the COVID-19 Epidemic on HIV, TB and Malaria in Low- and Middle-Income Countries (Imperial College London): Researchers have modelled the impact of COVID-19 on HIV, TB and malaria in low- and middle-income countries and predicted significant rises in cases and deaths. The greatest impact on HIV is estimated to be from interruption to supply and administering of ART; this could cause a 10 per cent rise in deaths over five years. See shorter Lancet version.
Lessons learned from HIV to inform COVID-19 response
COVID-19 and HIV: 1 moment, 2 epidemics, 3 opportunities—how to seize the moment to learn, leverage and build a new way forward for everyone’s health and rights (UNAIDS): This report highlights how the HIV response can help to jump-start an accelerated response to COVID-19 in ways that can help to ensure that such efforts do not come at the expense of the HIV response or other essential health priorities and that errors learned from the HIV response are not repeated.
Early reports indicated that children infected with SARS-CoV-2 tend to be asymptomatic or exhibit mild symptoms. See:
- Coronavirus Disease 2019 in Children (CDC): This morbidity and mortality report describes aggregated characteristics, disease progression and clinical outcomes in children in the United States from February 12–April 2, 2020.
SARS-CoV2-2 infection in Children and Adolescents(JAMA Pediatrics): This systematic review evaluates clinical features, diagnostic tests, therapeutic management and prognosis in reported cases among 10-19 years between Dec 1, 2019-March 3, 2020, mainly from China. The authors find that most paediatric cases have mild to no symptoms. See also Children with Covid-19 in Pediatric Emergency Departments in Italy
- SARS-CoV-2 infection in children and newborns: a systematic review (European Journal of Pediatrics): This study reviews main clinical characteristics and outcomes of SARS-CoV-2 infections in pediatric age described in papers published between 1 January and 1 May 2020 with a total sample size of 7480 children. The authors mention that a higher proportion of newborns were severely ill and that SARS-CoV-2 affects children less severely than adults.
- COVID-19 disease in children and adolescents (WHO): This scientific brief summarizes the current knowledge about SARS-CoV-2 infection and transmission as well as COVID-19 disease symptoms in children and adolescents.
Multi-system inflammatory syndrome
Clinical reports suggest that an inflammatory toxic shock syndrome observed in children in Europe and the United States may be linked to SARS-CoV-2 infection. See:
- Kawasaki-like disease: emerging complication during the COVID-19 pandemic (The Lancet) and clinical reports from the United Kingdom, Italy, France and the United States including New York City (29 June)
- Guidance with working case definition and approach to clinical management from The Royal College of Paediatrics and Child Health. See also case definition and webinar from CDC
- Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 (WHO): Scientific brief and case report form for suspected cases
- Rapid risk assessment: Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children (European Centre for Disease Control and Prevention): Risk assessment, epidemiology, disease background and response options.
Secondary Impacts on Children
Beyond Masks: Societal impacts of COVID-19 and accelerated solutions for children and adolescents (UNICEF): This review from November, 2020 explores the societal impacts of the pandemic on children, drawing on the existing literature – both of COVID-19 and other health crises – to guide child-sensitive responses, focusing on effective and feasible interventions.
The Impact of COVID-19 on children (UN): This policy brief released by the UN Secretary General points out that while children are not the face of the crisis, they are at risk of becoming the hidden victims. It highlights the potential long term impacts and key actions for children.
COVID-19: What it means for children and what we can do to protect them (UNICEF): Brief highlighting the impacts on children together with six actions UNICEF and partners need to take now to protect them.
Considerations for pregnancy, delivery and breastfeeding
Questions and answers
See additional resources from UNFPA on sexual and reproductive health and rights, contraception, maternal and newborn health in the context of COVID-19.
Management of pregnant women confirmed with COVID-19 (ACOG): The American College of Obstetricians and Gynecologists has developed an algorithm to aid practitioners in assessing and managing pregnant women with suspected or confirmed COVID-19 in this interim guidance.
Management of infants born to mothers with COVID-19 (AAP): Guidance and Q&A from the American Academy of Pediatrics to address the care of infants born to women who have or are suspected to have COVID-19 around the time of delivery.
Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis (Allotey et al.): This article is a living systematic review that will be updated to reflect emerging evidence.
COVID-19 management, prevention and treatment news
Interim clinical guidance for management of patients with suspected or confirmed COVID-19 is available from WHO and CDC. Current clinical management includes infection prevention and control measures and supportive care including supplemental oxygen and mechanical ventilatory support when needed.
Drugs and therapeutics
- EGPAF has created an overview of the drugs and other therapeutics currently being investigated in numerous clinical trials for prevention or treatment of SARS-CoV-2 infection.
- WHO Living guideline: Drugs to prevent COVID-19: This interim guideline strongly recommends against using hydroxychloroquine as a prophylactic drug.
- WHO Therapeutics and COVID-19: Living guideline: This interim guidance contains the most up-to-date recommendations for the use of therapeutics in the treatment of COVID-19. Recommendations are currently provided for or against the following: IL-6 receptor blockers, ivermectin, hydroxychloroquine, lopinavir/ritonavir, remdesivir, and systemic corticosteroids.
- Corticosteroids for COVID-19: living guidance (WHO): These living guidelines developed with investigators of seven clinical trials currently recommend systemic corticosteroids for treatment of patients with severe and critical COVID-19, whereas corticosteroids are not recommended in patients with non-severe COVID-19 (September 2020).
- A panel of American paediatricians have suggested Multicenter Initial Guidance on Use of Antivirals in Children with COVID-19 (Journal of the Pediatric Infectious Diseases Society).
- The United States has granted emergency authorization for use of the monoclonal antibody treatment from Eli Lily and Regeneron in patients with mild to moderate COVID-19.
Advice on the use of masks in the context of COVID-19: Interim guidance (WHO - updated December 2020)
Community Use of Cloth Masks to Control the Spread of SARS-CoV-2 (CDC): Scientific brief outlining the evidence for cloth mask use for prevention of SARS-CoV-2 acquisition and onward transmission
Considerations for implementing and adjusting public health and social measures in the context of COVID-19 (WHO): This interim guidance reviews non-pharmaceutical individual and societal interventions to control COVID-19. This updated version (June 2021) introduces considerations for relaxation of some measures for individuals with natural or vaccine-induced immunity.
Vaccines and Diagnostics
COVID-19 Vaccines and HIV (UNAIDS): Information note on vaccine safety and recommendations for vaccinating people living with HIV against COVID-19. See also Interim recommendations for an extended primary series with an additional vaccine dose for COVID-19 vaccination in immunocompromised persons (WHO).
Guidance on developing a national deployment and vaccination plan for COVID-19 vaccines (WHO, UNICEF): This interim guidance has been used as the guiding framework in over 100 countries and supports governments to develop their national COVID-19 vaccination strategies.
Diagnostic testing for SARS-CoV-2 (WHO): This document provides interim guidance to laboratories and other stakeholders involved in diagnostics for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It covers the main considerations for specimen collection, nucleic acid amplification testing (NAAT), antigen (Ag), antibody (Ab) detection and quality assurance.
Use of SARS-CoV-2 antigen-detecting rapid diagnostic tests for COVID-19 self-testing (WHO): This interim guidance provides a new recommendation that COVID-19 self-testing, using SARS-CoV-2 Ag-RDTs, should be offered as part of SARS-CoV-2 testing services. It also includes implementation considerations that can guide decisions on whether, and how, to adopt self-testing in different contexts.
Recommendations for national SARS-CoV-2 testing strategies and diagnostic capacities (WHO): This interim guidance describes recommendations for national testing strategies and the use of PCR and rapid antigen tests in different transmission scenarios of the COVID-19 outbreak, including how testing might be rationalized in low resource settings.
Free online course on COVID-19: Diagnostics and Testing (FIND, ASLM): Get the latest recommendations on COVID-19 diagnostics and testing, and how to improve testing capacity in low-income settings. See more resources and webinars from the African Society for Laboratory Medicine.
Access a complete list of currently available partner resources on diagnostics within the categories of webinars and courses, technical guidance, information for laboratories, and FAQs and testing information.
Operational guidance for maintaining essential health services during an outbreak (WHO): provides guidance on a set of targeted immediate actions that countries should consider at national, regional, and local level to reorganize and maintain access to high-quality essential health services for all during the COVID-19 pandemic. Can be used together with Analyzing and using routine data to monitor the effects of COVID-19 on essential health services: practical guide for national and sub-national decision-makers. See also Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic (CDC).
Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic (IFRC, WHO, UNICEF): This guidance outlines the critical role of community-based health care and adaptations to keep people safe, maintain the continuity of essential services, and ensure an effective response to COVID-19.
Public health and social measures for COVID-19 preparedness and response in low capacity and humanitarian settings (IASC): This interim guidance outlines how key public health and social measures needed to reduce the risk of COVID-19 spread and the impact of the disease can be adapted for use in low capacity and humanitarian settings. The recommendations need to be adjusted to the scale of transmission, context and resources.
COVID-19 and telemedicine (PAHO, IDB): Tool for assessing the maturity level of health institutions to implement telemedicine services : This tool helps health institutions assess their level of maturity to offer telemedicine services and facilitates the identification of possible gaps.
COVID-19: Considerations for tuberculosis (TB) care (WHO): This information note describes in Q&A form how to engage health services and national TB programmes in ensuring an effective and rapid response to COVID-19 while ensuring that TB services are maintained.
What people living with HIV need to know about COVID-19 (UNAIDS): Infographic and brochure outlining the precautions PLHIV and key populations should take to prevent COVID-19 infection and ensure continuity of their HIV treatment plan during the pandemic.
Q&A for adolescents living with HIV in time of COVID-19 (UNICEF): Developed by UNICEF ESARO in partnership with Y+ Global and country-level networks of adolescents and young people living with HIV, this Q&A-based publication providers answers to the most common questions submitted by adolescents and young people living with HIV through social media. Available in English and Spanish.
Video: Fatima talks about COVID-19, HIV and ARVs (Africaid Zvandiri): Updated animated film (June 2020) targeting adolescents in which Fatima talks about living with HIV during COVID-19.
Lessons learnt from the HIV response for COVID-19: Building community resilience: Commentary from the Executive Director of the Global Network of People Living with HIV (GNP+) and advice to HIV activists.
Personal and community guidance is available from the Internal Treatment Preparedness Coalition and is being regularly updated in English, French, Russian and Spanish.
COVID-19 Impacts on African Children (Save the Children): This pan-African policy paper provides a multi-sectoral analysis of the situation of African children, highlighting violence, food and migration risks for children, and provides recommendations for protection of children within key sectors
Eastern and Southern Africa
- UNICEF's HIV Programing in the Context of COVID-19: Sustaining the gains and reimagining the future for children, adolescents and women (UNICEF ESARO): This compendium provides a summary of innovative approaches being taken across nine HIV priority countries, Botswana, Eswatini, Kenya, Lesotho, Namibia, South Africa, Tanzania, Uganda and Zimbabwe.
- Tanzania: Interim guidelines on provision of HIV services during COVID-19 outbreak (National AIDS Control Programme)
West and Central Africa
- Nigeria: Health response to the COVID-19 pandemic (UNICEF): UNICEF Nigeria has developed a working document to provide guidance on a set of targeted actions that the health programme will implement at national, state and community level to respond to the outbreak while ensuring continuity and strengthening of essential health services for all. It summarizes key intervention components: (i) support immediate response to COVID-19; (ii) ensure continuation of life saving services for mothers, newborns, children and adolescents, and (iii) maintain a systems strengthening approach. The country office has also developed a strategy for utilizing existing networks for business continuity planning in the context of polio.
- Sierra Leone: COVID-19 guidance on comprehensive HIV service delivery (Ministry of Health and Sanitation, National AIDS Control Programme)
Additional national guidance documents from sub-Saharan African countries are available on the Differentiated Service Delivery website.
Latin America and the Caribbean
- This infographic from UNAIDS visualizes survey findings on the impact of COVID-19 on key areas of concern for people living with HIV in Latin America and the Caribbean. It is available for download in English and Spanish. Additional tailored resources on COVID-19 and HIV are available in Spanish on the UNAIDS regional information portal.
East Asia and the Pacific
- UNICEF's Approach to Mental Health during COVID-19 in East Asia and the Pacific (UNICEF EAPRO): This brief presents a snapshot of the multisectoral and adaptive approaches undertaken during the COVID-19 response, in collaboration with government, civil society, development partners and young people’s networks.
- Rapid Survey on the Needs of Young Key Populations and Young People Living with HIV in Asia and the Pacific in the Context of COVID-19 (Inter-agency Task Team on Young Key Populations): This post highlights regional YKP-reported socioeconomic impacts and access to information, HIV and health services.
- HIV: Impact on mental health & quality of life in time of COVID-19 (UNICEF): This blog from UNICEF East Asia and the Pacific describes survey findings for adolescent and young key populations living with HIV in the region and provides recommendations for mental health support.
- Social media package and key messages to address stigma and discrimination related to COVID-19.
The HIV-COVID Database monitors and reports on outcomes of COVID-19 occurring in adult HIV patients in the United States. The database, spearheaded by University of Maryland, Institute of Human Virology and the American Academy of HIV Medicine, is an open registry for providers in the United States and will soon be open for input by international providers.
- Rights in the time of COVID-19: Lessons from HIV for an effective, community-led response (UNAIDS): Drawing on 40 years of HIV response, this publication summarizes seven key take-aways for a community-centred empowerment approach that focuses on removing the barriers that people face to protecting their health and the health of others.
- COVID-19, marginalized populations and community engagement
Mental health and psycho-social support
- #CopingwithCOVID: Webinar series on young people and mental health (UN Youth Envoy)
- How teenagers can protect their mental health during coronavirus (UNICEF)
- Voices of Youth
- Technical note: Protection of children during the COVID-19 pandemic (Alliance for Child Protection in Humanitarian Action)
- UNICEF's programme guidance notes can be found in Arabic, French, English, Russian and Spanish here.
- UNICEF has developed tips and guidance for families, including parenting tips, essential knowledge for parents and mental health strategies for teenagers.
- Parenting for Lifelong Health provides open-access parenting tips and activities in multiple languages in collaboration with WHO, UNICEF, the Global Partnership to End Violence Against Children, the Internet of Good Things, USAID and CDC.
- New York Times compiles news and articles for parents in the time of COVID-19.