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The latest knowledge and evidence on HIV/AIDS
COVID-19 and HIV digests
COVID-19 and HIV digests
The COVID-19 and HIV Digest compiles news, updates, knowledge and resources related to the COVID-19 pandemic of interest to those working on HIV, health and well-being among children, adolescents and pregnant women. The digest aims to give a brief and curated overview of updates and resources each month or around specific moments.Teh first twelve issues were shared between April and July 2020, the COVID-19 and HIV: Weekly Digest compiled news, updates, knowledge and resources each week. The digest provided a brief and curated overview of ‘what’s new this week’ within select and changing categories related to HIV, health and well-being among children, adolescents and pregnant women along with links for further reading.
Understanding and improving viral load suppression
Understanding and improving viral load suppression
In 2019 it was estimated that 1.2 million children (0-14) were living with HIV in Eastern and Southern Africa, yet more than a half million of these children (504,000) were not receiving lifesaving treatment. Children with HIV need to achieve viral load suppression if they are to lead long and healthy lives. Population-based surveys in Malawi, Uganda and Zimbabwe found that children on treatment fare worse in achieving viral load suppression compared to adults; 42 per cent vs 67 per cent, 39 per cent vs 84 per cent and 47 per cent vs 86 per cent respectively. Ending AIDS will not be possible without accelerating progress for children.UNICEF, in collaboration with governments and partners, supported a mixed method study that included literature review, assessment of laboratory data in Malawi, Uganda and Zimbabwe and interviews with health workers and caregivers in Malawi to find out what is behind these low rates. The study found that one out of every three children who had a viral load test had not achieved viral load suppression. Support networks for caregivers and children improved adherence and made a difference towards outcome. The full report describes the methodology, key findings, challenges and proposes concrete recommendations to improve treatment outcomes for children with HIV. The accompanying advocacy brief summarizes the key findings and provides action-oriented next steps.
Improving the quality of pre-exposure prophylaxis implementation
Improving the quality of pre-exposure prophylaxis implementation
This implementation brief examines the current efforts in eastern and southern Africa to accelerate and scale up evidence-based PrEP delivery platforms for adolescent girls and young women. The brief provides current knowledge and builds on WHO guidance to provide key considerations for implementation, including driving demand and improving quality, as well as focus on wider combination prevention and integration agendas.Adolescent girls and young women (AGYW) remain disproportionately affected by HIV in eastern and southern Africa, however, they face many personal, social and structural barriers to access, uptake and use of traditional HIV prevention methods. Oral Pre-exposure Prophylaxis (PrEP) is proven to be highly effective as an additional prevention choice for reducing the risk of HIV acquisition, but the current demand for PrEP by AGYW is low with suboptimal adherence.Within the region, there is currently great impetus to address these challenges and scale up PrEP for AGYW. A critical aspect of this is to leverage the learnings and evidence from implementation of how to improve the demand and quality of PrEP programming for this population. Improving the Quality of Pre-Exposure Prophylaxis Implementation for Adolescent Girls and Young Women in Eastern and Southern Africa is informed by knowledge and lessons learned emerging from a virtual thank tank and webinar convened by UNICEF together with WHO AFRO and the Global Fund, with support from the SIDA funded 2gether 4 SRHR programme, in early 2021.--------------EVIDENCE UPDATE 2024Over the past three years, the PrEP landscape has evolved significantly including for AGYW in Eastern and Southern Africa who continue to be disproportionately affected by HIV. The evidence update titled: Pre-Exposure Prophylaxis and Adolescent Girls and Young Women in Eastern and Southern Africa: The latest insights, aims to enhance the quality and coverage of PrEP programming for AGYW. The brief, developed by AVAC, UNICEF and the Global Fund, summarizes the most recent evidence on AGYW PrEP provision and serves as a supplement to the original 2021 implementation brief.
Fast track countries: HIV-sensitive social protection in East and Southern Africa
Fast track countries: HIV-sensitive social protection in East and Southern Africa
This report presents the results of an exercise aimed at mapping HIV-sensitive social protection programmes in East and Southern Africa (ESA), the region most affect by HIV in the world. Particular focus was on 15 countries in the region (Angola, Botswana, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, South Africa, South Sudan, Tanzania, Uganda, Zambia, Zimbabwe) identified, on the basis of their HIV epidemic profiles, as ‘Fast Track’ countries in line with the UNAIDS Fast Track Commitment to end AIDS by 2030. The mapping exercise – commissioned by the World Food Programme (WFP) and the International Labour Organisation (ILO), the co-conveners of the UNAIDS Division of Labour area on scaling up HIV-sensitive social protection – was aimed at understanding how existing social assistance and social security programmes in ESA are integrating the vulnerabilities exacerbated by HIV.
Global guidance on criteria and processes for validation of EMTCT
Global guidance on criteria and processes for validation of EMTCT
The global community has committed to eliminating mother-to-child transmission (EMTCT), also known as vertical transmission, of HIV and syphilis as a public health priority. In 2014 the World Health Organization (WHO) released the first edition of the Global guidance on criteria and processes for validation: elimination of mother-to-child…
Mental nealth and antiretroviral treatment adherence among adolescents living with HIV
Mental nealth and antiretroviral treatment adherence among adolescents living with HIV
Good mental health and psychosocial wellbeing is especially important for adolescents during their transition to adulthood. It can support resilience, help initiate healthy behaviours, and shape long-term positive health outcomes. Mental health is influenced by a range of biological, social, psychological, and cultural factors, all of which may contribute to an adolescent’s ability to function independently and contribute positively to society.This brief presents combined findings from several published analyses using data from a longitudinal community-traced study of adolescents who initiated ART in South Africa. We draw from these analyses, and from evidence of promising interventions in low- and middle- income countries, to provide key programming considerations.
Systematic review of cash plus bundled interventions
Systematic review of cash plus bundled interventions
Our review demonstrated the potential for bundled, multisectoral interventions for preventing HIV and facilitating safe transitions to adulthood. Findings have implications for designing HIV sensitive programmes on a larger scale, including how interventions may need to address multiple strata of the social ecological model to achieve success in the prevention of HIV and related pathways.
Accelerating access to innovative Point-of-Care HIV diagnostics
Accelerating access to innovative Point-of-Care HIV diagnostics
This compiles knowledge, insights and recommendations from UNICEF focal points in country offices implementing a project aimed at introducing, scaling up, and integrating point-of-care (POC) diagnostics into national health systems.The project was implemented by UNICEF, CHAI and ASLM with funding from Unitaid in 10 sub-Saharan African countries between 2016-2020. As the project was winding down, we thought it was important to document the lessons learned from those with direct, hands-on experience in project implementation to offer guidance to other countries interested in adopting POC technologies to increase access to diagnostics.Innovative POC diagnostics can be a game changer in health systems as it enables testing outside the laboratory and closer to patients, can be used for the diagnosis of multiple diseases, addresses key limitations of conventional laboratory networks, and significantly increases access to diagnostic testing in a decentralized fashion. Decentralization of testing also carries an additional benefit as it strengthens elements of the health system around diagnostics (e.g., supply chain management, quality management, connectivity and data management, waste management) that have a broader impact on the health system. The multi-disease testing capacity of POC devices also contributes to pandemic preparedness and response, as has been shown by its use in the Ebola outbreak in West Africa (2014-2016) as well as its widespread use during the COVID-19 pandemic.The impact of POC diagnostic technologies cannot be overstated. This is particularly important in communities in low-resource settings with limited access to diagnostics as well as patients whose clinical management depends upon quick diagnostic test results – such as children infected with HIV. Without treatment, up to 50 per cent of children living with HIV die by their second birthday, with a peak mortality between two and three months of age. Thus, HIV-exposed infants need to be diagnosed before two months of age using molecular diagnostic methods until recently only available in conventional laboratories. However, such conventional laboratory systems carry inherent limitations that restrict their ability to provide timely results in various settings, particularly low-resource settings. It was this urgent need to diagnose HIV-positive infants and initiate them on treatment as soon as possible that motivated this project. POC diagnostics introduction and scale up allowed faster diagnosis, which in turn increased the number of HIV-infected children diagnosed and initiated on treatment within two months of age.Although the project was focused on increasing access to early infant diagnosis of HIV through POC testing, it also demonstrated the cost-effectiveness of POC diagnostics and the benefits of multi-disease testing by integrating HIV viral load and TB testing on the same POC diagnostic platforms. In spite of the focus on HIV, the lessons reported here are broadly relevant for other disease programmes. These lessons are organized in seven main topics: (1) Leadership commitment and support; (2) Laboratories and the supply chain; (3) Engagement with civil society organizations(CSOs); (4) Diagnostics network optimization (DNO); (5) Innovative approaches; (6) Transition to national governments and other long-term funding partners; and (7) Grant design and management. These lessons build upon the 'Key Considerations for Introducing New HIV Point-of-Care Diagnostic Technologies in National Health Systems' published in 2017, and 'Lessons Learned from Integrating Point-of-Care testing Technologies for Early Infant Diagnosis of HIV into National Diagnostic Networks' published by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in 2019. Together, these resources offer a comprehensive perspective on the strategies, challenges, and lessons learned in the course of integrating POC diagnostics into national health systems that countries should consider when introducing and/or scaling up POC diagnostics.
Measurement of mother-to-child transmission of HIV
Measurement of mother-to-child transmission of HIV
This document outlines the fundamentals of PMTCT impact determination and provides considerations for development of pragmatic, streamlined and resource-efficient systems for MTCT estimate generation in high burden settings. The guidance attempts to acknowledge the current reality of PMTCT programme data and the need for reliable MTCT rates while also encouraging a forward-looking approach towards sustainable PMTCT programme data improvements.Note that this document is intended for countries in sub-Saharan Africa with a high prevalence of HIV among women of reproductive age. Although many of the underlying principles are relevant to settings with a lower burden of HIV, the guidance is not targeted for those programmes.
New evidence and programming implications for adolescent
New evidence and programming implications for adolescent
Adolescents have the lowest rates of retention in HIV care and ART adherence when compared to other age groups. It is essential for programmers to better understand the adolescent HIV care pathways in sub-Saharan Africa, where public HIV services have been decentralised throughout the region. This evidence and programming brief is the first in a new series focusing on programming for adolescents living with HIV developed in collaboration with Oxford University and the University of Cape Town. It provides a summary of evidence from a systematic review of adolescent care pathways in low- and middle-income countries, a longitudinal community-traced cohort of ART-initiated adolescents in South Africa, and qualitative interviews with HIV care providers. The brief additionally highlights key considerations for strengthening programming and services for adolescents living with HIV.
Paediatric service delivery framework
Paediatric service delivery framework
The paediatric service delivery framework presents strategies to address bottlenecks across the continuum of care for each population: infants, children and adolescents. This includes keeping mothers who receive interventions for the prevention of mother-to-child HIV transmission (PMTCT) and their infants in care; locating missing infants, children and adolescents through family and index testing; linking those diagnosed with HIV to services; treating them with efficacious regimens and retaining them on treatment to achieve viral suppression. It describes comprehensive and targeted service delivery models, which emphasize strong linkages between testing, treatment and care, and between communities and facilities.The framework was developed by a group of global experts who were convened by UNICEF in June 2019 to advance the collective thinking on paediatric HIV service delivery. The partnership's analysis of current evidence and specific programme interventions that need to be scaled up to improve the quality of HIV treatment services and reach more infants, children and adolescents with these lifesaving medicines is presented here.
AGYW resource guide
AGYW resource guide
The AGYW Resource Guide is a nine-module training guide to strengthen national responses to the crisis of HIV amoung young women and girls. Topics range from stewardship and planning through strategy, innovation, and institutionalization.