Improving HIV Service Delivery for Infants, Children and Adolescents: Towards a framework for collective action

In June 2019, UNICEF convened a group of about 40 global experts from 24 organizations and institutions to advance the collective thinking on paediatric HIV service delivery. The aim of this “think tank” consultation was to build consensus on the 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.

Participating organizations included:

Aidsfonds
Africaid-Zvandiri
African Network for the Care of Children Affected by HIV/AIDS
(ANECCA)
Baylor College of Medicine
Centers for Disease Control and Prevention (CDC)
Clinton Health Access Initiative (CHAI)
Elizabeth Glaser Pediatric AIDS Foundation (EGPAF)
ELMA Philanthropies
Health Innovations Kenya
FHI 360
ICAP at Columbia University
Joint United Nations Programme on HIV/AIDS (UNAIDS)
Kenya Ministry of Health
Office of the Global AIDS Coordinator (OGAC)
Pact
Pediatric-Adolescent Treatment Africa (PATA)
Positive Action for Children Fund (PACF) / ViiV Healthcare
Réseau Enfants et VIH en Afrique (EVA)
United Nations Children’s Fund (UNICEF)
University of Nairobi
United States Agency for International Development (USAID)
World Health Organization (WHO)
World Council of Churches – Ecumenical Advocacy Alliance (WCC–EAA)
Yale University

Experts addressed the gaps in the continuum of care which are causing children to be missed before they are tested, before they are given their test results and before they are provided with lifelong treatment and care. Read more about the evidence base and the call for action in the brief above.

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.

The full framework, policy briefs and supporting worksheets are available for download (updated July 2020).

Knocking on every door: The Family-Centred Approach to reaching every child living with HIV

UNICEF’s latest Spotlight Report, Knocking on Every Door, showcases Tanzania's Family-Centred Approach, where dedicated community health workers, known as Wakili Tiba, embody compassion and unwavering commitment. They go above and beyond to locate and link children and adolescents to life-saving treatment, breaking barriers and ensuring no child is left behind.

Discover their inspiring journey and transformative impact by downloading the document below. 

Transforming Vision Into Reality: The 2024 Global Alliance Progress Report on Ending AIDS in Children by 2030

This status report shows how far we have come—and how much further we must go—if we hope to meet the global commitments to end AIDS in children. It offers a snapshot of global progress and permits an early assessment of the impact of the Global Alliance’s work. This report highlights the transformative work that is being undertaken in Global Alliance countries to accelerate gains towards ending AIDS in children, underscoring the urgent need to apply good practices, emerging innovations and critical lessons learned to overcome the barriers that slow progress.

For additional information, consult the joint press release and the video created for the report launch at AIDS 2024.

Integrating Mental Health and TB Services into Primary Health Care in Kazakhstan: Lessons Learned and Future Prospects for Integration of HIV/AIDS Services into Primary Health Care

The assessment for HIV/AIDS integration in primary health care in Kazakhstan was undertaken in 2022. The overall objective of the assessment was to use findings and lessons learnt from TB and mental health integration to guide and support integration of HIV/AIDS into primary health care. A mixed methods approach combining both qualitative and quantitative assessment methods was used. Assessment report available in English and Russian.

 

 

Assessing the impact of COVID-19 on people living with HIV, including pregnant women and children

The purpose of this study is to provide an assessment and analysis of the situation of people living with HIV/AIDS (PLWH) in the Republic of Moldova in the context of the COVID-19 pandemic, including COVID-19 awareness and concern, socioeconomic status, quality of life, mental health and social support, access to medical care/treatment (including digital methods), and stigma and develop recommendations for key government stakeholders to address the identified challenges and mitigate the negative impacts of COVID-19.

 This study considers available statistics and latest trends, including an analysis of the data before and during the pandemic, as well as quantitative and qualitative data collected in the field. The study also highlights the situation of pregnant women and children of caretakers with HIV or with HIV themselves.

Key findings: The COVID-19 pandemic has had widespread implications on the health and well-being of PLWH in the Republic of Moldova. One-fifth of PLWH in the national survey reported being severely affected by the pandemic and one-third reported being moderately affected. The multifaceted dimensions of PLWH’s vulnerabilities, compounded with restrictions during COVID-19 lockdowns, resulted in job loss, limited access to treatment, and continued stigma.

COVID-19 awareness and concern: 

  • PLWH received the bulk of COVID-19-related information from online news sources and TV. Less than half of all respondents felt family doctors were a good source of information.
  • Over one-third of PLWH said they were “definitely willing” to get the COVID-19 vaccine. A slightly smaller portion, reported no intention of receiving the vaccine at all.Socioeconomic indicators

Socioeconomic indicators: 

  • 1 in 10 PLWH experienced job loss.
  • Decrease in income was reported by half of all PLWH. Pandemic-induced income reduction was more frequent among urban dwellers.
  • More than half of PLWH expressed concerns regarding financial sustainability and ability to pay daily expenses (utilities, food, drugs).
  • Half of households spent savings, borrowed money, and bought cheaper food to cope with economic hardships during the COVID-19 pandemic. 2 in 5 limited their personal food consumption.
  • More than half of PLWH reported anxieties tied to not being able to pay utilities and buy medication.
  • Out-of-pocket expenses related to HIV care were reported by 56% of PLWH.

Quality of life: 

  • Self-reported quality of life during the COVID-19 pandemic was very poor to poor among over a quarter of PLWH.
  • Self-reported deterioration in health during the COVID-19 pandemic was reported by 17% of PLWH. Deterioration was expressed at a higher rate among the male population.

Access to medical care/treatment: 

  • Nearly 1 in 10 respondents had a lack of knowledge regarding existing HIV/AIDS programs offered by healthcare facilities during the COVID-19 pandemic and therefore had not accessed them.
  • 1 in 10 PLWH reported cancelled medical visits between July 2020 – July 2021. 
  • A quarter of PLWH indicated that the frequency of their visits to healthcare facilities had decreased during the COVID-19 pandemic period when compared to pre-pandemic periods. 
  • Fear of contracting COVID-19 was the most cited barrier in accessing healthcare facilities, reported by 41% of PLWH. 

Find the recommendations in the report.

HIV & SRHR SBC Toolkit for Adolescents and Young People in ESA Region: Question & answer resource documents

As part of the 2gether 4 SRHR joint UN programme, UNICEF ESARO in collaboration with Y+ Global and UNFPA ESARO, developed six key question and answer (Q&A) resource documents on HIV and SRH for adolescents and young people in ESA. The toolkit has been developed to assist country teams in improving knowledge and understanding, driving adolescent and youth engagement and behaviour change,​ and promoting uptake of services in ESA. The content has been developed with adolescents and young people. Part of a broader toolkit, the content is intended for adaptation and use across multiple SBC platforms, including digital approaches scripts for radio shows and peer counselling sessions.

Each Q&A has approximately 10 questions, and links to the other topic areas:

  • Healthy relationships
  • Staying safe
  • Sex and other stuff
  • All about HIV
  • Living with HIV
  • Being a young parent
  • Understanding Puberty
  • The HPV Vaccine
  • Talking with Your Children

Click and watch on how to access and use the toolkit

Ending HIV for Every Child, Every Adolescent: An investment opportunity for the public and private sectors

This document highlights opportunities for both public and private sectors to engage in the global HIV response for infants, children, and adolescents in partnership with UNICEF. Below is also a spotlight on the Global HIV and AIDS Thematic Fund, with financial results from 2023 programming.

UNICEF is a key partner and leader in the AIDS response for children, adolescents, and women. It collaborates with governments and partners worldwide, offering innovation, technical expertise, data and evidence, programme excellence, coordination, and convening power.

UNICEF is 100 per cent voluntarily funded, and is seeking support to deliver ambitious HIV results for children and to ensure the world can reach Sustainable Development Goal Target 3.3, to end the epidemic of HIV by 2030. 

Spotlight on the UNICEF HIV/AIDS Fund: Results achieved in 2022 to achieve an AIDS-free future for children and adolescents

UNICEF’s HIV/AIDS Thematic Fund is a global flexible funding pool. It enables us to strengthen systems to ensure an AIDS-free future for children and adolescents. This offers donors an exciting opportunity to target funding specifically to HIV/AIDS outcomes, while also giving UNICEF the flexibility to allocate funds based on where the need is greatest for children, including critically underfunded priorities at the country level, humanitarian response activities, and where funds will have the greatest impact. Thanks to our generous donors UNICEF’s Global HIV/ AIDS Thematic Fund income in 2022 reached over $5.7 million.

This document features the results achieved in 2022, when supporters of the HIV/AIDS Thematic Fund enabled UNICEF to allocate resources to 45 countries and territories. Funds were allocated to countries based on several measures determining the burden of HIV/AIDS on the population. These included the number of AIDS-related deaths in the country and the number of new infections among children and adolescents in the country. Funds were also allocated to UNICEF’s regional and global headquarters, supporting the vital work that allows thematic funding to unlock wide-scale results and impact the world over.

Progress Report and Road Map for the Triple Elimination of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B in the MENA and EM Region

This is the first report on progress towards the triple elimination of mother-to-child transmission (EMTCT) of HIV, syphilis and hepatitis B virus (HBV) across 23 countries in the Middle East and North Africa/ Eastern Mediterranean (MENA/EM) region.

Countries included in this report: Algeria, Afghanistan, Bahrain, Djibouti, Egypt, the Islamic Republic of Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, State of Palestine, Saudi Arabia, Somalia, Sudan, the Syrian Arab Republic, Tunisia, United Arab Emirates, Yemen.

To support countries in the region to achieve triple elimination goals, this report collects and assesses national policies and key indicators on EMTCT efforts against WHO criteria for validation of the EMTCT of HIV, syphilis and HBV. Based on analysis and consultations with national policymakers, the report provides a Road Map  for countries at different stages of readiness to follow towards triple elimination goals. The report also provides a set of recommendations for all countries to prioritize EMTCT policy and programming actions over the short, medium, and long term.