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).

CROI Summary 2017 (Mar 2017)

A total of 105 participants from Uganda, Nepal, Iran, Zimbabwe, South Africa, Kenya, and many other countries attended the webinar on March 9th which featured new research on PMTCT and pediatric treatment presented at CROI 2017.

The links to the webinar, presentations, and webinar summary are below:

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Presented on March 9, 2017

Technical Brief on Paediatric HIV Case-Finding: Beyond Infant Testing

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.

Global Accelerated Action for the Health of Adolescents (AA-HA!) - Second edition

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.

 

Paediatric Abacavir/Lamivudine/Dolutegravir (pALD) fixed-dose combination: Introduction and rollout planning considerations for national programmes

Dolutegravir (DTG)-based HIV treatment regimens are recommended by the World Health Organization for children living with HIV (CLHIV) who weigh at least 3 kg. In 2020, the United States Food and Drug Administration (US FDA) granted tentative approval of paediatric DTG 10 mg scored, dispersible tablets (pDTG) for CLHIV weighing a minimum of 3 kg and at least four weeks of age. In early 2021, national HIV programmes in low- and middle-income countries (LMICs) began to transition CLHIV from treatment regimens containing non-nucleoside reverse transcriptase inhibitor (NNRTI) and lopinavir/ritonavir to pDTG. As of the last quarter of 2022, at least 73 countries have already placed or received orders for pDTG1 and an estimated 130,000 children have transitioned to pDTG. pDTG currently is administered along with optimised backbone antiretrovirals (ARVs) such as abacavir/lamivudine 120/60 mg scored dispersible tablets (pABC/3TC) per the WHO’s 2021 Consolidated HIV Guidelines.

This brief aims to inform the transition from pDTG + pABC/3TC to the new fixed-dose combination (FDC) dispersible tablet of paediatric ABC/3TC/DTG 60/30/5 mg (pALD).

Leveraging the Learning from HIV Programming for Pregnant and Parenting Adolescent Girls

This brief, the first in UNICEF's new Leveraging the Learning series, sets out to leverage the learnings from holistic, integrated, multisectoral, and age- and gender-responsive approaches to respond to and reduce early and adolescent pregnancy, support young mothers, and improve health and well-being outcomes for adolescent girls and their children. 

Highlighting promising practices for pregnant adolescents living with HIV, the report is relevant for efforts to support all pregnant adolescent girls, regardless of their HIV status.

Ending the AIDS Epidemic Among Young People in the Middle East and North Africa

THIS REPORT IS FORTHCOMING AND WILL BE PUBLISHED JANUARY 2024.

This report examines the HIV epidemic and response among young people, including key populations, in the Middle East and North Africa, using both quantitative and qualitative data. It focuses on marginalized young people who are highly exposed to various health risks but not reached with information, services and tools.