2021

This regional report aims to strengthen risk-informed programming and facilitate scale up of simple and effective tools to identify and reach those adolescent girls and young women who are most in need of services and support. All the available tools included in the review are linked in the annexes and included in UNICEF's AGYW Programming and Implementation Repository. 

In the global quest to end the AIDS epidemic as a public health threat by 2030, meeting the HIV-related needs of children, adolescents and pregnant and breastfeeding women represents a critical piece of unfinished business. To inject a sense of urgency in to global efforts to end the epidemic among children, adolescents and young women, global partners joined together in 2015 to launch the Start Free, Stay Free, AIDS Free framework. Unveiled as the global community was embracing a series of 2020 targets intended to Fast-Track the HIV response, Start Free, Stay Free, AIDS Free called for a super-Fast-Track approach to end AIDS as a public health threat among children, adolescents and young women by 2020.

Since the deadline for achieving the targets passed in December 2020, this is the final Start Free, Stay Free, AIDS Free progress report. Although the targets were global, partners identified 23 countries for intensified focus under the framework. This report specifically highlights progress against the targets in focus countries. The only focus countries outside sub-Saharan Africa (India and Indonesia) do not report data on Start Free, Stay Free, AIDS Free targets and are not covered in this report. 

Download the IAS 2021 Roadmap to find sessions at the 11th International AIDS Society Conference on HIV Science relevant to HIV and children, adolescents and pregnant women.

This flyer provides a quick overview of UNICEF's results within HIV and AIDS in 2020. It describes achievements within UNICEF's main programmatic areas: prevention of mother-to-child transmission of HIV, treatment of children and adolescents living with HIV, and HIV prevention in adolescents. 

UNICEF's Global Annual Results Report - Goal Area 1 describes results achieved in more detail from p. 132-150.
 

Adolescents in Eastern and Southern Africa (ESA) are key to achieving the global goal of ending the AIDS epidemic by 2030. ESA is home to 1.74 million adolescents living with HIV (ALHIV), representing 60 per cent of this population globally. In 12 ESA countries, AIDS is the leading cause of adolescent mortality. While there is an increasing focus on adolescents, the pace of progress remains slow, especially when compared with the growing needs of ALHIV.

It is time to deliver programmes at scale to address the needs of ALHIV, accelerating evidence of interventions producing results or showing significant promise for scale. This document examines and consolidates the current experiences of ALHIV programming in the region to support further implementation and scale-up of evidence-driven models. The findings serve as a call to action and the key considerations as a guide for governments and funding and implementing partners in scaling up service delivery to ALHIV.

EGPAF, with funding and support from Unitaid and DNDi, is bringing new-to-market pediatric ARV formulations to full-scale implementation in eight African countries. We gathered and documented lessons learned from these eight project countries to inform, streamline and accelerate the introduction and roll-out of new, child-friendly ARVs so that all children living with HIV have access to optimal, WHO-recommended treatment and care.

This document was developed to compile 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.

 

Accelerating Access to Innovative Point-of-Care HIV Diagnostics

English - French

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