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. 

Toolkit for the Implementation of Baby Showers in Congregational Settings for the Prevention of Mother-to-Child Transmission of HIV

This toolkit — prepared by members of the U.S. Centers for Disease Control and Prevention in Nigeria and Atlanta, the University of Nigeria, the Healthy Sunrise Foundation, and the National AIDS and STI Control Program of Nigeria — provides implementers with the background, procedures, and resources/tools to support the implementation of Baby Showers in Congregational Settings. In PEPFAR programmes, countries are moving toward elimination of mother-to-child transmission of HIV (EMTCT). One gap in achieving EMTCT is reaching women and their infants who do not come to the facility for care. The Baby Showers approach in Nigeria is one way of reaching women and their families in the community through faith-based congregations, with a strong evidence base to support its positive impact.

Baby Showers are celebratory gatherings for pregnant women and their partners with routine celebrations marked by prayers for the safe delivery of babies and to support parents-to-be as they prepare for their new arrival. Health screening, including HIV testing for pregnant women and their partners, is offered during the celebration that brings women, their partners, and their newborns together in a congregation. Other countries have expressed interest in learning from Nigeria’s experience. This resource has been adapted for implementation in additional settings and contexts and includes six accompanying tools in the appendix to aid in data collection and documentation.

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.

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.

Key considerations for fast-tracking EMTCT in lower-prevalence settings

This key considerations document, developed by UNICEF and WHO, expands on the 2020 “last mile” operational guidance, with specific considerations for countries with lower HIV prevalence. It builds on the experiences of countries that have been validated for EMTCT of HIV and syphilis and translates the valuable lessons and promising practices of these countries into an operational framework for national programmes, consisting of 12 strategies and enablers to guide efforts towards Fast-Tracking EMTCT in lower prevalence countries.

It is based on a review of experiences, key lessons learned and promising practices in implementation of EMTCT interventions in lower prevalence countries, including Sri Lanka and Thailand, which have been validated by WHO for having eliminated vertical transmission of HIV, and three countries with the potential to achieve EMTCT by 2030: the Democratic Republic of the Congo, Ghana and India.

Operational Guidance for National Roll-Out of Family HIV Testing in West and Central Africa

HIV testing and treatment remains low among children in West and Central Africa. Various barriers prevent the scale-up of services and improved coverage for children, including limited coverage of early infant diagnostic capacity, limited decentralization of pediatric treatment including task-shifting/sharing from paediatricians to nurses and community actors, as well as prevalent HIV stigma at individual, family and community levels. Family-based HIV index testing has been identified as a game changer that can deliver quick gains for the paediatric HIV response in both high- and low prevalence settings. By using an individual family member living with HIV as an entry point to reaching the entire family unit, several underlying factors can be addressed, which limit access to HIV testing services especially for children.

This operational guidance is meant for use by national programme managers, implementers, advocates and health care providers in collaboration with partners, supported by national, regional and global experts. The guidance draws off the experience in family testing from within and outside West and Central Africa. It combines recommendations from the Dakar Expert consultation, which took place in June 2018, as well as lessons learned from the pilot of the Family Testing Operational Guidance in Liberia in June 2018. It is a living document that will be enriched as evidence on family Testing in the region grows. The use of this guidance will be complemented by a toolkit and a community of practice. It is a regional document drafted for the countries in West and Central Africa to guide country teams to design country-contextualized family HIV testing roll-out.

Nurturing care for children affected by HIV

In the early years, we lay down critical elements for health, well-being and productivity, which last throughout childhood, adolescence and adulthood. Failure to meet a child’s needs during this critical period limits the child’s ability to achieve their full developmental potential and threatens the future of human capital and society in general. This is particularly so for children affected by HIV who experience several interrelated factors that may hinder the achievement of a child’s full developmental potential.

This brief from UNICEF and WHO describes the specific nurturing care components for children affected by HIV as well as facility-level and community-level actions for early childhood development.

HIV Pediatrics 2020 Workshop Report

The International Workshop on HIV & Pediatrics 2020 took place virtually on 16-17 November. It provided a global update on paediatric HIV and explored pertinent issues through dedicated plenary and oral abstract sessions on prevention of mother-to-child transmission of HIV, paediatric treatment and care, and adolescents and HIV. It also included sessions on COVID-19 in children.

UNICEF and Virology Education have developed a workshop report that summarises highlights and learnings from each session.

Presentations and webcasts (provided speaker's consent) are also publicly available and can be accessed here.

Strengthening Paediatric TB and HIV Case Finding at the Frontline: TB/HIV Integrated Community Case Management (iCCM)

Community and primary health facility platforms have been recognized as important, but under-utilized entry points to address the large prevention, case detection and treatment gaps faced by young children with TB and/or HIV. In 2014, WHO and UNICEF revised community health worker packages for integrated community case management (iCCM) targeting children under five years of age, to include screening and referral for TB and HIV (TB/HIV iCCM). As part of an integrated, child-centered approach, TB/HIV iCCM is recommended for use in high TB and HIV burden settings.

Developed by UNICEF and Save the Children, Lessons from the Field (Uganda, Nigeria, Malawi) and Guidance (under development) are available for download.