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Aleny Couto (MD,MPH)�Head Of STI, HIV and AIDS National Control Program

Challenges providing ART to children:

  • How do we close the gap to achieve better outcomes across the Africa region

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Context

Worldwide:

  • 39 million people are living with HIV:
    • 1.5 million are children

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  • 1.3 million new infections:
    • 1.2 million in adults over 15 years of age;
    • 130 thousand in children aged 0-14 years;

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  • 630,000 deaths:
    • 84,000 are children

At regional level:

  • 21 million people are living with HIV;

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  • 500,000 new infections:
    • 440,000 in adults over 15 years of age
    • 58,000 in children aged 0-14 years

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  • 260,000 deaths.

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Where are we ?

Middle East and North Africa :

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  • The region has the lowest HIV treatment coverage globally (50%), with delayed HIV diagnoses contributing to poor HIV outcomes and a comparatively slow decline in AIDS-related deaths

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  • Only 34% of children living with HIV were on treatment in 2022.

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Where are we ?

West and Central Africa:

  • Only 37 % of children were diagnosed with HIV ( low case identification)

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  • Only 37% of children living with HIV were on treatment in 2022.

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Where are we ?

East and Southern Africa:

  • The region most heavily impacted by HIV, has made significant progress in reducing numbers of new HIV infections and AIDS-related deaths

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  • 64 % of children living with HIV were on treatment in 2022.

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Challenges on Pediatrics HIV

Missed opportunity with prevention of new infections among women leading to high MTCT rates

Low case identification ( low access to POC EID)

Missed opportunity for timely diagnoses and linkage and continuity on treatment for women and childbearing age

Service Delivery models not adapted to child and caregiver needs

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Challenges on Pediatrics

High stigma and discrimination

Limited investment in the implementation

Weak health systems that supports integration based on efficiencies

Limited community engagement and empowerment

Availability of friendly pediatric formulations, such us single dose tablets

Linkage and retention to care ( impact on treatment cascade mainly in viral suppression)

Low quality of clinical services

Universal health coverage (still not consolidated)

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How do we close the gaps ?

Global Alliance to end AIDS in Children by 2030:

  • Identified 12 countries that need to speed up to impact on the response
  • It has 4 pillars :
    • Accessible testing, optimized treatment and comprehensive care for infants, children, and adolescents living with and exposed to HIV
    • Closing the treatment gap for pregnant and breastfeeding adolescent girls and women living with HIV and optimizing continuity of treatment
    • Preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women
    • Addressing rights, gender equality and the social and structural barriers that hinder access to services

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How do we close the gaps?

Testing of every child with

signs and symptoms suggestive of HIV

POC PCR Expansion (TSD)

Routine testing for

Priority groups (children and adolescents)

of WLHIV, OVC)

Routine testing for all

Hospitalized child

Implement Community testing (tracing

of the index case, selftesting)

Integration of services (vacination, triage,nutrition)

1st 95 : Diagnostic and linkage to care

Exposed Children 0- 18months

Children older than 18 months 14 years old

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How do we close the gaps?

Implement pediatric and family focused DSD (differentiated models of standardized clinical care)

Improve the quality of care including the management of complicated clinical cases for HIV-infected children, including children with Advanced HIV Disease (ADH)

Clinical Mentorship

Reduce the pill burden with single tablets

Continue innovation in treatment access

Rapid transition children on ART to DTG and improve treatment outcomes (suppression)

2nd & 3rd 95 : Treatment and viral supression

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How do we close the gaps?

Peer support interventions targeting all priority populations (including prevention and support for AGYW and PBFW; treatment support for CLHIV)"

Use initiatives, platforms and community actors to support the connection and maintenance of children to treatment.

Engagement and empowerment of the community to participate in the design and monitoring of the quality of the programs, allowing the design of models that respond to the needs of the population

Sensitization campaign of testing and treatment literacy

Support from the Mentor Mother and OVC program

Continuous Improvement of Service Quality

2nd & 3rd 95 : Treatment and viral supression

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Thank You !