On 12 December 2019, the UNAIDS Programme Coordinating Board (PCB) held a full-day “Thematic Segment” on “Reducing the Impact of AIDS on Children and Youth” to discuss the many challenges facing children and young people living with, or at risk of acquiring, HIV.
UNAIDS Executive Director Winnie Byanyima and UNICEF Executive Director Henrietta Fore, speaking via video message, started the day with strong calls to ramp up paediatric prevention, treatment and care, not just as a medical imperative, but as a matter of human rights.
UNAIDS Deputy Executive Director Shannon Hader presented the Start Free, Stay Free, AIDS Free progress report, calling attention to the “failures” of the AIDS response in areas such as vertical transmission, testing of infants, paediatric treatment, and reduction of viral load among children living with HIV. WHO Assistant Director-General Dr Ren Minghui presented “Six solutions to reach the paediatric and adolescent treatment targets,” the game-changing interventions put forward in the Thematic Segment background paper to address these shortcomings.
Deborah Birx, United States Global AIDS Coordinator, inspired participants with a call to “translate political will into political action”, stressing in particular the need for governments to fully implement WHO guidelines and stop delivering suboptimal antiretrovirals (ARVs) to pregnant women and children.
A key focus of the discussion was the halted progress on prevention of mother-to-child HIV transmission (PMTCT). Even where statistics show high levels of antiretroviral therapy initiation, too many women are dropping out of treatment during pregnancy and breastfeeding, and many others are unknowingly becoming infected with HIV during this period.
With the global vertical transmission rate still high at 12.7% in 2018, it is critical to test all HIV-exposed infants within 2 months after birth and deliver the test results to caregivers quickly. Meg Doherty, WHO Coordinator of Treatment and Care at the Department of HIV/AIDS, told the meeting, “Using technologies such as point-of-care early infant diagnosis (EID) will allow us to virtually eliminate the time-lag between HIV diagnosis and treatment initiation,” saving many lives.
Children missed by EID should be identified and diagnosed through index case testing, combined with targeted approaches to test people presenting sick at malnutrition and tuberculosis units, as well as in inpatient services, as recommended in WHO guidelines.
Given challenges in testing and linkage to treatment, an alarming number of 700 000 children with HIV are missing treatment access. Martina Penazzato, WHO paediatric HIV technical lead, called on the private sector to work with the Global Accelerator for Paediatric Formulations to speed up development and deployment of new formulations. Shannon Hader from UNAIDS noted the unique collaborative framework known as the “Vatican initiative” that brings together faith-based organizations, the private sector, governments and other stakeholders to accelerate the development and uptake of optimal ARVs for children.
Such collaborative mechanisms prompted ViiV Healthcare to accelerate development of much-needed paediatric formulations of dolutegravir, with submission to both the US Food and Drug Administration and the European Medicines Agency, as announced today.
To address challenges of access to and uptake of HIV testing for adolescent participants, Lucie Cluver of Oxford University noted the benefits of a layered approach to promoting prevention and retention in care among adolescents, wherein good parenting, education, supportive clinical care and cash transfers were added together for best results.
A number of young panellists provided moving testimonies on the stigma they have faced due to their HIV status, including from their own families. As noted in the recently released “ Technical Brief: Adolescent-friendly health services for adolescents living with HIV: from theory to practice”, peer support groups can provide a useful means to overcome the psychological impact of such stigma.
Civil society decried the insufficient attention given to children, with PCB nongovernmental organization delegation members calling on UNAIDS and cosponsors to “wake up” to the mortal danger posed to millions of children by the shortcomings of the AIDS response. The Elizabeth Glaser Pediatric AIDS Foundation, co-chair with WHO of the AIDS Free Working Group, called on UNAIDS and the cosponsors “to address innovation inequities around children and HIV in its new strategic plan, from birth through adolescence”.
A final report and decision points from the PCB Thematic Day will be issued at the next PCB meeting in June 2020.
A follow-on meeting organized by WHO and the Coalition for Children Affected by AIDS on the special situation of HIV-affected adolescent mothers and their children in sub-Saharan Africa also took place today in Geneva.