Treatment and care in children and adolescents

An estimated 1.8 million children aged 0-14 were living with HIV at the end of 2019, and 150 000 children were newly infected. An estimated 100 000 children died of AIDS-related illnesses. To reduce HIV-related mortality and morbidity among this highly vulnerable population, early testing and treatment is essential. Without access to testing and treatment, 50% of children with HIV will die by the age of 2, and 80% will not live to their fifth birthday.

WHO recommends that infants born to mothers living with HIV are tested for HIV by two months of age, during breastfeeding, and when breastfeeding ends given continued risk of transmission during this period. Older children, especially offspring and siblings of persons infected with HIV, should also be tested in high prevalence regions. Community-based outreach and testing can improve access to testing while mitigating HIV-related stigma.

HIV-positive children should be started on antiretroviral drugs (ARV) immediately. Yet in 2018, almost half of all children living with HIV were not taking ARVs. Once treatment begins, children must take their medicine regularly to stay healthy into adolescence and adulthood. Failure to suppress the HIV virus remains a serious problem among children, aggravated by a lack of child-friendly formulations of the newest and most effective ARVs designed for adults.

Globally in 2019, an estimated 1.7 million adolescents (10-19 years old) were living with HIV and an estimated 190 000 were newly infected with HIV. Compared to other populations, adolescents face additional barriers in accessing testing and treatment, including health services that are not adapted to their needs and policies that require parental consent for services. HIV-positive adolescents also are less likely than adults to adhere to their treatment regularly, resulting in lower rates of viral suppression and lower declines in mortality.

Addressing the distinct and diverse needs of adolescents living with HIV to improve their HIV-related outcomes requires a comprehensive and integrated approach that leverages on global commitments and approaches to adolescent health, including the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) and the Global Accelerated Action for the Health of Adolescents (AA-HA!).

WHO recommends the implementation of adolescent-friendly health services in HIV services to ensure engagement and improved outcomes. Involving and engaging in their own care across the treatment cascade and through the cycle of planning, implementing, monitoring and evaluating programs is key. Peer-driven, adolescent-friendly services, integrated with other services including psychosocial interventions, are effective ways to improve health outcomes for adolescents.

WHO develops normative guidance on HIV prevention, testing, treatment and care, and works with policymakers and programme managers to promote their rapid adoption and implementation.