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Pediatric Treatment Scale-Up: The Unfinished Agenda of the Global Plan
Martina Penazzato1, Anouk Amzel, Elaine J Abrams
1*HIV Department, World Health Organization, Geneva, Switzerland; †Office of HIV/AIDS, United States Agency for International Development (USAID), Arlington, VA; ‡ICAP, Department of Epidemiology, Mailman School of Public Health, College of Physicians and Surgeons, Columbia University, New York, NY; §UNAIDS, Geneva, Switzerland; ‖National AIDS & STI Control Program, Ministry of Health, Nairobi, Kenya; ¶Department of Epidemiology, University of Texas School of Public Health, Houston, TX; #National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly and Children, United Republic of Tanzania, Dar es Salaam, Tanzania; and **United Nations Children's Fund, Abuja, Nigeria.
Insights
Despite global efforts, pediatric AIDS remains a challenge due to implementation hurdles. Accelerated action and community engagement are crucial for an HIV-free generation and ending AIDS by 2030.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Five million children have died of AIDS-related causes.
- The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive aimed to end pediatric AIDS.
- Progress has been slow due to implementation challenges.
Purpose of the Study:
- To review the progress and challenges of the Global Plan.
- To identify key lessons learned during the Global Plan period.
- To outline critical steps for the post-Global Plan phase to achieve universal treatment for children living with HIV.
Main Methods:
- Review of implementation and scale-up of the Global Plan.
- Analysis of hurdles encountered in service delivery.
- Identification of lessons learned and future challenges.
Main Results:
- Key challenges include lack of testing, poor integration of services, insufficient provider training, and inadequate pediatric antiretroviral formulations.
- Simplification, careful innovation planning, and family-centered care are essential for service delivery.
- The post-Global Plan phase requires tackling challenges to ensure universal treatment for children living with HIV.
Conclusions:
- Accelerated action for HIV diagnosis and treatment linkage is essential.
- Adapting service delivery models and community engagement are critical for efficiency.
- Achieving an HIV-free generation and ending AIDS by 2030 requires sustained commitment and strategic interventions.
Abstract:
Five million children have died of AIDS-related causes since the beginning of the epidemic. In 2011, the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan) created the political environment to catalyze both the resources and commitment to end pediatric AIDS. Implementation and scale-up have encountered substantial hurdles, however, which have resulted in slow progress. Reasons include a lack of emphasis on testing outside of prevention of mother-to-child transmission services, an overall lack of integration and coordination with other services, a lack of training among providers, low confidence in caring for children living with HIV, and a lack of appropriate formulations for pediatric antiretrovirals. During the Global Plan period, we have learned that simplification is essential to successful decentralization, integration, and task shifting of services; that innovations require careful planning; and that the family is an important unit for delivering HIV care and treatment services. The post-Global Plan phase presents a number of noteworthy challenges that all stakeholders, national programs, and communities must tackle to guarantee universal treatment for children living with HIV. Accelerated action is essential in ensuring that HIV diagnosis and linkage to treatment happen as quickly and effectively as possible. As fewer infants are infected because of effective prevention of mother-to-child transmission interventions and the population of children living with HIV will age into adolescence adapting service delivery models to the epidemic context, and engaging the community will be critical to finding new efficiencies and allowing us to realize a true HIV-free generation-and to end AIDS by 2030.