HIV TREATMENT
2020
Action 27. Mobilize their networks and work with communities to help build treatment literacy, generate demand, and expand access to ARVs among children.
Action 34. Increase efforts to share information on the roll-out of new paediatric formulations, including lessons learned.
Paediatric HIV & TB : Rome Action Plan
CHAI commits to:
137. Enable access to affordable commodities through increasing pricing transparency especially of supply chain markups, improving inclusiveness of global access pricing across countries, and exploring improved distribution options to minimize price variability and excess costs.
138. Facilitate timely infant diagnosis and VL monitoring through prioritizing point-of-care solutions and integrated diagnostic networks with efficient sample referral and data management systems.
139. Accelerate pediatric case-finding through scaling proven testing strategies, expanding targeted testing and innovation in facility and community settings, and optimizing use of diagnostic technologies such as POC EID/VL and HIVST.
All partners commit to:
163. Address inequities by tackling the stigma and discrimination in communities, schools, and healthcare settings that prevent children living with HIV from accessing testing and treatment.
164. Increase literacy about CD4 testing and viral load and promote a client-centred approach to support expansion of access to viral load for pregnant and breastfeeding women and children on treatment, including at the point-of-care.
165. Review and assess emerging co-infections for immunocompromised infants and children, including those with advanced HIV disease, such as severe bacterial infections, fungal infections, and others for country consideration and implementation.
166. Engage affected communities for input and guidance on investment and programmatic priorities, provide support to in-country civil society organizations to engage in advocacy and demand creation for new tools, and ensure data is publicly available to support communities and civil society to monitor progress regarding uptake and implementation of essential diagnostic tools.
137. June 2023:
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Facilitated $1 EXW ceiling price agreement between MedAccess and Wondfo across 140 eligible countries for Wondfo’s WHO-prequalified, blood-based HIV self-test; Continued to socialize findings from an assessment of pricing challenges with countries and other stakeholders, including pursuing opportunities to broaden the analysis to additional test types and geographies.
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Engaging with countries and other partners for ad-hoc troubleshooting when pricing barriers/challenges arise.
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Engaged with supplier to update the ICD molecular testing database (hosted by ASLM) to provide greater transparency around the pricing they offer to LMICs for molecular testing.
138. June 2023:
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CHAI is supporting MOH with DNO activities in Cameroon, Ethiopia, Lesotho, Malawi, and Zimbabwe. Modelling is to be completed between June/July 2023. All countries have included HIV VL and EID within agreed DNO scope and hope to design networks that improve access for both. DNO outputs are set to inform GC7 submissions and other resource mobilization efforts to implement the optimized network.
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In Zambia, CHAI supported point-of-care viral load scale up through partner coordination for site assessment and activations, data capture and analysis, formulation of monthly progress reports, gap identification and troubleshooting.
139. June 2023:
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CHAI, through the ELMA AIDS Free project, disseminated final results and lessons learned from demonstration project to operationalize HIVST for pregnant and breastfeeding women (PBFW), adolescents and children (via caregiver assisted HIVST) in Akwa Ibom and Anambra, Nigeria through state TWGs and webinars in Q1 2023 to inform scale-up. Results showed high yield (3.6%) and capacity for reaching first-time testers (84%) among adolescents, as well as identification of incident infections among PBFW (1.8%).
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Results from a FASTER demonstration project on HIVST among PBFW across 8 states in Nigeria were disseminated at the International Workshop on HIV & Women in February 2023. While results showed low yields across all testing timepoints (0.1% – 0.5%), the need to optimize testing in late pregnancy and early postpartum when yields are highest was emphasized.
CHAI commits to:
309. Support product development and introduction of paediatric ABC/3TC/DTG (pALD), paediatric darunavir/ritonavir (pDRV/r), and paediatric TAF (pTAF) once regulatory approvals are received.
310. Scale implementation of the WHO recommended STOP-AIDS toolkit for children living with HIV to identify more children in need and provide a comprehensive package of care for children to prevent, diagnose, and treat drivers of morbidity and mortality.
311. Support adoption of best practices for expanding and sustaining uptake of optimal ARVs for children (e.g., granular monitoring, peer support etc.) and innovate to improve continuity in care (e.g., disclosure, mental health).
312. Engage in market shaping activities to accelerate access to optimal generic paediatric treatment products, including long-acting medications and next generation delivery methods.
309. June 2023:
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Pediatric ALD is under review by the US FDA. Once tentative approval obtained, introduction activities will commence. Support for pediatric DRV/r and DTG/F/TAF will commence at the appropriate time based on product development and regulatory milestones.
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CHAI has led and supported the development of materials to support country programs with the adoption and introduction of pALD, including the GAP-f pALD Introduction and Rollout Planning Considerations for National Programs, CHAI’s pALD Product Profile and FAQ Document
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CHAI is working with our ministry partners to sensitize them about upcoming pediatric pipeline products and advocate for their inclusion in forecasting and quantification plans.
310. June 2023:
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CHAI conducted a Pediatric AHD landscape assessment in collaboration with MOHs in Nigeria, Uganda, and Zimbabwe to estimate prevalence of AHD in children and adolescents, identify status of and key barriers to adoption of STOP AIDS toolkit.
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CHAI distributed findings from the landscape assessment to national stakeholders in Nigeria, Uganda, and Zimbabwe, as well as WHO and major global donors (Unitaid, PEPFAR, and Global Fund) to highlight gaps in current service delivery, and to inform future programming both at the global and country level. We are also working to publish a manuscript.
311. June 2023:
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CHAI finalized a treatment optimization monitoring tool to support facilities to track weight-based ART monitoring for children living with HIV in South Africa. The tool is currently being updated to align with recently updated national ART guidance and outcomes from an upcoming pilot will be forthcoming.
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A baseline age-appropriate HIV disclosure assessment with accompanying psychosocial support training was conducted across five facilities in Nigeria in February 2023. A total of 976 clients aged 0-19 were assessed, of which 44% had received full disclosure, 18% partial disclosure, and ~40% no disclosure, based on their age. Gaps in documenting disclosure were identified, and informed next steps for assessing disclosure quality across age groups in upcoming quarters.
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CHAI conducted a mental health scoping exercise to understand current gaps and opportunities for adolescents in Nigeria. Prevalence of a mental health disorder is estimated to be 23.1% among older adolescents (15-19 years) and 19.9% among female adolescents aged 10-19 in country. While poor mental health increases the risk of acquiring HIV 4-10-fold and worsens treatment outcomes, fewer than 10% of all Nigerians have access to mental health care. These findings will inform future work to improve access.