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2022 Rome Action Plan on Paediatric HIV & TB

Catholic Mission Medical Board

HIV DIAGNOSTICS

Faith Based Organizations commit to:

153. Equip, mobilize, and support faith leaders, FBOs, people in places of worship, and the wider community to create demand for testing of infants and children.

154. Combat stigma and discrimination among faith leaders and within communities of faith.

155. Further collaborate and coordinate community mobilization, education and outreach to find otherwise hard-to-reach children, adolescents, youth and adults for age-appropriate prevention education, testing and linkage to treatment, health and social support services and integrate into the national system.

Catholic Medical Mission Board commits to:

 

159. Double down on paediatric and adolescent case finding, emphasizing the focus on identifying contacts of index patients – specifically children – and focusing on the use of risk assessment tools to identify likely cases as part of general care in project-supported facilities.

 

160. Support and participate in national efforts to improve and integrate the use and impact of pediatric diagnostics for HIV and to working to develop national strategies to optimize the use of new technologies and interventions.

 

161. Continue to emphasize identification of pregnant women in supported communities (relying on catchment community health workers to know the pregnancy intentions and status of each woman of reproductive age in the catchment). Ongoing focus on ensuring that all identified are tested for HIV, enrolled on ART if positive, and supported to adhere to treatment, and on following their HIV-exposed infants for testing at specified intervals until final status confirmation at 18 months.

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.

Updates

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TB DIAGNOSTICS

Faith Based Organisations commit to:

216. Support and participate in national efforts to improve the uptake of paediatric diagnostics for TB and HIV, ensuring that communities are educated and informed on health risks and the need for early health access as well as reducing stigma.

217. Introduce initiatives aimed at reducing catastrophic costs on individuals by providing financial and operational support (e.g., sample collection and delivery) to vulnerable populations to access essential screening and diagnostic services.

Updates

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HIV MEDICINES FOR CHILDREN

Catholic Medical Mission Board commits to:

345. Collaborating at all levels and working in communities, schools, and faith and healthcare settings to disseminate the HIV Messages of Hope and to combat HIV-related stigma and discrimination, including among faith leaders.

 

346. Continue to provide client-centered HIV care and treatment within health facilities as well as community-based treatment, and as part of that commitment, we commit to ensuring that such care is provided free of stigma.

 

347. Advocate to and support the national and state-level ministries of health to rapidly transition to optimal paediatric formulations per the latest WHO guidelines. We will provide coordinated support for the development and implementation of transition plans and will ensure that both clinicians and patients understand the benefits of the new formulations and their availability.

 

348. Support scale-up of access to priority formulations and diagnostics and facilitate their wider rollout by ensuring the availability of guidance, education, and materials, and by working through community health structures. CMMB works with various cadres of community resource people to support follow-up of children living with HIV as well as to prevent mother-to-child transmission of HIV, which remains too high across the countries we serve.

349. Ensure that we are fully implementing differentiated service delivery in all its variations—for example, flexible clinic hours and community drug distribution modalities such as home ARV delivery and community ART groups.

i. In Zambia, where many children live at their schools during the school year, we will scale up the scholar model, where antiretroviral medications are sent directly to the institution.

 

350. Mobilize our networks and work with communities to help build treatment literacy, generate demand, and expand access to diagnosis and treatment for both HIV and TB among children, collaborating with other stakeholders. We will work closely with stakeholders at all levels toward this end, including community health workers.

i. In Kenya, to improve outcomes, over the next year, CMMB will train 249 health workers of various cadres on treatment literacy and any new pediatric ART guidelines. We will support them to follow up with those having poor treatment outcomes and HIV-positive pregnant women for PMTCT. In addition, we commit to training them additionally on human rights and gender issues to address factors impeding optimal adherence.

351. Scaling up both age-appropriate adherence support groups as well as individualized and group support for caregivers, including psychosocial support. We will work with caregivers to strengthen the skills required to meet the needs of their HIV-positive children. Additionally, we will focus on providing support for HIV-positive pregnant women for prevention of mother-to- child transmission and follow-up testing.

i. In Haiti, we commit to scaling up the use of income-generating activities for adolescents and young adults to increase their economic autonomy, lessen reliance on risk behaviors by young women to provide spending money, and reinforce adherence.

ii. Also in Haiti, we will continue to implement directly observed therapy (DOT). In this approach borrowed from TB treatment, a project field worker visits the family of an HIV- positive child to directly observe the administration of the child’s medication. Currently 82% of unsuppressed paediatric patients have benefited from DOT, with a resuppression rate of 88%.

iii. As part of adherence support to caregivers, CMMB commits to supporting parents to disclose to their children, as disclosure is a first step toward paediatric adherence. Currently, in our projects in Haiti, 93% of disclosed preteens are virally suppressed.

352. To local, regional, and national governments, CMMB will promote an increase in investments in community HIV prevention, care and support programs that strengthen community-focused interventions to enhance support for children and adolescents living with HIV through the continuum of care. CMMB will also advocate for inclusion of interventions addressing social determinants of health into existing frameworks for paediatric HIV prevention, care and treatment funding mechanisms.

Updates

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TB TREATMENT for CHILDREN, PREGNANT, POST-PARTUM AND BREASTFEEDING WOMEN

Catholic Medical Missions Board commits to:

479. Collaboration at all levels and working in communities, schools, and faith and healthcare settings to disseminate messages of Hope for TB and to combat TB-related stigma and discrimination, including among faith leaders.

480. Working to mobilize community leaders and their faith communities in support of efforts to reduce stigma and discrimination efforts via evidence-based education and training.

481. Fostering and actively participating in coordinated and collaborative advocacy at regional and national levels to increase funding for TB research and development and the introduction and scale-up of priority paediatric drugs and formulations; to accelerate regulatory processes for rapid adoption and uptake of optimal paediatric TB drugs and formulations; and to ensure sustainable access to optimal TB testing and treatment for infants and children.

482. Mobilizing our networks and work with communities, in close collaboration with other stakeholders, to expand access to TB diagnosis and TB treatment initiation (new and retreatment) and adherence among children, adolescents, and families, including among those living in hard- to-reach places and in contexts affected by conflict and crisis. Specifically, we will support health facilities in their catchments, and ensure that assessment and diagnosis of TB among paediatric and adolescent HIV patients is routine and institutionalized. We will also incorporate TB screening and referral into training and task lists assigned to community health workers associated with our HIV projects. Additionally, community health workers in CMMB-supported health facilities’ catchments will be trained and empowered to visit households with under-five TB patients to provide health education, do contact screening, and refer those with presumptive TB. CMMB will provide treatment support and assist with finding children who have interrupted TB treatment.

 

483. Supporting and participating in national efforts to improve and integrate the use and impact of paediatric diagnostics for TB and to develop national strategies to optimize the use of new technologies and interventions.

484. Ensuring that all paediatric and adolescent patients receive TB preventive treatment, with provision of treatment support if necessary for the household.

Updates

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