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
2022 Rome Action Plan on Paediatric HIV & TB
EGPAF
EGPAF commits to:
140. In EGPAF programs, strive to achieve 95% of all HIV-exposed infants receive an EID test within 2 months of birth and, if negative, 95% are retested at 9 months and 95% at the end of exposure (post-breast-feeding), preferably using a same visit POC test, and 95% receive immediate linkage to care with ART initiation using an optimal formulation for those testing HIV positive.
141. Ensure that 95% of pregnant and breast-feeding women attending ANC in EGPAF-supported facilities with unknown HIV status and who are at risk for acquiring HIV are offered frequent HIV screening throughout pregnancy and breast-feeding, with linkage to PrEP services for those testing negative and immediate linkage to care with ART initiation using an optimal formulation for those testing positive.
142. In EGPAF programs, strive to achieve 95% of infants, children and pregnant and breast-feeding women on ART are offered viral load testing, as per the WHO recommended treatment monitoring algorithm, preferably using a same-visit POC test, with prompt initiation of adherence counselling and switch to second-line ART, as needed, for those who are persistently unsuppressed.
143. Annual data gathering and analysis on inequalities between children and adults in access to testing, treatment and viral load suppression across EGPAF programs.
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.
143. June 2023:
EGPAF has analyzed data from EGPAF-supported programs to see what inequalities exist — where we have fallen short, where we can improve, and where we have solutions for closing the gaps.
Our evidence makes it clear that, while great progress is being made in the global fight to end HIV, there is still a long way to go in improving the health of children. Our data from programs show moderate to high inequalities in the 95-95-95 cascade among children versus adults, with highest inequalities on viral load coverage and suppression. Data suggests higher inequities in the AIDS response in younger children (from 0 to 4).
EGPAF commits to:
218. Through its Unitaid-funded project CaP-TB, improve paediatric TB care, finding more children with latent (TB infection) or active TB (TB disease), and putting them on appropriate treatment. It includes improving the increased access and use of TB preventive treatment in high-risk populations of child contacts <5 and CLHIV.
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EGPAF commits to:
319. Work with MoH to contribute to scale up and sustain access to the full portfolio of WHO-recommended paediatric ARVs, including backbone and alternative products, which are needed to deliver optimal first-, second- and third-line treatment regimens.
320. As co-chair of the GAP-f Product Access and Treatment Delivery working group, sustain and strengthen collaboration among relevant stakeholders to ensure quick access to the most optimal paediatric ARV formulations, in close consultation with civil society and the communities, including the community of people living with HIV.
321. Work with MoH, GAP-f partners and other national and international stakeholders to contribute to scale up and sustain uninterrupted access to pDTG 10 mg along with backbone paediatric formulations in EGPAF countries.
322. Support a coordinated plan with key partners, including GAP-f members, to provide technical assistance in support of ALD fixed-dose combination therapy for children 10kg to 25kg introduction to ensure rapid policy update and effective uptake in EGPAF’s countries.
323. Continue to support the implementation of the STOP-AIDS package of care for advance HIV disease (AHD) in children and develop a paediatric AHD toolkit and training materials with support from the Gates Foundation to further strengthen the identification and management of paediatric AHD.
324. As co-chair of the GAP-f Product Access and Treatment Delivery working group, sustain and strengthen collaboration among relevant stakeholders to ensure quick access to the most optimal paediatric ARV formulations, in close consultation with civil society and the communities, including the community of people living with HIV.
325. With the support and in collaboration with Johnson & Johnson (J&J) and other key partners, the New Horizons Advancing Paediatric HIV Care Collaborative (NHC) will provide support to its participating countries with health systems strengthening and access to Darunavir (DRV) & Etravirine (ETR) through donations (from Johnson & Johnson subsidiary Janssen Products LP). The NHC team commits to seek additional stakeholders to support the expansion of these NHC critical initiatives.
319. October 2023:
EGPAF continuously monitor the availability of optimal pediatric ARVs formulations at all levels of the health system for improved treatment outcomes. This activity is undertaken in collaboration with MOH/NACP and other key stakeholders via technical support to implementing partners, pediatric technical working group and supply chain entities and actors.
320. June 2023:
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As co-chair of the PATD working group, EGPAF supported the development and the current implementation of its 2023 Workplan.
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EGPAF together with other GAP-f members actively supported the organization of the first CSO and community engagement forum in January 2023 to promote coordination and explore ways to support CSO and community engagement to accelerate access to better formulations for children.
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EGPAF, in collaboration with the MPP, DNDi and GAP-f Secretariat convened a side meeting on the margins of the WHA to advocate for accelerated access to medicines for children. Malaysia, Africa CDC among others shared their experiences. The follow up includes a more active engagement with member states to increase political and financial support to medicines for children.
321. October 2023:
Access to pDTG is wide in EGPAF supported zones and no stockout ≥15 days at heath facilities reported in the period review.
322. June 2023:
EGPAF actively engaged with GAP-f members to develop a memo to inform national programmes about the availability of the paediatric ABC/3TC/DTG 60/30/5 mg (pALD) fixed-dose combination (FDC) dispersible tablet and to support planning introduction of pALD. It is aimed at helping countries begin to plan for generic pALD introduction. This Memo outlines some considerations for national HIV programmes, implementing partners, and service providers. The document is available in English, French, Kiswahili, Portuguese and Spanish.
322. October 2023:
EGPAF has become chair of the pDTG task Team to support the introduction of pALD and sustainability of pDTG in countries.
EGPAF is working with GAP-f partners in preparations for a satellite event at IPHASA and ICASA in December 2023: "Accelerating access to better medicines for children: Ensuring successful introduction of pALD and sustainability of pDTG".
323. October 2023:
The paediatric AHD toolkit and training materials development is ongoing; the consultant firm has been recruited, the Self-Assessment has been finalized, the interviews with Key Informants from the 12 EGPAF countries is almost completed.
325. June 2023:
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Successfully implemented workplan across NHC countries with multiple trainings, supporting TWGs, transition of pediatric HIV regimens and access to HIV resistance testing.
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Worked to optimize the procurement process in series of NHC countries.
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NHC e-abstract included as a part of the INTEREST Workshop in Maputo, Mozambique, in May 2023.
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NHC abstract submitted and accepted as a poster at IAS in July 2023, Brisbane
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Presented NHC Disclosure Toolkit at the WHO ECHO webinar of June 5th with >500 attendees from around the globe.
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EGPAF commits to:
464. Improve the proportion of children and adolescents living with HIV (CALHIV) initiating and completing TB preventive treatment (TPT) among newly diagnosed CALHIV who access care at EGPAF supported facilities.
465. Improve the proportion of CALHIV that are identified as presumptive TB as well as the proportion finally diagnosed with TB among the CALHIV who access care at EGPAF supported facilities. Improve the linkage to TB treatment initiation among those diagnosed with TB.
466. Develop a paediatric and adolescent TB monitoring and evaluation framework for patient level and programmatic level indicators.
467. At least three public events and/or advocacy products led or co-led by EGPAF in collaborations with other TB stakeholders to sensitize, increase awareness and advocate for childhood TB at the national, regional and global levels in 2023.
468. Provide technical support to National TB Programs for policy change to adopt the new child and adolescents TB guidelines and recommendations released by WHO in 2022.
466. October 2023:
EGPAF is developing a pediatric and adolescent TB M&E framework to better document TB interventions and cascades of care in children and adolescents.
EGPAF is currently routinely collecting MER indicators under the PEPFAR funded projects. Those indicators are focused on CALHIV as a target population. The current TB indicators included among MER indicators are ill suited to rigorously assess the pediatric and adolescent TB treatment and prevention cascades.
467. October 2023
EGPAF has worked with other TB partners to influence, sensitize and increase awareness on childhood TB. A Commentary on the Lancet Child & Adolescent Piece on TB in children and adolescents has been published to continue advocate for access to better TB services for children and adolescents.