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2022 Rome Action Plan on Paediatric HIV & TB



489. Expand access to appropriate, timely, high quality, cost-effective infant diagnosis, and viral load technologies, as well as urine-based LF-LAM and geneXpert Ultra for TB diagnosis in children, using comprehensive diagnostic mapping and use of all available di gnostic resources, recognizing the significant patient benefits of point-of-care infant diagnosis and ART initiation and optimized diagnostic networks possible when using multiplex, integrated technologies.

490. Introduce a national Essential Diagnostics List that includes HIV and TB diagnostics, particularly point-of-care infant diagnosis and LF-LAM in decentralized non-laboratory settings.

491. Prioritize an optimized strategy of effective, evidence-based case-finding testing approaches to increase demand for testing of children of all ages and improve patient identification, including HIV testing all children attending malnutrition, TB, and inpatient wards, tracking of mother-infantpairs and opportune testing points, scaling up index testing, etc.

492. Integrate TB screening at all service delivery points and enhance the use of TB diagnostic algorithms to ensure early clinical diagnosis for TB in children hence averting mortality due to TB.

493. Support EMTCT, viral suppression and retention in treatment and care (of pregnant and breastfeeding women and HIV-positive infants and children) through consistent viral load testing and consideration for point-of-care viral load for prioritized populations, including infants and children, pregnant and breastfeeding women.

494. Develop more accurate, transparent, and consolidated forecasts (through data collection and public reporting on diagnostics uptake and implementation) to support manufacturing, improve supply chain management and reagent availability, and support national, regional or global pooled procurement and related activities and to track progress.

495. Support current efforts to transition from outright instrument procurement to all-inclusive bundles or other novel pricing models for centralized and point-of-care platforms to address issues around stock-outs, sample backlog, high cost per test and long turn-around time.


496. Prioritize implementation and documentation of the final diagnosis/outcome after the period of risk for transmission of HIV-exposed infants (at 18 months of age or 3 months' post-cessation of breastfeeding, whichever is later)

497. Implement legal provisions and national programs for post-market surveillance of diagnostic products, including procedures and tools for supplier responsibilities and reporting incidents, adverse events and field safety corrective actions promptly to the national regulator.



TB and HIV Treatment

498. Accelerate the transition to more optimal regimens and formulations much as described in 2021 WHO Guidelines and Optimal formulary by:

i. Enhancing efforts to fully roll out DTG for 1st and 2nd line.

ii. Actively transition All stable infants and children with a valid viral load to DTG­ based regimen irrespective of VL availability by Q4 2023.

iii. Securing appropriate quantities of LPVr granules for the small proportion of children who don't tolerate DTG.

iv.  Adoption of the 2022 WHO guidelines on the management of tuberculosis in children and adolescents that includes the use of a shorter regimen four-month treatment regimen for those children with drug-sensitive non-severe TB, and all oral regimen for children with multi-drug-resistant TB with the new molecules, Bedaquline/Delamanid as applicable.

v. Accelerate scale-up of TB preventive therapy with child-friendly fix d-dose combination medication. This includes lobbying for fast-tracking the child-friendly fixed-dose combination of the weekly rifapentine and lsoniazid.

499. Mobilize resources, plan, and implement a national HIVDR survey on HIV-expose infants to monitor the selection of drug resistance in infants and children by the end of 2 24.

500. Support and contribute to strengthening monitoring of uptake, safety and effectiveness for all Paediatric products for treatment and prevention of HIV and TB in infants and children by fostering data collection and use as well as by joining global efforts to accelerate safety and effectiveness monitoring.

501. Enhance efforts to implement the STOP AIDS AHD package by optimizing diagnosis and management of severe bacterial infections, malnutrition, and cotrimoxazole (CTX) prophylaxis delivery.

502. To collaborate in fast-tracking registration of ALD and co-formulated DRV/r for children and adolescents where possible (via the WHO Collaborative Registration Procedure and other reliance mechanisms).

503. Develop a last-mile distribution strategy for Pediatric ARVs that includes an early warning system that rapidly addresses supply issues that arise at the facility level (the drug is in the country but not necessarily at all facilities).

504. Improve communication and capacity between MOH, Pediatric TWG, supply chain colleagues, and healthcare workers to improve forecasting of Pediatric ARVs and anticipate shortages and stockouts by establishing routine collaboration pathways. A routine communication plan should also be established between facilities to allow the stock to move more readily between facilities in stock-out or low-stock situations.

505. Establishing unified data systems that allow monitoring (VL/regimen, stocks, number of children by weight and age bands, etc.) by regimen across all country data platforms.

506. Ensure collaboration between Implementing partners and Country Government in putting surveillance systems and cause of death audits in place to allow for targeted mortality prevention efforts.

507. Working with partners to improve CLHIV estimates through innovative data collection methods with household surveys.



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