2022 Rome Action Plan on Paediatric HIV & TB
Funders commit to promote the implementation of the Call To Action principles through their investments, this includes:
53. Support country action and a global platform to strengthen active surveillance of safety of HIV agents (such as TAF, DRV/r and CAB LA) in pregnancy, building harmonization and linkages between surveillance networks, with a focus on the most-affected countries and populations.
Donors commit to:
105. Work towards reducing disease funding silos for diagnostics in order to encourage and support more comprehensive diagnostic strategies, including person-centred care, diagnostic integration and network optimization.
106. Support improved global and national coordination across donors, including funding mechanisms, pooling procurement volumes in negotiations with diagnostic manufacturers, and other activities.
107. Prioritize and re-invigorate paediatric-specific funding for strengthened implementation of HIV and TB diagnostics and support of person-centred diagnostic technologies (ie. point-of-care infant diagnosis, simplified TB sample types).
108. Support current efforts to transition from outright instrument procurement to all-inclusive bundles, or other novel pricing model to ensure in-country harmonization of commodity procurement.
109. Support in a transparent manner, including key performance indicators, the procurement of commodities and operational costs to maintain and further scale-up POC infant diagnosis, as well as viral load testing for infants, children, and pregnant and breastfeeding women and advanced HIV disease diagnostics, including TB, as an integral part of optimized and integrated national diagnostic networks and in accordance with national plans and targets.
110. Continue (and expand) support to WHO PQ to broaden their mandate as planned and to shorten timelines for review and minimize time to national registration.
PEPFAR commits to:
116. Work towards reducing disease funding silos for diagnostics in order to encourage and support diagnostic integration and multiplex testing to allow use of current platforms to address multiple diseases.
117. Accelerate multi-disease diagnostic network optimization at the national level to support increased access to testing and network efficiencies, decrease total cost per test, and improvement in specimen-to-clinical action turnaround.
118. Continue engaging governments for policy change in support of all-inclusive pricing models and accelerated complementary use of point-of-care and centralized platforms.
119. Ensure implementing agencies and partners are aware of current paediatric diagnostics that can be procured with PEPFAR funds and ensure safe and ethical HIV testing services are offered to all biological children of parents living with HIV and biological siblings of children living with HIV This can include further scaling appropriate/approved use of HIVST assays including caregiver assisted oral self-testing for screening children at home.
120. Expanding case finding modalities to find undiagnosed children and conducting audits of children newly testing positive for HIV––to inform new approaches to find the missing children, including improving demand generation linked to clinical services through multiple avenues.
121. Working with partners to improve CLHIV estimates through innovative data collection methods in tandem with household surveys.
122. Work with African based institutions to strengthen their capacity for regional regulatory approval of products.
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.
119. June 2023: For pediatric HIVST, shared study information with WHO to inform 2023 HIVST guidance. WHO will issue neutral guidance in 2023, neither recommending for, nor against, caregiver-assisted pediatric HIVST, due to a lack of evidence. PEPFAR included guidance on pediatric HIVST in COP23 guidance and is working to develop implementation resources based on completed studies and demonstration projects. This gives countries great autonomy to expand pediatric HIVST.
120. June 2023: Zambia is conducting a newly diagnosed child audit to identify factors contributing to missed opportunities in pediatric case identification to inform interventions that can bring down the age a diagnosis.
121. June 2023: PEPFAR supported pediatric target setting and review in COP23 to ensure appropriate and ambitious targets aligned with countries treatment gaps to allocate sufficient testing commodities to identify undiagnosed children; PEPFAR updated the Pediatric index testing module and developed an Adolescent index testing module. Trainings are planned for South Africa in July 2023 and other priority countries later this year; Through LIFT UP, 5 PEPFAR OUs proposed activities focusing on improving case finding in children and 5 OU’s proposed CLHIV estimation work.
PEPFAR commits to:
197. See the HIV commitments
197. June 2023: PEPFAR is making strides in improving the number of CLHIV screened for TB (overall coverage) and the number of TB diagnoses in the last year, although there are still many gaps to address.
PEPFAR commits to:
275. Procuring only optimal Paediatric ART formulations (per optimal formulary) and ensuring implementing Agencies and partners are informed of the formulations that can be procured with PEPFAR funding.
276. Ensuring implementing agencies and partners are prepared for the introduction of pALD by not overstocking ABC/3TC 120/60 mg and DTG 10 mg.
277. Ensuring implementing agencies and partners are prepared for co-formulated DRV/r introduction and transition from other PI based regimens in children 3 and older.¨
278. Addressing preventable deaths in CLHIV by implementing the STOP AIDS WHO package of care for all children with AHD; supporting mortality surveillance systems and cause of death audits, in collaboration with country governments, to allow for targeted mortality prevention efforts; ensuring CLHIV newly initiating on ART are provided with intensive case management until VLS is achieved; and ensuring malnutrition is diagnosed and treated early in CLHIV.
PEPFAR commits to:
422. Through COP, closing the remaining gap in contact investigation and TPT for household contacts and for all children and adolescents living with HIV.