Expanding access to timely, affordable and equitable testing of HIV-exposed infants and Securing Pediatric ARV Access in Africa.
Challenges
The first phase of the project demonstrated that the routine use of point-of-care testing technologies increases access to timely and rapid diagnosis for HIV-exposed infants and improves linkage to care and treatment for those who are HIV-infected. However, long-term treatment and care of HIV-infected infants will only be successful if children and health systems have immediate and sustainable access to child-friendly formulations of antiretrovirals (ARVs) that are safe, effective, affordable and palatable.
Of the estimated 1.8 million children (< 15 years) living with HIV in 2019, only half were receiving antiretroviral treatment (ART).[1] An estimated 95 000 children died of AIDS-related illnesses in 2019, in part due to lack of early diagnosis of HIV among infants and children and immediate linkage to optimal HIV treatment regimens. Untreated, 50% of infants infected with HIV during or around the time of birth will die before the age of two years.1 Even when infants receive treatment, the available medicines and formulations were inadequate for children’s needs and lead to poor outcomes.
[1] UNAIDS Data 2020
Solutions
Diagnosing and treating HIV-infected babies with child-friendly ARVs as soon as possible after birth greatly improves their chances of long-term survival. Fortunately, several new such treatments, which are safe, effective and palatable, are available and more are on the horizon.
Through the second phase, the project focused on facilitating the transition to new improved pediatric ARV formulations in Cote d’Ivoire, Eswatini, Lesotho, Mozambique and Zimbabwe with the aim to increase the number of HIV-positive children initiated on improved treatment.
“Through our partnership with Unitaid we can quickly identify and test and treat infants who are at-risk as early as possible. By facilitating access to improved pediatric formulations means more infant lives will be saved.”
Charles Lyons, President and CEO, EGPAF
The impact
The project integrated Point-of-Care Early Infant Diagnosis into health systems and facilities in nine countries, created tools for scale up, demonstrated its public health impact and cost effectiveness, negotiated lower prices and more sustainable pricing models, improved service and maintenance conditions and secured funding commitments from national governments and international donors towards scale-up.
Over the life of the grant, approximately a quarter of a million POC EID tests were performed, which identified and placed on live-saving treatment nearly 5,000 HIV positive infants.
The second phase focused on country transition to new improved pediatric ARV formulations and started in August 2019. By the end of the one-year project, all five countries introduced new, child-friendly formulations of lopinavir/ritonavir (LPV/r) and/or dolutegravir (DTG) into their national treatment guidelines and essential medicines lists (EMLs), and developed and implemented roll out plans for these formulations.
By the end of the second phase, among all children 0 to 14 years on first-line treatment at project sites, 13,828 (66%) were receiving new pediatric formulations (i.e. LPV/r tablets, pellets, or granules; or DTG 50mg tablets). Over the five subsequent years, the one-year project is expected to result in an estimated 2,057 years of life saved.
Related Resources
Accelerating Access to Innovative Point of Care HIV Diagnostics Project (EN)
The catalytic investment in point-of-care early-infant-diagnosis and viral-load technologies by the Accelerating Access to Innovative Point of Care HIV Diagnostics Project, implemented in partnership between UNICEF, CHAI, ASLM, EGPAF and Unitaid, has shown significant results over the years. It has contributed to filling the gap of the AIDS response in Cameroon, DRC, Ethiopia, Kenya, Malawi, Mozambique, Senegal, Tanzania, Uganda, and Zimbabwe. This short video conveys the message that innovation continues to be on the forefront of the fight against HIV, and that in the past fifteen years remarkable growth in diagnostic testing in low- and middle-income countries occurred, aiming to complement conventional laboratories and to influence the achievement of the 2030 Fast Track targets for ending the AIDS epidemic. UNICEF: HIV & AIDS
Treating HIV-positive children with speed and skill | UNICEF
Dr. Denis Nansera, a paediatrician, examines Kansiime Ruth, 25, and her daughters aged 1 and 4 years, at the Mbarara Regional Referral Hospital in Mbarara District, Western Region, Uganda on 20 August 2019.
These guidelines provide new and updated recommendations on the use of point-of-care testing in children under 18 months of age and point-of-care tests to monitor treatment in people living with HIV; the treatment monitoring algorithm; and timing of antiretroviral therapy (ART) among people living with HIV who are being treated for tuberculosis.New recommendations launched today outline key …
