access to treatment for children diagnosed with HIV infection, the 2013 WHO ARV guidelines have recommended immediate treatment without the need for CD4 testing for children up to 5 years of age.69 Addressing the needs of HIV-exposed but uninfected infants: An increasing amount of evidence suggests that all children born to women living with HIV – whether the children are HIV-infected or not – have poorer health outcomes than children born to HIV-free mothers.70 This evidence underscores the importance of early identification and linkage to care and treatment for pregnant women living with HIV. It also highlights the need for increased emphasis on early identification of all HIV-exposed children and linking these mothers and their children to care and support through a wide range of settings.
Innovation Combined technology, treatment and programming innovations are expanding access to HIV services and increasing the speed of service delivery – and such improvements are often more cost-effective than before. They include:
To build upon the progress made in recent years and take advantage of new opportunities to address HIV among children in the first decade of childhood, the following 11 strategies need to be pursued:
1. P ut the health of women at the centre of the response to HIV among children The shift to provide ART to all pregnant and breastfeeding women living with HIV, regardless of CD4 count (previously known as Options B and B+), means that the past distinction between ARVs as prophylaxis to prevent HIV transmission to children and ART for the health of pregnant women is becoming obsolete. The 2013 WHO guidelines on ARVs71 and emerging practice in countries now
1
2
3
• SMS technology, delivering test results and reminders to patients in Malawi and Zambia
• Point-of-care machines and communication
technology in decentralized settings, speeding up diagnoses in Eastern and Southern Africa (supported by UNITAID, the Clinton Health Access Initiative and UNICEF)
• ‘Telemedicine’, a decentralized approach to HIV testing, treatment and care in India (supported by the MAC AIDS Fund and UNICEF).
© UNITAID/2013/Giulio Donini
INITIATIVES
•
STRATEGIES TO ACCELERATE PROGRESS IN THE FIRST DECADE OF LIFE
17