Eliminating Pediatric HIV/AIDS: What It Will Take and What It Will Bring

From the United States Agency for International Development (USAID)'s AIDSTAR-One (AIDS Support and Technical Assistance Resources, Sector 1, Task Order 1), this report starts with the statement that: "In the coming decade, the world can look forward to the virtual elimination of new HIV infections among infants...Early epidemiologic research has been critical to this victory." The elements required for achieving that vision are described here (with communication elements highlighted below) as:

• Optimising interventions, such as voluntary medical male circumcision, treatment as prevention, pre-exposure prophylaxis, and couples testing with treatment for the infected partner in a discordant couple.
• Maximising coverage and retention: Stigma and disempowerment are amongst the barriers noted to uptake and retention.
• Strengthening health systems: One strategy involves ensuring modern information and communication systems to improve patient tracking, resource planning, accountability, data quality, and ability to use data to guide programmes.
• Engaging communities: "Communities must be knowledgeable about HIV transmission and be aware of high-quality PMTCT [prevention of mother-to-child transmission of HIV] services in order to demand them. Moreover, communities will be the source of the best ideas for dealing with such challenges as stigma, discrimination, empowerment of women, and reaching male partners who may not come to antenatal clinics or other health services. In addition, critical services such as psychosocial support and HIV testing must be available in communities. Finally, links between facilities and communities, particularly through the use of peer support structures and community health workers, can help ensure the retention of women and children in the longitudinal services needed for HIV prevention and care. For instance, involving community counselors in PMTCT service delivery and client follow-up in Côte d'Ivoire led to a significant increase in uptake of PMTCT services, with 100 percent of pregnant women offered HIV testing in antenatal care, compared to 51 percent before placement of community counselors (Elizabeth Glaser Pediatric AIDS Foundation 2011)."
• Assuring adequate human resources, such as through "task shifting" and "task sharing", as well as training or retraining for all roles.
• Implementing favourable policies: "Advocacy activities at various levels to increase awareness and demonstrate the impact and costs of such proposed policy changes can support needed changes."
• Promoting leadership and coordination: "Local leadership must mobilize communities and advocate for services, collaborating and coordinating with health facilities to ensure seamless service delivery."
• Mobilising adequate financial resources, with an emphasis on the importance of health economics research.
• Developing research and innovation, for instance toward the introduction of new tools to improve communication, uptake, retention, adherence, drug packaging, and point-of-care testing.
• Conducting surveillance and measurement in order to allow countries to better assess their progress toward achieving the goal of eliminating paediatric HIV.