I. Introduction

As of the end of 2004, about 2.1 million children were living with HIV/AIDS. HIV/AIDS accounts for 7.7 percent of mortality of children less than five years old worldwide, and as much as 40-60 percent in several southern African countries; HIV/AIDS is also the third-leading cause of disability-adjusted life years lost.¹,²

The clinical, immunologic, and virologic manifestations of HIV/AIDS in children differ from those in adults. Moreover, children are growing, have different metabolisms, and are dependent on adults. As a result, infants and adolescents have very specific and age-dependent needs that vary with age.

The prevention of HIV infection in children and the care and treatment of HIV-infected children are important priorities of the President's Emergency Plan for AIDS Relief. The purpose of this document is to describe preventive care interventions the Emergency Plan can support for children born to HIV-infected mothers (HIV-exposed children), including children in whom an HIV diagnosis has been confirmed (HIV-infected children). Since other health programs support basic health care and basic social services for children, in many cases, the Emergency Plan should link delivery of these interventions with existing community and health facilities that provide such care, supported by other mechanisms. Emergency Plan programs should also link, where possible, with other Emergency Plan programs, such as those to prevent mother-to-child HIV transmission (PMTCT), those to serve orphans and vulnerable children (OVCs), and those to provide home-based care. In addition, United States Government (USG) teams in countries that are also part of the President�s Malaria Initiative (PMI) and/or are recipients of grants for the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), should work closely to integrate Emergency Plan work with activities funded by these two programs. This document does not address antiretroviral treatment for children.

USG teams should request funding for the Preventive Care Package for Children in Country Operational Plans, in appropriate program areas such as: Laboratory; OVC; Palliative Care; TB/HIV; Treatment; and Strategic Information. USG teams in countries that are also part of the PMI and/or are recipients of grants from the GFATM should work closely to integrate Emergency Plan work with activities funded by these two programs.

There is ongoing discussion regarding which interventions Emergency Plan teams should include in a preventive care package. Recognizing that a package cannot be standardized for all situations and countries, interventions within the care package are likely to vary within regions, and even within countries, depending on the setting and the capacity of the partners who are implementing such programs. However, the Office of Global AIDS Coordinator (OGAC) believes it is valuable to offer a "menu" of interventions. Emergency Plan programs should link the preventive components within this document to other key health care, such as routine medical care and voluntary family planning, which play a key role in reducing morbidity and mortality. Those interventions for PLWHA and their families that cannot be funded directly should be considered for "wrap-around" funding from other sources. Such "wrap-around" services may benefit non-HIV-infected, as well as HIV-infected, persons in the household or elsewhere in the community. Prioritization and selection of the components of a preventive care package must be performed locally, and should be consistent with national guidelines and those sponsored by the World Health Organization (WHO) operative within the country.

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