VI. Priorities for Moving Forward

Continuing challenges

Although considerable progress has been made in laying the foundation for a major scale-up in HIV prevention in children and diagnosing and treating children with HIV, there are a number of significant challenges which the Emergency Plan is working to address.

A family-based approach to HIV/AIDS is essential to combating the global pandemic. Success requires strengthening linkages across partners and service providers so that there are seamless PMTCT, treatment, care and community services for children and families. The Emergency Plan has had success in linking women and children in PMTCT settings to treatment programs. Yet U.S. Government and host country-supported interventions to support orphans and vulnerable children and community and home-based care programs must be more strongly linked with treatment programs as well. Treatment for children also needs to consider their special needs for school and play, and must be sensitive to the issues of stigma they may face. Also important to fostering an AIDS-free generation is the integration of prevention programs for children that focus on abstinence until marriage.

Continued focus to ensure the availability of HIV testing, ARVs, and drugs to treat opportunistic infections will be important. Also essential is improving access to care for children who are more difficult to reach, as the adults who need to bring them into care may be ill themselves. As always, confronting the barriers of stigma will be of great importance.

Taking medicines for life is a considerable challenge.  It is important that support for ART adherence in the pediatric population take into account developmental stages (infancy, childhood and adolescence), the presence or absence of caregivers, and the availability of pediatric formulations.  The Emergency Plan is focused on these critical issues.

Enhancing the Emergency Plan response

The Emergency Plan is focused on partnership with host country governments to assess the needs of children and to improve monitoring and evaluation of pediatric programs. Baseline data concerning the number of children living with AIDS is largely based on estimates from antenatal care surveillance. Monitoring systems for children with AIDS are virtually non-existent, as many countries do not disaggregate health information by age, and many children are being cared for in adult treatment settings. Supporting systems that better disaggregate interventions and associated costs of care for children are also essential to ensure adequate programming and budget. The Office of the Global AIDS Coordinator has required FY2006 Country Operational Plans (COPs) to provide information that will improve the U.S. Government�s ability to attribute budgets for children with HIV/AIDS.

To further its pediatric treatment and PMTCT efforts, the Emergency Plan has constituted the PMTCT/Pediatric HIV Working Group in FY2005, with a specific mandate to support pediatric care and treatment issues.  This inter-agency group, drawing on some of the world�s experts in the area, has developed specific guidelines for focus countries as they begin preparing for FY2006 programming.  The guidelines include guidance for countries in identifying treatment targets for children, as well as improving infant diagnosis and follow-up, systematizing infant and childhood HIV testing, and increasing ART access.  The pediatric working group has also created a subcommittee to bring together experts who will guide efforts for developing infant diagnosis capacity at a national level.  The Emergency Plan�s inter-agency working group has already worked to:

  • Develop COP FY2006 guidance for PMTCT and pediatric program development
  • Provide guidance to country teams on estimating the minimum number of children that should be targeted for ART starting in FY2006, recognizing the country-level variation in the HIV epidemic
  • Develop simplified ARV dosing tables
  • Lead the development and testing and counseling materials and tools for PMTCT that include a section specifically addressing pediatric testing, in conjunction with UNICEF, USAID, WHO and other global stakeholders
  • Develop a comprehensive preventive care package for children who are exposed to or infected with HIV and for orphans and vulnerable children
  • Work to develop models of family-based treatment and care

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