The time is now to use the tools we have to end AIDS in children

TL;DR

Ending AIDS in children is possible with existing tools, but requires urgent action to ensure funding, access, and implementation of effective strategies.

Contribution

The paper emphasizes the need to prioritize and scale up existing tools to prevent and treat pediatric HIV, especially in low- and middle-income countries.

Findings

Existing tools for preventing vertical HIV transmission are effective but underutilized.

Same-day infant HIV testing and rapid treatment linkage improve outcomes for children.

Equitable access and political will are critical to ending AIDS in children.

Abstract

Progress in reducing and eliminating vertical transmission of HIV in children has stagnated over recent years. Unfortunately, recent decisions in the global donor space are likely to lead to considerably lower funding available for HIV and other disease programmes in high‐burden low‐ and middle‐income settings. Understanding and implementing the most effective strategies to prevent, diagnose, treat and monitor HIV acquisition in children are critical to maximize available resources and provide the best care for children.

A set of tools to support the elimination of vertical transmission and end AIDS in children exists across the cascade of care for pregnant mothers and their children, including those for prevention, diagnosis, treatment, monitoring and service delivery. Each tool comes with its own challenges in implementation and scale‐up; however, the effectiveness of many has been well‐studied and documented. Ensuring all women living with HIV have consistent and secure access to optimized antiretroviral therapy will prevent the largest number of leaks in the cascade that can lead to vertical transmission events. Implementing effective infant diagnosis strategies, including same‐day point‐of‐care testing and birth testing where feasible, will lead to earlier and faster identification of children living with HIV. Subsequently, rapid linkage to optimized treatment will save and improve the lives of children living with HIV. Finally, implementing accompanying monitoring modalities and country‐specific service delivery approaches will improve implementation and the effectiveness of these tools as well as retention and commitment in care programmes by children as they become adolescents and adults.

Ending AIDS in children is possible. We have the tools to do so. However, now is the time for national, regional and global stakeholders to come together to prioritize children and ensure appropriate funding, implementation and equitable access are in place. Testing infants quickly and accurately for HIV is the first step to ensuring their lifelong health and wellbeing. As national and global public health structures shift, programmes need to act quickly—gains in paediatric HIV cannot be lost but must be accelerated. Doing so will require political will, financing, infrastructure, community‐led initiatives, and commitment by and access to all to achieve those goals.