HIV/AIDS in Pediatric and Adolescent Populations


While many countries continue to progress towards reaching HIV epidemic control among the adult population, children (ages 0-14), adolescents (ages 10-19), and youth (ages 20-29) living with HIV consistently lag across the clinical cascade -- that is, case identification, treatment, and viral suppression. According to UNAIDS, an estimated 1.8 million children are living with HIV, of whom only 53% know their status and are on treatment. Additionally, nearly four million youth aged 10 to 24 are living with HIV, and AIDS-related illnesses are the second leading cause of death among African adolescents. Furthermore, adolescents and youth have the lowest rates of continuity of treatment in HIV care, life-saving antiretroviral therapy (ART) adherence, and viral suppression compared to other age groups.

Case Identification and Testing

Identification of children and adolescents living with HIV is a key priority of PEPFAR and USAID to ensure timely diagnosis and linkage to life-saving ART. Prevention of mother to child transmission of HIV has improved significantly over the past 20 years, resulting in a decrease in HIV incidence among children 0-14 and allowing for increased early identification of infants living with HIV. However, there are still many children and adolescents who do not know their HIV status. Early diagnosis and linkage of children and adolescents to care and treatment improves their quality of life and reduces their risk of passing the virus onto others.


Ensuring children and adolescents living with HIV receive optimal ART regimens and providing caregiver support for administering treatment helps address some of the barriers to adherence and continuity of treatment and improves the health of these children. Additionally, addressing HIV in adolescence (10-19 years old) and youth (15-29 years old) requires that services are provided in an adolescent- or youth-friendly way, including ensuring that healthcare workers are trained in communicating in a non-judgmental manner; services are provided at days, times, and locations that are preferable to adolescents and youth living with HIV; and proper support is available to decrease the risk of interruptions in treatment and increase chances of adherence and viral suppression (e.g., through peer support groups and/or adherence clubs). As new HIV/AIDS prevention, care and treatment activities are designed and implemented, USAID Missions are engaging and working directly with youth, alongside their families, to ensure youth voices are represented and prioritized so as to increase the acceptability of, access to, and use of health services.

Viral Load Suppression

HIV viral load suppression is key to achieving and maintaining HIV epidemic control. However, viral load testing coverage and suppression for children and adolescents lags adults in almost all countries. This is due to a variety of factors, including challenges with lab draws for young children, adherence to ART (particularly in adolescents), and also delays in some countries to transition to pediatric dolutegravir 10mg for children over four weeks of age and over 3kgs, which has shown to improve viral suppression among the youngest children living with HIV.

USAID Impact

USAID works to support partner countries’ Ministries of Health and other partner organizations at the facility and community levels to identify children, adolescents, and youth at risk for HIV and ensure access and support along each step in the clinical cascade, including HIV testing, enrollment in life-saving ART, and adherence and continuity of treatment support. The pediatric, adolescent, and youth HIV programs also provide children and adolescents living with HIV with referrals to age-appropriate HIV prevention and other health services. In each of its programs, USAID leverages deep technical expertise to work in partnership with host country governments, multilateral organizations, the private sector, service providers, and local stakeholders.

Examples of USAID’s work within this technical area include:

  • Supporting increased uptake and coverage of index testing to ensure that 100% of biological children less than 19 years of age of all people living with HIV are offered safe and ethical HIV testing services.
  • Monitoring uptake and implementation of caregiver assisted HIV self-testing in children and adolescents.
  • Implementing activities that improve psychosocial support for children, adolescents, and youth, including guidance on age- and developmentally-appropriate HIV status disclosure, adherence counseling, and support with transitioning from pediatric to adult health facilities.
  • Implementing health care worker training on how to provide non-judgemental and supportive services to adolescents and youth.
  • Analyzing barriers to continuity of treatment and supporting the implementation of differentiated service delivery (DSD) models for children, adolescents, and youth in order to ensure client-centered care.
  • Promoting family-centered clinical appointments and multi-month dispensing (MMD) of ARVs, along with models of service delivery that promote viral suppression for caregiver-child pairs.
  • Providing guidance for implementation of new viral load testing technologies and protocols for children.
  • Collaborating with Orphans and Vulnerable Children (OVC) programs to strengthen bi-directional referrals between clinical and OVC programs, increase testing, linkage to treatment services, adherence and continuity of treatment, and viral suppression among children and adolescents living with HIV.
  • Engaging youth living with HIV as peer navigators and leaders responsible for linking other youth to communities and facilities to support access and continuity of treatment in HIV care.
  • Providing ongoing clinical and supply chain technical assistance as partner countries introduce and transition children and adolescents living with HIV to optimized ART regimens (e.g. dolutegravir-based therapy), and engaging non-clinical partners as valuable stakeholders to support the transition.

2022 Achievements

In Fiscal Year 2022, USAID:

  • Tested 2,004,958 children under the age of 15, and 3,238,537 adolescents ages 10-19 for HIV through PEPFAR-funded programs
  • Newly identified 29,297 children and 43,734 adolescents living with HIV, and enrolled 29,951 children and 37,995 adolescents on ART
  • Supported a total of 243,279 children and 286,405 adolescents living with HIV on ART

Additional highlights include:

  • Continued to increase the client-centered nature of USAID’s HIV/AIDS programs and expanded access to multi-month dispensing (MMD) to 66% of children living with HIVViral load coverage and suppression rates reached 80% and 85% respectively, the highest result yet among children under 15 living with HIV in USAID-supported PEPFAR programs.
  • The once daily, more effective pediatric medication, 10 milligram dolutegravir dispersible tablets, is now available in almost all PEPFAR countries. As of FY23, the majority of children below 15 years of age are now on a dolutegravir-based ART regimen and viral suppression rates continue to increase.

Additional Resources