Pediatric and Adolescent Populations
USAID's investments in pediatric and adolescent populations help identify children, adolescents, and youth at risk for HIV and ensure access and support along each step of the clinical cascade, including HIV testing, timely enrollment in life-saving ART, and continuity of treatment support.
While many countries continue to progress towards reaching HIV epidemic control among the adult population, children (ages 0-14) and adolescents (ages 10-19) living with HIV consistently lag across the clinical cascade -- that is, case identification, treatment, and viral suppression. According to UNAIDS, at the end of 2022, an estimated 1.5 million children are living with HIV, of whom only 57% know their status and are on treatment. Furthermore, children and adolescents 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. Though considerable progress has been made in the last two decades supporting pediatric and adolescent HIV prevention, care, and treatment, a child dies every six minutes from AIDS-related causes.
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 the risk of transmitting HIV to others.
Treatment
Ensuring children and adolescents living with HIV receive optimal ART regimens and are provided with caregiver and/or peer support for administering treatment helps address some of the barriers to adherence and continuity of treatment. Additionally, addressing HIV in adolescence and youth 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 living with HIV; and proper support is available to decrease the risk of interruptions in treatment and support medication adherence and viral suppression (e.g., through peer support, support groups and/or adherence clubs). As new HIV/AIDS prevention, care and treatment activities are designed and implemented, USAID is working directly with youth, alongside their families, to ensure their voices are represented and prioritized to increase the acceptability of, access to, and use of health services.
Viral Load Suppression
HIV viral load suppression is key to improved quality of life for children and adolescents living with HIV, as well as 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 health system challenges to identify and prioritize children and adolescents in need of a viral load test, challenges with blood sample collection for young children to conduct the viral load test, challenges with adherence to ART, and the continued use of suboptimal ART regimens.
Our Approach and Results
USAID works to support partner countries’ government entities including Ministries of Health and other stakeholders at the national, community and facility 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, timely enrollment in life-saving ART, and adherence and continuity of treatment support. The pediatric and adolescent 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 technical expertise to work in partnership with host country governments, multilateral organizations, the private sector, service providers, and local stakeholders. USAID's work with pediatric and adolescent populations includes:
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 via non-judgemental and supportive services tailored to adolescents and youth.
Monitoring uptake and implementation of caregiver assisted HIV self-testing in children and adolescents.
Implementing activities that improve psychosocial support for children and adolescents, including guidance and training on age- and developmentally-appropriate HIV status disclosure, adherence counseling, and support with transitioning from pediatric to adult HIV services.
Promoting family-centered clinical appointments and multi-month dispensing (MMD) of ARVs, along with other differentiated service delivery models that promote viral suppression for children and adolescents.
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 peers and leaders to support adherence, continuity of care, improve treatment outcomes and overall well-being.
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 containing regimens including pALD).
USAID's efforts with pediatric and adolescent populations have led to achievements in the following areas:
Supported more than 220,000 children (age<15 years) living with HIV to stay on HIV treatment and to achieve 86 percent viral load suppression, promoting healthier outcomes.
Supported the global rollout of easier-to-use and more effective pediatric antiretroviral therapy (ART) regimens, including pediatric DTG (pDTG) and the new fixed dose combination regimen, pediatric ALD (pALD).
Tested 2,711,901 children and adolescents <15, and 432,223 adolescents ages 10-19 for HIV through PEPFAR-funded programs.
Newly identified 26,665 children and 41,030 adolescents living with HIV, and enrolled 26,619 and 36,903 adolescents on ART.
Supported 204,576 children and 269,559 adolescents living with HIV.
In terms of outcomes, children living with HIV under 15 years of age had HIV viral load coverage and suppression rates of 91% and 89% respectively.
As of FY24, the majority of children below 15 years of age are on a dolutegravir-based ART regimen and viral suppression rates continue to increase. In 2023, the FDA approved a new fixed dose combination ARV for children between 6 to 24.9 kgs and over 3 months of age (pALD).