PEPFAR Scale-up of Pediatric HIV Services: Innovations, Achievements, and Challenges

ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 08/2012; 60 Suppl 3:S105-12. DOI: 10.1097/QAI.0b013e31825cf4f5
Source: PubMed


HIV/AIDS has had a profound impact on children around the world since the start of the epidemic. There are currently 3.4 million children under the age of 15 years living with HIV globally, and more than 450,000 children currently receiving lifesaving antiretroviral treatment. This article describes efforts supported by the President's Emergency Plan for AIDS Relief (PEPFAR) to expand access to treatment for children living with HIV in high-burden countries. The article also highlights a series of case studies that illustrate the impact that the PEPFAR initiative has had on the pediatric HIV epidemic. Through its support of host governments and partner organizations, the PEPFAR initiative has expanded HIV testing and treatment for pregnant women to reduce vertical transmission of HIV, increased access to early infant diagnosis for HIV-exposed infants, improved training and resources for clinicians who provide pediatric care and antiretroviral treatment, and, through public-private partnerships with pharmaceutical manufacturers, helped increase the number of medications available for the treatment of HIV-infected children in resource-limited settings.

30 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The global epidemiology of HIV/AIDS is rapidly evolving in low and middle income countries. Women and adolescent females in sub-Saharan Africa are at risk of HIV acquisition due to a myriad of complex biological, behavioral and structural factors. Primary HIV infection among women primarily drives the pediatric HIV epidemic. Postnatal transmission of HIV during breastfeeding is a major concern in LMIC, particularly in sub-Saharan Africa where breastfeeding remains the only feasible, safe and culturally acceptable infant feeding choice. Given the remarkable discoveries in biomedical interventions to prevent sexual transmission of HIV and MTCT during breastfeeding, there is now a unique opportunity to rapidly implement combination HIV prevention packages, provide quality prevention of mother-to-child HIV transmission services, and improve maternal and infant survival. Although rapid scale-up of PMTCT interventions has occurred in sub Saharan Africa in the past five years, significant challenges remain towards reaching the ambitious goal of virtual elimination of new HIV infections among children on a global scale by 2015 and keeping their mothers alive. Rapid translation of scientific discoveries into policy and practice in conjunction with strong commitment from national leadership and global partners is crucial to end the pediatric AIDS and achieve a HIV-free generation.
    Current HIV research 02/2013; 11(2). DOI:10.2174/1570162X11311020002 · 1.76 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: HIV/AIDS has become a chronic and manageable disease owing to the remarkable advancement in medication, and it is now suggested that a palliative approach should be integrated into the trajectory of the disease to alleviate patients' psychosocial distress and optimally improve their quality of life.This article synthesises a body of literature to highlight several clinical and systematic challenges that should be addressed in implementing a palliative approach to care for HIV/AIDS patients. They involve pain and symptom management, health-care providers' perceptions of HIV/AIDS, patients' beliefs about palliative care, variability in informal care resources, socioeconomic and demographic determinants of palliative care, and difficulties in evaluating the effectiveness of palliative care. To inform current practice in the palliative care domain, responses to the identified challenges are discussed. A disease stage-specific model is also presented to respond to the prolonged course of HIV/AIDS.
    International journal of palliative nursing 05/2013; 19(5):218, 220-5. DOI:10.12968/ijpn.2013.19.5.218
  • [Show abstract] [Hide abstract]
    ABSTRACT: There are 3.4 million children infected with HIV worldwide, with up to 2.6 million eligible for treatment under current guidelines. However, roughly 70% of infected children are not receiving live-saving HIV care and treatment. Strengthening case finding through improved diagnosis strategies, and actively linking identified HIV-infected children to care and treatment is essential to ensuring that these children benefit from the care and treatment available to them. Without attention or advocacy, the majority of these children will remain undiagnosed and die from complications of HIV. In this article, we summarize the challenges of identifying HIV-infected infants and children, review currently available evidence and guidance, describe promising new strategies for case finding, and make recommendations for future research and interventions to improve identification of HIV-infected infants and children.
    AIDS (London, England) 11/2013; 27 Suppl 2(Suppl 2):S235-45. DOI:10.1097/QAD.0000000000000099 · 5.55 Impact Factor
Show more