Opinion: Is an AIDS-free generation still achievable?

In 2019, 880 children and adolescents became infected with HIV each day. In the same year, only 53% of children living with HIV accessed lifesaving antiretroviral treatment, compared with 74% of adults; and only 37% of children were virally suppressed, compared with 60% of adults. 

Amid such stark inequality, we ask ourselves: Is an AIDS-free generation achievable?

The tools to secure an AIDS-free generation do exist, but to move the needle, we need real leadership and dedicated resources that prioritize children.

Recent data indicates that a staggering 150,000 children were newly infected in 2019, meaning the world significantly missed its targets for preventing new pediatric HIV infections to fewer than 20,000 per year.

This astounding failure underscores the need for renewed focus on children living with HIV and dying from AIDS.

World leaders convened on Tuesday at the U.N. General Assembly high-level meeting on AIDS during a complex and chaotic moment in the global health landscape.

As world leaders gather in New York, we are calling for bold commitments from the U.S., Europe, Asia, and Africa to drive action on rapid development and rollout of pediatric diagnostics and treatment of HIV.

In the last year, COVID-19 has led to fewer people seeking critical health care due to fears of contracting the virus, feeding anxiety, and fueling stigma and discrimination. In 2020, UNICEF reported acute disruptions to HIV testing and treatment for children and pregnant women; the Elizabeth Glaser Pediatric AIDS Foundation has also seen fewer women accessing prenatal care, leading to decreases in HIV testing for pregnant women by up to 30% in some countries.

Yet we believe that COVID-19 can catalyze positive change and drive world leaders to regain lost momentum for children, by emphasizing partnership, diagnostics, and the need for improved pediatric drug options.

The need for speed

Innovative approaches, informed by robust evidence, are urgently required to address the gap in life-saving pediatric treatment and services.

• Expediting availability of early infant diagnosis: Point-of-care, early infant diagnosis for HIV significantly decreases diagnostic turnaround time from nearly two months to a matter of days. Conventional HIV testing for newborns is substandard and access to POC EID should be within four weeks of life, per World Health Organization recommendations.

Without access to such technology, infants are more likely to become gravely ill and die within their first 8-12 weeks of life. Global health leaders must work with countries to overcome obstacles to implementation. This includes device maintenance, adequate test cartridge availability, and health care worker training, to expand this lifesaving and game-changing technology. Countries must also prioritize generating data to assess EID’s cost-effectiveness in diverse settings.

• Universal access to age-appropriate medicines: Without optimal treatment, 50% of babies living with HIV will die before their second birthday. Investment in the development and availability of improved pediatric formulations is needed to dramatically reduce the nearly 100,000 preventable and treatable pediatric AIDS-related deaths each year. 

Many countries continue to use suboptimal antiretroviral formulations for children, which leads to high rates of treatment failure and ultimately increases HIV-related morbidity and mortality. Global and country leaders must urgently adopt the use of more optimal antiretroviral formulations, suitable for children.

National decision-makers also need to improve forecasting, budgeting, and procurement of these medicines to ensure availability and continuity of care. Training for health care workers, focused on the administration of newer formulations, is also essential, as are new and much speedier national medicine registration pathways.

• Accelerating innovation through partnership: Speed up the adoption of cutting-edge pediatric diagnostic tools and affordable pharmaceuticals, as outlined in the Rome Action Plan, a unique public-private coalition driven by the Vatican.

This diverse multi-sector stakeholder partnership has led to new ways of working, demonstrating what can be achieved through collaboration. The action plan includes specific stakeholder pledges to accelerate the development of new HIV and tuberculosis medicines suitable for children; improve testing devices for pediatric TB and expand affordability and availability of HIV tests for young infants.

The successful development of novel and more streamlined clinical trial models for HIV medicines has led to regulators welcoming an adapted approach for priority TB drugs.

This partnership commitment has contributed to the accelerated development of the world’s first dispersible pediatric antiretroviral tablet formulation of dolutegravir; reducing generic manufacturer development timelines by over two years; and enabling one of the first tentative FDA approvals for a generic medicine within five months of regulatory approval for an originator product. 

Ending pediatric AIDS is both ambitious and achievable, but it will take a united, well-resourced effort by communities, governments, businesses, NGOs, and global health agencies to eliminate glaring disparities in the global AIDS response that continue to impact children so disproportionately.

The high-level meeting presents an opportunity for U.N. member states to take meaningful action and elevate children in the conversation on how we effectively recover from an unparalleled year battling dual pandemics. Any strategy must incorporate the hard-won lessons of COVID-19 that advance tangible steps to achieve an AIDS-free future.

Children around the world are waiting.