Over 30 years into the HIV and AIDS epidemic, the need to work together to solve the sometimes monumental challenges the disease presents is without question. The Elizabeth Glaser Pediatric AIDS Foundation has witnessed first-hand the exponential impact of bringing together the resources, experience, ideas, and capacity of many to build a multi-national, multi-sectoral global HIV and AIDS response.
The global health community must continue to forge dynamic partnerships of every shape and size, between nongovernmental organizations, the private and public sector, country governments, and international bodies to address the myriad obstacles and barriers that lay ahead of us on the road to the end of AIDS — particularly when it comes to ending AIDS in children.
During our 25-year history, EGPAF has been committed to working together with a host of public and private sector partners to realize the best outcomes for children, families, and communities affected by HIV and AIDS. Truthfully, EGPAF would not be the global organization it is today, working in 15 countries around the world to end AIDS in children, without our partners. We suspect that many of our partners might say the same about us.
One of the most valuable outcomes of any partnership is that it often yields new ideas and innovation. And now, as the global community sets ambitious new goals to end AIDS in children around the world, we need innovation more than ever.
It is now widely recognized that children have been left behind in the global progress towards access to safe and effective HIV treatment. Of the 3.2 million children currently living with HIV, only one quarter have access to lifesaving antiretroviral therapy. And often the medications they do have aren’t conducive to ensuring long-term adherence. They can be bitter, hard to swallow, and sometimes the side effects including nausea are worse than the symptoms of HIV. This is unacceptable if we are going to meet our goal of an AIDS-free future.
However, in 2014 there have been encouraging signs that international momentum and resources are finally being marshaled to change this.
Prioritizing treatment for children with HIV
Bringing partners together to advocate for children living with HIV has long been a key focus of EGPAF’s work. While HIV-positive children have a right to HIV services, they often have no voice in how their needs are addressed when policymakers are setting political and programmatic priorities.
To place emphasis on the urgent HIV treatment needs of children, EGPAF, UNAIDS, UNICEF, and the World Health Organization partnered in June 2014 to host a stakeholder consultation on how to prioritize and operationalize pediatric treatment targets over the next several years. The result is that U.N. agencies are moving forward with a new “90-90-90” HIV treatment target specifically for children: 90 percent of HIV-positive children know their status; 90 percent are on ART; and 90 percent are virally suppressed by 2020.
More good news came this year with the announcement of the Accelerating Children’s HIV/AIDS Treatment initiative by the U.S. President’s Emergency Plan for AIDS Relief in partnership with the Children’s Investment Fund Foundation. This new $200 million initiative aims at the ambitious goal of doubling the number of children receiving ART in 10 priority countries across Africa over the next 10 years. This means more than 300,000 children gaining access to lifesaving treatment.
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These new targets and the launch of the ACT represent a larger, welcome, and much needed change in the thinking and approach to pediatric HIV treatment from the global health community: one that signals the recognition that access to treatment for children living with HIV is not peripheral, but central to combined efforts to end the epidemic.
Safe and effective medication
Another exciting development this year was the announcement of the Pediatric HIV Treatment Initiative in May 2014 by UNITAID with Medicines Patent Pool, the Drugs for Neglected Diseases initiative, and the Clinton Health Access Initiative.
This initiative will bring the combined capabilities of these organizations to bear on one of the most pressing issues facing pediatric HIV treatment: the lack of availability and access to kid friendly and safe medication. By working together on three key areas — research and development, intellectual property, and market-shaping to ensure the availability of treatment regimens for children living with HIV — PHTI partners will develop key missing pediatric ARV formulations identified by WHO and support their manufacture and procurement.
Already we have seen pharmaceutical companies announce new licensing agreements to help develop and improve pediatric formulations. Simply changing the form and quantity of medications, from regimens of multiple pills per day to fixed dose combinations in a single, easily digestible sprinkle or powder, can improve adherence to treatment for children living with HIV.
These are the types of innovative approaches and methods that PHTI is focused on developing and distributing.
While an NGO such as EGPAF has the expertise to create the programs and infrastructure necessary to care and treat children with HIV, these are rendered meaningless without a sustainable supply of safe and effective pediatric medications that form the backbone of these services. That is why EGPAF is using its voice to advocate and build support for this partnership on Capitol Hill and beyond, and extending our programmatic expertise to support the evaluation of new pediatric antiretroviral formulations as they become available.
PHTI represents the kind of public and private partnerships that are necessary to tackle complex issues such as the lack of pediatric formulations, where solutions lie beyond the abilities of any one sector or organization.
Increased access on the ground
EGPAF has also been directly involved in partnerships that have driven success and improved specific health outcomes in the countries where we work. In 2010, we began a two-year project in partnership with ViiV Healthcare to improve early infant diagnosis and treatment services in three of the countries where they are needed most, namely Lesotho, Malawi, and Swaziland.
The project focused not only on increasing the number of infants tested and initiated on ART, but also on strengthening national health systems and infrastructures by involving each country’s health ministry at every stage of the project. Two years later, in 2012, we saw that this potent combination of NGO, private, and public efforts had yielded encouraging results.
In Malawi, we saw the percentage of infants with HIV initiated on antiretroviral therapy explode from 10 percent to 72 percent. By integrating prevention of mother-to-child transmission of HIV services and pediatric care and treatment services in Lesotho, we were able to achieve 100 percent initiation of HIV-positive infants onto ART.
In Swaziland, we developed a pediatric HIV training curriculum that was integrated into standard nurse training and allowed nurses nationwide to initiate ART — which used to require a medical doctor — dramatically improving access to lifesaving treatment for infants, children, and their families living with and affected by HIV.
This kind of rapid progress represents a fraction of the potential impact that can result from working together across sectors and interests, towards common goals.
Building on shared successes
Success in global health, and particularly in the field of HIV, has always been founded in the principles of collaboration, cooperation, and working together. While we work toward a future free of AIDS, the youngest, most vulnerable population living with HIV — children — must not be neglected. Every day almost 700 babies become newly infected with HIV and these children will need appropriate, effective medications as well as care and support services to meet their needs as they grow from infants to children to adolescents and into adulthood.
Ending AIDS is not just about the first generation that will be free of the virus, but about the generation before them — this generation — that deserves to live to see the next generation emerge as AIDS-free.
Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.