Timely and Efficient Infant Diagnosis Is Required to End AIDS in Children

INTRODUCTION: Though considerable effort and investment has significantly increased the proportion of pregnant women living with HIV accessing lifesaving antiretroviral therapy and lowered the prevalence of vertical HIV transmission, more than 70,000 children die each year due to AIDS-related deaths, and nearly half of the 1.4 million children living with HIV are not receiving antiretroviral treatment (ART). Improving case-finding and identification of children acquiring HIV and accelerating linkage to ART will be fundamental to end AIDS in children. DISCUSSION: A variety of existing infant and child case-finding strategies could be tailored by countries to complement testing within vertical HIV transmission programmes, including establishing the HIV exposure status of sick infants and children attending malnutrition and inpatient wards and children accessing vaccines, as well as out-of-facility strategies such as community and family-based testing. Because the risk of HIV acquisition is persistent throughout pregnancy, delivery and breastfeeding, repeated testing throughout the exposure period and especially after cessation of breastfeeding will be critical in capturing HIV acquisitions as early as possible. Immediate or rapid linkage to ART is now possible through using same-day point-of-care testing technologies. CONCLUSIONS: As countries aim to end AIDS in children, adapted and nuanced strategies for case-finding, test timing and the technologies used should be leveraged to meet the needs of each setting and country. Several countries have shown us that it is possible to end AIDS; however, it requires political will, strategic thinking, funding, prioritization and creative innovations.