Rashida Ferrand rashida.ferrand@lshtm.ac.uk Getting to the first 95 for children and adolescents: Innovative approaches for pediatric case finding IAS Satellite Session – JSI/AIDSFree Project and Partners July 23, 2018 8–10 am Rashida Ferrand rashida.ferrand@lshtm.ac.uk

Dynamics of the paediatric HIV epidemic Dramatic scale up of Prevention of mother-to-child transmission (PMTCT) programmes across Africa PMTCT coverage variable across the region “PMTCT” includes HIV testing of HIV-exposed infants & early infant diagnosis (EID); rates remain poor A third of infected infants have “slow-progressing” disease―median survival 16 years: identified in older childhood UNAIDS Global Report 2017 Wettstein C et al AIDS 2012 Ferrand RA et al AIDS 2009

Barriers to HIV testing in children Supply Demand Ethico-legal framework Resource competition Language to discuss HIV Perception of low risk Relatively low HIV prevalence Fragile guardianship Disclosure of family status Competing priorities “Protection of child” Kranzer K et al PloS Med 2014; Bandason T et al AIDS Care 2013;

“The first 95” 95% of individuals with HIV will be diagnosed by 2030 Testing strategies have targeted infants (PMTCT) and adults Strategies will need to take into account: Barriers to testing in children Physical and social heterogeneity across childhood Dropping incidence in children