1. WHO, UNICEF, UNFPA, UNESCO & GNP+
Adolescent HIV Testing and Counselling (HTC) and care for adolescents living with HIV (ALHIV) Guidelines
WHO, UNICEF, UNFPA, UNESCO & GNP+
Rachel Baggaley, coordinator, Key Populations and Innovative Prevention
Jane Ferguson, coordinator, Adolescent Health
WHO Geneva
22/09/2018

2. Why adolescent guidelines?
Adolescents (10-19 years of age) have significantly lower HTC, ART & PMTCT access & coverage than other population groups (i.e. adults & paediatrics)
Retention in care and adherence to ART is often sub-optimal
3 groups of adolescents need consideration:
adolescents infected vertically, diagnosed early & started on ART
>500,000 infants/young children now on ART – little experience of care & treatment for adolescents
adolescents infected vertically, not diagnosed early & not started on ART
Significant mortality & morbidity before & after 'late' ART
adolescents acquiring HIV horizontally, through sexual or parenteral transmission
39% of new HIV infections are in year olds
Adolescents: no longer children, not yet adults
Adolescence is a period of rapid development – they acquire new capacities & face new challenges.
Health workers often feel unable to address adolescents’ needs

3. HIV testing & counselling (HTC) for adolescents
HTC with linkage to prevention treatment and care is recommended for adolescents from key affected populations in all settings (generalized, low and, concentrated epidemics)
Low quality evidence, strong recommendation
In generalized epidemics, HTC with linkage to prevention treatment and care is recommended for all adolescents Low quality evidence, strong recommendation
We suggest that in low and concentrated epidemics, HTC with linkage to prevention treatment and care be accessible for adolescents
Very low quality evidence, conditional recommendation

4. Consent for HIV testing
The requirement for parental/guardian/caregiver consent can be a barrier for adolescents in accepting HTC, care, & services
The ages at which adolescents can consent for HTC varies widely from 12 to ≥ 18 years of age
Many countries have 'exceptions' – mature minors, pregnant adolescents, child-headed households
Countries where age of consent for HTC has been lowered (e.g. to 12 years) –no adverse consequences have been reported
There are no global guidelines for age of consent since it is not possible to address with GRADE –reflecting human rights and ethical issues. Rather it is proposed that countries review consent polices to facilitate access to HTC & other health service delivery for adolescents

5. Disclosure recommendations
Disclosure to adolescents
All adolescents should be disclosed to about their HIV status
All adolescents should be disclosed to about the HIV status of their parents/guardians
Low quality evidence, strong recommendation
Disclosure by adolescents
We suggest that adolescents be counselled about the potential benefits and risks of disclosure of their HIV status and empowered and supported to determine if, when, how, and to whom to disclose
Very low quality evidence, conditional recommendation
Disclosure of HIV status can have many benefits, e.g. disclosure for support from family, partner, friends.
But disclosure to sexual partners and for adolescents from key populations may have challenges, e.g. stigma, discrimination, criminalization

6. Service delivery recommendations: support retention in care & adherence to ART
Community based care and support
We suggest that HIV care and treatment programmes include community-based approaches to improve adherence and retention of adolescents living with HIV
Low quality evidence, Conditional recommendation
Health worker training
We suggest that training of health care providers can contribute to improved adherence to treatment and retention in care among adolescents living with HIV

7. Recommendations: ART service delivery
Decentralization of HIV care & treatment
Integration with TB, ANC, & IDU services
Task shifting for HIV care & treatment
Interventions to optimize adherence to ART
strong recommendations, low quality evidence