1. Agenda Introduction- Jessica Rodrigues, IATT Paediatric Treatment Optimization- George Silberry, Senior Technical Advisor for Pediatric HIV, OGAC Optimal regimen selection and sequencing- Elaine Abrams Senior Director for Research, ICAP Optimal formulation selection- Marc Lallemant Head of Pediatric HIV, DNDi and Janice Lee Project Manager for Pediatric HIV, DNDi Optimizing supply chain management- Nandita Sugandhi, Senior Clinical Advisor, CHAI and Marianne Gauval Associate Director of Pediatric Access, CHAI Q&A/Discussion- Surbhi Modi, Maternal and Infant HIV Team Lead, CDC

2. Estimated 2.6 Million HIV Positive Children Globally, 2014 Source: UNAIDS Estimate, 2015 Country# of infected children Nigeria380,000 South Africa340,000 Mozambique160,000 Kenya160,000 Zimbabwe150,000 Uganda150,000 Tanzania140,000 Top Seven Countries Children (0-14) living with HIV (2014)

3. Children are almost one-third less likely to be put on treatment than are adults Source: UNAIDS Estimate, 2015 45%31% 27% 23% 19% 13%

4. Pediatric Treatment: Percent of children <15 years living with HIV on lifelong ART by country, 2014 Source: UNAIDS Estimate, 21 Countries, 2015 Global pediatric ART coverage: 31%

5. Partnering to save children PEPFAR & Children’s Investment Fund Foundation (CIFF) Accelerating Children’s HIV/AIDS Treatment (ACT) – $200M partnership – Doubling the number of children on life saving ART – FY 2017 Target: 600,000 on treatment – Interim FY 2016 Target: 500,000 on treatment – Countries : Cameroon, DRC, Kenya, Lesotho, Malawi, Mozambique, Tanzania, Zambia, Zimbabwe

6. Children on Treatment – ACT & Other Countries 2nd ACT meeting November 2015

7. Identification of HIV-infected children Optimize Early Infant Diagnosis Active case finding of children – Family-centered and index patient approaches to HIV testing – Provider-initiated testing and counseling in high yield settings (inpatient, TB, malnutrition) Aim for universal testing of children receiving OVC services Targeted community testing HIV Exposed Infant Cohort Analysis: Results from an Innovative Method for Routinely Monitoring Longitudinal Outcomes of HIV Exposed Infants, Kenya tz HIV Exposed Infant Cohort Analysis: Results from an Innovative Method for Routinely Monitoring Longitudinal Outcomes of HIV Exposed Infants, Kenya Early infant diagnosis services in Kenya 6 EID laboratories >5,000 PMTCT sites Maximize Case Identification by Targeting Approaches to HTC

8. Targeted Approach to Dramatically Increase Pediatric Treatment Coverage Objectives -Provide ART to an additional 300,000 children living with HIV -Increase # of adolescents (15-19) on ART by the end of 2016 Strategic Principles Pillar 1: Policy for pediatric HIV services Pillar 2: Community engagement Pillar 3: HIV case identification Pillar 4: Linkage to HIV care and treatment services Pillar 5: HIV treatment initiation, monitoring, adherence and retention Pillar 6: Strategic information for pediatric HIV services Pillar 7: Domestic resource commit- ments for pediatric HIV services

9. Paediatric HIV Treatment Optimization: What does it mean? And it needs to be SIMPLE

10. “But treating children is hard” Regimens choices are confusing Long term treatment options needed Dosing is hard Administration is difficult Drugs are out of stock