Priorities for Optimizing HIV Care in Children and Adolescents

Prominent gaps in pediatric and adolescent HIV care translate into priorities that need to be addressed for optimizing care among these patients to move forward. These gaps include testing, consent policies and practices, self-testing, and improving adherence and retention, explained Priscilla Tsondai, MD, MPH, the lead for the pediatric and adolescent program at the International AIDS Society through the Collaborative Initiative for Paediatric HIV Education and Research.

Tsondai was comoderator of the session, “Filling the Gaps: Challenges and Opportunities in the Care of Children and Youth With Perinatal HIV,” at the 2025 Conference on Retroviruses and Opportunistic Infections.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

What are some of the most urgent research gaps that need to be addressed for pediatric and HIV adolescent care?

I’ll just start by saying, had that question been posed to me [in] early January, I would have answered it probably with a bit more confidence, and really said what literature is saying are the gaps. But I just want to acknowledge that currently, we do not know the full impact of the changing funding landscape in the pediatric HIV response. My response to this question will be based on what I know and what we've heard as of today, which might change based on some things that we thought we had figured out [that need] to be refigured out. That's the first, sort of, disclaimer I want to put as I respond to this question.

I'll start from testing, because we can't really talk about gaps in treatment if we have not found those children that need to be put on treatment. I think there are gaps there in terms of the innovative and optimal testing strategies so that we can find those children who are now at school, probably, or they are now in the community. Those are not the children [who] are typically coming to the facilities every month, because they haven't been diagnosed, so finding those children, including: what entry points can we use outside of baby immunization clinics to find those undiagnosed infants and children? What approaches can we use [that] are sustainable, that are scalable at the community level? That are community-led, and community-based?

With adolescents and young people, we have not yet figured out the consent policies and practices that allow us to offer HIV testing services to adolescents and yet align with the core societal values for any given context, in terms of sexuality, sexual reproductive health, and offering HIV care testing services. The best approaches to self-testing for pediatrics, we haven't figured that out yet. And what are the key interventions that we can use to timely link those children [who] have been diagnosed to care and immediately [initiate them] onto ART [antiretroviral therapy]?

Interventions to improve adherence and retention. We know with adults, for example, differentiated service delivery models have been studied, and there are so many publications around that. But with children, because of that family component, because of that dependence [on] the caregiver, we still need to find the differentiated service delivery model that can assist us with those interventions to improve adherence and retention in care.

The support to the families. What's sustainable, scalable? Psychosocial and family support strategies can be rolled out to support the parents or the caregivers and the health care providers to facilitate [the] caring of children, but also disclosure, when they're now the appropriate age, in terms of disclosing to the children. Stigma and discrimination.... What strategies or interventions can be deployed to reduce the stigma and discrimination that is experienced by children, their caregivers, and the families that are affected by HIV?

Then going into the novel drug delivery systems that we are seeing that are being investigated. I think they still work. That needs to happen there, especially for children, for the very young children. Looking also at the long-term treatment options. And then access. I stress access and uptake of sexual and reproductive health services for adolescents, that the adolescents will actually access and uptake and use. What strategies or interventions can we use to support adolescents and young people that have multiple vulnerabilities? We're talking of young people that are pregnant, that are being abused, that have experienced gender-based violence, that are, in context, that have conflict. How do we still sustain them being on treatment, initiated, and retained in those set-ups, in those settings?

I think I will wrap up by just talking about the tracking of patient-level data. We know [with] children, what happens to them as children does have an impact, or an effect, as they grow older, and if we don't have systems that can track that health data, there will [be] some children who probably were on treatment, then they stopped taking medications, and then they are now appearing at the age of 18, either in an antenatal care unit, etc—all of that is lost in terms of providing the adequate or appropriate care to that young person. The tracking of patient-level health data across various disease areas for accurate monitoring of that young person, I think it's something we still have not really managed to grasp. I'm not talking about intensive tracking that's happening with small cohorts or within research settings. I'm talking about this at a population level.

I think, for now, those are the gaps I will just highlight.