The global community moved closer to ending both paediatric HIV and childhood TB with the announcement of the 2022 Rome Action Plan on Paediatric HIV & TB. The action plan builds upon earlier commitments made during the Vatican’s previous 5 High-Level Dialogues, which focused on addressing the alarming inequities facing children in the current response to paediatric HIV and childhood TB. Brought together under the UNAIDS-PEPFAR Faith Initiative, the dialogues have included leaders from private and public sectors, governments, regulatory authorities, civil society, faith-based organizations, and other implementing partners.
The latest High-Level Dialogue – the High-Level Dialogue to Assess Progress on and Intensify Commitment to Scaling Up Prevention, Diagnosis, and Treatment of Paediatric HIV and TB – was held in December 2022. His Excellency Archbishop Vincenzo Paglia, President of the Pontifical Academy for Life, convened the meeting. The gathering was hosted at the Pontifical Academy of Science by His Eminence Peter Kodwo Appiah Cardinal Turkson, Prefect of the Dicastery for the Promotion of Integral Human Development.
“The 2022 Rome Action Plan demonstrates that by collaborating across sectors and prioritizing children, youth, and families the global health community can take strides needed to achieve an AIDS-free generation and a TB-free future once and for all,” said Chip Lyons, President and CEO of the Elizabeth Glaser Pediatric AIDS Foundation.
During the meeting, leaders from ## countries, the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), the President’s Emergency Plan for AIDS Relief (PEPFAR), the Stop TB Partnership, the Joint United Nations Programme on HIV/AIDS (UNAIDS), WHO, and a number of faith-based organizations reaffirmed their commitment to end paediatric HIV and address the impact of TB on children, youth and families.
Together, partners strategized on the best ways to accelerate the research and development of safe, affordable and effective HIV and TB diagnostics and medicines for children and pregnant and breastfeeding women who are most in need, while addressing the lost momentum caused by the COVID-19 pandemic. The action plan, which was built upon the attendees’ commitments, addresses prevention, diagnosis, and treatment in 3 core areas:
Ending paediatric HIV
Partners agreed that the plight of children in the existing global HIV response is unacceptable. According to UNAIDS, in 2021, 800 000 children living with HIV did not have access to treatment, and only 41% of them have achieved viral suppression. Additionally, only 52% of children who became infected with HIV accessed HIV treatment services, compared to 76% for adults; a gap that has continued to grow. These figures are even more frustrating when considering that TB is the leading cause of death among HIV-positive people and accounts for nearly one-third of all AIDS-related deaths globally – 10% of which were children.
Eliminating childhood TB
Data from the WHO shows that children under the age of 10 and adolescents between 10–14 years of age accounted for 11% of the total burden of TB in 2021, and only 40% of all childhood TB cases were reported, leaving the majority of children and adolescents undiagnosed and without access to care or not reported. Case identification is critical in ending TB in children and adolescents. Without finding and diagnosing those children and adolescents most impacted by HIV and/or TB – as well as those co-infected with both HIV and TB – the global health community cannot effectively serve those most in need of treatment.
Prioritizing pregnant and breastfeeding women
While attendees agreed that including children and youth in the global fight against HIV and TB is critical to ending the epidemics, they called for the need to prioritize pregnant and breastfeeding women as well. For the first time, stakeholders committed to the timely generation of data for the use of new medicines for pregnant and breastfeeding women. Including this population in clinical trials, partners agreed, will help curb the rate of vertical transmission of HIV and congenital transmission of TB, as it helps guarantee these women will have better access to medicines at the time of drug approvals.
"The Rome Pediatric HIV & TB Action Plan provides a roadmap for ensuring that children affected by HIV and TB receive the care, treatment and support they need to thrive. If we want to address the unique needs of children, we must intensify our efforts to implement each of the Action Plan’s commitments. By working together, we can build a world where no child is left behind," said Winnie Byanyima, UNAIDS Executive Director.
“The message from Uganda’s Ministry of Health ’Turn off the faucet, do not mop the floor' reminds us of the importance of focusing on the root causes of new infections and deaths among children and mothers as we strive to end paediatric HIV. Let's use the Rome Action Plan commitments to make sustainable changes by addressing these causes, assuring access to the best medicines and diagnostics where needed most, and securing an HIV-free generation,” said Dr Meg Doherty, Director of WHO’s Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes.