We Can Regain Momentum

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 five High-Level Dialogues— that specifically 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, convened by His Excellency Archbishop Vincenzo Paglia, President of the Pontifical Academy for Life, convened the meeting, and 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.

“This Platform offers intelligence and courage to respond to the many challenges that limit ending paediatric HIV and childhood TB today. The commitment of each of the stakeholders involved to save the lives and future of children living with HIV and TB infections certainly has borne much fruit during the past six years. And the platform’s success could serve as an important model for addressing access to healthcare and for development and sharing of treatment and vaccines that are so urgently needed, especially in the poorest and most marginalized communities in so many countries of the world.” – His Excellency Archbishop Vincenzo Paglia, President of the Pontifical Academy for Life

“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.” – Chip Lyons, President and CEO of the Elizabeth Glaser Pediatric AIDS Foundation

During the meeting, leaders from five 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), the World Health Organization (WHO), and a number of faith-based organizations (FBOs) reaffirmed their commitment to the fight 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 three core areas:

Ending Pediatric HIV

Partners agreed that the plight of children in the current global response to HIV is unacceptable. According to UNAIDS, in 2021, 800,000 children living with HIV are not accessing treatment, and only 41% of them have achieved viral suppression. Additionally, only 52% of children who become infected with HIV are accessing HIV treatment services, whereas the same treatment coverage for adults is 76%, 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.

“We must focus on the root causes of new infections and deaths among children and mothers as we strive to end paediatric HIV,” said Dr. Meg Doherty, Director of WHO’s Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes. “Let’s utilize the commitments of the Rome Action Plan to bring about sustainable changes by tackling these causes, ensuring access to the best medicines and diagnostics where they are most needed, and securing a generation free of HIV”.

Eliminating Childhood TB

Data from the World Health Organization (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 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.

“Every day more than 4,000 people, including over 700 children, die from TB. We now have a strong foundation for action on saving lives and make this unwanted statistic a thing of the past. At STP we are and we will continue to support countries to implement the commitments made. But we know this alone will not be enough – these commitments demand urgent political action. I call on World Leaders to commit to end pediatric deaths from TB. Yes! Together we can end TB.” – Lucica Ditiu, Executive Director, Stop TB Partnership

“Children, adolescents and pregnant women, including those with HIV are vulnerable to developing TB and losing their lives to this preventable and curable disease. The commitments made at the Vatican in December 2022, emphasize our resolve and leadership to end TB, including in these vulnerable groups. In collaboration with countries, technical partners, civil society and affected communities, WHO will continue to provide up-to-date evidence-based guidelines, and support countries reach all children, adolescents and pregnant women with TB or at risk of TB with care, reducing unnecessary suffering and deaths.” – WHO Director, Global Tuberculosis Programme, Dr. Tereza Kasaeva

Prioritizing Pregnant & Breastfeeding Women

While the participants acknowledged the crucial role of involving children and youth in the global effort to combat HIV and TB, they also emphasized the importance of prioritizing pregnant and breastfeeding women. For the first time, stakeholders committed to the timely generation of data for the use of new medicines for pregnant and breastfeeding women. Partners reached consensus that Including them in clinical trials would help in reducing the vertical transmission of HIV and congenital transmission of TB, as it would ensure that that these women have improved 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.” – UNAIDS Executive Director, Winnie Byanyima

“Knowing and closing the gaps in HIV prevention and treatment are vital to saving the lives of the most vulnerable populations and ending the HIV/AIDS pandemic as a public health threat by 2030,” said U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy Ambassador Dr. John Nkengasong, who oversees PEPFAR. “The Rome Pediatric HIV & TB Action Plan will guide us as we work together to address the inequities that leave children vulnerable to HIV/AIDS.” – Ambassador Dr. John N. Nkengasong, U.S. Global AIDS Coordinator and Special Representative for Health Diplomacy, the U.S. President’s Emergency Plan for AIDS Relief