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Pediatric treatment 2.0: ensuring a holistic response to caring for HIV-exposed and infected children

Essajee, Shaffiq M.a; Arpadi, Stephen M.b; Dziuban, Eric J.c; Gonzalez-Montero, Rauld; Heidari, Shirine; Jamieson, David G.f; Kellerman, Scott E.g; Koumans, Emiliac; Ojoo, Atienoh; Rivadeneira, Emiliac; Spector, Stephen A.i; Walkowiak, Helenag; The Child Survival Working Group of the Interagency Task Team on the Prevention and Treatment of HIV infection in Pregnant Women, Mothers and Children

doi: 10.1097/QAD.0000000000000091
Supplement Articles

Treatment 2.0 is an initiative launched by UNAIDS and WHO in 2011 to catalyze the next phase of treatment scale-up for HIV. The initiative defines strategic activities in 5 key areas, drugs, diagnostics, commodity costs, service delivery and community engagement in an effort to simplify treatment, expand access and maximize program efficiency. For adults, many of these activities have already been turned into treatment policies. The recent WHO recommendation to use a universal first line regimen regardless of gender, pregnancy and TB status is a treatment simplification very much in line with Treatment 2.0. But despite that fact that Treatment 2.0 encompasses all people living with HIV, we have not seen the same evolution in policy development for children. In this paper we discuss how Treatment 2.0 principles can be adapted for the pediatric population. There are several intrinsic challenges. The need for distinct treatment regimens in children of different ages makes it hard to define a one size fits all approach. In addition, the fact that many providers are reluctant to treat children without the advice of specialists can hamper decentralization of service delivery. But at the same time, there are opportunities that can be availed now and in the future to scale up pediatric treatment along the lines of Treatment 2.0. We examine each of the five pillars of Treatment 2.0 from a pediatric perspective and present eight specific action points that would result in simplification of pediatric treatment and scale up of HIV services for children.

aClinton Health Access Initiative, Boston, Massachusetts

bICAP, Columbia University, New York, New York

cCDC, Atlanta, Georgia, USA

dWorld Health Organization

eInternational AIDS Society, Geneva, Switzerland

fPartnership for Supply Chain Management

gManagement Sciences for Health, Washington, DC, USA

hUNICEF, Copenhagen, Denmark

iUniversity of California, San Diego, California, USA.

Correspondence to Dr Shaffiq M. Essajee. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.