In the photo: Dr. Claudia Llanten, Senior Specialist, Maternal, Newborn, and Child Health at CMMB presenting the organization’s commitments to pediatric HIV and TB at the Rome6 high-level dialogue at the Vatican on Dec. 6, 2022. (CMMB)

ROME, Italy (Dec. 6, 2022) — The faith-based global health organization CMMB presented the following commitments to scaling up the prevention, diagnosis, and treatment of pediatric HIV and TB for children in Haiti, Kenya, and Zambia at a high-level dialogue held by the Vatican this week in Rome. CMMB is one of 17 faith-based organizations that are part of a convening group brought together by the Vatican to assess the progress on and intensify commitment to its HIV Pediatric Action Plan, which was launched in 2016. 

HIV

Stigma and Discrimination Around HIV

Toward Stigma-Free Faith Environments. Stigma and discrimination prevent children and adolescents living with HIV from accessing testing and treatment and thus prevent children and adolescents at risk for acquiring HIV infection or already infected by HIV from living healthy lives. CMMB commits to collaborating at all levels and working in communities, schools, and faith and healthcare settings to disseminate the HIV Messages of Hope and to combat HIV-related stigma and discrimination, including among faith leaders.

Stigma-Free Healthcare. CMMB commits to continue to provide client-centered HIV care and treatment within health facilities as well as community-based treatment, and as part of that commitment, we commit to ensuring that such care is provided free of stigma.

HIV Prevention Case Finding, and Linkage

Finding the Missed. CMMB will double down on pediatric and adolescent case finding, emphasizing the focus on identifying contacts of index patients—specifically children—and focusing on the use of risk assessment tools to identify likely cases as part of general care in project-supported facilities.

  • In Zambia, we will scale up our Know Your Child’s HIV Status campaign.
  • In Kenya, we will support ministry of health community testing approaches, especially family testing among households of index patients, including pregnant women.

Pediatric Diagnostics. CMMB commits to supporting and participating in national efforts to improve and integrate the use and impact of pediatric diagnostics for HIV and to working to develop national strategies to optimize the use of new technologies and interventions.

Following and Following Up on Pregnant Women. CMMB will continue to emphasize identification of pregnant women in supported communities (relying on catchment community health workers to know the pregnancy intentions and status of each woman of reproductive age in the catchment). We will focus on ensuring that all identified are tested for HIV, enrolled on ART if positive, and supported to adhere to treatment, and on following their HIV-exposed infants for testing at specified intervals until final status confirmation at 18 months.

HIV Treatment, With Adherence and Retention

HIV Pediatric Formulations. CMMB will advocate to and support the national and state-level ministries of health to rapidly transition to optimal pediatric formulations per the latest WHO guidelines. We will provide coordinated support for the development and implementation of transition plans and will ensure that both clinicians and patients understand the benefits of the new formulations and their availability.

Rollout of New HIV Pediatric Regimens. CMMB will support scale-up of access to priority formulations and diagnostics and facilitate their wider rollout by ensuring the availability of guidance, education, and materials, and by working through community health structures. CMMB works with various cadres of community resource people to support follow-up of children living with HIV as well as to prevent mother-to-child transmission of HIV, which remains too high across the countries we serve.

Facilitating HIV Treatment Access. We will ensure that we are fully implementing differentiated service delivery in all its variations—for example, flexible clinic hours and community drug distribution modalities such as home ARV delivery and community ART groups.

  • In Zambia, where many children live at their schools during the school year, we will scale up the scholar model, where antiretroviral medications are sent directly to the institution.

HIV Treatment Literacy. CMMB will mobilize our networks and work with communities to help build treatment literacy, generate demand, and expand access to diagnosis and treatment for both HIV and TB among children, collaborating with other stakeholders. We will work closely with stakeholders at all levels toward this end, including community health workers.

  • In Kenya, to improve outcomes, over the next year, CMMB will train 249 health workers of various cadres on treatment literacy and any new pediatric ART guidelines. We will support them to follow up with those having poor treatment outcomes and HIV-positive pregnant women for PMTCT. In addition, we commit to training them additionally on human rights and gender issues to address factors impeding optimal adherence.

Supporting Adherence to HIV Regimens. CMMB commits to scaling up both age-appropriate adherence support groups as well as individualized and group support for caregivers, including psychosocial support. We will work with caregivers to strengthen the skills required to meet the needs of their HIV-positive children. Additionally, we will focus on providing support for HIV-positive pregnant women for prevention of mother-to-child transmission and follow-up testing.

  • In Haiti, we commit to scaling up the use of income-generating activities for adolescents and young adults to increase their economic autonomy, lessen reliance on risk behaviors by young women to provide spending money, and reinforce adherence.
  • Also in Haiti, we will continue to implement directly observed therapy (DOT). In this approach borrowed from TB treatment, a project field worker visits the family of an HIV-positive child to directly observe the administration of the child’s medication. Currently 82% of unsuppressed pediatric patients have benefited from DOT, with a resuppression rate of 88%.

Support for Disclosure to Children of Their HIV Status. As part of adherence support to caregivers, CMMB commits to supporting parents to disclose to their children, as disclosure is a first step toward pediatric adherence. Currently, in our projects in Haiti, 93% of disclosed preteens are virally suppressed.

Social Determinants

Investments to Support Achieving and Maintaining the three 95s. To local, regional, and national governments, CMMB will promote an increase in investments in community HIV prevention, care and support programs that strengthen community-focused interventions to enhance support for children and adolescents living with HIV through the continuum of care. CMMB will also advocate for inclusion of interventions addressing social determinants of health into existing frameworks for pediatric HIV prevention, care and treatment funding mechanisms.

Tuberculosis

TB Stigma and Discrimination

Toward Stigma-Free Environments. Stigma and discrimination depress uptake of testing and impede prevention and thus prevent children and adolescents at risk for acquiring TB infection or infected by TB from living healthy lives. CMMB commits to collaborating at all levels and working in communities, schools, and faith and healthcare settings to disseminate the Messages of Hope for TB and to combat TB-related stigma and discrimination, including among faith leaders. We also commit to working to mobilize these leaders and their faith communities in support of these anti-stigma and anti-discrimination efforts via evidence-based education and training.

Advocacy Supporting the National TB Response

At Regional and National Levels. CMMB commits to fostering and actively participating in coordinated and collaborative advocacy to increase funding for TB research and development and the introduction and scale-up of priority pediatric drugs and formulations; to accelerate regulatory processes for rapid adoption and uptake of optimal pediatric TB drugs and formulations; and to ensure sustainable access to optimal TB testing and treatment for infants and children.

TB Treatment

Case Finding. In close collaboration with other stakeholders, CMMB will mobilize our networks and work with communities to expand access to TB diagnosis and support and to increase TB treatment initiation and retreatment among children, adolescents, and families, including among those living in hard-to-reach places and in contexts affected by conflict and crisis. Specifically, in health facilities we support and their catchments, CMMB will ensure that assessment and diagnosis of TB among pediatric and adolescent HIV patients is routine and institutionalized. CMMB will incorporate TB screening and referral know-how into trainings and task lists assigned to community health workers associated with our HIV projects. Additionally, community health workers in CMMB-supported health facilities’ catchments will be facilitated to visit households of under-five TB patients to provide health education, do contact screening, and refer those presumptive. They will also facilitate tracing of pediatric TB patients who interrupt treatment.

Support for Innovation around TB Diagnosis. CMMB commits to supporting and participating in national efforts to improve and integrate the use and impact of pediatric diagnostics for TB and to develop national strategies to optimize the use of new technologies and interventions.

TB Preventive Therapy. CMMB commits to ensuring that all pediatric and adolescent patients receive TB preventive therapy, with provision of DOT if necessary for the household.