The THRIVE project aims to optimise the implementation of STOP AIDS package through research and stakeholder collaboration. A key component of the project is the Paediatric Expert Advisory Group (PEAG), a stakeholder group led by Penta under the THRIVE project to facilitate cross-country learning, review the current paediatric-specific evidence, and inform future research and tailored interventions to ensure that each child receives the most appropriate level of care.
The PEAG consists of representatives from Ministries of Health, paediatric experts, AFROCAB, CHAI, Penta, and external advisors to:
- Provide strategic oversight, technical advice, and country-level alignment within the THRIVE project.
- Advise on training, implementation, and dissemination of materials related to paediatric advanced HIV disease (AHD).
- Facilitate networking and collaboration on paediatric AHD, including alignment with the pAHD Alliance.
- Continuously evaluate new evidence relevant to the management of AHD in children.
Recently, the PEAG convened for its inaugural face-to-face meeting in Kampala, a pivotal gathering where critical challenges in paediatric AHD management were brought to the forefront. A primary concern that dominated the discussions was the persistent disparity in paediatric AHD research, which continues to be overshadowed by studies focused on adults.
Much of the evidence informing the STOP AIDS package—the current international guideline for managing AHD in children and adolescents—is derived from adult trials such as REMSTART and REALITY. Similarly, the 2023 WHO policy brief, Providing Care to People with Advanced HIV Disease Who Are Seriously Ill, lacked specific recommendations for paediatric populations. Indeed, a recent WHO analysis of the AHD research landscape further underscored this gap, noting the frequent exclusion of children and infants from AHD-related clinical trials.
The group discussed the specific current research gaps on paediatric AHD, including:
- Cytomegalovirus (CMV): Confirming CMV’s role as a cause of severe pneumonia in infants living with HIV. The group also emphasised the importance of studying the impact of the CMV prophylaxis before pneumonia onset.
- Early infant diagnosis of HIV: evaluating the cost-effectiveness of nucleic acid testing for all severely ill infants admitted in hospitals in areas with high HIV prevalence, conducted in parallel to maternal testing, rather than waiting for the maternal HIV result. This approach could facilitate earlier treatment of infections like Pneumocystis pneumonia (PCP), which are sometimes forgotten or delayed without HIV confirmation.
- Bacterial infections: developing guidelines for bacterial infection prophylaxis, informed by local antimicrobial resistance patterns, particularly for young, malnourished children with low CD4 counts and post-discharge.
- Malnutrition: considering malnutrition prophylaxis among CLHIV, emphasising the integration of HIV and nutrition programs and ensuring antiretroviral treatment efficacy in undernourished children. It was also proposed more research on alternative therapeutic food options based on local products.
- Other areas: highlighting the need for booster pneumococcal vaccination doses, investigating specific causes of mortality among CLHIV, and scaling up preventive treatments like 3-month regimen of isoniazid and rifapentine (3HP), and examining the significance and impact of anemia on the prognosis of children living with AHD.
Moving beyond research, the meeting also addressed the significant challenges posed by training gaps and implementation hurdles. Findings from a recent trainings gap survey Penta conducted across THRIVE countries revealed limited training and low confidence among healthcare providers in managing complex paediatric cases. To address these challenges, the PEAG will collaborate in the development and review of training materials on paediatric AHD, which will be used during the project’s operational research activities.
Addressing these critical gaps in research and implementation is essential to improve outcomes for children with AHD. The THRIVE project and the PEAG are committed to bridging these gaps by fostering collaboration, advancing research priorities, and developing actionable solutions tailored to the unique needs of paediatric populations. By leveraging these initiatives, we can transform the care and survival of children living with HIV in resource-limited settings.
Author: Sheila Fernández-Luis PhD, on behalf of THRIVE Pediatric Expert Advisory Group and Penta.