HIV continues to be a global health challenge among vulnerable populations like children, adolescents, and youth. In 2023, HIV treatment coverage was markedly lower for children than for adults — 57 percent versus 77 percent— and children accounted for 12 percent of all AIDS-related deaths. Children can acquire HIV in utero, during childbirth, or while breastfeeding; yet provision of antiretroviral therapy (ART) to pregnant and breastfeeding people living with HIV has remained stagnant at 84 percent over the past decade. For adolescents and youth, the risk of HIV acquisition is heightened at the time of sexual debut and thereafter, due in part to stigma, violence, poor physical and mental health, and lack of education.  

The PEPFAR- and USAID-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project works with national governments and civil society organizations to establish and strengthen programs for prevention of mother-to-child transmission; early infant diagnosis; and reaching pediatric, adolescent, and youth with testing, prevention, and treatment services through: 

• Offering decentralized points of care to increase access to antenatal care, including HIV testing and treatment for pregnant and breastfeeding women, their partners, and infants. 
• Designing and scaling up effective HIV prevention and case-finding strategies, including index testing of sexual partners and biological children (0-19 years) of key populations, caregiver assisted youth HIV-self testing, and reaching children at key entry points such as caregivers’ sexually transmitted infection appointments or child immunization clinics. 
• Offering differentiated paths for ART initiation and retention, such as family-centered approaches, youth-friendly clinics for adolescents, peer-led caregiver support groups, and multi-month medication dispensing. 
• Layering structural interventions, such as linking mother-infant pairs to services including vulnerable children’s programs, nutritional support, mental health support, life skills and parenting training, and violence prevention and response. 
• Promoting innovations such as automated electronic systems for timely viral load monitoring and designing social media campaigns and telehealth platforms to increase engagement and access among youth. 

Between October 2019 and September 2024, EpiC reached 693,876 children, adolescents, and youth between 0 and 20 years of age with prevention and HIV testing services, diagnosing 21,195 new HIV cases across 24 countries in Asia, Africa and Latin America. Among those newly diagnosed with HIV, 13,225 were enrolled on ART and 90 percent achieved viral load suppression.   

Key resources 

• Multi-Month Dispensing of Antiretroviral Medications for Adolescents and Children Living with HIV 
• Case Management Toolkit for HIV Antiretroviral Therapy Services to Prevent Interruption in Treatment, Optimize Adherence, and Achieve and Sustain Viral Suppression 
• Are Children of Key Population Individuals at Higher Risk of HIV Than Other Children? Results From a Multi-Country Analysis of Routine Program Data 
• Community index testing effectively reaches children of female sex workers and of other vulnerable populations: Results from routine service data analysis in Tanzania [recording, INTEREST 2023]
• A Multi-Country Analysis of HIV Testing Strategies for Identifying Adolescents Living with HIV [recording, International Workshop on Pediatrics and HIV 20234]

This blog is part of a series highlighting EpiC’s technical approaches, key results, tools, and strategies that have driven positive change in HIV outcomes.