BACKGROUND: Despite significant progress in scaling up antiretroviral therapy (ART) to adults, and guidance from the World Health Organization (WHO) on a package of care for children and adolescents with Advanced HIV Disease (AHD), global momentum in pediatric AHD remains limited, with fatal outcomes.
DESCRIPTION: In July 2022, the Uganda Ministry of Health (MoH), with support from the Clinton Health Access Initiative through funding from Unitaid, undertook a landscape assessment to evaluate adoption of the WHO recommendations, identify adoption and implementation hurdles, and develop recommendations for investment in pediatric AHD. The assessment involved interviewing MoH officials, healthcare workers (HCWs), and facility administrators at 10 sites across eight regions, selected based on availability of AHD services, volume of clients, availability of electronic medical records, and representation across all levels of care. In addition, data was abstracted from health records of pediatric clients at the selected health facilities.
LESSONS LEARNED: CD4 testing was available at all sites, with low utilization; baseline screening at 43.6% for newly initiating pediatrics. Screening for cryptococcal infection amongst adolescents was low. For treatment, while all sites offered first-line TB regimens and 60% offered second-line regimens, dose adjustment was a challenge for most HCWs. Reporting tools did not include other opportunistic infections thus making it difficult to assess their screening and management. All sites offered pre-ART services, routine adherence assessment, and counseling but tests for drug toxicity monitoring were mostly only available at a fee to clients. Regarding prevention, there was non-uniformity and limited clarity on the availability, awareness, and utilization of azithromycin, and fluconazole prophylaxis. TB preventive therapy was available although HCW’s prescription of pyridoxine was inconsistent. Lastly, some HCWs were not aligned on the timing for Bacillus Calmette–Guérin (BCG) vaccination. among neonates with HIV.
CONCLUSIONS: Implementing the WHO STOP AIDS package of care for children and adolescents with AHD to fidelity will require addressing HCW knowledge gaps in knowledge and improving monitoring and evaluation systems to track implementation.

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