Addressing and Improving Gaps in HIV Care for Children and Adolescents

In this discussion with Priscilla Tsondai, MD, MPH, technical lead for the pediatric and adolescent program at the International AIDS Society through the Collaborative Initiative for Paediatric HIV Education and Research, she discusses her work focused on improving outcomes for infants, children, and adolescents affected by and living with HIV; in particular, addressing the health care transition into adult care for adolescents living with HIV.

Comoderator of the session, “Filling the Gaps: Challenges and Opportunities in the Care of Children and Youth With Perinatal HIV,” which took place at the 2025 Conference on Retroviruses and Opportunistic Infections, here she highlights key research findings that were presented.

In “Advanced HIV Disease in Children,” research was presented on the pediatric HIV testing and treatment cascade, and it emphasized the disparities between pediatric and adult HIV diagnosis rates. The investigators explored barriers to pediatric HIV testing, especially after infancy, and strategies to improve diagnostic rates beyond early infant diagnosis. For example, only 66% of children living with HIV are diagnosed compared with 91% of adult women.

During “HIV Care Continuum in Children,” data were presented from an investigation into care gaps when addressing advanced HIV disease in children and adolescents, and identified implementation challenges and approaches to reducing HIV-related mortality in this population.

The final presentation, “Sexual and Reproductive Health, Including Pregnancy Among People With Perinatal HIV,” examined these health concerns for adolescents with perinatally acquired HIV and addressed the unique challenges this patient population faces in navigating relationships, pregnancy, and health care access.

Tsondai also explains why early diagnosis and prompt antiretroviral therapy initiation are critical for children due to the rapid progression of HIV in infants. Unlike adults, she notes, children require age-appropriate formulations, caregiver support, and strategies to ensure adherence. Pediatric treatment, she adds also involves negotiating with caregivers, addressing stigma, ensuring proper dosing, providing nutritional support, and continuous monitoring for co-infections that can include tuberculosis and pneumonia, while for adolescents, comprehensive sexual and reproductive health education and preparation for transitioning to adult care are vital.