Onyema Ogbuagu

The conference-themed plenary session “putting people first: the way forward” highlighted the critical importance of addressing unmet needs of vulnerable children, adolescents and pregnant people living with HIV, engaging and incentivizing community organization partners meaningfully, and building resilient integrated health systems as essential to achieving the UNAIDS 2030 95-95-95 goals.

Moderated by Dr. Atul Gawande (USAID), the session included 3 presentations: First, Dr Anna Turcova (University College, London), highlighted the disparate outcomes among children and adolescents relative to adults including high rates of new infections, under-5 mortality, and subpar HIV treatment cascade. To improve these, scaling-up early infant diagnoses, roll-out of pediatric fixed dose Dolutegravir-based ART (informed by CHAPAS-4 and Odyssey trials) and accelerating pediatric studies for long-acting ART are crucial. Remarkably, 18 countries had eliminated mother-to-child transmission. Next, Richard Angell, CEO of Terrence Higgins Trust, UK, discussed the important roles the volunteer and community sector (VCS) play in HIV response including focus on social determinants of health, advocating for impactful public health interventions - such as HIV testing in emergency departments and AI chatbot for sexual health promotion. He decried underfunding as threatening VCS activities. The third presentation by Olga Gvozdetska, Deputy Director-General of Ukraine’s Ministry of health discussed the devastating impact of war on health systems and specifically, HIV, Tuberculosis and viral hepatitis programs. However, through support of external partners (Global fund and PEPFAR), decentralization of programs, people-centered approach and sheer determination of its health workforce, Ukraine was able to sustain its service delivery systems with outstanding results.

There remain serious regional disparities in pediatric HIV testing and treatment particularly for countries in the Middle East and North Africa as well as high burden countries in West and Central Africa that must be addressed and eliminated. Also concerning is the high frequency of integrase inhibitor resistance in children who experience treatment failure on those regimens, lending urgency to developing effective and tolerable treatment options. A lot more resources are required to achieve UNAIDS 2030 targets; unfortunately, cuts to funding when more is needed, and factors such as war and climate change, can perturb health systems and threaten progress.

Beo Oliveira Leite

The plenary session emphasized the importance of addressing the gaps in children's and adolescents' prevention and treatment, along with the crucial role of community-based organizations in ending the HIV epidemic. It also showed the damage and resilience of the health care structure in the context of humanitarian crises.

2. Atul Gawande (Assistant Administrator for Global Health, USAID, United States) introduced the session and speakers on the theme. The first speaker, Anna Turkova (Research clinician at the MRC Clinical Trials Unit at University College London), presented data from children and young populations. There is a treatment gap between adults and children. New strategies for treatment are still unclear for younger populations. Adolescent, children, and breastfeeding populations are still overrepresented in research. Strengthening the health system, such as integrated and community-based health care services, is the best way to amplify diagnosis and treatment timely. Protests took place for “community are experts”. The second speaker, Richard Angell (Terrence Higgins Trust, United Kingdom), focused on community organization participation role in ending the HIV epidemic through strategies for improving the HIV responses, such as highlighting social determinants of health, integrated services, intersectionality, and health cost cover. The final speaker, Olga Gvozdetska (Deputy Director General of Ukraine's Public Health Center, Ukraine), brings the context of war and HIV care in Ukraine. She highlights the impact of the war, especially in keeping services working. The Ukraine efforts increased for services decentralization, full participation of stakeholders, ensuring access to technologies and services, and testing screening.

3. Despite the efforts to “Put people first,” community voices were missing. In addition to the voices of researchers, policymakers, and stakeholders, the community needs spaces to talk by themselves, share their experiences, and explain their own context. Efforts to reach the most vulnerable populations must also be allied to all strategies regarding the community’s needs: What is the community looking for? How can we provide better services and make the community engaged and participate in the process? In the words of the session protest, “community are the experts.”

Julie Ngo

This session discussed the proposed actions to improve HIV prevention and treatment among children, adolescents, and pregnant women living with HIV, communities as experts, and the current HIV and other health responses in Ukraine, followed by presentation of the Prize for Excellence in HIV Research Related to Children and Adolescents.

Anna Turkova from University College London discusses the geographic disparities in pediatric HIV prevention and treatment and widening gap in ART coverage between children and adults. Calling for tailored innovations in finding undiagnosed children, equitable and affordable access to long-acting injectables for children, adolescents, and pregnant women in LMICs, and integrated person-centered services, peer and psychosocial support. “Communities are experts!“: Protesters call to expand the definition of experts to include communities with skills in advocacy, use of community data, and leadership. Richard Angell from Terrence Higgins Trust highlighted the contributions and expertise of the voluntary and community sector in the HIV response, calling for more funding, appreciation, and acknowledged value of their work. Olga Gvozdetska from Public Health Centre of the Ministry of Health of Ukraine associates Ukraine with “Notwithstanding, We Keep Going”. Increases in HIV, TB, OST, and viral hepatitis services amid war pin-pointing to adaptation, anti-fragility, and support from international assistance. Scale-up and decentralization of integrated services brought services as close as possible to growing displaced populations.

The session highlighted what it means to Putting people first! It means thinking of the whole person, not the disease, and ensuring health services meet the needs of vulnerable and priority populations, including children, adolescents, and pregnant women living with HIV in LMICs and people in conflict zones. What is needed is making sure communities are at the centre of the work, as experts and co-designers, with country- and population-tailored innovations, and integrating HIV services with other health services in a comprehensive person-centered primary healthcare approach are necessary responses.