Reimagining Paediatric HIV Care: Centering Infants and Young Children in Optimized, Integrated Models of Care.

introductionDespite substantial gains in the global HIV response, infants and young children continue to experience poorer outcomes across the HIV testing and care cascade. Rates of early infant diagnosis, timely antiretroviral therapy (ART) initiation, retention in care and viral suppression remain unacceptably low in paediatric populations. These disparities are compounded by systemic challenges, including fragmented service delivery, limited availability of child-friendly ART and other drug formulations, and health systems that fail to integrate HIV services within broader maternal and child health platforms. As a result, many children living with HIV are diagnosed and start treatment late and face high risks of mortality and morbidity, particularly in the first 2 years of life. DISCUSSION: In this commentary, we advocate for the urgent reimagining of paediatric HIV service delivery, emphasizing the need to centre infants and young children within models of care. We highlight four promising approaches: (1) Integrated mother-infant follow-up models that ensure continuity of care from pregnancy through the postpartum period and infancy until the infant's final HIV status is determined; (2) Family-centred models that treat the household as the unit of care; (3) Advanced HIV care strategies tailored to the needs of children with late presentation or treatment failure, including paediatric tailored ART regimens and diagnostics; and (4) Community-based interventions that leverage peer support, lay health workers, and provide stigma-free entry points to expand access and retention to care and treatment. These approaches have demonstrated that when services are designed to reflect the developmental, clinical and social needs of children and their caregivers, outcomes significantly improve. However, many of these models remain underutilized, fragmented or inadequately resourced.

conclusionsTo close the paediatric HIV treatment gap, we must move beyond pilot projects towards national, integrated and adequately funded child-centred systems. This requires political will, strategic investment and prioritization of children in HIV policy, innovation and implementation research. A sustained and equitable HIV response must include infants and young children not as an afterthought, but as a core priority. Epidemic control cannot be achieved if the youngest children are left behind.