World Immunization Day: One visit, more opportunities to protect children living with HIV
Updated: 1 hour ago
Through THRIVE, routine HIV care visits are becoming opportunities to address multiple health needs at once, including immunization. A simple tracking tool is helping healthcare workers identify vaccination gaps, document referrals, and connect children to immunization services—all as part of a more integrated approach to pediatric HIV care.
For children living with HIV (CLHIV), a missed vaccination can mean more than a gap in their immunization record. It can leave them vulnerable to vaccine-preventable illness at a time when their immune system may already be severely compromised.
But immunization is only one part of the challenge. A CLHIV in Nigeria may also face more than one health threat. They may be malnourished, harboring tuberculosis (TB) without a single visible symptom, or at risk of cryptococcal meningitis (CM)—a life-threatening infection affecting the brain and surrounding tissues—with no one yet aware.
Children with advanced HIV disease (AHD) are among the most vulnerable patients in the HIV response. Their immune systems are so depleted that opportunistic infections (OIs)—TB, CM, severe bacterial infections—can take hold rapidly. Mortality among children initiating HIV treatment has historically been high, particularly among those presenting with advanced disease, in part because infections are diagnosed too late, or not at all.¹,²
Yet for much of Nigeria's HIV program history, these health needs have been managed separately. A child attending an antiretroviral therapy (ART) clinic might receive HIV treatment without having their vaccination status reviewed. Identifying an OI could require tests sent to centralized laboratories, with results taking days or weeks. Nutritional support might sit in another department, while immunization required a separate referral or appointment.
In a country where getting to a health facility can mean hours of travel, and where a caregiver may have to choose between a clinic visit and a day's income, that kind of fragmented care is not just inconvenient. It puts a child's chances of recovery at risk.
The challenge has never been simply a lack of medical solutions. WHO guidelines outline a comprehensive package of care for children with AHD, including CD4 testing, OI screening, appropriate prophylaxis and treatment, and nutritional support. Immunization review and access to recommended vaccines are also important components of comprehensive pediatric HIV care. The challenge has been bringing these services together in a way that meets the needs of children and their caregivers.
This World Immunization Day, November 10, the Unitaid-funded THRIVE program is demonstrating how this can change. By integrating essential AHD services into routine pediatric HIV care and strengthening linkages to existing immunization programs, THRIVE is helping ensure that children receive more comprehensive care without having to navigate multiple disconnected services.
The program's central idea is disarmingly simple:
Every child living with HIV who presents at an ART clinic should be able to access the full AHD package—diagnosis, treatment, prophylaxis, nutritional assessment, and immunization review—through one coordinated care pathway, without unnecessary appointments or referrals.
Making that work required rethinking how care is organized, bringing services that have historically operated separately into the same clinical pathway.
Immunization, built into the visit
One assumption was that immunization was someone else's job. THRIVE is helping change this by integrating vaccination status reviews into routine pediatric clinical evaluations and strengthening linkages with Nigeria's National Program on Immunization. During these evaluations, healthcare workers (HCWs) review each child's vaccination history, identify missed doses, and facilitate referrals to immunization clinics.
But identifying missed vaccinations is only part of the challenge. Nigeria's national vaccine quantification and reporting system does not currently capture children older than 24 months, leaving children aged two to five who have missed routine vaccinations at risk of being overlooked in public-sector catch-up efforts. THRIVE is working with national immunization stakeholders to better understand these gaps, generate evidence on missed vaccinations among children with AHD, and advocate for improved access to catch-up immunization.
To support this work, CHAI developed an Excel-based tool to document immunization status, identify missed vaccinations, and track referrals. Particular attention is given to zero-dose children—those who have received no routine vaccines—and children missing recommended doses, including pneumococcal and measles vaccines. In an initial review, 37 children were evaluated, of whom 14 were identified with missed Pentavalent doses, highlighting gaps that might otherwise go undetected during routine HIV care.
THRIVE is also strengthening referral pathways for human papillomavirus (HPV) vaccination among adolescent girls living with HIV. In collaboration with CHAI's Vaccines team, state-based consultants, and AFROCAB community champions, the program is supporting in-facility referrals, caregiver awareness, and linkages to immunization clinics. In Benue State, community facilitators and champions accompany families to services, while in Anambra, engagement with state and local government networks is helping strengthen referral pathways to primary healthcare facilities and hospitals.
These efforts are beginning to show results. In Q1 2026, 10 of 12 newly identified girls aged 9–14 living with HIV (83%) were linked to HPV vaccination. In-facility refresher training on immunization and nutritional support in Benue State has also supported healthcare workers and community champions in integrating these services into routine care.
Newly identified girls living with HIV were linked to HPV vaccinations
Bringing diagnostics and treatment closer to children
The same approach extends beyond immunization.
CD4 testing has historically relied on laboratory infrastructure, delaying identification of children with advanced immunosuppression. VISITECT CD4, a point-of-care test that delivers results in approximately 40 minutes from a finger-prick blood sample, enables children to be assessed for AHD and receive appropriate follow-up during the same clinic visit.
TB diagnosis has traditionally relied on sputum samples, which young children often struggle to produce. Urine-based TB LAM tests help overcome this barrier for eligible children, while rapid CrAg testing enables screening for cryptococcal infection in eligible older children and adolescents with advanced immunosuppression. Both bring essential OI screening closer to patients.
Nutritional assessment has also been integrated into routine nursing workflows. Simple mid-upper arm circumference (MUAC), weight, and height measurements help identify nutritional needs and facilitate referrals for additional support.
What emerged from these changes was not a new program running parallel to the existing one. It was a reordered version of what already existed: streamlined, sequenced, and designed around what a child and their caregiver actually needed.
What this looks like in practice
TThrough THRIVE, the WHO-recommended STOP AIDS pathway is being implemented to streamline care for children initiating or re-engaging in ART during a single clinic visit; VISITECT CD4 with a same-visit result; CrAg testing where indicated; TB-LAM for eligible children; sputum collection and Xpert MTB/RIF for presumptive TB cases, with same-day or next-day results where on-site GeneXpert is available; initiation of appropriate treatment and prophylaxis; nutritional assessment and brief counseling; and immunization review with on-site administration where available or referral to the national immunization program.
For children who need more—confirmatory CM testing, TB treatment, supplementary feeding follow-up, or full catch-up immunization schedules—the pathway continues beyond that first visit, tracked by adherence counsellors, community facilitators, and AHD champions working to ensure no child is lost between steps.
The numbers are beginning to reflect what this model makes possible. In Q2 2026, at THRIVE sentinel sites in Nigeria, 45 children living with HIV were identified with AHD, including children under five. Of those 45 children, 89% started ART, 80% received a TB test, and 93% had a documented nutritional assessment, a significant improvement from previously absent baseline documentation.
started ART
received a TB test
had a nutrition assessment
Alongside these improvements in AHD care, systematic immunization reviews, referral tracking, and linkages to the national immunization program are helping facilities identify and address missed opportunities for vaccination.
These are not just statistics. Each one represents a gap that used to leave children without the care they needed.
What one visit can change
"When clients with advanced HIV disease arrive at our facilities, every hour matters. Early diagnosis and prompt treatment can mean the difference between life and death."
— Massey Street Children Hospital healthcare worker quote
CLHIV have long been among the hardest to reach in the HIV response: a relatively small population, dispersed across facilities, with complex needs that no single program has fully addressed in one place.
Across 21 facilities in four states, with more than 200 children reached with the AHD package, THRIVE is demonstrating how essential services can be integrated into routine HIV care, while strengthening connections to existing programs that support children's health.
On World Immunization Day, the experience in Nigeria offers a lesson that extends beyond vaccines alone. For children with AHD, care cannot be delivered one disease at a time. Preventing vaccine-preventable illness, diagnosing OIs early, initiating appropriate treatment, and addressing malnutrition must all be part of the same continuum of care.
When a health system is redesigned around what a child actually needs, rather than around what is convenient to deliver, fewer opportunities for care are missed.
The question for every country carrying a share of the global AHD burden is whether this model can be taken to scale before more children fall through gaps that no longer need to exist.
References
Mortality in a Cohort of HIV-Infected Children: A 12-Month Outcome of Antiretroviral Therapy in Makurdi, Nigeria (2018). https://pmc.ncbi.nlm.nih.gov/articles/PMC6029505/
Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis (2019). BMC Public Health. https://doi.org/10.1186/s12889-019-6482-1
Through the generous support of Unitaid, the Clinton Health Access Initiative (CHAI)-led THRIVE Project is enabling access to critical prevention, screening, and treatment commodities for advanced HIV disease to dramatically reduce mortality among adults and children living with HIV. The THRIVE project is conducted in partnership with AFROCAB and Penta.
Disclaimer: The views expressed are those of CHAI and do not necessarily reflect those of Unitaid or other partners.
