Models of Care for Paediatric HIV

1
Models of Care for Paediatric HIV

• Miriam Chipimo MD MPH
• Reproductive Health HIVAIDS Manager,
• UNICEF, Malawi

2
Global Context

• In 2005 UNICEF raised a call to action to all
  working to protect children from the AIDS
  epidemic
• Based on the UN General Assembly Special session
  on HIV AIDS in 2001 to attain the MDGs
• Call to Action set targets for 2010 in four key
  areas
• P1 Prevent infections among adolescents
  young people
• P2 Prevent Mother To Child Transmission of
  HIV
• P3 Provide paediatric treatment
• P4 Protect and support children affected by
  HIV AIDS

3
Global Estimates

• Following the call to action in 2005
• documentation on pART improved
• number of children on ART increased
• 75,000 by end 2005
• 127,300 by end 2006 (60 in East Southern
  Africa region)
• 198,000 by 2007
• By end 2007
• 2.1 million (6) of 33.2 million people with HIV
  were children under 15 years
• 420,000 children were newly infected mostly
  through MTCT
• 290,000 children had died
• Number of deaths had started to fall due to
  scale up of PMTCT

4
(No Transcript)
5
Global Programming Framework for scale up of HIV
related prevention, diagnosis, care treatment
for infants children

• Published in 2008 by WHO UNICEF reviewed by
  IATT
• Outlines the following strategies
• Government leadership, ownership and
  accountability
• Integrated decentralised delivery of HIV
  services for children
• Enhanced early identification of infants exposed
  to HIV
• Reliable procurement supply management
• Laboratory capacity to support HIV services
• Community based capacity to support those
  infected and affected by HIV
• Strengthening ME systems to enhance quality of
  care

6
Children and AIDS in Malawi
7
(No Transcript)
8
HIV Prevalence by Age Among Pregnant Women 2007
Sentinel Surveillance
Source Malawi Sentinel Surveillance
9
POLICY, PROGRAMMING FUNDING ENVIRONMENT

• Strong political will to fight HIV/AIDS
• National AIDS Policy, 2004 HIV/AIDS Action
  Framework 2005- 2009 are in place
• Global Funds Development Partners
  provide financial technical contributions
  coordinated by NAC
• Strengthening of drug supply
  management, laboratory and diagnostic services
  ongoing
• Strong ART and HTC programmes
• PMTCT Paediatric Guidelines updated
• Accelerated scale up of PMTCT services
• Roll out of Early Infant Diagnosis
  programme has started
• Strengthening the continuum of care from
  various entry points into ART

10
Tools to improve adherence in children on ART

• Children are provided with a take home booklet to
  support adherence to ART that provides
• clear explanation,
• reinforcement and documentation of dosing using
  pill count,
• asking for missed doses
• appointment schedule for follow up visit
• Parent/guardian is counselled on paediatric ART
  and use of the booklet using the National
  Paediatric HIV Flipchart

11
(No Transcript)
12
(No Transcript)
13
UNDER FIVE CLINICS PAEDIATIC WARDS NUTRITION
WARDS
PITC
75
NUTRITION COUNSELLING
Testing for family
Early Infant Diagnosis
Rapid HIV Test
PMTCT
Negative
15
10
CPT
Initiation of ART
14
STAND ALONE AND INTEGRATED PAEDIATRIC ART CLINICS
FEW DEDICATED PAEDIATRIC ART CLINICS
Community mobilisation
Teen Club
MAJORITY ARE INTEGRATED ADULT PAEDIATRIC ART
CLINICS
FEW FAMILY CENTRED ART CLINICS

• FIXED DRUG COMBINATION SPLIT ADULT TABLETS AT
  ALL ART SITES- 2 month supplies given
• CHILD FORMULATIONS AT 10 HIGH BURDEN SITES FOR
  CHILDREN BELOW 1 YEAR
• CD4 COUNTS CAN BE MONITORED AT ALL SITES AND
  VIRAL LOAD AT A FEW CLINICS
• VERY FEW DEDICATED SOCIAL WORKERS AT ART SITES

15
Achievements

• Increased number of children accessing HIV
  testing including DBS PCR from 6 weeks after
  birth in total over 5,000 children tested in
  2007
• No. of children receiving ART increased
  dramatically from 2000 in 2005 to 11,865 in 2007
• Strong political will and leadership by the
  government of Malawi in the fight against HIV and
  AIDS
• Strong partnership between UNICEF, Baylor,
  Lighthouse, WHO, CDC and Clinton Foundation to
  support MOH
• A steady supply of quality AIDS drugs,
  strengthening of lab
• services for CD4 counts and EID
• Revised registers for ME and job aides for PMTCT
  pART

16
Challenges

• Weak continuum of care of PMTCT services from
  ANC, maternity to under five clinics
• Low coverage of more efficacious regimens for
  PMTCT and Cotrimoxazole Preventive Therapy
• Late diagnosis of HIV children
• Long turnaround time from HIV diagnosis to
  starting ART
• ME system does not monitor outcomes pART
• Relatively poor access to ART services (30 of
  facilities)
• Human resource constraints
• Community not well sensitised on PMTCT
  Paediatric HIV care
• Psychosocial support for teenagers living with
  HIV
• Disclosure to the child
• Disclosure to family, friends and school

17
Finally a short movie thank you for your
attention