University Teaching Hospital Pediatric Centre Of Excellence

1
University Teaching HospitalPediatric Centre Of
Excellence
Imiti Ikula e Mpanga
C. Kankasa
2
Introduction

• The University Teaching Hospital (UTH) of
  Lusaka, Zambia has partnered with Columbia
  University and Boston Medical Center to develop
  and pilot a Pediatric Center of Excellence in HIV
  Care. This model site has become a referral
  center for Lusaka district clinics and other
  healthcare facilities countrywide, and is the
  pediatric ART training center for Zambia and
  potentially neighboring countries.

3
Models of Pediatric HIV Care

• Centers of Excellence
• Develop expertise in the care and treatment of
  children multidisciplinary
• Regional training centers
• Greater access to specialty laboratories
• Community-based HIV care and treatment
• Family-focused model
• Linking HIV status identified through PMTCT to
  pediatric follow-up services
• Services accessible near home - bringing care to
  the child, reducing transportation burden
• Complex care referred to centers of excellence

4
Goal

• The main goal of the PCOE is to
• increase the number of infants and children
• receiving comprehensive care and treatment
• for HIV/AIDS.
• Training of health workers
• Direct care at the PCOE
• Care through outreach activities support of
  other satellite PCOEs

5
PCOE Current Activities

• Infrastructure development
• Inpatient Routine opt out testing
• Infant Diagnosis national reference laboratory
• Care and treatment
• Collaborating nationally on ME systems
• Training (Rapid Testing, PCR, DBS, Pediatric ART
  Curriculum counseling)
• One stop Center for defiled children
• Family support unit
• Drug resistance testing

6
Goals of the UTH Pediatric HIV Counseling and
Testing Program
Goal To counsel and HIV test all children
admitted to pediatric department at the
University Teaching Hospital (UTH) regardless of
their medical diagnosis during the period of
hospitalization
7
Benefits

• Standardizing the identification, care and
  treatment for children with HIV hospital-wide.
• Initiating CT at first point of contact allows
  follow-up and more interaction, education and
  assessment for children and families.
• ART assessment can be initiated while the child
  is still in the hospital.
• At-risk and pre-natally exposed children are
  identified earlier.

8
Program Implementation II
Counseled in admitting ward
Tested and Confirmed
Not Tested
Ongoing Counseling
Negative
Positive
STOP
FBC, LFT KFT and CD4 counts ordered and drawn on
the ward
Discharged before baseline labs drawn
Draw baseline labs at Review Clinic
Review Results _at_ follow-up appointment
(Childrens clinic and/or HIV Clinic)
Ongoing Care and Treatment
9
Counseling
Eligible for Counseling Total admissions less,
patients too ill to be counseled and patients who
died before counseling documented known status
10
Percentage of Admitted Patients Counseled
11
Testing
12
Percentage of Counseled Patients Tested
13
Age Distribution of children who are Antibody
Positive
14
Infant Diagnosis at UTH

• National reference laboratory
• Currently using both 1.5 Amplicor and Real Time
  PCR
• Started rolling out the use of dried blood spots
  (DBS) to Southern province.

15
Testing children under 18 monthson PCR at UTH
If child is breastfeeding, repeat PCR 6 weeks
after mother stops breastfeeding (for child
under 18 months) or rapid test 3 months after
last breast milk (for child over 18 months) - OR
-repeat PCR sooner if child falls ill
If child has not breastfed for 6 weeks before
PCR, he/she is NOT INFECTED
HIV-infected do appropriate post-test
counselingand refer to care treatment
16
PCR Testing
17
Percentage Of Seropositive Infants PCR Testing
18
UNITED NATIONS CONVENTION ON THE RIGHTS OF THE
CHILD (UNCRC)

• (UN DOC. A/44/49/1989) Article 34 states
• State parties undertake to protect the child
  from all forms of sexual exploitation and sexual
  abuse
• This is not happening in most African countries
  including Zambia.
• Child sexual abuse (CSA) in and out the family is
  increasing at an alarming rate
• With the advent of HIV the risks become life
  threatening.

19
Child Sexual Abuse program

• Risk factors
• Broken homes
• Poor socio-economic status (Poverty)
• Culture
• HIV (cleansing)
• Female sex
• Who is the abuser?
• Relatives -30
• Trusted people known to the child 60
  (teachers, fellow students, neighbors etc.)
• Strangers account for only 10

20
(No Transcript)
21
Reported cases of CSA at UTH
22
Post Exposure Prophylaxis

• Given within 72 hrs after a high risk sexual
  abuse.
• 3 drugs - Combivir (lamivudine and Zidovudine
  LPV/rit)
• Given for 28 days
• Follow up 3 months, six months

23
Achievements of the Multidisciplinary Centre

• Establishment of a data and M E unit
• 5,904 children in care 2,409 on ART
• Increase in the number of children accessing PEP
• Development of pediatric ART training manuals
• Training/Updating Skills i.e. 250 HW trained in
  pediatric ART in 2007
• Sensitization of the communities and enlisting
  their support