Scalingup Access to Paediatric ART in India

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Scaling-up Access to Paediatric ART in India

• Dr. B B Rewari
• National AIDS Control Organisation
• India

XVII International AIDS Conference Mexico City,
7th August 2008
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Paediatric HIV in India

• Estimated 2.5 million persons living with HIV
  infection in India (0.36 prevalence)
• Of these, the number of children estimated to be
  HIV infected in India is 100,000 (4)
• Number of children estimated requiring ART
  services is 40,000

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National ART programme in India

• Started April 2004 at 8 centers now 176 centres
• Adult first line ART fixed dose combination (FDC)
• Children were treated in limited numbers
• By Oct 2006, 43,744 persons on ART in India
• Only 1,800 children on ART

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National Paediatric HIV/AIDS Initiative public
health approach, 2006

• Scale-up with simplified standardized tools and
  training
• National paediatric ART guidelines established
• Simplified weight-based dosing schedules
• Procurement of paediatric FDCs for first line
  ART
• Training for paediatricians and ART centre staff

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National Paediatric HIV/AIDS Initiative forging
partnerships

• Partnerships with international and national
  agencies
• Indian Academy of Paediatrics
• UNICEF
• WHO
• Clinton Foundation
• Engagement with national and regional NGO, CBO,
  FBOs and positive networks

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Constraints identified and solutions that worked
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Reaching out to children in need
Mass awareness campaigns approach used to screen
diagnose and link HIV-infected children to ART
services
Over 380 camps done 17,000 children screened
medically 7,000 found HIV positive 3,000
required ART
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Launch of National Pediatric HIV/AIDS Initiative
November 2006
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Scaling up Access to Pediatric ART Bringing
treatment to children, 2004 2008
Paediatric AIDS Initiative
Before
After ART
Source Monthly ART Centre reports, NACO 2008
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Distribution of paediatric ART patients in India
by gender, 2004-2008
Percent
Year
Source Computerized HIV patient database, NACO
(25,394 records)
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Paediatric ART patients in India by age group,
2004 -- 2008
Percent
Year
Source Computerized HIV patient database, NACO
(25,394 records)
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Paediatric ART services, May 2008
Source Monthly ART Centre reports, NACO 2008
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Lessons learned

• Mass campaigns played a key role in the initial
  expansion of paediatric HIV treatment services
• Generated public and provider awareness of
  treatment
• Focused on most at risk children diagnose and
  link them to care and treatment
• Availability of paediatric FDC was key to
  simplifying delivery of ARV to children
• Training of paediatricians and ART centre staff
  in core competencies of services for HIV infected
  children is essential

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Next steps

• Continued expansion of paediatric HIV treatment
  services including establishing regional
  Pediatric HIV Centers of Excellence and
  addressing issues in HIV early infant diagnosis
• Comprehensive care support both for infected
  and affected children
• Nutritional Counseling supplementation
• Care, support psychosocial issue
• AZT based regimen for children
• Second line ART for children
• Care of affected children
• Develop longer term strategies to improve access
  to care and integrate HIV into general child
  health services
• Integrated Management of Neonatal and Childhood
  Illness including HIV (IMNCI-HIV)
• Improve access for orphans and children not
  linked to CBOs or NGOs

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Tools
Paediatric ART Adherence Tools
Treatment Guidelines
Dosing Tools
Paediatric ART Counselling Training
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A childhood free of HIV
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Acknowledgments

• We thank the children and their caregivers,
  development partners, partner NGO,CBO,FBO,
  positive networks.