Pediatric HIVAIDS Services in Ethiopia: Supporting a National Agenda

1
Correspondence Zenebe Melaku, MDColumbia
University ICAP PO Box 5566, Addis Ababa
EthiopiaE-mail zy2115_at_columbia.eduTelephone
251 11 5547454Fax [phone] www.columbia-ic
ap.org/ethiopia
Pediatric HIV/AIDS Services in Ethiopia
Supporting a National Agenda Zenebe Melaku1,
Mengistu Tafesse1, Yibeltal Assefa 2, Tsegaye
Awano1, Ruby Fayorsey3, Elaine Abrams3 1Columbia
Universitys International Center for AIDS Care
and Treatment Programs (CU ICAP), Addis Ababa,
Ethiopia 2Federal HIV Prevention and Control
Office, Federal Ministry of Health, Addis Ababa,
Ethiopia 3Columbia Universitys International
Center for AIDS Care and Treatment Programs
(CU-ICAP) NY, USA
BACKGROUND
OUTCOMES AND CHALLENGES
Ethiopias Federal Ministry of Health (FMoH)
is committed to increasing access to HIV/AIDS
services, and significant progress made since the
national free antiretroviral (ART) program began
in January 2005. Pediatric HIV/AIDS services,
however, have lagged significantly behind those
of adults.

• In the 18 months since the 1st Situational
  Assessment, CU-ICAP has supported the FMoH and
  other implementing partners to
• Expand the pediatric component of the national
  ART training from 2 hours to 2 days in length
• Develop, pilot, and launch pediatric training
  materials and support tools, including a pocket
  manual, dosing guidelines, site assessment tools,
  posters on pediatric testing and treatment, and
  pediatric intake forms
• Initiate a national Early Infant Diagnosis (EID)
  program using DNA PCR via dried blood spots
  (DBS). The program has been successfully piloted
  and initiated in 16 sites, 778 HIV-exposed
  infants have been tested to date, and the program
  is rolling out to additional sites and regions
• Develop and implement a standardized minimum
  package of pediatric HIV/AIDS services used by
  all implementing partners in Ethiopia
• Expand national pediatric HIV/AIDS leadership
  capacity by seconding a pediatric HIV/AIDS
  specialist to the FMoH
• Enhance the capacity of pediatric HIV/AIDS
  specialists by bringing 23 clinicians from across
  the country to the ICAP/Stellenbosch
  South-to-South pediatric training program in
  South Africa
• Strengthen human resource capacity by providing
  a 2 day supplemental training on Pediatric
  HIV/AIDS to 300 ART providers from across the
  country
• Write a National Guideline on Pediatric HIV/AIDS
  Care and Treatment
• Form a National Technical Working Group on
  Pediatric HIV/AIDS Care and Treatment
• Launch a pediatric HVI/AIDS website to
  disseminate best practices, guidelines, training
  materials, and support tools
• As of 3/07, the number of infants and children
  enrolled in care had markedly increased and the
  number on ART grew from 551 (lt1 of eligible
  children) to 3,326 (7.7 of eligible children).

APPROACH

• In January 2006, the FMoH and Columbia
  Universitys International Center for AIDS Care
  and Treatment Programs (CU-ICAP) co-hosted a
  National Situational Assessment and Conference to
  identify ways to expand access to pediatric
  HIV/AIDS services in Ethiopia. As of 1/06, only
  551 children were receiving ART less than 1 of
  those eligible. National and international
  experts, stakeholders, and donors worked to
  identify critical steps required to deliver
  prevention, diagnosis, care and treatment
  services to Ethiopian children with HIV/AIDS.
• Recommendations from this conference included
• Expanding access to PMTCT services
• Enhancing family-focused care at all treatment
  venues
• Initiating inpatient and outpatient HIV diagnosis
  programs for infants and children, including
  early infant diagnosis (EID)
• Developing and implementing a standardized
  minimum package of services for HIV-exposed and
  HIV-infected infants and children
• Creating national pediatric guidelines and
  training materials
• Expanding pediatric HMIS tools
• Supporting advocacy for pediatric HIV/AIDS
  services.
• Over the past year, CU-ICAP has worked closely
  with the FMoH, National Laboratory (EHNRI),
  Regional Health Bureaus, and implementing
  partners to support this national pediatric
  agenda.

Children lt 15 years eligible for ART
Bringing partners together
Children lt 15 years ever starting ART
The 2nd National Conference on Pediatric HIV/AIDS
in Ethiopia (4/07)
Sharing resources electronically at
www.columbia-icap.org
Cumulative of Children Ever Started on ART Feb
06 Mar 07
LESSONS LEARNED AND RECOMMENDATIONS
Nation-wide scale-up of pediatric HIV/AIDS
prevention, care and treatment services requires
a multi-pronged approach including effective
advocacy, strengthening of entry points
(family-focused HIV services, PMTCT and EID),
careful attention to training, mentorship, and
human resources and ongoing decentralization of
pediatric HIV services and expertise. Although
Ethiopias national program has made significant
progress in the past year, access to pediatric
HIV/AIDS services in Ethiopia remains severely
limited.
Training health care workers on pediatric HIV/AIDS
Piloting early infant diagnosis via Dried Blood
Spots
South-to-South training partnership with the
University of Stellenbosch and Tygerberg
Childrens Hospital
The 2nd National Conference on Pediatric HI/AIDS
in Ethiopia (4/07)
ACKNOWLEDGEMENTS

• Federal HIV/AIDS Prevention Control Office /
  Federal Ministry of Health of Ethiopia
• Presidents Emergency Plan for AIDS Relief
  (PEPFAR)
• U.S Center for Disease Control and Prevention
  (CDC)- Ethiopia
• Columbia Universitys ICAP-Ethiopia is funded
  by PEPFAR through CDC- Ethiopia

2007 HIV/AIDS Implementers Meeting, June 16
19, Kigali, Rwanda