Scaling up HIV Paediatric careHarvard – PEPFAR

Program

Chalamilla Guerino

11.08.2008

Pediatric HIV Overview (Nigeria, Botswana & Tanzania)

In these countries HIV prevalence among pregnant women is quite high (In Tanzania 8.7%, Botswana 33.7%)

Thousands of children are infected with HIV every year (In Tanzania est. 48,000)

50% are dying before they celebrate their second birthday. Under 5 mortality is highly attributed by HIV HIV diagnosis in children has been low (low attendance in

VCT, dependent on rapid test)

Pediatric HIV - Program Objectives

Facilitate access of service to all, increase pediatric enrollment

To Improve the Quality of care To Provide child friendly services

Cumulative Pediatric Treatment NumbersAPIN- Nigeria (Program started in 2005)

Indicator

As of March 2008

Achieved (Pediatric)

Service outlets providing ART Services 29

Number of individual who ever received ART by the end of the reporting period

1,360

Number of individual receiving ARV by the end of reporting period

1,155

Number on first-line drugs 1,091

Percentage on first line 96

Table 3: Number of children on HAART

Year No. of children on HAART

2005 4,997

2006 6,831

2007 6,267

Feb-08 6,381

Number of children on HAART

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

2005 2006 2007 Feb-08

Year

No

. of

child

ren

Figure 13: Number of children on HAART

Pediatric enrollment Harvard Tanzania

85 (8.8%)879 (10.9%)

1559 (12.6%)1247 (7.8%) 756 (6.8%)

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

Number

2004 2005 2006 2007 Jul-08

Year

Pediatric enrollment, 2004-2008

Pediatric enrollment by age group Harvard - Tanzania

0

200

400

600

800

1000

1200

1400

1600

Number

2004 2005 2006 2007 Jul-08

Year

Pediatric enrollment by age group, 2004-2008

Total childrenenrolled(cummulative)0-<2yrs

2-<5yrs

5-<15yrs

Quality of care Harvard - Tanzania

80 (39.4%)

295 (43.3%)

128 (54.0%) 78 (76.5%)

0

100

200

300

400

500

600

700

Number

2005 2006 2007 Jul-08Year

Co-trimoxazole coverage among infants (0-18 months), 2004-2008

Annual 0-18 monthsenrolled

N (%) on septrin

Pediatric – patient retention Tanzania

48 (5.0%)219 (8.9%)

667 (18.3%) 769 (18.3%)

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Number

2005 2006 2007 Jul-08Year

Pediatric loss to follow up, 2005-2008

Cum. Enrollment

Cum. Loss to follow up

Efforts to increase enrollment specific strategies in Tanzania

Strengthening tracking system of exposed infants (Map cue and tel. conduct)

Access to Providers Initiated Counseling & Testing (PICT) at Pediatric IPD,OPD, RCH

Early Infant Diagnosis (EID) by coding of MCH card

Access to DNA PCR test to exposed infants (scale up use of DBS)

Efforts to increase enrollment specific strategies in Tanzania

Train HCW at entry points on early signs and symptoms of HIV in children

Establish children friendly environment in the clinics

- Pediatric specific day – Saturday,

- games, toys,

Specific strategies – Botswana

Universal PMTCT Botswana Government has been proactive in combating the HIV/AIDS epidemic including prevention of HIV infection in children, and treating PMTCT failure cases

While the specific needs of HIV-infected children are not addressed in national HIV policy documents, the needs of children living with HIV have been for the most part addressed in overall HIV treatment guidelines

The ARV program for children has expanded rapidly and ART is provided to children in all 32 sites nationally (100% of districts).

Pediatric Case finding StrategiesNigeria

Screening of children using rapid test at all service delivery points in the health facility using the - Provider initiated testing and counseling (PITC).

Screening at: Children Emergency room PEPFAR pediatric clinics Children wards Infectious disease clinic( including TB patients) Case finding among children of adults accessing care in the

ART clinic

Pediatric Case finding Strategiesin Nigeria cont…….

Community outreaches for HCT in orphanages

Infant Welfare clinic, Primary health care centers

Other private and public health facilities where children are seen

Labor wards, postnatal wards, and the Nursery

Directly observed therapy (DOTs) clinic

Community outreaches for HCT with the adult ART in conjunction with HBC group.

CHALLENGES

Unfavorable infrastructure that hinder tracking of HIV positive infants

Stigma attached to AIDS and myths/Misconceptions well as beliefs and practices. Prevents parents/Guardians from enrolling children to CTC.

WAY FORWARD

Strengthening of tracking system to identify exposed children hence improve EID

Introduction of DBS collection from sites with and without CTC.

Community sensitization regarding treatment of children by Use of various communication channels.

WAY FORWARD cont…..

Strengthen linkages with other points of service delivery such as private hospitals and dispensaries

Integration RCH and CTC hence improve referrals and recording systems.

Increase training programs for health care workers.

THANK YOU ALL FOR LISTENING