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Christian Pitter, MD MPHElizabeth Glaser Pediatric AIDS Foundation

WHO Guidelines: 2010 and Beyond

Global Summary of the AIDS Epidemic, 2008

People newly infected with HIV in 2008

AIDS-related deaths in 2008

Total 33.4 million [31.1 - 35.8 million] Adults 31.3 million [29.2 - 33.7 million] Women 15.7 million [14.2 - 17.2 million] Children under 15 years 2.1 million [1.2 - 2.9 million]

Total 2.7 million [2.4 – 3.0 million]Adults 2.3 million [2.0 – 2.5 million]Children under 15 years 430,000 [240,000 - 610,000]

Total 2.0 million [1.7 – 2.4 million]Adults 1.7 million [1.4 – 2.1 million]Children under 15 years 280,000 [150,000 – 410,000]

Number of people living with HIV in 2008

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EGPAF’s Mission

The Elizabeth Glaser Pediatric AIDS Foundation seeks to prevent pediatric HIV infection and to eradicate pediatric AIDS through research, advocacy, and prevention and treatment programs.

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Estimate of the annual number of infant infections averted through the provision of ARV prophylaxis to HIV-positive pregnant women, globally, 1996–2008

1996 1998 2000 2002 2004 2006 2008

60 000

50 000

40 000

20 000

0

30 000

10 000

70 000

1997 1999 2001 2003 2005 2007

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Estimated number of new pediatric infections with and without PMTCT prophylaxis globally,

1996-2008

UNAIDS, AIDS Epidemic Update2009

70,000 infections averted in 2008

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PMTCT Study Results and Guidelines Revisions (1994-2009)

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Four Linked Guidelines

ARVs for Vertical

TransmissionPediatric ART

Adult & Adolescent ARTIYCF

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What the New Guidelines Represent

• Progress of knowledge in provision of HIV services

• The first step in codifying knowledge into standards of care

• Opportunity to improve approaches, service delivery, and outcomes

• A relatively rare “leverage point” to focus attention and effort

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New Elements of the Guidelines

PMTCT:

• Emphasis on treating eligible pregnant women

– CD4 threshold 200 → 350

• Start ARV prophylaxis earlier

– 28 → 14 weeks

• Phase out sd-NVP

• Prophylaxis during the breast-feeding period

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New Elements of the Guidelines

• Pediatrics: – Immediately start treatment for all HIV-positive

children less than 2 years old

• Adults:

– Simplified and more tolerable regimens

– CD4 threshold 200 → 350

• Infant and Young Child Feeding:

– Primacy of exclusive breast-feeding

– System-wide decision of optimal feeding practices

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Overall Major Changes

If implemented at scale, the virtual elimination of pediatric HIV

• ↑ logistical and supply-chain needs

• ↑ need for long-term follow-up and integration between PMTCT and HIV care and treatment

• ↑ need for treatment

• Advancement of monitoring and evaluation

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Guidelines as a Leverage Point Elimination of

Pediatric HIV

National Systems and Partners Current Success

EGPAF EffortsImplementation

AdvocacyResearch

WHO Guidelines

National Systems and Partners

EGPAF EffortsImplementation

AdvocacyResearch

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What We Need to Do: Be of Service…

1. To our host countries’ HIV response o Assist/Advise in adaptationo Assist/Advise in implementation

2. To districts and facilities we serveo Implementation planning and support

3. To our Missiono See 1 & 2 aboveo Evaluate o Document & Share

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Supporting Guideline Adaptation & Implementation

• Toolkits phases I, II, and III

• Technical advocacy/support at national level

• Technical support at implementation level

• Inter-country support

• Global sharing and leadership

• DOCUMENT, EVALUATE, DOCUMENT

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Continuing the Cycle

• Revisions planned for 2012

• What direction for the next revisions?

• What do we need to know to inform the decisions?

• Who will do the research?

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Final Thoughts

• Challengeso Accelerate scale-up and improve quality

o Fundamental changes to health system functioning (Integration! Supply chain! Funding! Human resources!)

o Monitoring & evaluation

• Opportunitieso Collaborate in a new way internally & externally

o Move closer to our mission: believe, plan, communicate & execute

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Thank You

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DISCLAIMER: This program was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief, as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Private donors also supported costs of activities in many countries. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.