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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
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