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Expanding Pediatric Access To ART In South Africa

Expanding Pediatric Access To ART In South Africa. Desireé Michaels, University of Cape Town (Public Health & Fam. Med) Brian Eley, University of Cape Town (Child and Adolescent Health) Lewis Ndhlovu , Horizons/Population Council Naomi Rutenberg , Horizons/Population Council. Objectives.

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Expanding Pediatric Access To ART In South Africa

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  1. Expanding Pediatric Access To ART In South Africa Desireé Michaels, University of Cape Town (Public Health & Fam. Med) Brian Eley, University of Cape Town (Child and Adolescent Health) Lewis Ndhlovu, Horizons/Population Council Naomi Rutenberg, Horizons/Population Council

  2. Objectives • Provide information on current practices and perceptions related to the treatment of children with HIV. • Offer evidence-based recommendations regarding expansion of ARV access to children. Nathan Golon

  3. Data and methods • Study period: 11 April to 21 June 2005. • Convenience sample of 16 sites in 5 provinces providing ARV services to children. • Semi-structured interviews with 72 health workers (facility managers, doctors, nurses, pharmacists, counselors, social workers). • Structured questionnaires with 126 caregivers of children on ARVs.

  4. Progress in pediatric ARV service provision • Children are getting treatment services. • As of March 2005, study sites reported 1,300 children on ARVs with about 60% under the age of 6 years. • Adherence is generally good. • Dedicated professionals are working to expand treatment access for children. • Doctors have forged links and partnerships with organizations to provide services. • MSF and donors have played a large role. • Providers are building skills in the area of pediatric HIV care and management. • Recognized need for additional attention to chronic care issues and adolescents, as well as for pediatric-specific training.

  5. Pediatric-trained health workers are essential to the rollout • Most doctors had no formal training in pediatric HIV management. • Trained by colleagues, self study, seminars, workshops. • Nurses felt shortage of skills in pediatric HIV care. • Most trained by workshops, VCT, government training. • Many found working with children complicated (e.g., dosing calculations, drawing blood from children). • Pharmacists found it difficult to assess adherence. • Changing pediatric formulations as child grows requires re-training caregivers regularly. • Much time spent packaging, labeling, color coding bottles.

  6. Early referral of children is critical • From where are children referred to HIV clinics? • Community clinic (71%), inpatient ward (21%), private practitioner (6%), PMTCT service (2%). • Why were these children first tested for HIV? • Chronically ill (44%), hospitalized (40%), TB (6%), other reason (8%). • Primary-level clinics lack lab equipment and/or transportation needed for viral loads and CD4 counts to assess children for treatment.

  7. Better data collection is needed • No standardized data collection for HIV management and pediatric treatment currently exists. • Forecasting drug quantities is problematic without information on the number of kids in need of treatment.

  8. Community-level barriers are a serious obstacle • Lack of community awareness and skepticism surrounds ARVs for children. • Ignorance of HIV status. • Changing caregivers results in incomplete patient history and inconsistent follow-up. • Lack of documentation impedes grant process for poor families.

  9. Supporting caregivers is also important • High burden of disease: 75% of caregivers reported at least one person in the family infected with HIV besides the child. • Caregivers depended on disability grants (71%), child care grants (56%), old age pensions (19%). • 17% of caregivers missed appointments because they couldn’t pay for transport.

  10. Where do we go from here? • How do we better identify HIV-infected children? • Build effective, comprehensive PMTCT programs and referral services. • How do we better train health professionals to meet treatment needs of children? • Uniform training programs and manuals, pediatric- specific training. • How do we monitor services for HIV-infected children? • Advocate policy for better data collection, including clear definitions for children.

  11. Where do we go from here? • How do we foster collaboration between different clinical and non-clinical sectors, government, and NGOs? • DOH should play facilitative role bringing groups together. • What are the models of care for children? • Family-centered model is ideal and feasible at primary care-level, and should include integration of PMTCT, child health, SRH, ART, STI, and TB services.

  12. Acknowledgements • Research team at University of Cape Town • Provincial Health Departments, Eastern Cape and Free State • USAID/PEPFAR through Horizons/Population Council • Collaborators: EASTERN CAPE • MSF – Lusikisiki/Dr. Herman Reuter, East London (CM)/Dr. Gerald Boon GAUTENG • Baragwaneth Hospital/Dr. Tammy Myers FREE STATE • University of Free State/Dr. Lizzy Tabane KWA-ZULU NATAL • McCord Hospital/Dr. Willem Vlok WESTERN CAPE • Red Cross Hospital/Dr. Brian Eley, MSF – Khayelitsha/Dr. Eric Goemaere

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