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Models of Care for Paediatric HIV

Models of Care for Paediatric HIV. Miriam Chipimo MD MPH Reproductive Health & HIV&AIDS Manager, UNICEF, Malawi. Global Context. In 2005 UNICEF raised a call to action to all working to protect children from the AIDS epidemic

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Models of Care for Paediatric HIV

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  1. Models of Care for Paediatric HIV Miriam Chipimo MD MPH Reproductive Health & HIV&AIDS Manager, UNICEF, Malawi

  2. Global Context • In 2005 UNICEF raised a call to action to all working to protect children from the AIDS epidemic • Based on the UN General Assembly Special session on HIV & AIDS in 2001 to attain the MDGs • Call to Action set targets for 2010 in four key areas: P1 –Prevent infections among adolescents & young people P2 – Prevent Mother To Child Transmission of HIV P3 – Provide paediatric treatment P4 – Protect and support children affected by HIV & AIDS

  3. Global Estimates Following the call to action in 2005: • documentation on pART improved • number of children on ART increased • 75,000 by end 2005 • 127,300 by end 2006 (60% in East & Southern Africa region) • 198,000 by 2007 By end 2007: • 2.1 million (6%) of 33.2 million people with HIV were children under 15 years • 420,000 children were newly infected mostly through MTCT • 290,000 children had died • Number of deaths had started to fall due to scale up of PMTCT

  4. Global Programming Framework for scale up of HIV related prevention, diagnosis, care & treatment for infants & children Published in 2008 by WHO & UNICEF & reviewed by IATT: Outlines the following strategies: • Government leadership, ownership and accountability • Integrated & decentralised delivery of HIV services for children • Enhanced early identification of infants exposed to HIV • Reliable procurement & supply management • Laboratory capacity to support HIV services • Community based capacity to support those infected and affected by HIV • Strengthening M&E systems to enhance quality of care

  5. Children and AIDS in Malawi

  6. HIV Prevalence by Age Among Pregnant Women2007 Sentinel Surveillance Source: Malawi Sentinel Surveillance

  7. POLICY, PROGRAMMING & FUNDING ENVIRONMENT • Strong political will to fight HIV/AIDS • National AIDS Policy, 2004 & HIV/AIDS Action Framework 2005- 2009 are in place • Global Funds & Development Partners provide financial & technical contributions coordinated by NAC • Strengthening of drug & supply management, laboratory and diagnostic services ongoing • Strong ART and HTC programmes • PMTCT & Paediatric Guidelines updated • Accelerated scale up of PMTCT services • Roll out of Early Infant Diagnosis programme has started • Strengthening the continuum of care from various entry points into ART

  8. Tools to improve adherence in children on ART • Children are provided with a take home booklet to support adherence to ART that provides: • clear explanation, • reinforcement and documentation of dosing using pill count, • asking for missed doses • appointment schedule for follow up visit • Parent/guardian is counselled on paediatric ART and use of the booklet using the National Paediatric HIV Flipchart

  9. UNDER FIVE CLINICSPAEDIATIC WARDSNUTRITION WARDS 75% PITC NUTRITION COUNSELLING Testing for family Early Infant Diagnosis Rapid HIV Test PMTCT Negative 15% 10% CPT Initiation of ART

  10. STAND ALONE AND INTEGRATED PAEDIATRIC ART CLINICS FEW DEDICATED PAEDIATRIC ART CLINICS Community mobilisation Teen Club MAJORITY ARE INTEGRATED ADULT & PAEDIATRIC ART CLINICS FEW FAMILY CENTRED ART CLINICS • FIXED DRUG COMBINATION – SPLIT ADULT TABLETS AT ALL ART SITES- 2 month supplies given • CHILD FORMULATIONS AT 10 HIGH BURDEN SITES FOR CHILDREN BELOW 1 YEAR • CD4 COUNTS CAN BE MONITORED AT ALL SITES AND VIRAL LOAD AT A FEW CLINICS • VERY FEW DEDICATED SOCIAL WORKERS AT ART SITES

  11. Achievements • Increased number of children accessing HIV testing including DBS PCR from 6 weeks after birth – in total over 5,000 children tested in 2007 • No. of children receiving ART increased dramatically from 2000 in 2005to 11,865 in 2007 • Strong political will and leadership by the government of Malawi in the fight against HIV and AIDS • Strong partnership between UNICEF, Baylor, Lighthouse, WHO, CDC and Clinton Foundation to support MOH • Asteady supply of quality AIDS drugs, strengthening of lab services for CD4 counts and EID • Revised registers for M&E and job aides for PMTCT & pART

  12. Challenges • Weak continuum of care of PMTCT services from ANC, & maternity to under five clinics • Low coverage of more efficacious regimens for PMTCT and Cotrimoxazole Preventive Therapy • Late diagnosis of HIV+ children • Long turnaround time from HIV+ diagnosis to starting ART • M&E system does not monitor outcomes pART • Relatively poor access to ART services (30% of facilities) • Human resource constraints • Community not well sensitised on PMTCT & Paediatric HIV care • Psychosocial support for teenagers living with HIV • Disclosure to the child • Disclosure to family, friends and school

  13. Finally a short movie & thank you for your attention

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