Transcript Slide 1
WHO Guidelines:
2010 and Beyond
Christian Pitter, MD MPH
Elizabeth Glaser Pediatric AIDS Foundation
Eliminate Pediatric HIV Now.
EGPAF International Programs: 2000
8 sites in 6 countries 2010
>5,400 sites in 16 countries United States India Rwanda Cote d’Ivoire Cameroon D.R. Congo Uganda Kenya Tanzania Malawi Mozambique South Africa Lesotho Zimbabwe Swaziland Zambia * Program initiated with EGPAF support and transitioned to other implementers China
70 000 60 000 50 000 40 000 30 000 20 000 10 000 0 1996 1998 2000 2002 2004 2006 2008
Estimate of the annual number of infant infections averted through the provision of ARV prophylaxis to HIV-positive pregnant women, globally, 1996 –2008 Estimated number of new pediatric infections with and without PMTCT prophylaxis globally, 1996-2008 70,000 infections averted in 2008
UNAIDS/WHO/UNICEF 2010
Four Linked Guidelines
ARVs for Vertical Transmission Pediatric ART IYCF Adult & Adolescent ART
What the 2010 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
Overall Major Changes
• ↑ 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
If implemented at scale, the virtual elimination of pediatric HIV
Guidelines as a Leverage Point
Elimination of Pediatric HIV Concerted Efforts
Implementation Advocacy Research Advocacy
National Systems, Partners and Communities
Research
WHO Guidelines Current Success
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What We Need to Do:
Be of Service…
1. To our host countries’ HIV response
o Assist/Advise in adaptation o Assist/Advise in implementation
2. To districts and facilities we support
o Implementation planning and support
3. To our Mission
o See 1 & 2 above o Evaluate o Document & Share
Supporting Guideline Adaptation & Implementation
• Phase I, II, and III Toolkits • Technical advocacy/support at national level • Technical support at implementation level • Inter-country support • Tracking and sharing country progress on adaptation and implementation for four technical areas • DOCUMENT, EVALUATE, DOCUMENT
Phase 1 Toolkit
Phase 2: Program, District and Facility Level Planning for Implementation
• • • • • Revised National Guideline Implementation Planning Tools District Implementation Roll-Out Planning Tools Costing Implementation of the Revised PMTCT Guidelines Tool Site Implementation Roll-out Planning Tools Linkage and Integration of PMTCT and HIV Care and Treatment Site Assessment Tool
Phase 2: Program, District and Facility-Level Planning for Implementation Con’t.
• • • • Development of Standard Operating Procedures Tools Slide sets on the 2010 Revised WHO Guidelines/ Adapted National Guidelines Monitoring and Evaluation Tools Partnership Planning Tools
* All tools available on website
Phase 3: Measuring Impact and Implementation of the Revised WHO Guidelines
• PMTCT Indicator Matrix to monitor the revised WHO guidelines • Q&A Interview on Revising M&E Systems at the Country Level • Using EZQI PMTCT to measure clinical quality of care.
Country/ Indicator Cameroon China Côte d’Ivoire DRC India Kenya Lesotho Malawi
Status of Guideline Adaptation and Implementation for PMTCT (1)
Revised national guidelines Roll-out of trainings Distribution of tools/job aids to health facilities Drugs forecasted Revision of national indicators Revision of registers/nationa l reporting forms Implementation at facilities
Status of Guideline Adaptation and Implementation for PMTCT (2)
Country/ Indicator Mozambique Rwanda South Africa Swaziland Tanzania Uganda Zambia Zimbabwe Revised national guidelines Roll-out of trainings Distribution of tools/job aids to health facilities Drugs forecasted Revision of national indicators Revision of registers/nationa l reporting forms Implementation at facilities
Status of guideline revision at national level
PMTCT guidelines 1 Prophylaxis regimen adopted 1 3 15
Yes countries No countries
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Option A countries Option B countries Other*
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?
Final Thoughts
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Challenges
o Accelerate scale-up and improve quality o Fundamental changes to health system functioning (Integration, Supply chain, Funding, Human resources) o Monitoring & Evaluation •
Opportunities
o Collaborate in a new way o Move closer to elimination: believe, plan, communicate & execute o Bring non-clinical elements to the fore
Thank You
• • • • • • • • Host Governments EGPAF Country Teams International and local partners US Centers for Disease Control and Prevention USAID Johnson & Johnson CIFF ViiV Healthcare