Transcript SCALE UP OF HIV-RELATED PREVENTION, DIAGNOSIS, CARE AND TREATMENT FOR INFANTS AND CHILDREN A Programming Framework.

SCALE UP OF HIV-RELATED
PREVENTION, DIAGNOSIS, CARE
AND TREATMENT FOR INFANTS AND
CHILDREN
A Programming Framework
CONTENTS
I. Background: Putting HIV care and treatment
for children in context
II. Components of the care package:
Interventions to aid child survival in the
context of HIV
III. Key Strategies: 7 Strategies and action points
for scaling up HIV diagnosis, care, support
and treatment for children
IV. Resources and Tools: Links to key resources
I. BACKGROUND
HIV burden among children
• 2 million children (under 15 yrs old) have HIV
– 90% live in sub-Saharan Africa
• Nearly 370 000 children were newly infected
in 2007
– Most infections could be avoided through PMTCT
interventions
BACKGROUND
HIV affects child survival
• Without treatment, 50% of children with HIV
die by age 2 (30% by age 1)
• About 270 000 children died of causes related
to HIV in 2007, most from sub-Saharan Africa
• Those with HIV are more likely to die from
common childhood illnesses (respiratory
infections, TB, malaria, undernutrition, etc.),
including those who survive the first year of
their life
BACKGROUND
Scope of the Programming Framework
• To guide governments in
resource constrained settings
scale up HIV prevention,
diagnosis, care and treatment
for children who are exposed to
or who have HIV
• Focuses on the needs of
countries with a high HIV
burden
BACKGROUND
Guiding Principles for peds care and treatment
Urgency
Universal
Access
Familycentered
Care
Life-long
Care
Highquality
care
II. COMPONENTS OF THE CARE
PACKAGE
1. Interventions for all infants
and children to aid survival
All children
HIV exposed
children
HIV pos
children
2. Survival interventions
for infants and
children who are
exposed to HIV
3. Survival interventions
for infants and children
who are infected with
HIV
1. Interventions for all children to aid
survival
• Newborn care, including
– Skilled care at birth
– Early initiation of exclusive breastfeeding
– Early postnatal visit
• Prevention interventions, including
–
–
–
–
Exclusive breastfeeding up to 6 months of age
Good maternal nutrition
Growth monitoring
Complete, timely immunization
• Treatment interventions, including
– Oral rehydration therapy for diarrhoea
– Prompt treatment for pneumonia and malaria
2. Survival interventions for infants
and children who are exposed to HIV
• Antiretroviral prophylaxis (maternal and infant)
• Provider-initiated HIV testing,
including infant viral testing
• Early and regular clinical assessment
• Co-trimoxazole prophylaxis
• Counseling and support around
nutrition and infant feeding
• Care, treatment and support for family members
3. Survival interventions for infants
and children who have HIV
•
•
•
•
•
Early antiretroviral therapy and follow-up care
Adherence and treatment support
Regular clinical and laboratory monitoring
Psychosocial support
TB screening, prevention and management
3. Survival interventions for infants and
children who have HIV (cont.)
• Nutrition, infant and young child feeding
– Macronutritional support, vitamin
supplementation, regular growth monitoring
• Management of severe malnutrition
• Prevention, active early detection and
management of opportunistic
infections
– Pneumonia, diarrhoea, malaria
• Additional Immunizations
III. STRATEGIES FOR SCALING UP
1. Enhance government leadership, ownership and
accountability
2. Integrate and decentralize delivery of HIV prevention,
diagnosis, care and treatment services to children
3. Enhance early identification of infants who are
exposed to or have HIV
4. Ensure reliable procurement and supply management
5. Bolster laboratory capacity
6. Strengthen community-based capacity for care and
support
7. Strengthen monitoring and evaluation systems
1. Enhance government leadership,
ownership, and accountability
i. Initiate a rapid, systemic situational analysis
of current programming, including an
assessment on pediatric interventions
ii. Update pediatric treatment targets
iii. Ensure that management and coordination
structures address pediatric care and
treatment
2. Integrate and decentralize delivery of
HIV prevention, care, support and
treatment services to children
Integrate HIV diagnosis, care, treatment, and support for
children into:
i. Existing HIV care and treatment services
ii. Existing maternal, newborn and child health programs
Decentralize:
iii. Interventions to lower-level health systems where
applicable
iv. Utilize communities for early identification and provision
of care
2. Integrate and decentralize delivery
Simplified approaches to dosing and use of
simplified formulations such as FDCs help to
decentralize pediatric care
Pediatric Dosing
Chart example
3. Enhance early identification of infants and
children who are exposed to or have HIV
i. Ensure updated policy and technical
guidance that follow-up with identified HIVexposed infants and children
ii. Document info on receipt of serves for
PMTCT on maternal and child health cards
iii. Use DBS to support early diagnosis
iv. Implement provider-initiated testing and
counseling at sites likely to yield a high
volume of positive test results
3. Enhance early identification of infants and
children who are exposed to or have HIV (cont.)
v. Use family-centered approaches; secure HIV
testing for additional family members
vi. Use IMCI and IMAI approaches at peripheral
sites with referral for HIV testing
vii. Better use CHWs
viii. Identify where routine determination of HIV
exposure status is feasible and efficient
3. Enhance early identification of infants and children
who are exposed to or have HIV (cont.)
E.g.: Child Health Card (Zambia)
Test
Follow-up time
Co-trimoxazole
Date baby referred to ART;
Date initiated; Age of
initiation
Infant feeding
3. Enhanced early identification of infants and children
who are exposed to or have HIV (cont.)
Simple tools that
explain the process
of sample collection
for DBS can help
ensure high quality
samples are
collected
Care for child
Potential
Bottleneck!
Example of EID System (Kenya)
1 day
Packaging
4 days
Sample
Collection
ART/PMTCT
centre
2 Week turnaround to receipt
of results
Potential
Bottleneck!
Courier
Samples
LA BORA T OIRE NA T IONA L DE RE F E RE NCE
HIV S A MPLE S U MMA RY F ORM
Nam e:
1 day
5 days
Courier Results
D ate:
D
D
/
M
M
/
Y
Y
Heamatology
Chemistry
(purple tube)
(red - plain tube)
Viral Load
#
(purple tube)
#
CD4
#
Infant PCR
S am pl es :
ID
(purple tube)
of
(lavender tube)
P a t ie nt
HIV Elisa
Num be r
(red - SST tube)
S i te
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Cl i ni c
S i gnature:
L ab
Si gnature:
Cl i ni c
I ni ti al s :
L ab
I ni ti al s :
Testing lab
1 day
Source: J. Hungu, CHAI
4. Ensure reliable procurement and
supply management
i.
Coordination of supply stakeholders and linkages
with overall supply implementation plans
ii. Integrated supply systems based on what exists and
already works
iii. Ensure children are included in national PSM plans
5. Bolster laboratory capacity
i. Plan for lab service expansion to
accommodate early infant testing for HIV
ii. Select assays for viral diagnosis
iii. Develop systems for timely and reliable use
of lab results
iv. Provide staff with appropriate education and
training to ensure high-quality diagnostic
services
6. Strengthen
community-based
capacity for care
and support
i.
Integrate community-based
approaches into child health and
HIV programming strategies
ii. Accelerate case-finding through
integration into communityhealth programmes
iii. Improve case follow-up and
essential care for HIV-exposed
newborns and their families
iv. Enhance community capacity to
provide care and support
v. Promote child survival through
nutrition, immunization, malaria,
and TB interventions
vi. Adapt norms for confidentiality
and disclosure to specific local
settings
7. Strengthen monitoring and
evaluation systems
i. Include core indicators of PMTCT and HIV
care and treatment services for children in
national monitoring and evaluation
frameworks
ii. Expand efforts to monitor programme
effectiveness and quality
IV. SELECTED RESOURCES AND TOOLS
1. Guidance documents
2. Websites
3. Training curricula
4. Tools
1. Guidance documents referred to in
the Programming Framework
• WHO
– Guidelines
• African Network for Care of Children Affected by
HIV/AIDS (ANNECA)
– Handbook
• Columbia University ICAP
– Pocket Guide and Clinical Manual
• Centers for Disease Control and Prevention
– A range of tools to support programming
2. Websites
• WHO HIV/AIDS: http://www.who.int/hiv/en
• UNICEF: http://www.unicef.org
• International HIV/AIDS Alliance:
http://www.aidsalliance.org
• Mothers2Mothers (m2m):
http://www.m2m.org
• Elizabeth Glaser Pediatric AIDS Foundation:
http://www.pedaids.org
3. Training Curricula
• IMAI/IMCI
– Complementary course on HIV/AIDS (chart
booklet)
• WHO/UNICEF
– Infant and young child feeding counseling: an integrated
course
• African Network for the Care of Children affected by
HIV/AIDS (ANECCA)
– An HIV care training curriculum
4. Tools
• Spectrum
– software package developed by UNAIDS, used to
determine consequences of current trends and
future programme interventions with respect to
the HIV epidemic
– For more info, visit
http://www.unaids.org/en/KnowledgeCentre/HIV
Data/Methodology