Transcript Activities by IATT on PMTCT and Paediatric HIV Care and Treatment Siobhan Crowley On Behalf of PMTCT/Pediatric HIV IATT.

Activities by IATT on PMTCT and
Paediatric HIV Care and
Treatment
Siobhan Crowley
On Behalf of
PMTCT/Pediatric HIV IATT
Global Impact of HIV on Children
• Children constitute:
– 12 percent (530,000 of 4.3 million) of new global HIV/AIDS
infections
– 13 percent (380,000 of 2.9 million) of HIV/AIDS deaths annually
– 6 percent (2.3 million of 39.5 million) of the persons living with
HIV
– 15 million AIDS orphans by the end of 2006
Source: UNAIDS 2006
Recommendation GPF London, 2006
• Integrate and provide routine HIV and AIDS prevention and
treatment services for children.
• Integrate guidance on paediatric treatment and care into
child and maternal health
– Develop simple generic guidelines and training on paediatric ART,
cotrimoxazole and nutrition and integrate into modules within IMCI,
PMTCT, TB and HIV and AIDS care training.
• Integrate the distribution of free cotrimoxazole to eligible
children into health services
– Develop decentralized plans to scale up provision through broader
pediatric care, including through clinics, home-based care and youth
friendly centers.
Integrate and provide routine HIV and AIDS
prevention and treatment services for children
• Scale up PMTCT Plus
– Endorse the 2005 Abuja Call for Action in order to ensure universal
access to PMTCT Plus interventions by 2010
• Scale up prevention for young people
– IATT on HIV/AIDS and Young People to strengthen comprehensive
prevention, including through sexual and reproductive health services
for young people
• Pediatric ART formulations and diagnostic availability
– Develop secure funding agreements to support local and generic
production of pediatric formulations, and to provide secure funds for
bulk purchasing of ART. All partners to encourage and support
pharmaceutical companies to develop appropriate formulation for
pediatric ART
IATT on PMTCT and Pediatric HIV
• Initially focused on PMTCT; mission recently expanded
to explicitly include Pediatric HIV
• Broad membership including:
– UN (UNICEF, WHO, UNFPA, World Bank)
– USG (CDC, PEPFAR, USAID-funded orgs., inlc. EGPAF,
Columbia, AED, etc.)
– Foundations (Clinton Foundation)
– Other Academic orgs, including Baylor College
IATT on PMTCT and Pediatric HIV
• Key areas of focus:
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Strategic approaches
Advocacy and mobilisation of national and international partners
Translating norms and standards into Programming
Monitoring and evaluation including harmonization of indicators and
annual report card
• Joint Technical Missions
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To assist with accelerating scale up
Countries with high MTCT burden
High paediatric infections
Significant contribution to under 5 mortality
Government interest in scaling up PMTCT and Peds.
Joint Technical Missions for Scaling
up PMTCT and Pediatric HIV
• 2005
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Rwanda
Cote d’Ivoire
Cameroon
Malawi
• 2007
– Botswana
– Lesotho
– Myanmar
• Planned 2007-2008
• 2006
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India
Burkina Faso
Zambia
Tanzania
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Swaziland
Nigeria
Uganda (?)
Ethiopia (?)
Kenya (?)
Opportunities provided by Joint IATT
missions
• Broad representation of partners
• One voice regarding technical and programmatic
recommendations
• Partners jointly plan and commit to provision of TA,
resources and implementation support for follow up
• Partners respond based on comparative advantages (in
country & regionally)
Government-owned Process
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Invitation from Government
TORs set by Government
Rapid situation or program assessment undertaken
Planning Team organized by Government
Thematic discussions chaired by Govt.
Scale up plan monitored and implemented by Government
JM: Thematic Areas usually
examined
• Program Management
• Comprehensive PMTCT (primary prevention, prevention of
unintended pregnancies, prevention of MTCT, care and support of
children, mothers, and families)
• Infant Feeding
• Paediatric Care and Treatment (optimizing identification, e.g.
diagnosis, and scaling up treatment)
• Monitoring and Evaluation
• Procurement and Supplies Management
Major areas for recommendations (1)
• Program Management
– Mechanism for National coordination of activities,
including those of partners
– Focal Points for PMTCT and Pediatrics
– Decentralized implementation strategy
– Task Shifting or “Task Sharing”
– Training of existing health care workers
Major areas for recommendations (2)
• PMTCT
– How to decentralize service provision, & expand geographical
service coverage
– increase uptake of HIV testing and counseling in ANC settings
– Prioritisation of CD4 testing for pregnant women
– Introduce more efficacious regimens outlined in revised clinical
guidelines (2006)
– Develop program linkages for PMTCT & CH services, e.g. include
HIV exposure status on child health card prior to mother’s
discharge after delivery
– Increase coverage of maternal ARV, e.g. distribution of motherbaby pack prior to delivery in case delivery takes place at home
– Enhance primary prevention activities
Major areas for recommendations (3)
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Pediatric HIV Care and Treatment
• Review treatment and care guidelines
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Reinforce family based HIV care
– HIV-Exposed infants
• Strengthen infant follow up
• Introduce or pilot early virological HIV testing at 6 weeks wherever possible (including
using DBS)
• Introduce earlier antibody testing (9-12 months)
• Institutionalize Co-trimoxazole prophylaxis
– HIV-infected infants
• Increase entry points for children ,e.g. through PITC of sick children and others of
unknown exposure status in certain settings
• expand PCR capacity through DBS
• Increase access to treatment through training of ART providers in pediatric HIV clinical
management.
Major areas for recommendations (4)
• Infant feeding
– Promotion of EBF & reaffirm BFI
– Clarification of AFASS
– Review tools and Training curricula of counselors
• M&E
– Harmonization of programme indicators across partners
– Streamlining of data reporting systems
• PSM
– Integration of Pediatric HIV supply into existing adult supply
mechanism
– Review all HIV commodities
Mission Follow Up Actions
Rwanda
•Development of integrated workplan for PMTCT and Peds.
•Development of steering committee for children & HIV
•Integration of services significantly improved by end of 2006: i)
94% of VCT sites are also PMTCT; ii) 83% of ARV sites are also
PMTCT; iii) 89% of ARV sites also provide ART for children.
•Ministerial instruction for testing of hospitalised children
•PMTCT training modules updated
Nutritional support for HIV+ mothers in last trimester and first 6
months after delivery
Malawi
•PMTCT coordinator moved from RH to HIV unit (locus for ART and
VCT)
•IMCI revised to include paediatric HIV care
•Generic PMTCT training package adapted for local use
•Community IMCI programme adapted to optimize ID of children
Mission Follow Up Actions
India
• Early diagnosis for children incorporated into national HIV
plan
• Paediatric HIV package of care defined by Indian Institute
of Paediatrics after request by Government
• Nutritional support package for HIV-infected children being
revamped.
•Paeditric ARV dosing and formulary established
Zambia
• National PMTCT and paediatric guidelines revised and
disseminated
• U5 card revised to include exposure status and prompt for
early diagnosis and initiation of co-trimoxazole prophylaxis
• PMTCT and paediatric M&E indicators revised and rolled
out
Mission Follow Up Actions
Burkina Faso • Focal points for PMTCT and Paediatrics placed in MOH
• Collaboration developed with Clinton Foundation to
expand access to paediatric HIV care and treatment
Tanzania
• National PMTCT and paediatric M&E indicators finalized
• New National strategic plan on HIV will include children
Lesotho
• Policy developed to expand PITC for all children in the
country being seen at U5 clinics
All Countries • Received UNITAID funding for PMTCT scale up and
introduction of more efficacious regimens
• Received funding for other PMTCT/Peds activities from
HQ.
•Ongoing TA and review of policy and related documents
Other IATT achievements &
products
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Global strategy
Report card
Draft indicator registry and programming tool
Draft programming guide on scaling up
paediatric care and treatment
• Scale planning guide
• Regional workshops on scale up planning
GPF Follow up
Integrate Guidance on Paediatric Treatment and Care
into
Child and Maternal Health
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Revised WHO guidelines available (2006)
– ARV Treatment, including staging
– Infant diagnosis guidelines (PMTCT f/u and PITC)
– Co-trimoxazole guidelines
– Complementary IMCI
– Ped care integrated into adult tools (IMAI)
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Promtion of keeping information regarding HIV exposure on child health cards
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Expansion of co-trimoxazole use for exposed infants by incorporation into national
guidelines
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HIV expanded course on IMCI (field tested in Zambia, Uganda, Nigeria and
subsequently revised)
Paeditrid HIV and PMTCT integarted inot adult HIV care approaches (IMAI)
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Integrate the Distribution of Free Co-trimoxazole to
Eligible Children into Health Services
• Advocacy for provision of free co-trimoxazole in national plans and
guidelines
• Inclusion of co-trimoxazole in UNITAID funding for both
UNICEF/WHO and Clinton Foundation
• Recommend addition of prompt on child health cards for HIVexposed infants
Scale up PMTCT Plus
• Advocacy for training for decentralized approach and
increased geographical coverage
• Introduction of routine HIV screening in ANC settings
• Focus on all four prongs during JMs
• Look for increased linkages/integration to care and
treatment, for mothers, children, families to ANC services.
Scale up Prevention for Young People
• Increased focus on prongs 1 and 2 during joint
missions
• Technical lead by UNFPA
• Activities coordinated through IATT on YP
Pediatric ART Formulations and
Diagnostic Availability
• Guidance on appropriate pediatric formulations being developed
through WHO leadership
• Development of pediatric formulations by generic manufacturers (e.g.
CIPLA, Ranbaxy)
• Support for bulk purchase of ARTs and diagnostics trough UNITAID
• Public Private Partnership – addressing bottlenecks in formulations,
supply management, in-country registration, education & training
• Expanded training in Pediatric HIV clinical management (e.g. through
Baylor)
• Expanded training and capacity building in DBS (Clinton Foundation,
EGPAF, Columbia, etc.)
• Results: Significant increase in numbers on treatment.
% of all HIV + pregnant women receiving ARV
prophylaxis
PMTCT Access Increasing but Lowest
in Regions with Greatest Need
100%
91.5%
85.6%
90%
80%
70%
60%
50%
40%
30%
21.6%23.6%
20%
10%
9.5%10.3%
13.9%
7.5%
1.6% 2.3%
0%
West and
Central Africa
C. and S
America
East and South East Asia and
Africa
Pacific
2004
2005
Source: UNICEF PMTCT and Pediatric Care Report Card 2006
C & Eastern
Europe
PMTCT Access
• Scores expected to be higher for next report
card as a result of increasing commitment and
involvement, but still below needed levels to
reach UNGASS targets in 2010.
Conclusions
• IATT has been an effective forum in
strengthening and consolidating the global
response to PMTCT and Pediatric HIV Care
and Treatment
• Joint Technical Missions have been instrumental
in changing landscape in countries so far with
introduction of new policies, capacity building,
and new resources