Models of Care for PaediatricHIV
Miriam Chipimo MD MPH
Reproductive Health & HIV&AIDS Manager,
UNICEF, Malawi
Global Context
In 2005 UNICEF raised a call to action to all working toprotect children from the AIDS epidemic
Based on the UN General Assembly Special session onHIV & 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
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 childrenunder 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
Global Programming Framework for scale up of HIV relatedprevention, diagnosis, care & treatment for infants & children
Published in 2008 by WHO & UNICEF & reviewed by IATT:
Outlines the following strategies:
1.Government leadership, ownership and accountability
2.Integrated & decentralised delivery of HIV services forchildren
3.Enhanced early identification of infants exposed to HIV
4.Reliable procurement & supply management
5.Laboratory capacity to support HIV services
6.Community based capacity to support those infected andaffected by HIV
7.Strengthening M&E systems to enhance quality of care
Children and AIDS in Malawi
HIV Prevalence by Age Among Pregnant Women2007 Sentinel Surveillance
Source: Malawi Sentinel Surveillance
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 anddiagnostic 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 pointsinto ART
Tools to improve adherence in children on ART
Children are provided with a takehome booklet to supportadherence to ART that provides:
– clear explanation,
–reinforcement and documentationof dosing using pill count,
–asking for missed doses
–appointment schedule for followup visit
Parent/guardian is counselled onpaediatric ART and use of thebooklet using the NationalPaediatric HIV Flipchart
PITC
Early InfantDiagnosis
RapidHIV Test
CPT
NUTRITION COUNSELLING
Initiation ofART
PMTCT
Testingforfamily
UNDER FIVE CLINICS PAEDIATIC WARDS NUTRITION WARDS
Negative
75%
10%
15%
FEWDEDICATEDPAEDIATRICART CLINICS
MAJORITY AREINTEGRATED ADULT &PAEDIATRIC ART CLINICS
FEW FAMILYCENTRED ARTCLINICS
FIXED DRUG COMBINATION – SPLIT ADULT TABLETS AT ALL ARTSITES- 2 month supplies given
CHILD FORMULATIONS AT 10 HIGH BURDEN SITES FOR CHILDRENBELOW 1 YEAR
CD4 COUNTS CAN BE MONITORED AT ALL SITES AND VIRAL LOADAT A FEW CLINICS
VERY FEW DEDICATED SOCIAL WORKERS AT ART SITES
STAND ALONE AND INTEGRATED PAEDIATRIC ART CLINICS
Teen Club
Communitymobilisation
Achievements
Increased number of children accessing HIV testing including DBSPCR from 6 weeks after birth – in total over 5,000 children tested in2007
No. of children receiving ART increased dramatically from 2000 in2005 to 11,865 in 2007
Strong political will and leadership by the government of Malawi in thefight against HIV and AIDS
Strong partnership between UNICEF, Baylor, Lighthouse, WHO, CDCand Clinton Foundation to support MOH
A steady 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
Challenges
Weak continuum of care of PMTCT services from ANC, &maternity to under five clinics
Low coverage of more efficacious regimens for PMTCT andCotrimoxazole 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
Finally a short movie &thank you for your attention