1. Capstone Session: Integrating Child Counselling in Adult ART Clinics By the end of this session, trainees should be able to: Explain the key entry points to HIV care for children and adolescents Identify the Essential Elements for the continuum of care for children

2. Integrating Paediatric Care To be effective, paediatric care and treatment interventions need to become an integral part of infant and child survival and health programmes. Family centred care model should be promoted.

3. Essential Elements for the Continuum of Care for Children Mechanism of identifying HIV infected and exposed infants Effective referral system Defined care package Functional care team Staff supportive services Logistics management systems Health management information systems

4. Mechanism of Identifying HIV Infected and Exposed Infants Ensure all entry points are identifying and testing children – Train them – Provide test kits and all materials – Provide registers Entry points – Paediatric ward – ANC – Maternity – Youth Centre – Therapeutic Feeding – Outpatient Dept – Community – Adult wards

5. Organize Know Your Childs Status Day (KYCSD) Campaigns Campaign aimed at testing children Set a date and venue for the activity Prepare logistics: test kits, personnel Conduct mobilization during clinic days Conduct the activity and refer all exposed and infected children for care

6. Establish an Effective Referral System Intra-facility (inter-departmental) referrals – Youth Care Clinic to ART clinic – Antenatal Care to ART clinic – ART clinic to laboratory – ART clinic to wards Inter-facility referrals Community to facility referrals Referral must be written NOT word of mouth

7. A Defined Care Package- 10 Point Care Plan Early infant diagnosis Cotrimoxazole prophylaxis for OI prevention Growth and development monitoring Immunization, nutritional support, including multivitamins and iron Routine quarterly deworming with Mebendazole Aggressive management of acute illnesses Psychosocial support and palliative care Adolescent care and support Family-focused care including PMTCT ART when indicated and available

8. A Functional Care TEAM with a Strategic Direction and a Leader

9. Staff Supportive Services Capacity Building – Formal/didactic Training – CME Multi-disciplinary team meetings Management-support Support supervision/mentorship frame work Exchange programmes/attachments Prevention and management of staff burn-out 9

10. Logistics Management Systems Must have stock cards ARV bi-monthly report and order forms ARV dispensing logs Good storage facilities for the drugs

11. Health Management Information Systems What tools are recommended for data collection and reporting? Data collection tools EID register Pre ART register ART register ART dispensing log Reporting tools Quarterly ART report books Bimonthly Logistics report

12. Family Centred Care Approach Should Be Encouraged HIV infected children and their parents should be cared for in the same clinic. Paediatric HIV and AIDS care and treatment services should therefore be integrated into existing adult ART care services. Parallel care clinics for children should therefore not be initiated at sites that already have adult care clinics.

13. Integration of Paediatric Services into Adult HIV Clinics Involves: Creation of a child-friendly clinic environment – play materials, elementary pictorial books and arts/craft materials Ensure availability of child friendly drug formulations (ARVs and OI drugs) Re-align appointment with adult caregiver seen in the same clinic

14. Integration of Paediatric Services into Adult HIV Clinics Involves: Introduce family-focused approach – Build capacity among staff to care for the children – Active identification of children of the same household – Focus on pregnant women Introduce capacity for routine infant diagnosis Continuous mentoring by experienced clinicians

15. Challenges of Integrating Paediatric HIV Care into Adult HIV Clinic Lack of personnel trained in paediatric care Resistance among adult staff to deal with children Poor paediatric and adolescent approach Lack of child-friendly environment Risk of indirect and inadequate disclosure Weak referral system between paediatric services and adult HIV clinic

16. REVIEW Why is it important to have an effective referral system for all departments in the clinic? What are the key points included in the 10 point management plan for HIV+ children? What are 3 strategies for integrating paediatric services into adult ART clinics? Integrating Paediatric Care into Adult ART Clinics

17. 1.In your team (per facility), think about three specific actions to integrate paediatric HIV counseling in the existing adult clinics 2.When you are ready ask the facilitator to give you a pledge of action form 3.The actions must be completed within the next 3 months

18. Self-Assessment Drafting a Skills Development Plan Think about the 4 counselling events: 1.Feeding and HIV Testing for the Exposed Infant 2.HIV Testing and Counselling 3.Counselling to Prepare for the Start of ART and Supporting Adherence 4.Living with HIV (including Crisis Intervention) For each type, identify 2-3 skills to work on Create an action plan for how you will do it

19. Weve Reached the End of the Course… But not the end of learning!

20. Where Weve Been Introduction: Course Goal, Objectives and Overview Module I: Essential Background Paed HIV Counselling Module II: Feeding and HIV Testing for Exposed Infants Module III: HIV Counselling and Testing Module IV: Preparing to Start of ARVs and Supporting Adherence Module V: Living with HIV (including Crisis Intervention) Capstone: Putting it all together

21. Course Objectives By the end of this 5-day course, trainees should be able to: Explain the importance of EARLY infant diagnosis and treatment in order to reduce infant mortality. Identify the role of effective counselling as part of a comprehensive approach to the care and treatment of HIV infected infants, children, and adolescents. Appropriately use MoH Tools and Guides (Job Aids) to counsel HIV-exposed or infected children, adolescents and their caretakers.

22. Course Objectives (2) By the end of this 5-day course, trainees should be able to: Demonstrate confidence, knowledge and skills to communicate with and counsel HIV-exposed or infected children, adolescents and their caregivers. Effectively address disclosure, positive living, and stigma and discrimination as key parts of the process for every counselling event. Recommend specific actions to improve HIV clinic systems that will result in more effective provision of paediatric HIV counselling services.

23. Job Aids for 5As Paediatric HIV Counselling Flipchart – (all) HIV testing, ARVs, Positive Living Lukias Story – (kids 5-10) stigma, disclosure, adherence Thinking About Sex? Adolescent Booklet (kids 10- 18) SRH prevention with positives Caregiver Booklet – all topics By the bottom of each page of the Paediatric HIV Counselling Flipchart, you will be prompted to work with your client toward an agreed next steps. Infant feeding Algorithm – infant feeding risk reduction Paediatric HIV Counselling Flipchart – infant feeding, disclosure, adherence, abstinence, SRH Lukias Story – disclosure & adherence) Thinking About Sex? Adolescent Booklet – SRH prevention with positives Caregiver Booklet – all topics Exposed Infants Care Guidelines Testing Algorithm for HIV Exposed Infants Child Health Card (2011) Paediatric HIV Counselling Flipchart – profiling pages Counselling HCT Card ART adherence card ASSESSADVISEAGREEASSISTARRANGE

24. Thank You