1. Assoc.Prof. Thanyawee Puthanakit, MD. Division of Infectious Diseases, Department of Pediatric Faculty of Medicine, Chulalongkorn University AND HIVNAT, Thai Red Cross AIDS Research Center A clinician perspective’s Why is treatment coverage in children so low? A clinician perspective’s Why is treatment coverage in children so low?

2. Framework of HIV treatment and care WHO Global update on HIV treatment 2013 ENTRY POINTS PED ARV CLINICS UNDERSTAND DYNAMICS

3. Challenges in HIV diagnosis 1. Entry points of high risk infants Infants born to HIV-positive mothers – Depend on coverage of HIV-screening during antenatal care – Rate of infant follow-up after delivery and stop breast-feeding Sick child; malnourished, tuberculosis, hospitalized child e.g. severe pneumonia, severe diarrhea 2. Laboratory tests Virological tests: dried blood spot Point of care testing 3. Awareness and knowledge in the community

4. Cascade of PMTCT WHO Global update on HIV treatment 2013

5. Challenges enrollment in care 1. No. of ARV clinics that could provide pediatric care Thailand: 1016 adult ARV clinics, 616 ped ARV clinics Chiang Rai model: decentralized from tertiary care to community hospital after initial viral suppression. 2. No. of trained personnel to provide pediatric care Difference between adult and children e.g. treatment initiation criteria, adherence rely on family/caretakers, skills to deal with adolescents 3. ART-Eligibility assessment Simplify guideline, in case of CD4-guided approach – access to lab tests 4. Treatment literacy in community J International AIDS Society. 2012; 15: 17358.

6. Linkage into HIV care: Thailand experience Mean age (days) at first CD4517429379269176 Mean age (days) at ART535425398268156 NAP database: 30 Jun 2012

7. d4T 5 mg/ml 3TC 10 mg/ml NVP 10 mg/ml = GPOvir 60 tab/bottle d4T (30 mg) + 3TC (150 mg)+ NVP (200 mg) 5 cm Challenges in ARV initation: ped formulation Thai program: 2004

8. Challenges in ARV initiation Limited ARV formulations/supplies Dosage calculation – per kg, per BSA  body weight band Vulnerable periods – Infancy – Changes of caretaker – Adolescent

9. Our life By K-19 yr M/ Vocation Cert. in Architecture “ For my future, I would like to have family, house, rice farm, job and money, which I earn for a living.” “I am on the promising way of hope.” Our life By K-19 yr M/ Vocation Cert. in Architecture “ For my future, I would like to have family, house, rice farm, job and money, which I earn for a living.” “I am on the promising way of hope.”