1. ICASA 2008 Academic and industrial priorities on HIV research in children Ruth Nduati Associate professor of Paediatrics University of Nairobi

2. ICASA 2008 Magnitude of HIV among children in 2007 370,000 new paediatric HIV infections 370,000 new paediatric HIV infections Declining number of new infections Declining number of new infections because of roll-out of Prevention of Mother to child transmission (PMCT) programs because of roll-out of Prevention of Mother to child transmission (PMCT) programs declining HIV prevalence among younger women declining HIV prevalence among younger women 2.0million children living with HIV 90% in sub Sahara Africa 2.0million children living with HIV 90% in sub Sahara Africa Increasing numbers of children living with HIV Increasing numbers of children living with HIV Declining mortality as treatment programs roll out. Declining mortality as treatment programs roll out.

3. ICASA 2008 Children’s HIV research priorities Who defines the priorities? Who defines the priorities? Priorities frequently defined at global level and less so at Regional and National levels. Priorities frequently defined at global level and less so at Regional and National levels. Various WHO technical working groups Various WHO technical working groups Academic institutions from developed country settings Academic institutions from developed country settings National universities – grey literature National universities – grey literature How well are children’s research priorities defined? How well are children’s research priorities defined? Global themes are better articulated compared to local problems eg. diagnosis, treatment, what to start with, Global themes are better articulated compared to local problems eg. diagnosis, treatment, what to start with, Who should define the research agenda? Who should define the research agenda?

4. ICASA 2008 Research themes around prevention- PMCT (i) A. PMCT HIV diagnosis in HIV infected women HIV diagnosis in HIV infected women What ARV protocols? What ARV protocols? When to start and for how long When to start and for how long What to do in subsequent pregnancies What to do in subsequent pregnancies Women’s long term treatment needs versus multiple ARV protocols for pMCT Women’s long term treatment needs versus multiple ARV protocols for pMCT Infant feeding Infant feeding

5. ICASA 2008 Research themes around prevention beyond PMCT Behaviour change communication Behaviour change communication Post-exposure prophylaxis following sexual assault Post-exposure prophylaxis following sexual assault

6. ICASA 2008 Research themes around HIV treatment Testing/diagnosis Testing/diagnosis When to start treatment When to start treatment What to start treatment with What to start treatment with When to switch When to switch What to use as second-line treatment What to use as second-line treatment HIV/TB treatment HIV/TB treatment HIV/severe malnutrition treatment HIV/severe malnutrition treatment Clinical laboratory monitoring Clinical laboratory monitoring Adherence Adherence non-ART care. non-ART care.

7. ICASA 2008 Research themes around prevention – Uncharted waters ARV treatment of children with severe malnutrition – pharmacokinetics of the ARV’s. ARV treatment of children with severe malnutrition – pharmacokinetics of the ARV’s. Pharmacological doses of micronutrients in management of HIV in children. Pharmacological doses of micronutrients in management of HIV in children. Short and long term effects of ARV’s on growth and development Short and long term effects of ARV’s on growth and development Mental and psychomotor development of children on treatment. Mental and psychomotor development of children on treatment. Interaction of ART and immunization and other treatment protocols Interaction of ART and immunization and other treatment protocols

8. ICASA 2008 New horizons in paediatric HIV research Long term effects of ARV’s Long term effects of ARV’s Short and long term effects of ARV’s on growth and development Short and long term effects of ARV’s on growth and development Mental and psychomotor development. Mental and psychomotor development. Interaction of ART and immunization and other treatment protocols Interaction of ART and immunization and other treatment protocols Male circumcision Male circumcision Infant circumcision Infant circumcision Pre-adolescent and adolescent circumcision Pre-adolescent and adolescent circumcision VCT for older children and adolescents VCT for older children and adolescents

9. ICASA 2008 ACQUISITION OF NEVIRAPINE RESISTANCE (NVP ®) IN MOTHER AFTER SINGLE DOSE NVP ALONE OR IN COMBINATION WITH OTHER ANTIRETROVIRALS Lochman and McIntyre Lancet 2007

10. ICASA 2008 What is the way forward? (i) There is a need to formally review the research agenda around paediatric HIV There is a need to formally review the research agenda around paediatric HIV An inclusive process will yield better results – program, policy and research folks meeting together. An inclusive process will yield better results – program, policy and research folks meeting together. Deliberate efforts to develop in-country mechanisms as well as the international forums. Deliberate efforts to develop in-country mechanisms as well as the international forums.

11. ICASA 2008 What is the way forward? (2) An output from the IAS meetings should be research questions and not only the summary of the key findings. An output from the IAS meetings should be research questions and not only the summary of the key findings. The research agenda should then be widely disseminated though peer reviewed journals The research agenda should then be widely disseminated though peer reviewed journals Research funding agencies should be involved in the process. Research funding agencies should be involved in the process.

12. ICASA 2008 Thank you