Presentation on theme: "Activities by IATT on PMTCT and Paediatric HIV Care and Treatment"— Presentation transcript:
1Activities by IATT on PMTCT and Paediatric HIV Care and Treatment Siobhan CrowleyOn Behalf ofPMTCT/Pediatric HIV IATT
2Global Impact of HIV on Children Children constitute:12 percent (530,000 of 4.3 million) of new global HIV/AIDS infections13 percent (380,000 of 2.9 million) of HIV/AIDS deaths annually6 percent (2.3 million of 39.5 million) of the persons living with HIV15 million AIDS orphans by the end of 2006Source: UNAIDS 2006
3Recommendation 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 healthDevelop 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 servicesDevelop decentralized plans to scale up provision through broader pediatric care, including through clinics, home-based care and youth friendly centers.
4Integrate and provide routine HIV and AIDS prevention and treatment services for children Scale up PMTCT PlusEndorse the 2005 Abuja Call for Action in order to ensure universal access to PMTCT Plus interventions by 2010Scale up prevention for young peopleIATT on HIV/AIDS and Young People to strengthen comprehensive prevention, including through sexual and reproductive health services for young peoplePediatric ART formulations and diagnostic availabilityDevelop 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
5IATT on PMTCT and Pediatric HIV Initially focused on PMTCT; mission recently expanded to explicitly include Pediatric HIVBroad 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
6IATT on PMTCT and Pediatric HIV Key areas of focus:Strategic approachesAdvocacy and mobilisation of national and international partnersTranslating norms and standards into ProgrammingMonitoring and evaluation including harmonization of indicators and annual report cardJoint Technical MissionsTo assist with accelerating scale upCountries with high MTCT burdenHigh paediatric infectionsSignificant contribution to under 5 mortalityGovernment interest in scaling up PMTCT and Peds.
7Joint Technical Missions for Scaling up PMTCT and Pediatric HIV 2005RwandaCote d’IvoireCameroonMalawi2006IndiaBurkina FasoZambiaTanzania2007BotswanaLesothoMyanmarPlannedSwazilandNigeriaUganda (?)Ethiopia (?)Kenya (?)
8Opportunities provided by Joint IATT missions Broad representation of partnersOne voice regarding technical and programmatic recommendationsPartners jointly plan and commit to provision of TA, resources and implementation support for follow upPartners respond based on comparative advantages (in country & regionally)
9Government-owned Process Invitation from GovernmentTORs set by GovernmentRapid situation or program assessment undertakenPlanning Team organized by GovernmentThematic discussions chaired by Govt.Scale up plan monitored and implemented by Government
10JM: Thematic Areas usually examined Program ManagementComprehensive PMTCT (primary prevention, prevention of unintended pregnancies, prevention of MTCT, care and support of children, mothers, and families)Infant FeedingPaediatric Care and Treatment (optimizing identification, e.g. diagnosis, and scaling up treatment)Monitoring and EvaluationProcurement and Supplies Management
11Major areas for recommendations (1) Program ManagementMechanism for National coordination of activities, including those of partnersFocal Points for PMTCT and PediatricsDecentralized implementation strategyTask Shifting or “Task Sharing”Training of existing health care workers
12Major areas for recommendations (2) PMTCTHow to decentralize service provision, & expand geographical service coverageincrease uptake of HIV testing and counseling in ANC settingsPrioritisation of CD4 testing for pregnant womenIntroduce 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 deliveryIncrease coverage of maternal ARV, e.g. distribution of mother-baby pack prior to delivery in case delivery takes place at homeEnhance primary prevention activities
13Major areas for recommendations (3) Pediatric HIV Care and TreatmentReview treatment and care guidelinesReinforce family based HIV careHIV-Exposed infantsStrengthen infant follow upIntroduce or pilot early virological HIV testing at 6 weeks wherever possible (including using DBS)Introduce earlier antibody testing (9-12 months)Institutionalize Co-trimoxazole prophylaxisHIV-infected infantsIncrease entry points for children ,e.g. through PITC of sick children and others of unknown exposure status in certain settingsexpand PCR capacity through DBSIncrease access to treatment through training of ART providers in pediatric HIV clinical management.
14Major areas for recommendations (4) Infant feedingPromotion of EBF & reaffirm BFIClarification of AFASSReview tools and Training curricula of counselorsM&EHarmonization of programme indicators across partnersStreamlining of data reporting systemsPSMIntegration of Pediatric HIV supply into existing adult supply mechanismReview all HIV commodities
15Mission Follow Up Actions RwandaDevelopment of integrated workplan for PMTCT and Peds.Development of steering committee for children & HIVIntegration 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 childrenPMTCT training modules updatedNutritional support for HIV+ mothers in last trimester and first 6 months after deliveryMalawiPMTCT coordinator moved from RH to HIV unit (locus for ART and VCT)IMCI revised to include paediatric HIV careGeneric PMTCT training package adapted for local useCommunity IMCI programme adapted to optimize ID of children
16Mission Follow Up Actions IndiaEarly diagnosis for children incorporated into national HIV planPaediatric HIV package of care defined by Indian Institute of Paediatrics after request by GovernmentNutritional support package for HIV-infected children being revamped.Paeditric ARV dosing and formulary establishedZambiaNational PMTCT and paediatric guidelines revised and disseminatedU5 card revised to include exposure status and prompt for early diagnosis and initiation of co-trimoxazole prophylaxisPMTCT and paediatric M&E indicators revised and rolled out
17Mission Follow Up Actions Burkina FasoFocal points for PMTCT and Paediatrics placed in MOHCollaboration developed with Clinton Foundation to expand access to paediatric HIV care and treatmentTanzaniaNational PMTCT and paediatric M&E indicators finalizedNew National strategic plan on HIV will include childrenLesothoPolicy developed to expand PITC for all children in the country being seen at U5 clinicsAll CountriesReceived UNITAID funding for PMTCT scale up and introduction of more efficacious regimensReceived funding for other PMTCT/Peds activities from HQ.Ongoing TA and review of policy and related documents
18Other IATT achievements & products Global strategyReport cardDraft indicator registry and programming toolDraft programming guide on scaling up paediatric care and treatmentScale planning guideRegional workshops on scale up planning
20Integrate Guidance on Paediatric Treatment and Care into Child and Maternal Health Revised WHO guidelines available (2006)ARV Treatment, including stagingInfant diagnosis guidelines (PMTCT f/u and PITC)Co-trimoxazole guidelinesComplementary IMCIPed care integrated into adult tools (IMAI)Promtion of keeping information regarding HIV exposure on child health cardsExpansion of co-trimoxazole use for exposed infants by incorporation into national guidelinesHIV expanded course on IMCI (field tested in Zambia, Uganda, Nigeria and subsequently revised)Paeditrid HIV and PMTCT integarted inot adult HIV care approaches (IMAI)
21Integrate the Distribution of Free Co-trimoxazole to Eligible Children into Health Services Advocacy for provision of free co-trimoxazole in national plans and guidelinesInclusion of co-trimoxazole in UNITAID funding for both UNICEF/WHO and Clinton FoundationRecommend addition of prompt on child health cards for HIV-exposed infants
22Scale up PMTCT PlusAdvocacy for training for decentralized approach and increased geographical coverageIntroduction of routine HIV screening in ANC settingsFocus on all four prongs during JMsLook for increased linkages/integration to care and treatment, for mothers, children, families to ANC services.
23Scale up Prevention for Young People Increased focus on prongs 1 and 2 during joint missionsTechnical lead by UNFPAActivities coordinated through IATT on YP
24Pediatric ART Formulations and Diagnostic Availability Guidance on appropriate pediatric formulations being developed through WHO leadershipDevelopment of pediatric formulations by generic manufacturers (e.g. CIPLA, Ranbaxy)Support for bulk purchase of ARTs and diagnostics trough UNITAIDPublic Private Partnership – addressing bottlenecks in formulations, supply management, in-country registration, education & trainingExpanded 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.
25PMTCT Access Increasing but Lowest in Regions with Greatest Need Source: UNICEF PMTCT and Pediatric Care Report Card 2006
26PMTCT AccessScores 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.
27ConclusionsIATT has been an effective forum in strengthening and consolidating the global response to PMTCT and Pediatric HIV Care and TreatmentJoint Technical Missions have been instrumental in changing landscape in countries so far with introduction of new policies, capacity building, and new resources