1. Integrating Paediatric HIV/AIDS services into exisitng adult ART services

2. Key Questions 1.What are the key entry points to HIV care for children and adolescents? 2. What are the Essential Elements for the continuum of care for children?

3. Introduction To be effective, paediatric care and treatment interventions need to become an integral part of infant and child survival and health Programmes. Family centered care model should be promoted

4. Essential elements for the continuum of care for children 1.Mechanism of Identifying HIV infected and exposed infants 2.Effective referral system 3.A defined care package 4.A functional care team 5.Staff supportive services 6.Logistics management systems 7.Health management information systems

5. 1.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 Paed ward ANC Maternity YCC TFC OPD Community Adult wards

6. Organize “Know Your Child Status day” (KYCSD)campaigns in the existing Adult ART clinics Campaign aimed at testing children of clients. Set a date and venue for the activity. Prepare necessary logistics ( test kits, personnel etc…) Conduct mobilization during clinic days. Conduct the activity and refer all exposed and infected children for care.

7. 2. Establish an Effective Referral System Intra facility referrals(inter departmental referrals) – YCC to ART clinic – ANC to ART –ART clinic-Lab. –ART clinic-Wards Inter facility Referrals Community-Facility referrals Referral must be written NOT word of mouth

8. 3.A defined care package- ten point care package 1.Early infant diagnosis 2.Cotrimoxazole prophylaxis for OI prevention 3.Growth and development monitoring 4. Immunization, nutritional education, supplementation, and support, including multivitamins and iron 5.Routine quarterly deworming with Mebendazole 6. Aggressive management of acute illnesses 7. Psychosocial support and palliative care 8. Adolescent care and support 9. Family-focused care including PMTCT 10. ART when indicated and available

9. 4.A functional care TEAM with a strategic direction and a leader

10. A functional care TEAM Must be a dedicated multidisciplinary team –Clinician, nurse/midwife, lab tech, dispensor, counselor and Records clerk, cleaners Defined roles and responsibilities of each team member Clear Management structure Facility specific SOP’s Regular multi-disciplinary team meetings (MCH/inpatients/CTC)

11. 11 5.Staff Supportive Services Capacity Building –Formal/didactic Training –CME Multi-disciplinary Team Meetings Management-support Support supervision/mentorship frame work Exchange programs/attachments Prevention and Management of Staff burn-out

12. 6. Logistics management systems Must have Stock cards ARV Bi- monthly report and order forms ARV dispensing logs Good storage facilities for the drugs

13. 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 7.Health management information systems

14. Family centered care approach should be encouraged HIV infected Children and their parents should be care for in the same clinic. Paediatric HIV/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

15. 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 (ARV’s and OI drugs) Re align appointment with adult caregiver seen in the same clinic.

16. Integration of paediatric services into adult HIV clinics Involves: Introduce family-focused approach to adults in care Build capacity among staff to care for the children Active identification of children of the same household focus on pregnant women Introduce capacity to do routine infant diagnosis Continuous mentoring by experienced clinicians

17. Challenges of integrating Paediatric HIV care into adult HIV clinic Lack of personnel trained in Paedaitric care Resistance among adult staff to deal with children Poor Paedaitric and adolescent approach Lack of ‘child-friendly environment’ Risk of indirect and inadequate disclosure weak referral system between Paedaitric services and adult HIV clinic

18. Summary To successfully set up Comprehensive care for children with HIV one must be define systems for  Clear mechanisms for identifying and enrolling children into care  Define and provide a comprehensive care package  Have a committed team  Use family centered care model to Integrate paediatric care into adult care clinics