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Models of Care for Paediatric HIV Miriam Chipimo MD MPH Reproductive Health & HIV&AIDS Manager, UNICEF, Malawi.

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Presentation on theme: "Models of Care for Paediatric HIV Miriam Chipimo MD MPH Reproductive Health & HIV&AIDS Manager, UNICEF, Malawi."— Presentation transcript:

1 Models of Care for Paediatric HIV Miriam Chipimo MD MPH Reproductive Health & HIV&AIDS Manager, UNICEF, Malawi

2 Global Context  In 2005 UNICEF raised a call to action to all working to protect children from the AIDS epidemic  Based on the UN General Assembly Special session on HIV & AIDS in 2001 to attain the MDGs  Call to Action set targets for 2010 in four key areas: P1 –Prevent infections among adolescents & young people P2 – Prevent Mother To Child Transmission of HIV P3 – Provide paediatric treatment P4 – Protect and support children affected by HIV & AIDS

3 Global Estimates Following the call to action in 2005:  documentation on pART improved  number of children on ART increased  75,000 by end 2005  127,300 by end 2006 (60% in East & Southern Africa region)  198,000 by 2007 By end 2007:  2.1 million (6%) of 33.2 million people with HIV were children under 15 years  420,000 children were newly infected mostly through MTCT  290,000 children had died  Number of deaths had started to fall due to scale up of PMTCT

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5 Global Programming Framework for scale up of HIV related prevention, diagnosis, care & treatment for infants & children Published in 2008 by WHO & UNICEF & reviewed by IATT: Outlines the following strategies: 1.Government leadership, ownership and accountability 2.Integrated & decentralised delivery of HIV services for children 3.Enhanced early identification of infants exposed to HIV 4.Reliable procurement & supply management 5.Laboratory capacity to support HIV services 6.Community based capacity to support those infected and affected by HIV 7.Strengthening M&E systems to enhance quality of care

6 Children and AIDS in Malawi

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8 HIV Prevalence by Age Among Pregnant Women 2007 Sentinel Surveillance Source: Malawi Sentinel Surveillance

9 POLICY, PROGRAMMING & FUNDING ENVIRONMENT  Strong political will to fight HIV/AIDS  National AIDS Policy, 2004 & HIV/AIDS Action Framework 2005- 2009 are in place  Global Funds & Development Partners provide financial & technical contributions coordinated by NAC  Strengthening of drug & supply management, laboratory and diagnostic services ongoing  Strong ART and HTC programmes  PMTCT & Paediatric Guidelines updated  Accelerated scale up of PMTCT services  Roll out of Early Infant Diagnosis programme has started  Strengthening the continuum of care from various entry points into ART

10 Tools to improve adherence in children on ART  Children are provided with a take home booklet to support adherence to ART that provides: – clear explanation, –reinforcement and documentation of dosing using pill count, –asking for missed doses –appointment schedule for follow up visit  Parent/guardian is counselled on paediatric ART and use of the booklet using the National Paediatric HIV Flipchart

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13 PITC Early Infant Diagnosis Rapid HIV Test CPT NUTRITION COUNSELLING Initiation of ART PMTCT Testing for family UNDER FIVE CLINICS PAEDIATIC WARDS NUTRITION WARDS Negative 75% 10% 15%

14 FEW DEDICATED PAEDIATRIC ART CLINICS MAJORITY ARE INTEGRATED ADULT & PAEDIATRIC ART CLINICS FEW FAMILY CENTRED ART CLINICS  FIXED DRUG COMBINATION – SPLIT ADULT TABLETS AT ALL ART SITES- 2 month supplies given  CHILD FORMULATIONS AT 10 HIGH BURDEN SITES FOR CHILDREN BELOW 1 YEAR  CD4 COUNTS CAN BE MONITORED AT ALL SITES AND VIRAL LOAD AT A FEW CLINICS  VERY FEW DEDICATED SOCIAL WORKERS AT ART SITES STAND ALONE AND INTEGRATED PAEDIATRIC ART CLINICS Teen Club Community mobilisation

15 Achievements  Increased number of children accessing HIV testing including DBS PCR from 6 weeks after birth – in total over 5,000 children tested in 2007  No. of children receiving ART increased dramatically from 2000 in 2005 to 11,865 in 2007  Strong political will and leadership by the government of Malawi in the fight against HIV and AIDS  Strong partnership between UNICEF, Baylor, Lighthouse, WHO, CDC and Clinton Foundation to support MOH  A steady supply of quality AIDS drugs, strengthening of lab services for CD4 counts and EID  Revised registers for M&E and job aides for PMTCT & pART

16 Challenges  Weak continuum of care of PMTCT services from ANC, & maternity to under five clinics  Low coverage of more efficacious regimens for PMTCT and Cotrimoxazole Preventive Therapy  Late diagnosis of HIV+ children  Long turnaround time from HIV+ diagnosis to starting ART  M&E system does not monitor outcomes pART  Relatively poor access to ART services (30% of facilities)  Human resource constraints  Community not well sensitised on PMTCT & Paediatric HIV care  Psychosocial support for teenagers living with HIV  Disclosure to the child  Disclosure to family, friends and school

17 Finally a short movie & thank you for your attention


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