1. Dr. Philippe Chiliade Technical Advisor, Clinical Care, FHI 12 August 2008 Family Health International Lessons learned and challenges in scaling up Pediatric HIV clinical care and treatment in Zambia

2. Background ZPCT is a collaboration with the Zambia MOH –to strengthen & expand existing HIV/AIDS services –PEPFAR funded January 2007 - launch of Children’s Initiative within FHI FHI/ZPCT’s key strategies for increasing pediatric ART: 1.Increase entry points for identification of HIV infected children 2.Increase capacity to initiate and manage infants and children on ART

3. Pediatric counseling and testing Increase entry points for pediatric CT –Training & mentorship for lay counselors in PICT for children –Pilot routine pediatric CT using the opt-out approach for children on admission and under-five clinics –Integration of HIV services into MCH services All HIV exposed children are tested for HIV

4. PMTCT Improve identification of HIV positive babies –Strengthen the follow-up of mother-baby pairs PMTCT Mother-Baby Tracking Tool –Establish a DBS lab referral system Infants tested at 6 weeks

5. Pediatric ART Improve access to & management of ART for children –Guidelines & job aids in pediatric HIV care & treatment: Co-trimoxazole prophylaxis ART dosage, 1st and 2nd line regimens, OI management WHO Clinical Staging of HIV infections in Infants and Children –Onsite pediatric ART training for HCWs –Mentorship –Strengthening pediatric component in the general ART adherence training

6. Lessons Learned (1) Broadening entry points for pediatric counseling and testing results in a reduced positivity rate

7. Lessons Learned (2) HIV+ children are identified an earlier stage of disease; therefore fewer need to be initiated on ART

8. Challenges Loss of children from the time of diagnosis to the time of initiation –Long queues –Human resource shortages –Lack of HCWs trained in pediatric ART –Challenges of initiation of therapy on the wards –Skepticism about pediatric ART CD4 testing –Difficulty obtaining CD4% from absolute CD4 number