© 2006 Baylor College of Medicine Antiretroviral Treatment for Children in Resource-Limited Settings: Africa Mark W. Kline, M.D.

© 2006 Baylor College of Medicine

Pediatric HIV/AIDS in Africa Sub-Saharan Africa is home to about 2 million HIV-infected children Almost 90% of all HIV-infected children live in sub-Saharan Africa Children are underrepresented among those accessing treatment in virtually every African setting

© 2006 Baylor College of Medicine Deaths Under Five Years of Age Attributable to HIV/AIDS

© 2006 Baylor College of Medicine “In the instance of antiretroviral therapy, the scenario for children is, quite simply, doomsday.” Stephen Lewis January 18, 2005

© 2006 Baylor College of Medicine

Barriers to Pediatric HIV/AIDS Care and Treatment Lack of infrastructure Lack and loss of human capacity Expense Lack of commitment to treatment of children Perceived complexity of pediatric treatment

© 2006 Baylor College of Medicine The Baylor International Pediatric AIDS Initiative (BIPAI) Committed to improving the health and lives of HIV-infected children and families globally Currently active in Romania, Ukraine, Mexico, China and 20 countries in Africa

© 2006 Baylor College of Medicine

Annual Pediatric HIV/AIDS Death Rate: Constanta, Romania

© 2006 Baylor College of Medicine

Botswana-Baylor Children’s Center: Early Outcomes The center has hosted more than 200 health professionals for training experiences More than 5000 children have been tested for HIV More than 1400 children are receiving HAART

© 2006 Baylor College of Medicine Median CD4%: 787 Children Receiving HAART for >6 Months at the Botswana COE

© 2006 Baylor College of Medicine % of Botswana COE Patients with Virus Load 6 Months

© 2006 Baylor College of Medicine Mortality Rate by Duration of HAART: Botswana COE

© 2006 Baylor College of Medicine

The BIPAI Children’s Clinical Centers of Excellence Network Established January, 2004 Mission: High quality, high impact, highly ethical pediatric and family HIV/AIDS care and treatment, health professional training and clinical research Currently includes ten centers on four continents

© 2006 Baylor College of Medicine The BIPAI Network - Africa

© 2006 Baylor College of Medicine BIPAI Network Monthly Report July, 2006 Ro- mania Bots- wana Leso- tho Swazi- land Malawi Ugan- da TOTAL Active COE caseload Active outreach caseload Pts. receiving ART

© 2006 Baylor College of Medicine Defining Characteristics of the Centers of Excellence Collaborative Comprehensive Family-centered Care and treatment focused Provide support for regional and national scale up of pediatric and family HIV/AIDS care and treatment

© 2006 Baylor College of Medicine Spin-off Benefits of the Centers of Excellence Building capacity for pediatric health care generally (collateral benefit) Reversal of “brain drain” Powerful impetus for HIV testing Destigmatization

© 2006 Baylor College of Medicine

Pediatricians/100,000 Children (<15 years)

© 2006 Baylor College of Medicine Factors in the Dearth of African Pediatric Health Professionals Low productive capacity of African professional schools Exodus of African health professionals to the developed world Deaths of professionals from HIV/AIDS and other causes Crushing burden of care and treatment posed by HIV/AIDS and other diseases

© 2006 Baylor College of Medicine The Pediatric AIDS Corps Announced in June, 2005 Recruitment of pediatricians, internists and family doctors Attachment to seven children’s centers in Africa and one in China Minimum one-year commitment Training in tropical medicine and HIV Living stipend Housing Student loan debt repayment

© 2006 Baylor College of Medicine Goals of the Pediatric AIDS Corps Provide primary pediatric and HIV/AIDS care and treatment directly to at least 80,000 African children and families Train hundreds of African health professionals in the care and treatment of pediatric HIV/AIDS Dramatically expand access of African children to HIV/AIDS care and treatment

© 2006 Baylor College of Medicine Pediatric AIDS Corps: Status Fifty-two physicians were recruited in a period of about seven months Seven PAC physicians have been working in Africa for six months or more each The full Corps will be at assignment sites by August 21, 2006

© 2006 Baylor College of Medicine Our Partners and Funders Abbott Fund Bristol-Myers Squibb Foundation UNICEF Elizabeth Glaser Pediatric AIDS Foundation U.S. Centers for Disease Control and Prevention Fogarty International Center / NIH