Pediatric HIV Care & Treatment in Uganda A Five-Day Training Course For Health Professionals

Module I: Introduction to Paediatric HIV Care & Treatment in Uganda Key questions: Why is there a need for Paediatric HIV care and treatment? (WHY ARE WE HERE?) What difference can Paediatric HIV care and treatment make? Why is Paediatric HIV care for children and infants so challenging? How is Uganda currently addressing Paediatric HIV Care & Treatment? How can you be part of the solution?

Global & National HIV Estimate for adults and children, 2009 GlobalUganda People Living with HIV33.3 million1 million Children living with HIV2.5 million (7.5%) 146,000 (14.6%) Total New Infections2.6 million132,500 New Infections in Children370,000 (14%) 25,000 (18.8%) Death due to HIV1.8 million70,000 Deaths due to HIV children260,000??

Overall HIV Prevalence in Uganda by Sex % of infants are exposed to HIV What percentage of infants are exposed to HIV?

What key factors contribute to the high HIV prevalence in children in Uganda? High prevalence of HIV infection in women of child bearing age Low coverage of PMTCT interventions Stigma Lack of male partner involvement Multiple and concurrent sexual partners Intergeneration sexual issues

Modes Of HIV Transmission To Children Vertical transmission Refers to mother-to-child transmission of HIV (MTCT); contributes 95% of infected infants In an untreated breastfeeding population the total transmission rate is % How or when does MTCT occur? During pregnancy 5-10% During labor & delivery 10-15% Through breast feeding 5-20%

Contribution of AIDS to Child Mortality 30% of children admitted with malnutrition have HIV HIV predisposes one to pneumonia and diarrhoea Is AIDS the leading cause of death among children?

What main activities are included in Paediatric HIV Prevention, Care & Treatment program? Maximize Interventions for prevention of Mother to child transmission Increase availability of EID services Proactively identify and link to care HIV exposed and HIV infected infants and children. Ensure quality care, treatment, follow up of HIV exposed / infected infants and children Increase availability of and access to Paedaitric ART Promote family centered care model.

Strategic Framework for Prevention of HIV Infection in Infants and Young Children Prevention of unintended pregnancies in HIV infected women Provision of care and support for HIV-infected women, their children, and their families Prevention of mother-to-child HIV transmission Primary Prevention Of HIV

10 Revised PMTCT guidelines -Option A Mother If CD4 >350 or stage 1,2 Ante partum AZT (from 14 weeks) sdNVP + AZT/3TC at delivery AZT/3TC for 7 days postpartum If CD4 ≤350 or stage 3 or 4: Lifelong ART Infant If breastfeeding: daily NVP from birth until one wk after breastfeeding has stopped If not breastfeeding or mother on ART: NVP for 6 wks Uganda has adopted Option A with plan to transition to Option B when sufficient resources are available

National PMTCT Guidelines Option A

Dosing schedule for infant NVP prophylaxis 12 Infant Age NVP Daily Dose (10 mg/ml formulation) Birth to 6 weeks Birth weight 2.0 to 2.5 kg 1 ml once daily Birth weight > 2.5 kg 1.5 ml once daily >6 weeks to 6 months2 ml once daily >6 months to 9 months3 ml once daily >9 months to end of breastfeeding4 ml once daily

What difference can Paediatric HIV care & treatment make?

14 Provide care for exposed and infected infants Newell et al. Lancet 2004: vol 364: Without ART, 50% of HIV-positive infants will die by age 2

15 Provide care for exposed and infected infants Newell et al. Lancet 2004: vol 364: Typical age at initiation of ART Without ART, 50% of HIV-positive infants will die by age 2

16 Provide care for exposed and infected infants Newell et al. Lancet 2004: vol 364: Typical age at initiation of ART Without ART, 50% of HIV-positive infants will die by age 2

Why is it so challenging to care and treat HIV exposed children and infants in our country? What are the challenges you experience? What are the main barriers you face? Activity: Pair work Discuss with your partner, and then in your Guides, list the main BARRIERS or CHALLENGES you experience in your working areas/clinics in caring for and treating HIV exposed / infected children.

What did we learn about the challenges and barriers we face in implementing effective Paediatric HIV care? There are certainly many challenges, but there are also several actions you can take to help mitigate some of these barriers! This training is designed to provide you with knowledge and skills to help you take appropriate actions and better serve HIV exposed and infected children and their families.

You are part of the solution! We hope you will become front-line pediatric HIV care and treatment providers. This training will help you: Gain the necessary skills, knowledge, and tools to effectively treat and care for HIV infected children/infants. Gain the confidence, knowledge and skills to communicate with caretakers of HIV exposed or infected children/infants. Become equipped with the tools and skills to improve your systems to effectively integrate pediatric HIV services into your clinics.

The Government is also part of the solution Ugandan Government is committed to: To virtually eliminate Paediatric HIV/AIDS by 2015 Scale up care & treatment for HIV Infected children to all sites providing ARV’s by 2012 Level of effort: Strengthen the PMTCT-EID program & scale up to 20% of HCIII Train and mentor Ensure availability of commodities Strengthen lab capacity for EID to improve turn around time Ensure availability of ARV’s