Group III: Demand Forecasting

Demand forecasting Objectives Minimum requirements Tools Gaps Recommendations

Demand forecasting Objectives Global level: Advocacy for inclusion of children in treatment initiatives, including setting targets for children Advocacy for price reduction on pediatric ARV formulations for both high and low prevalence countries Market development by the industry National/Provincial/District level Advocacy with national/provincial/district leadership for inclusion of children in treatment plans Planning purposes

Demand forecasting Minimum information requirements Pediatric treatment goals/targets: Estimated number of CLWHA needing RX Country capacity to treat Programming approach Recommended drug regimens Profile of children to be treated

Demand forecasting Minimum information requirements The number of CLWHA in need of RX: Current estimates of number of CLWHA Projected annual birth and death rates HIV prevalence in ANC settings MTCT rates Breastfeeding practices HIV-related morbidity and mortality rates CD4%, TLC (Risk of under-estimation) Existing care practices: CTX, nutrition etc…

Demand forecasting Minimum information requirements Programming approach: entry points: PMTCT, pediatric wards, OPD, nutrition programs etc… Implementation plan: where to start, expansion plan etc… Expected uptake Capacity to treat at all levels: Human resources Financial resources and price of drugs (generics versus brand names) Systems and infrastructure, including laboratory capacity

Demand forecasting Minimum information requirements The recommended drug regimens: National guidelines: First line Second line Change in case of toxicity, TB etc… Generics versus brand names Patients’ profile: Age and weight groups % on first and second lines, toxicity rate, TB co-infection rate etc…

Demand forecasting Special considerations for procurement of pediatric formulations Lead time Storage and distribution capacity Generics versus brand names Number of manufacturers to deal with Buffer stock

2005 Target Current CLWHA (Countries, districts etc…) Projected annual births, deaths, HIV infections Total CLWHA in 2005 CLWHA needing RX Capacity to treat e.g. 50%

Tools Age-specific quantification of disease burden tool ART capacity assessment tool Drug quantification tool (e.g. Clinton Model) MIS tool to monitor program uptake, drug consumption and treatment outcomes,

Gaps Knowledge: Age and weight distribution of HIV-infected children Predictors of disease progression in resource-poor countries Capacity to treat children Laboratory diagnostic technologies in young infants below 18 months Pediatric treatment goals not defined on many initiatives and programs Current MIS do not include treatment outcomes Age and weight-specific burden of disease ill-defined Limited number of demand forecasting tools

Advocacy statement Of the estimated 1.9m children living with HIV/AIDS in sub-Saharan Africa approx 0.5m need treatment, which is about 16% of the adults who need treatment Therefore of the 3m by 2005 to be put on treatment 450,000 should be children This would also hold true in a national setting Of particular importance are the infants under 1 yr, one-third of whom will die in the first year

Recommendations User friendly tool on CD to assess the child needs in ARV Tx which acknowledges that for planning purposes the first year is different from other years of enrollment Need to improve diagnostic facilitgies, Access to antibody, PCR test to increase access to Tx Drug supply chain Communication

Capacity Set the minimum standards for the site to be able provide ART Adapt adult ART sites assessment tools by adding pediatric part Political will to create the requested capacity for ped ARV Characteristic of the clinical sites Training need Prescription of the drugs Family centered care cites, link child ARV and parent ARV PMTCT, malnutrition clinics entry point

Community involvement IMCI, home based care to identify children in need pediatric ART adherence support

Agencies responsible for implementation UNICEF – coordinate the work on development of forecasting model for ped TX, age specific burden of disease, capacity assessment tool, MIS tool in collaboration with other UN agencies WHO – clinical diagnostic tool, facility assessment tool AMDS – technical support USAID funded FHI, JSI