1. Scaling up HIV Paediatric care Harvard – PEPFAR Program Chalamilla Guerino 11.08.2008

2. Pediatric HIV Overview (Nigeria, Botswana & Tanzania) In these countries HIV prevalence among pregnant women is quite high (In Tanzania 8.7%, Botswana 33.7%) Thousands of children are infected with HIV every year (In Tanzania est. 48,000) 50% are dying before they celebrate their second birthday. Under 5 mortality is highly attributed by HIV HIV diagnosis in children has been low (low attendance in VCT, dependent on rapid test)

3. Pediatric HIV - Program Objectives Facilitate access of service to all, increase pediatric enrollment To Improve the Quality of care To Provide child friendly services

4. Cumulative Pediatric Treatment Numbers APIN- Nigeria (Program started in 2005 ) Indicator As of March 2008 Achieved (Pediatric) Service outlets providing ART Services29 Number of individual who ever received ART by the end of the reporting period 1,360 Number of individual receiving ARV by the end of reporting period 1,155 Number on first-line drugs1,091 Percentage on first line96

5. Table 3: Number of children on HAART YearNo. of children on HAART 20054,997 20066,831 20076,267 Feb-086,381 Figure 13: Number of children on HAART

6. Pediatric enrollment Harvard Tanzania

7. Pediatric enrollment by age group Harvard - Tanzania

8. Quality of care Harvard - Tanzania

9. Pediatric – patient retention Tanzania

10. Efforts to increase enrollment specific strategies in Tanzania Strengthening tracking system of exposed infants (Map cue and tel. conduct) Access to Providers Initiated Counseling & Testing (PICT) at Pediatric IPD,OPD, RCH Early Infant Diagnosis (EID) by coding of MCH card Access to DNA PCR test to exposed infants (scale up use of DBS)

11. Efforts to increase enrollment specific strategies in Tanzania Train HCW at entry points on early signs and symptoms of HIV in children Establish children friendly environment in the clinics - Pediatric specific day – Saturday, - games, toys,

12. Specific strategies – Botswana  Universal PMTCT Botswana Government has been proactive in combating the HIV/AIDS epidemic including prevention of HIV infection in children, and treating PMTCT failure cases  While the specific needs of HIV-infected children are not addressed in national HIV policy documents, the needs of children living with HIV have been for the most part addressed in overall HIV treatment guidelines  The ARV program for children has expanded rapidly and ART is provided to children in all 32 sites nationally (100% of districts).

13. Pediatric Case finding Strategies Nigeria Screening of children using rapid test at all service delivery points in the health facility using the - Provider initiated testing and counseling (PITC). Screening at: Children Emergency room PEPFAR pediatric clinics Children wards Infectious disease clinic( including TB patients) Case finding among children of adults accessing care in the ART clinic

14. Pediatric Case finding Strategies in Nigeria cont……. Community outreaches for HCT in orphanages Infant Welfare clinic, Primary health care centers Other private and public health facilities where children are seen Labor wards, postnatal wards, and the Nursery Directly observed therapy (DOTs) clinic Community outreaches for HCT with the adult ART in conjunction with HBC group.

15. CHALLENGES Unfavorable infrastructure that hinder tracking of HIV positive infants Stigma attached to AIDS and myths/Misconceptions well as beliefs and practices. Prevents parents/Guardians from enrolling children to CTC.

17. WAY FORWARD Strengthening of tracking system to identify exposed children hence improve EID Introduction of DBS collection from sites with and without CTC. Community sensitization regarding treatment of children by Use of various communication channels.

18. WAY FORWARD cont….. Strengthen linkages with other points of service delivery such as private hospitals and dispensaries Integration RCH and CTC hence improve referrals and recording systems. Increase training programs for health care workers.

19. THANK YOU ALL FOR LISTENING