Scale up of HIV-related prevention, diagnosis, care and treatment for infants and children

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Scale up of HIV-related prevention, diagnosis,
care and treatment for infants and children

• A Programming Framework

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CONTENTS

• Background Putting HIV care and treatment for
  children in context
• Components of the care package Interventions to
  aid child survival in the context of HIV
• Key Strategies 7 Strategies and action points
  for scaling up HIV diagnosis, care, support and
  treatment for children
• Resources and Tools Links to key resources

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I. BACKGROUND HIV burden among children

• 2 million children (under 15 yrs old) have HIV
• 90 live in sub-Saharan Africa
• Nearly 370 000 children were newly infected in
  2007
• Most infections could be avoided through PMTCT
  interventions

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BACKGROUNDHIV affects child survival

• Without treatment, 50 of children with HIV die
  by age 2 (30 by age 1)
• About 270 000 children died of causes related to
  HIV in 2007, most from sub-Saharan Africa
• Those with HIV are more likely to die from common
  childhood illnesses (respiratory infections, TB,
  malaria, undernutrition, etc.), including those
  who survive the first year of their life

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BACKGROUNDScope of the Programming Framework

• To guide governments in resource constrained
  settings scale up HIV prevention, diagnosis, care
  and treatment for children who are exposed to or
  who have HIV
• Focuses on the needs of countries with a high HIV
  burden

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BACKGROUNDGuiding Principles for peds care and
treatment
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II. COMPONENTS OF THE CARE PACKAGE
All children
1. Interventions for all infants and children to
aid survival
2. Survival interventions for infants and
children who are exposed to HIV
HIV exposed children
HIV pos children
3. Survival interventions for infants and
children who are infected with HIV
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1. Interventions for all children to aid survival

• Newborn care, including
• Skilled care at birth
• Early initiation of exclusive breastfeeding
• Early postnatal visit
• Prevention interventions, including
• Exclusive breastfeeding up to 6 months of age
• Good maternal nutrition
• Growth monitoring
• Complete, timely immunization
• Treatment interventions, including
• Oral rehydration therapy for diarrhoea
• Prompt treatment for pneumonia and malaria

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2. Survival interventions for infants and
children who are exposed to HIV

• Antiretroviral prophylaxis (maternal and infant)
• Provider-initiated HIV testing,
• including infant viral testing
• Early and regular clinical assessment
• Co-trimoxazole prophylaxis
• Counseling and support around
• nutrition and infant feeding
• Care, treatment and support for family members

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3. Survival interventions for infants and
children who have HIV

• Early antiretroviral therapy and follow-up care
• Adherence and treatment support
• Regular clinical and laboratory monitoring
• Psychosocial support
• TB screening, prevention and management

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3. Survival interventions for infants and
children who have HIV (cont.)

• Nutrition, infant and young child feeding
• Macronutritional support, vitamin
  supplementation, regular growth monitoring
• Management of severe malnutrition
• Prevention, active early detection and management
  of opportunistic
• infections
• Pneumonia, diarrhoea, malaria
• Additional Immunizations

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III. STRATEGIES FOR SCALING UP

• Enhance government leadership, ownership and
  accountability
• Integrate and decentralize delivery of HIV
  prevention, diagnosis, care and treatment
  services to children
• Enhance early identification of infants who are
  exposed to or have HIV
• Ensure reliable procurement and supply management
• Bolster laboratory capacity
• Strengthen community-based capacity for care and
  support
• Strengthen monitoring and evaluation systems

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1. Enhance government leadership, ownership, and
accountability

• Initiate a rapid, systemic situational analysis
  of current programming, including an assessment
  on pediatric interventions
• Update pediatric treatment targets
• Ensure that management and coordination
  structures address pediatric care and treatment

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2. Integrate and decentralize delivery of HIV
prevention, care, support and treatment services
to children

• Integrate HIV diagnosis, care, treatment, and
  support for children into
• Existing HIV care and treatment services
• Existing maternal, newborn and child health
  programs
• Decentralize
• Interventions to lower-level health systems where
  applicable
• Utilize communities for early identification and
  provision of care

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2. Integrate and decentralize delivery
Simplified approaches to dosing and use of
simplified formulations such as FDCs help to
decentralize pediatric care
Pediatric Dosing Chart example
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3. Enhance early identification of infants and
children who are exposed to or have HIV

• Ensure updated policy and technical guidance that
  follow-up with identified HIV-exposed infants and
  children
• Document info on receipt of serves for PMTCT on
  maternal and child health cards
• Use DBS to support early diagnosis
• Implement provider-initiated testing and
  counseling at sites likely to yield a high volume
  of positive test results

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3. Enhance early identification of infants and
children who are exposed to or have HIV (cont.)

• Use family-centered approaches secure HIV
  testing for additional family members
• Use IMCI and IMAI approaches at peripheral sites
  with referral for HIV testing
• Better use CHWs
• Identify where routine determination of HIV
  exposure status is feasible and efficient

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3. Enhance early identification of infants and
children who are exposed to or have HIV
(cont.)E.g. Child Health Card (Zambia)
Test
Follow-up time
Co-trimoxazole
Date baby referred to ART Date initiated Age of
initiation
Infant feeding
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3. Enhanced early identification of infants and
children who are exposed to or have HIV (cont.)
Simple tools that explain the process of sample
collection for DBS can help ensure high quality
samples are collected
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Example of EID System (Kenya)
Care for child
Potential Bottleneck!
1 day
Packaging
4 days
Sample Collection
2 Week turnaround to receipt of results
Potential Bottleneck!
ART/PMTCT centre
Courier Samples
1 day
1 day
5 days
Source J. Hungu, CHAI
Testing lab
Courier Results
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4. Ensure reliable procurement and supply
management

• Coordination of supply stakeholders and linkages
  with overall supply implementation plans
• Integrated supply systems based on what exists
  and already works
• Ensure children are included in national PSM plans

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5. Bolster laboratory capacity

• Plan for lab service expansion to accommodate
  early infant testing for HIV
• Select assays for viral diagnosis
• Develop systems for timely and reliable use of
  lab results
• Provide staff with appropriate education and
  training to ensure high-quality diagnostic
  services

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6. Strengthen community-based capacity for care
and support

• Integrate community-based approaches into child
  health and HIV programming strategies
• Accelerate case-finding through integration into
  community-health programmes
• Improve case follow-up and essential care for
  HIV-exposed newborns and their families
• Enhance community capacity to provide care and
  support
• Promote child survival through nutrition,
  immunization, malaria, and TB interventions
• Adapt norms for confidentiality and disclosure to
  specific local settings

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7. Strengthen monitoring and evaluation systems

• Include core indicators of PMTCT and HIV care and
  treatment services for children in national
  monitoring and evaluation frameworks
• Expand efforts to monitor programme effectiveness
  and quality

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IV. SELECTED RESOURCES AND TOOLS

• Guidance documents
• Websites
• Training curricula
• Tools

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1. Guidance documents referred to in the
Programming Framework

• WHO
• Guidelines
• African Network for Care of Children Affected by
  HIV/AIDS (ANNECA)
• Handbook
• Columbia University ICAP
• Pocket Guide and Clinical Manual
• Centers for Disease Control and Prevention
• A range of tools to support programming

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2. Websites

• WHO HIV/AIDS http//www.who.int/hiv/en
• UNICEF http//www.unicef.org
• International HIV/AIDS Alliance
  http//www.aidsalliance.org
• Mothers2Mothers (m2m) http//www.m2m.org
• Elizabeth Glaser Pediatric AIDS Foundation
  http//www.pedaids.org

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3. Training Curricula

• IMAI/IMCI
• Complementary course on HIV/AIDS (chart booklet)
• WHO/UNICEF
• Infant and young child feeding counseling an
  integrated course
• African Network for the Care of Children affected
  by HIV/AIDS (ANECCA)
• An HIV care training curriculum

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4. Tools

• Spectrum
• software package developed by UNAIDS, used to
  determine consequences of current trends and
  future programme interventions with respect to
  the HIV epidemic
• For more info, visit http//www.unaids.org/en/Know
  ledgeCentre/HIVData/Methodology

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