Title: HIV Testing of Infants and Children - Just the Beginning
1HIV Testing of Infants and Children - Just the
Beginning Elaine Abrams Track 1.0 Meeting August
12, 2008
2HIV Testing of Infants Children
- Introduction
- Two illustrative programs
- HIV antibody testing program for children
admitted to hospital wards at University Teaching
Hospital, Lusaka, Zambia - Early Infant Diagnosis using Dried Blood Spots
for DNA PCR Testing, Tanzania - Successes Challenges
- Issues for consideration
3Why arent more children receiving
antiretroviral treatment?
- Despite noteworthy successes with the scale-up of
HIV services worldwide, the number of children in
care and receiving ART remains low - Only 200,000 children worldwide were initiated on
antiretroviral treatment (ART) as of December
2007 - Estimated 420,000 new pediatric infections and
290,000 pediatric HIV-related deaths in 2007 - The identification and the diagnosis of the HIV-
infected child, whether as infant or older,
continue to pose formidable barriers to
successful pediatric roll-out. - Furthermore, once diagnosed, multiple impediments
prevent families from engaging in HIV services
4Background Pediatric HIV Care in Lusaka, Zambia
in 2006
- Estimated 28,000 children with HIV in need of ART
but only 2,500 children on ART, December 2006 - 10,000 -15,000 pediatric admissions annually to
University Teaching Hospital (UTH) - Hospitalized children suspected of HIV infection
were sent to the Family Support Unit (FSU), a
free standing VCT program for children and
families - Many children died prior to testing
- Most children were not tested for HIV
- CDC in collaboration with the MOH, UTH and ICAP
supported the development of a Pediatric Center
of Excellence (PCOE) for Pediatric HIV Care and
Treatment at UTH - PCOE with ICAP support initiated the pediatric
inpatient testing program
5Pediatric Inpatient Testing Initiative at UTH
- Counselors at FSU were re-oriented and
re-deployed to the admissions ward where all but
the sickest children needing intensive care were
kept for 10-12 hours prior to admission - Individualized and group counseling of parents
present with their child on the admission ward - Rapid HIV testing of children by counselors
results within 30-60 minutes - Follow-up counseling and testing on the hospital
wards - Mothers needing to consult with father
- Parents of critically ill children who couldnt
be counseled
629 of children with unknown HIV status admitted
to UTH tested HIV antibody positive (June
2006-Jan 2007)Jan 2006-June 2007
85
87
29
70
11,571
3,373
2,348
13,239
15,670
7 Of 1276 HIV antibody positive children lt18
months of age, 63.2 tested DNA PCR positive,
April 2006-June 2007
Percent
2006
2007
8Success of the Pediatrics Inpatient Testing
Program
- More than 15,000 children were newly tested for
HIV and gt3000 tested HIV antibody positive - Many with symptomatic disease
- Offered HIV services at the PCOE or within the
district - Testing and referral of family members initiated
- Young age of children hastened the availability
of DNA PCR testing - DNA PCR laboratory established at the PCOE
- Modest investment of resources
- Dedicated counseling staff, secure supply chain
for HIV antibody tests - Children were assured access to ART at the PCOE
9Challenges Stemming from the Inpatient Testing
Program
- Large number of HIV-infected children overwhelmed
capacity of HIV care services - Particularly providers and space
- The majority of children were enrolled in HIV
care at the PCOE - Poor follow-up after hospital discharge
- Delayed initiation of ART
- Complexities of assuring PCR results were
provided to each child/family tested
10(No Transcript)
11Early Infant Diagnosis (EID) Tanzania
- The CDC and ICAP, in collaboration with other
partners, have supported the MOH to initiate and
roll-out EID using dried blood spots for DNA PCR
testing - Pilot program in Lake Region prior to National
Expansion - ICAP support has focused on three primary areas
- laboratory capacity
- clinical training and support
- guidelines and tool development
12HIV-exposed infants (HEI) identified and
testedICAP Tanzania (Oct 06-Mar 08)
Oct-Dec06
Jan-Mar07 Apr-Jun07 Jul-Sep07
Oct-Dec07 Jan-Mar08
13Follow-Up After 1st PCR test ICAP
Tanzania
51 did not come back for results
54 did not come back for results
14Successes of the EID program in Tanzania
- Established clinical capacity to identify and
care for HIV exposed infants - Established laboratory capability for EID
- Increasing number of infants being tested for DNA
PCR to establish infection status during the
first year of life - Should lead to increased number of young babies
on ART - Plan in place to increase laboratory and clinical
capacity to perform EID throughout the country
15Challenges confronted in the EID program
- Significant systems barriers
- Slow turn around of results
- Limited laboratory capacity
- Delays getting results to sites
- Poor follow-up of infants tested for EID
- For further exploration
- Hypothesized reasons cost, travel, competing
priorities, unaccustomed to appointment system,
death, relocation - Linkages between PMTCT and infant follow-up care
as well as between EID and HIV care and treatment
services not fully developed
16Conclusions Questions
- Testing programs for children, including early
infant diagnosis, are successfully identifying
HIV exposed and infected children - Engaging HIV exposed and infected children in
successful long term follow-up and HIV treatment
requires further attention and innovative
programming - Importance of building programs that are
family-focused and provide services to adults and
children in a cohesive and coherent manner - Pressing need to transform health systems from an
acute care model to one prepared to meet the
health needs of children and adults with chronic
diseases like HIV
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