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Assoc.Prof. Thanyawee Puthanakit, MD. Division of Infectious Diseases, Department of Pediatric...
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Transcript of Assoc.Prof. Thanyawee Puthanakit, MD. Division of Infectious Diseases, Department of Pediatric...
Assoc.Prof. Thanyawee Puthanakit, MD.Division of Infectious Diseases, Department of Pediatric
Faculty of Medicine, Chulalongkorn UniversityAND HIVNAT, Thai Red Cross AIDS Research Center
A clinician perspective’sWhy is treatment coverage in children so low?
Framework of HIV treatment and care
WHO Global update on HIV treatment 2013
1 2 3
ENTRY POINTS
PED ARV
CLINICS
UNDERSTAND DYNAMICS
Challenges in HIV diagnosis
1. Entry points of high risk infants• Infants born to HIV-positive mothers
– Depend on coverage of HIV-screening during antenatal care– Rate of infant follow-up after delivery and stop breast-feeding
• Sick child; malnourished, tuberculosis, hospitalized child e.g. severe pneumonia, severe diarrhea
2. Laboratory tests• Virological tests: dried blood spot• Point of care testing
3. Awareness and knowledge in the community
Challenges enrollment in care1. No. of ARV clinics that could provide pediatric care• Thailand: 1016 adult ARV clinics, 616 ped ARV clinics• Chiang Rai model: decentralized from tertiary care to community
hospital after initial viral suppression.
2. No. of trained personnel to provide pediatric careDifference between adult and children e.g. treatment initiation criteria, adherence rely on family/caretakers, skills to deal with adolescents
3. ART-Eligibility assessment Simplify guideline, in case of CD4-guided approach – access to lab tests
4. Treatment literacy in community
J International AIDS Society. 2012; 15: 17358.
Linkage into HIV care: Thailand experience
2007 2008 2009 2010 2011
81
118108 104
81
44
92 94
78
3732
65 6357
35
Number of infant positive at first PCR Total infant received CD4 count testTotal infant initiated ART
Mean age (days) at first CD4 517 429 379 269 176 Mean age (days) at ART 535 425 398 268 156
NAP database: 30 Jun 2012
d4T5
mg/ml
3TC10
mg/ml
NVP
10 mg/ml
=
GPOvir 60
tab/bottle
d4T (30 mg) +3TC (150 mg)+ NVP (200 mg)
5 cm
Challenges in ARV initation: ped formulation
Thai program: 2004
Challenges in ARV initiation
• Limited ARV formulations/supplies• Dosage calculation– per kg, per BSA body weight band
• Vulnerable periods– Infancy– Changes of caretaker– Adolescent