Dr. Philippe Chiliade Technical Advisor, Clinical Care, FHI 12 August 2008 Family Health...
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Transcript of Dr. Philippe Chiliade Technical Advisor, Clinical Care, FHI 12 August 2008 Family Health...
Dr. Philippe Chiliade
Technical Advisor, Clinical Care, FHI
12 August 2008
Family Health International
Lessons learned and challenges in scaling up Pediatric HIV clinical care
and treatment in Zambia
Background
• ZPCT is a collaboration with the Zambia MOH– to strengthen & expand existing HIV/AIDS services– PEPFAR funded
• January 2007 - launch of Children’s Initiative within FHI
• FHI/ZPCT’s key strategies for increasing pediatric ART:
1. Increase entry points for identification of HIV infected children
2. Increase capacity to initiate and manage infants and children on ART
Pediatric counseling and testing
Increase entry points for pediatric CT– Training & mentorship for lay counselors in
PICT for children– Pilot routine pediatric CT using the opt-out
approach for children on admission and under-five clinics
– Integration of HIV services into MCH services• All HIV exposed children are tested for HIV
PMTCT
Improve identification of HIV positive babies– Strengthen the follow-up of mother-baby pairs
• PMTCT Mother-Baby Tracking Tool
– Establish a DBS lab referral system • Infants tested at 6 weeks
Pediatric ART
Improve access to & management of ART for children– Guidelines & job aids in pediatric HIV care &
treatment:• Co-trimoxazole prophylaxis• ART dosage, 1st and 2nd line regimens, OI management• WHO Clinical Staging of HIV infections in Infants and
Children
– Onsite pediatric ART training for HCWs– Mentorship– Strengthening pediatric component in the general
ART adherence training
Lessons Learned (1)• Broadening entry points for pediatric counseling
and testing results in a reduced positivity rate
No.of children who tested HIV positive, ZPCT
275 327 326 253 344 340 476 509 512 511 557 562 730 701 982 700 851 1225 1285 1242 1022 1117 1356 1453
3023
010002000
30004000
2006Apr
2006May
2006Jun
2006Jul
2006Aug
2006Sep
2006Oct
2006Nov
2006Dec
2007Jan
2007Feb
2007Mar
2007Apr
2007May
2007Jun
2007Jul
2007Aug
2007Sep
2007Oct
2007Nov
2007Dec
2008Jan
2008Feb
2008Mar
2008Apr
0.0%10.0%20.0%30.0%40.0%50.0%
No. of children tested No. of children who tested HIV+ Percentage of children who tested HIV+
Lessons Learned (2)• HIV+ children are identified an earlier stage of disease;
therefore fewer need to be initiated on ART
Children newly initiated on ART (ZPCT)
89111
94
55
92 101130 131 138
99124 129 122
171
11092
115 124150
171
127155
103 114138
0
50
100
150
200
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
No. of children newly initiated on ART % HIV+ children initiated on ART
Challenges
• Loss of children from the time of diagnosis to the time of initiation– Long queues– Human resource shortages– Lack of HCWs trained in pediatric ART– Challenges of initiation of therapy on the wards– Skepticism about pediatric ART
• CD4 testing – Difficulty obtaining CD4% from absolute CD4 number