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Scaling up HIV Paediatric care

Scaling up HIV Paediatric care. Harvard – PEPFAR Program Chalamilla Guerino 11.08.2008. Pediatric HIV Overview (Nigeria, Botswana & Tanzania). In these countries HIV prevalence among pregnant women is quite high ( In Tanzania 8.7%, Botswana 33.7%)

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Scaling up HIV Paediatric care

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  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 NumbersAPIN- Nigeria (Program started in 2005)

  5. Table 3: Number of children on HAART 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 StrategiesNigeria 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 Strategiesin 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.

  16. 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.

  17. 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.

  18. THANK YOU ALL FOR LISTENING

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