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State of National Guidelines Paediatric HIV Care

State of National Guidelines Paediatric HIV Care. Survey 2008 Martina Penazzato ATC HIV/AIDS Department WHO Geneva. Methods. 40 countries with burden of disease Questionnaire Phone interview WHO HIV/AIDS country officers Appointed experts within the country. Countries. Botswana Brazil

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State of National Guidelines Paediatric HIV Care

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  1. State of National GuidelinesPaediatric HIV Care Survey 2008 Martina Penazzato ATC HIV/AIDS Department WHO Geneva

  2. Methods 40 countries with burden of disease Questionnaire Phone interview WHO HIV/AIDS country officers Appointed experts within the country

  3. Countries • Botswana • Brazil • Burkina Faso • India • Jamaica • Malawi • Morocco • Mozambique • Nigeria • Pakistan • South Africa • Sudan • Tanzania • Thailand • Tunisia • Uganda • Zambia • Zimbabwe African 12 South American 2 Asian 2 Middle East 2

  4. National Guidelines • National guidelines available All • Currently updating or updated within the 2007 10/18 • Stand alone guidelines 13/18 • Distribution to health facilities All but Pakistan Sudan

  5. PMTCT • PMTCT Coverage high i.e. Thailand 93.9% reported by National Department of Health mid South africa 30% low Uganda 10% • PMTCT Regimen • sdNVP 6 • AZT+sdNVP 8 • AZT+sdNVP+1week AZT/3TC 2 • sdNVP+1week AZT/3TC 2 • AZT/3TC/NVP intrapartum Burkina • NVP regimen in pregnancy 4 • LPV regimen in pregnancy 2 • sdNVP 6 • sdNVP+AZT (1, 4 or 6 weeks) 9 mothers infants

  6. ART Starting Criteriain infants • WHO • 8 countries • WHO + viral threshold • Tunisia • Brazil (tend to start in all <1year) • All • Jamaica • Botswana • South Africa (Official reccomandation: symptomatic or CD4<35% and <1500 absolute count)

  7. First Line Regimen • All NNRTI based regimen South Africa either NNRTI or PI • Backbone preferred D4T/3TC • Switch from1st to 2nd line 13/18 reporting 0%-15%

  8. Distribution of first line regimens in children

  9. Lab facilities Virological tests available: DNA PCR 6 RNA PCR 5 DNA PCR and RNA PCR 7 DNA PCR, RNA PCR and Agp24 1 - Dried Blood Spots available in 10/18 countries - Number of Lab performingBrazil 30 Tunisia 15 (10 private) South Africa all province covered by NHLS Thailand, Burkina, Uganda and Tanzania >3 Others 1 or 2 - Health facilities offering In patients, Out patients, PMTCT sites and ART sites CD4% and CD4 countavailable in all the countries reporting

  10. Element Specified Fee HIV antibody test All HIV virological test 15 ART All Cotrimoxazole prophylaxis All but Tunisia Isoniazid prophylaxis 9 (3 IPT) 1 Follow up visit All Pneumococcal vaccine 1 (Brazil) Management OI All Counselling 17 Social support 14 Transport 2 Other Nutritional Support Home visits 3 2 CARE PACKAGE Is Nationally Specified? All but Malawi

  11. Challenges • Feasibility of recommendations • Need of human resources dedicated to infants care • Need of specifically trained lab staff • Implementation at different health service levels • Tools and dissemination activities • Monitoring of quality and outcomes of service provided. • Suitable formulation • Long term care implications • Sustainability

  12. Acknowledgements: WHO Regional and Country officers WHO HIV/AIDS country officers Elisabeth Lowenthal Jorge Pinto GenevièveOnadja Rakesh Lodha Po-Lin Chan Russell Pierre Peter Kazembe Soumia Benchekroun Taoufik Paula Vaz Velephi Okello Eiaz Khan Brian Eley Mark Cotton Tammy Meyers Nour Elhouda Ata Alla Roland Swai Bhakeecheep Sorakij Mohammed Chraknoun Israel Kalyesubula Anthony Mutiti Filda Mutsawashe Francis Onyango Myrto Schaefer Evgeny Voronin Thank you!

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