scale up of hiv-related prevention, diagnosis, care and treatment for infants and children a...

SCALE UP OF HIV-RELATED PREVENTION, DIAGNOSIS, CARE

AND TREATMENT FOR INFANTS AND CHILDREN

SCALE UP OF HIV-RELATED PREVENTION, DIAGNOSIS, CARE

AND TREATMENT FOR INFANTS AND CHILDREN

A Programming Framework

CONTENTSCONTENTS

I. Background: Putting HIV care and treatment for children in context

II. Components of the care package: Interventions to aid child survival in the context of HIV

III. Key Strategies: 7 Strategies and action points for scaling up HIV diagnosis, care, support and treatment for children

IV. Resources and Tools: Links to key resources

I. Background: Putting HIV care and treatment for children in context

II. Components of the care package: Interventions to aid child survival in the context of HIV

III. Key Strategies: 7 Strategies and action points for scaling up HIV diagnosis, care, support and treatment for children

IV. Resources and Tools: Links to key resources

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I. BACKGROUND HIV burden among children

I. BACKGROUND HIV burden among children

• 2 million children (under 15 yrs old) have HIV– 90% live in sub-Saharan Africa

• Nearly 370 000 children were newly infected in 2007– Most infections could be avoided through PMTCT

interventions

BACKGROUNDHIV affects child survival

BACKGROUNDHIV affects child survival

• Without treatment, 50% of children with HIV die by age 2 (30% by age 1)

• About 270 000 children died of causes related to HIV in 2007, most from sub-Saharan Africa

• Those with HIV are more likely to die from common childhood illnesses (respiratory infections, TB, malaria, undernutrition, etc.), including those who survive the first year of their life

BACKGROUNDScope of the Programming Framework

BACKGROUNDScope of the Programming Framework• To guide governments in

resource constrained settings scale up HIV prevention, diagnosis, care and treatment for children who are exposed to or who have HIV

• Focuses on the needs of countries with a high HIV burden

BACKGROUNDGuiding Principles for peds care and treatment

BACKGROUNDGuiding Principles for peds care and treatment

II. COMPONENTS OF THE CARE PACKAGE

II. COMPONENTS OF THE CARE PACKAGE

1. Interventions for all infants and children to aid survival

2. Survival interventions for infants and children who are exposed to HIV

3. Survival interventions for infants and children who are infected with HIV

All children

HIV exposed children

HIV pos children

1. Interventions for all children to aid survival

1. Interventions for all children to aid survival

• Newborn care, including– Skilled care at birth– Early initiation of exclusive breastfeeding– Early postnatal visit

• Prevention interventions, including– Exclusive breastfeeding up to 6 months of age– Good maternal nutrition– Growth monitoring– Complete, timely immunization

• Treatment interventions, including– Oral rehydration therapy for diarrhoea– Prompt treatment for pneumonia and malaria

2. Survival interventions for infants and children who are exposed to HIV2. Survival interventions for infants

and children who are exposed to HIV• Antiretroviral prophylaxis (maternal and infant)• Provider-initiated HIV testing,

including infant viral testing• Early and regular clinical assessment• Co-trimoxazole prophylaxis• Counseling and support around

nutrition and infant feeding• Care, treatment and support for family members

3. Survival interventions for infants and children who have HIV

3. Survival interventions for infants and children who have HIV

• Early antiretroviral therapy and follow-up care• Adherence and treatment support• Regular clinical and laboratory monitoring• Psychosocial support• TB screening, prevention and management

3. Survival interventions for infants and children who have HIV (cont.)

3. Survival interventions for infants and children who have HIV (cont.)

• Nutrition, infant and young child feeding– Macronutritional support, vitamin

supplementation, regular growth monitoring• Management of severe malnutrition• Prevention, active early detection and

management of opportunistic infections – Pneumonia, diarrhoea, malaria

• Additional Immunizations

III. STRATEGIES FOR SCALING UPIII. STRATEGIES FOR SCALING UP

1. Enhance government leadership, ownership and accountability

2. Integrate and decentralize delivery of HIV prevention, diagnosis, care and treatment services to children

3. Enhance early identification of infants who are exposed to or have HIV

4. Ensure reliable procurement and supply management5. Bolster laboratory capacity6. Strengthen community-based capacity for care and

support7. Strengthen monitoring and evaluation systems

1. Enhance government leadership, ownership and accountability

2. Integrate and decentralize delivery of HIV prevention, diagnosis, care and treatment services to children

3. Enhance early identification of infants who are exposed to or have HIV

4. Ensure reliable procurement and supply management5. Bolster laboratory capacity6. Strengthen community-based capacity for care and

support7. Strengthen monitoring and evaluation systems

1. Enhance government leadership, ownership, and accountability

1. Enhance government leadership, ownership, and accountability

i. Initiate a rapid, systemic situational analysis of current programming, including an assessment on pediatric interventions

ii. Update pediatric treatment targetsiii. Ensure that management and coordination

structures address pediatric care and treatment

2. Integrate and decentralize delivery of HIV prevention, care, support and

treatment services to children

2. Integrate and decentralize delivery of HIV prevention, care, support and

treatment services to children Integrate HIV diagnosis, care, treatment, and support for

children into:i. Existing HIV care and treatment servicesii. Existing maternal, newborn and child health programs

Decentralize:iii. Interventions to lower-level health systems where

applicableiv. Utilize communities for early identification and provision of

care

Pediatric Dosing Chart example

2. Integrate and decentralize delivery2. Integrate and decentralize delivery

Simplified approaches to dosing and use of simplified formulations such as FDCs help to decentralize pediatric care

3. Enhance early identification of infants and children who are exposed to or have HIV

3. Enhance early identification of infants and children who are exposed to or have HIV

i. Ensure updated policy and technical guidance that follow-up with identified HIV-exposed infants and children

ii. Document info on receipt of serves for PMTCT on maternal and child health cards

iii. Use DBS to support early diagnosis iv. Implement provider-initiated testing and

counseling at sites likely to yield a high volume of positive test results

3. Enhance early identification of infants and children who are exposed to or have HIV (cont.)


v. Use family-centered approaches; secure HIV testing for additional family members

vi. Use IMCI and IMAI approaches at peripheral sites with referral for HIV testing

vii. Better use CHWsviii. Identify where routine determination of HIV

exposure status is feasible and efficient


E.g.: Child Health Card (Zambia)


E.g.: Child Health Card (Zambia)

Test

Follow-up time

Co-trimoxazole

Date baby referred to ART; Date initiated; Age of initiation

Infant feeding

3. Enhanced early identification of infants and children who are exposed to or have HIV (cont.)

3. Enhanced early identification of infants and children who are exposed to or have HIV (cont.)

Simple tools that explain the process of sample collection for DBS can help ensure high quality samples are collected

Example of EID System (Kenya)

Sample Collection

Packaging

ART/PMTCT centre

Site Name: Date: D D / M M / Y Y

Number of Samples: # # #

Patient ID HIV

E

lisa

(re

d - S

ST

tu

be

)

In

fan

t P

CR

(la

ve

nd

er tu

be

)

CD

4

(p

urp

le

tu

be

)

Viral Lo

ad

(p

urp

le

tu

be

)

Ch

em

istry

(re

d - p

la

in

tu

be

)

Heam

ato

lo

gy

(p

urp

le

tu

be

)

f s f s f s f s f s f sf s f s f s f s f s f s






















Clinic Signature: Lab Signature:

Clinic Initials: Lab Initials:

LABORATOIRE NATIONAL DE REFERENCEHIV SAMPLE SUMMARY FORM

Testing lab

Courier Samples

Courier Results

2 Week turnaround to receipt of results

1 day

4 days

1 day5 days

1 day

Source: J. Hungu, CHAI

PotentialBottleneck!

PotentialBottleneck!

Care for child

4. Ensure reliable procurement and supply management

4. Ensure reliable procurement and supply management

i. Coordination of supply stakeholders and linkages with overall supply implementation plans

ii. Integrated supply systems based on what exists and already works

iii. Ensure children are included in national PSM plans

5. Bolster laboratory capacity5. Bolster laboratory capacity

i. Plan for lab service expansion to accommodate early infant testing for HIV

ii. Select assays for viral diagnosisiii. Develop systems for timely and reliable use

of lab resultsiv. Provide staff with appropriate education and

training to ensure high-quality diagnostic services

6. Strengthen community-based capacity for care

and support

6. Strengthen community-based capacity for care

and support

i. Integrate community-based approaches into child health and HIV programming strategies

ii. Accelerate case-finding through integration into community-health programmes

iii. Improve case follow-up and essential care for HIV-exposed newborns and their families

iv. Enhance community capacity to provide care and support

v. Promote child survival through nutrition, immunization, malaria, and TB interventions

vi. Adapt norms for confidentiality and disclosure to specific local settings

7. Strengthen monitoring and evaluation systems

7. Strengthen monitoring and evaluation systems

i. Include core indicators of PMTCT and HIV care and treatment services for children in national monitoring and evaluation frameworks

ii. Expand efforts to monitor programme effectiveness and quality

IV. SELECTED RESOURCES AND TOOLSIV. SELECTED RESOURCES AND TOOLS

1. Guidance documents2. Websites3. Training curricula4. Tools

1. Guidance documents2. Websites3. Training curricula4. Tools

1. Guidance documents referred to in the Programming Framework

1. Guidance documents referred to in the Programming Framework

• WHO– Guidelines

• African Network for Care of Children Affected by HIV/AIDS (ANNECA)– Handbook

• Columbia University ICAP– Pocket Guide and Clinical Manual

• Centers for Disease Control and Prevention– A range of tools to support programming

2. Websites2. Websites

• WHO HIV/AIDS: http://www.who.int/hiv/en• UNICEF: http://www.unicef.org• International HIV/AIDS Alliance:

http://www.aidsalliance.org• Mothers2Mothers (m2m):

http://www.m2m.org• Elizabeth Glaser Pediatric AIDS Foundation:

http://www.pedaids.org

http://www.who.int/hiv/en

http://www.unicef.org/

http://www.aidsalliance.org/

http://www.m2m.org/

http://www.pedaids.org/

3. Training Curricula3. Training Curricula

• IMAI/IMCI– Complementary course on HIV/AIDS (chart

booklet)• WHO/UNICEF

– Infant and young child feeding counseling: an integrated course

• African Network for the Care of Children affected by HIV/AIDS (ANECCA) – An HIV care training curriculum

4. Tools4. Tools

• Spectrum – software package developed by UNAIDS, used to

determine consequences of current trends and future programme interventions with respect to the HIV epidemic

– For more info, visit http://www.unaids.org/en/KnowledgeCentre/HIVData/Methodology

http://www.unaids.org/en/KnowledgeCentre/HIVData/Methodology

http://www.unaids.org/en/KnowledgeCentre/HIVData/Methodology

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scale up of hiv-related prevention, diagnosis, care and treatment for infants and children a...

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