1、Activities by IATT on PMTCT and Paediatric HIV Care and Treatment,Siobhan Crowley On Behalf of PMTCT/Pediatric HIV IATT,Global Impact of HIV on Children,Children constitute: 12 percent (530,000 of 4.3 million) of new global HIV/AIDS infections 13 percent (380,000 of 2.9 million) of HIV/AIDS deaths a
2、nnually 6 percent (2.3 million of 39.5 million) of the persons living with HIV15 million AIDS orphans by the end of 2006,Source: UNAIDS 2006,Recommendation GPF London, 2006,Integrate and provide routine HIV and AIDS prevention and treatment services for children.Integrate guidance on paediatric trea
3、tment and care into child and maternal health Develop simple generic guidelines and training on paediatric ART, cotrimoxazole and nutrition and integrate into modules within IMCI, PMTCT, TB and HIV and AIDS care training. Integrate the distribution of free cotrimoxazole to eligible children into hea
4、lth services Develop decentralized plans to scale up provision through broader pediatric care, including through clinics, home-based care and youth friendly centers.,Integrate and provide routine HIV and AIDS prevention and treatment services for children,Scale up PMTCT Plus Endorse the 2005 Abuja C
5、all for Action in order to ensure universal access to PMTCT Plus interventions by 2010Scale up prevention for young people IATT on HIV/AIDS and Young People to strengthen comprehensive prevention, including through sexual and reproductive health services for young peoplePediatric ART formulations an
6、d diagnostic availability Develop secure funding agreements to support local and generic production of pediatric formulations, and to provide secure funds for bulk purchasing of ART. All partners to encourage and support pharmaceutical companies to develop appropriate formulation for pediatric ART,I
7、ATT on PMTCT and Pediatric HIV,Initially focused on PMTCT; mission recently expanded to explicitly include Pediatric HIV Broad membership including: UN (UNICEF, WHO, UNFPA, World Bank) USG (CDC, PEPFAR, USAID-funded orgs., inlc. EGPAF, Columbia, AED, etc.) Foundations (Clinton Foundation) Other Acad
8、emic orgs, including Baylor College,IATT on PMTCT and Pediatric HIV,Key areas of focus: Strategic approaches Advocacy and mobilisation of national and international partners Translating norms and standards into Programming Monitoring and evaluation including harmonization of indicators and annual re
9、port cardJoint Technical Missions To assist with accelerating scale up Countries with high MTCT burden High paediatric infections Significant contribution to under 5 mortality Government interest in scaling up PMTCT and Peds.,Joint Technical Missions for Scaling up PMTCT and Pediatric HIV,2005 Rwand
10、a Cote dIvoire Cameroon Malawi2006 India Burkina Faso Zambia Tanzania,2007 Botswana Lesotho MyanmarPlanned 2007-2008 Swaziland Nigeria Uganda (?) Ethiopia (?) Kenya (?),Opportunities provided by Joint IATT missions,Broad representation of partners One voice regarding technical and programmatic recom
11、mendations Partners jointly plan and commit to provision of TA, resources and implementation support for follow up Partners respond based on comparative advantages (in country & regionally),Government-owned Process,Invitation from Government TORs set by Government Rapid situation or program assessme
12、nt undertaken Planning Team organized by Government Thematic discussions chaired by Govt. Scale up plan monitored and implemented by Government,JM: Thematic Areas usually examined,Program ManagementComprehensive PMTCT (primary prevention, prevention of unintended pregnancies, prevention of MTCT, car
13、e and support of children, mothers, and families)Infant FeedingPaediatric Care and Treatment (optimizing identification, e.g. diagnosis, and scaling up treatment) Monitoring and EvaluationProcurement and Supplies Management,Major areas for recommendations (1),Program Management Mechanism for Nationa
14、l coordination of activities, including those of partners Focal Points for PMTCT and Pediatrics Decentralized implementation strategy Task Shifting or “Task Sharing” Training of existing health care workers,Major areas for recommendations (2),PMTCT How to decentralize service provision, & expand geo
15、graphical service coverage increase uptake of HIV testing and counseling in ANC settings Prioritisation of CD4 testing for pregnant women Introduce more efficacious regimens outlined in revised clinical guidelines (2006) Develop program linkages for PMTCT & CH services, e.g. include HIV exposure sta
16、tus on child health card prior to mothers discharge after delivery Increase coverage of maternal ARV, e.g. distribution of mother-baby pack prior to delivery in case delivery takes place at home Enhance primary prevention activities,Major areas for recommendations (3),Pediatric HIV Care and Treatmen
17、t Review treatment and care guidelines Reinforce family based HIV careHIV-Exposed infants Strengthen infant follow up Introduce or pilot early virological HIV testing at 6 weeks wherever possible (including using DBS) Introduce earlier antibody testing (9-12 months) Institutionalize Co-trimoxazole p
18、rophylaxisHIV-infected infantsIncrease entry points for children ,e.g. through PITC of sick children and others of unknown exposure status in certain settings expand PCR capacity through DBS Increase access to treatment through training of ART providers in pediatric HIV clinical management.,Major ar
19、eas for recommendations (4),Infant feeding Promotion of EBF & reaffirm BFI Clarification of AFASS Review tools and Training curricula of counselors M&E Harmonization of programme indicators across partners Streamlining of data reporting systems PSM Integration of Pediatric HIV supply into existing a
20、dult supply mechanism Review all HIV commodities,Mission Follow Up Actions,Mission Follow Up Actions,Mission Follow Up Actions,Other IATT achievements & products,Global strategy Report card Draft indicator registry and programming tool Draft programming guide on scaling up paediatric care and treatm
21、ent Scale planning guide Regional workshops on scale up planning,GPF Follow up,Integrate Guidance on Paediatric Treatment and Care into Child and Maternal Health,Revised WHO guidelines available (2006) ARV Treatment, including staging Infant diagnosis guidelines (PMTCT f/u and PITC) Co-trimoxazole g
22、uidelines Complementary IMCI Ped care integrated into adult tools (IMAI)Promtion of keeping information regarding HIV exposure on child health cardsExpansion of co-trimoxazole use for exposed infants by incorporation into national guidelinesHIV expanded course on IMCI (field tested in Zambia, Uganda
23、, Nigeria and subsequently revised) Paeditrid HIV and PMTCT integarted inot adult HIV care approaches (IMAI),Integrate the Distribution of Free Co-trimoxazole to Eligible Children into Health Services,Advocacy for provision of free co-trimoxazole in national plans and guidelines Inclusion of co-trim
24、oxazole in UNITAID funding for both UNICEF/WHO and Clinton Foundation Recommend addition of prompt on child health cards for HIV-exposed infants,Scale up PMTCT Plus,Advocacy for training for decentralized approach and increased geographical coverageIntroduction of routine HIV screening in ANC settin
25、gsFocus on all four prongs during JMsLook for increased linkages/integration to care and treatment, for mothers, children, families to ANC services.,Scale up Prevention for Young People,Increased focus on prongs 1 and 2 during joint missions Technical lead by UNFPA Activities coordinated through IAT
26、T on YP,Pediatric ART Formulations and Diagnostic Availability,Guidance on appropriate pediatric formulations being developed through WHO leadership Development of pediatric formulations by generic manufacturers (e.g. CIPLA, Ranbaxy) Support for bulk purchase of ARTs and diagnostics trough UNITAID P
27、ublic Private Partnership addressing bottlenecks in formulations, supply management, in-country registration, education & training Expanded training in Pediatric HIV clinical management (e.g. through Baylor) Expanded training and capacity building in DBS (Clinton Foundation, EGPAF, Columbia, etc.)Re
28、sults: Significant increase in numbers on treatment.,PMTCT Access Increasing but Lowest in Regions with Greatest Need,Source: UNICEF PMTCT and Pediatric Care Report Card 2006,PMTCT Access,Scores expected to be higher for next report card as a result of increasing commitment and involvement, but stil
29、l below needed levels to reach UNGASS targets in 2010.,Conclusions,IATT has been an effective forum in strengthening and consolidating the global response to PMTCT and Pediatric HIV Care and Treatment Joint Technical Missions have been instrumental in changing landscape in countries so far with introduction of new policies, capacity building, and new resources,
