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