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Chareeya Thanee , M.D. Infectious Disease Unit, Department of Pediatric

Pediatric AND Adolescent HIV. Chareeya Thanee , M.D. Infectious Disease Unit, Department of Pediatric Sanpasitthiprasong Hospital, Ubon Ratchathani. Case Study : Shadaporn, a-19-year-old ● Perinatally HIV-infected child ● Living with her aunty

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Chareeya Thanee , M.D. Infectious Disease Unit, Department of Pediatric

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  1. Pediatric AND Adolescent HIV ChareeyaThanee, M.D. Infectious Disease Unit, Department of Pediatric Sanpasitthiprasong Hospital, UbonRatchathani

  2. Case Study : Shadaporn, a-19-year-old ● Perinatally HIV-infected child ● Living with her aunty ● Diagnosed with HIV infection: 9 years old ● Start HAART regimens: AZT+3TC+EFV (CD4 = 394 cell/ mm3, class B ), age 10 years old ● Good HAART adherence

  3. VL=3,600 • 2004: Poor adherence, quiet personality, separate, lonely • Intervention: Advice and emphasize ARV Zilavir+IDV+RTV

  4. Zilavir+IDV+RTV VL=3,600 • - จบชั้น ม. 3 • - จัดยากินเอง • - อยู่บ้าน ดูแลน้อง • ให้ประวัติกินยาตรงเวลาตลอด ไม่เคยลืม • Pill count: • adherence > 95%

  5. After clinical assessment, ARV adherence, genotype mutation pattern, What’s should you do? • change ARV regimen • assess HIV knowledge • assess self-esteem and life skills • assess risk behaviors including sexual risks, substance use, alcohol • All of above

  6. What’s we do? • Change regimens: TDF+3TC + LPV/r • Team Counsellor found about : - Reported good ARV adherence but………?? - Quiet personality, friendless, lack confidence, no hope for future, nothing to talk. - Difficult to approach - Don’t have boyfriend, no sexual behavior risk

  7. Interventions • Assessment knowledge and their perception about the disease. • - High HIV Knowledge, high opinion of ARV regimens. • - Low social support • - Lonely, bored, nothing to do

  8. Interventions 2. Review disclosure status, focus on: - Evolution of the disease that related to stigma - Caused of infection: blood, sharp injury, perinatal & sexual transmission - Advantages to patients with other diseases - Tell the difference from other disease by herself - A success and long life patient who continue ARV medication

  9. Interventions 3. Empowerment: - Empowerment media - Not different from the others - Choose not to be born but choose to be by yourself if your heart strong - Fight for herself and aunty - Offered to work at ARV clinic

  10. Interventions 4. Opportunity to vent her feelings

  11. Interventions 5. HIV youth campus 2011 Adolescents health Reproductive health ART adherence Sex education

  12. ● 2011 Shadaporn come back to study (non-formal education) graduated grade 12 ● 2012-2013 - Study at Ubon Ratchathani Rajabhat university - Good adherence - March 2013: CD4 682, VL < 40 - Self confidence, friendly, pretty - Want to be computer programer - Came to work at ARV clinic for education fees

  13. HIV Youth Clinic at Sunpasitthiprasong Hospital ● Self care and reproductive health ● HIV transmission ● ART adherence ● Empowerment and self esteem ● Sex education and risk behavior ● Life skills and responsibilities ● Educational scholarships ● Travel expenses to visit ARV clinic ● Home visit and telephone calling

  14. Effectiveness of telephone calling on ARV adherence 2010 (N=17) • I • Improved ARV adherence 83.3% to 97.1% • VL < 40: 97.1% • Improved CD4 733.3 to 873.6 cell/mm3

  15. HIV Youth Campus 2011 • - Satisfaction >90 % • - Adherence > 95%: 87.5 % • - On condom 100% • Unwanted pregnancy 0% • Wanted pregnancy 2.7% • Came back to school 41.6% • Have a job 19.4%

  16. HIV Youth Campus 2013 • N=49, 15-22 year, Boy 10, Girl 39 • 8: experience of SI, 12: experience of relationship, partner • They wants to known about - How to say with their boyfriend/girl friend about HIV status? - How to select good boyfriend/girl friend? • - How to have a good and interested characteristics? • - Communication skills with their friends, family • - Contraception

  17. Conclusions • HIV-infected youth wants to known about reproductive health, adolescents health, sex education. • HIV, sex education, reproductive health knowledge should be provided to all HIV-infected youth. • Self-esteem, risk behaviors, ARV adherence, career and education plan should be evaluated. • Listen carefully, trust, understand, “they can do it”

  18. Conclusions sexual abuse PMTCT service full disclosure

  19. Acknowledgements HIV Youth Campus 2013, All Staff of HIV Youth Clinic, Sunpasitthiprasong Hospital

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