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Group III: Demand Forecasting. Demand forecasting. Objectives Minimum requirements Tools Gaps Recommendations. Demand forecasting Objectives. Global level: Advocacy for inclusion of children in treatment initiatives, including setting targets for children

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demand forecasting
Demand forecasting
  • Objectives
  • Minimum requirements
  • Tools
  • Gaps
  • Recommendations
demand forecasting objectives
Demand forecastingObjectives
  • Global level:
    • Advocacy for inclusion of children in treatment initiatives, including setting targets for children
    • Advocacy for price reduction on pediatric ARV formulations for both high and low prevalence countries
    • Market development by the industry
  • National/Provincial/District level
    • Advocacy with national/provincial/district leadership for inclusion of children in treatment plans
    • Planning purposes
demand forecasting minimum information requirements
Demand forecastingMinimum information requirements
  • Pediatric treatment goals/targets:
    • Estimated number of CLWHA needing RX
    • Country capacity to treat
    • Programming approach
  • Recommended drug regimens
  • Profile of children to be treated
demand forecasting minimum information requirements5
Demand forecastingMinimum information requirements
  • The number of CLWHA in need of RX:
    • Current estimates of number of CLWHA
    • Projected annual birth and death rates
    • HIV prevalence in ANC settings
    • MTCT rates
    • Breastfeeding practices
    • HIV-related morbidity and mortality rates
    • CD4%, TLC (Risk of under-estimation)
    • Existing care practices: CTX, nutrition etc…
demand forecasting minimum information requirements6
Demand forecastingMinimum information requirements
  • Programming approach:
    • entry points: PMTCT, pediatric wards, OPD, nutrition programs etc…
    • Implementation plan: where to start, expansion plan etc…
    • Expected uptake
  • Capacity to treat at all levels:
    • Human resources
    • Financial resources and price of drugs (generics versus brand names)
    • Systems and infrastructure, including laboratory capacity
demand forecasting minimum information requirements7
Demand forecastingMinimum information requirements
  • The recommended drug regimens:
    • National guidelines:
      • First line
      • Second line
      • Change in case of toxicity, TB etc…
    • Generics versus brand names
  • Patients’ profile:
    • Age and weight groups
    • % on first and second lines,
    • toxicity rate,
    • TB co-infection rate etc…
demand forecasting special considerations for procurement of pediatric formulations
Demand forecastingSpecial considerations for procurement of pediatric formulations
  • Lead time
  • Storage and distribution capacity
  • Generics versus brand names
  • Number of manufacturers to deal with
  • Buffer stock
tools
Tools
  • Age-specific quantification of disease burden tool
  • ART capacity assessment tool
  • Drug quantification tool (e.g. Clinton Model)
  • MIS tool to monitor program uptake, drug consumption and treatment outcomes,
slide11
Gaps
  • Knowledge:
    • Age and weight distribution of HIV-infected children
    • Predictors of disease progression in resource-poor countries
    • Capacity to treat children
  • Laboratory diagnostic technologies in young infants below 18 months
  • Pediatric treatment goals not defined on many initiatives and programs
  • Current MIS do not include treatment outcomes
  • Age and weight-specific burden of disease ill-defined
  • Limited number of demand forecasting tools
advocacy statement
Advocacy statement
  • Of the estimated 1.9m children living with HIV/AIDS in sub-Saharan Africa approx 0.5m need treatment, which is about 16% of the adults who need treatment
  • Therefore of the 3m by 2005 to be put on treatment 450,000 should be children
  • This would also hold true in a national setting
  • Of particular importance are the infants under 1 yr, one-third of whom will die in the first year
recommendations
Recommendations
  • User friendly tool on CD to assess the child needs in ARV Tx which acknowledges that for planning purposes the first year is different from other years of enrollment
  • Need to improve diagnostic facilitgies, Access to antibody, PCR test to increase access to Tx
  • Drug supply chain
  • Communication
capacity
Capacity
  • Set the minimum standards for the site to be able provide ART
  • Adapt adult ART sites assessment tools by adding pediatric part
  • Political will to create the requested capacity for ped ARV
  • Characteristic of the clinical sites
  • Training need
  • Prescription of the drugs
  • Family centered care cites, link child ARV and parent ARV
  • PMTCT, malnutrition clinics entry point
community involvement
Community involvement
  • IMCI, home based care to identify children in need
  • pediatric ART adherence support
agencies responsible for implementation
Agencies responsible for implementation
  • UNICEF – coordinate the work on development of forecasting model for ped TX, age specific burden of disease, capacity assessment tool, MIS tool in collaboration with other UN agencies
  • WHO – clinical diagnostic tool, facility assessment tool
  • AMDS – technical support
  • USAID funded FHI, JSI