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Elimination of Pediatric AIDS: a district approach Roland van de Ven, MD DTM&H MPH Technical Director presentation at the Governance for Health Systems Development workshop SOAS – University of London Thursday 21 st July 2011 Dar es Salaam - Tanzania. Outline. History of the Foundation

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  1. Elimination of Pediatric AIDS: a district approachRoland van de Ven, MD DTM&H MPHTechnical Directorpresentation at the Governance for Health Systems Development workshopSOAS – University of LondonThursday 21st July 2011Dar es Salaam - Tanzania

  2. Outline • History of the Foundation • EGPAF Global • Virtual elimination of pediatric AIDS • Tanzania program • Achievements • Challenges • Conclusion

  3. Elizabeth Glaser Pediatric AIDS Foundation Together we can eliminate pediatric AIDS

  4. Elimination of Pediatric AIDS • Mission: To eliminate pediatric AIDS. • Pediatric AIDS has been virtually eliminated in the United States. • Global elimination is possible, and global cooperation is needed to stem the tide of new infections. • We have the science – and we have the medicines – to do this. Photo: James Pursey

  5. Foundation History One woman’s commitment to eliminate pediatric AIDS

  6. Elizabeth’s Story “People say they care, but actions are what save lives.” – Elizabeth Glaser Photo: EGPAF

  7. Elizabeth’s Story • Following her daughter’s death in 1988, Elizabeth joined with two close friends to create a foundation to bring hope to all children with AIDS. Photo: EGPAF • Elizabeth lost her own battle with AIDS in 1994. • Thanks to the Foundation, hundreds of thousands of other children have the chance to lead longer, healthier lives. Photo: EGPAF

  8. Our Work Our global efforts to eliminate pediatric AIDS

  9. Major Areas of Work International Programs Global Advocacy Global Research

  10. International Programs • Preventing new infections in babies. • Providingcare and treatment for those children already infected with HIV. • Ensuring mothers receive the treatment they need to live healthy live. Photo: James Pursey

  11. International Programs • Working with governments and partners in 17 countries, • the Foundation supported programs have: • Provided more than 11.6 million women with the services to prevent the transmission of HIV from mothers to babies; • Tested more than 10 million women for HIV; • Enrolled more than 1.2 million individuals in to care and support programs, including nearly 100,000 children under the age of 15. • * All data as of December 31, 2010 Photo: James Pursey

  12. Global Research • Supporting scientists and clinicians and encouraging collaboration. • Ensuring programs reach as many children and familiesas possible. • Gauging the effectiveness of key programs in the field. • Pursuing the development of a pediatric HIV vaccine. Photo: Jon Hrusa

  13. Global Advocacy • Supporting global efforts to improve the health and longevity of children and women. • Advocating for increased funding and support for HIV and AIDS research. • Prioritizing children in global HIV and AIDS strategy. Photo: Nigel Barker, LLC

  14. Supporting MDGs • The Foundation impacts three of the international community’s Millennium Development Goals: • Goal 4: Reduce child mortality rate. • Goal 5: Improve maternal health. • Goal 6: Combat HIV/AIDS, malaria, and other diseases. Photo: James Pursey

  15. Progress • Globally, 53 percent of HIV-positive pregnant women receive medicines to prevent transmission of HIV to their babies - up from 14 percent in 2005. Photo: James Pursey

  16. Children and Families Still Need Our Help • More than 1,000 children are infected with HIV every day. • Without treatment, almosthalf of all children born with HIV will die by age 2. • Half of HIV-positive pregnant women around the world are not receiving help they need to have HIV-negative children. Photo: Jon Hrusa Photo: Nigel Barker, LLC

  17. Virtual elimination of pediatric AIDS

  18. Key Elimination Targets (IATT) • Reduce new pediatric infections by 90% from 2009 • Reduce MTCT rate to below 5% (to less than 40,000 infected infants each year) • AND (related to MDGs 4, 5 and 6): • Reduce HIV incidence in women 15-49 by 50% • Reduce unmet need for family planning to 0% • Reduce maternal mortality by 90% • Reduce HIV-attributable deaths among children <5 years

  19. What would be needed?

  20. The 4 key strategies for Prevention of MTCT • Primary prevention of HIV among women of childbearing age • Preventing unintented pregnancies among women living with HIV • Preventing HIV transmission from a woman living with HIV to her infant • Providing appropriate treatment, care and support to mothers living with HIV and their children and families

  21. Tanzania

  22. HIV SITUATION IN TANZANIA • An average of 5.7% of adults men and women aged 15-49 years are living with HIV • Regional variation ranging from 1.5% in Manyara to 15.7% in Iringa region. • Prevalence is higher in urban than in rural areas (8.7% vs. 4.7%) • By end of 2010, it was estimated that 83,216 people became infected and that, a total of1,350,609 children and adults were living with HIV in the country;

  23. Prevention of mother to child transmission of HIV (PMTCT) services • PMTCT services available in 4,301 of 5,416 (79%) health facilities • Of the 1,665,300 estimated pregnant women, 1,402,315 (84%) were tested for HIV. • Among the estimated HIV infected women and HIV exposed babies, 80,748 (70%) and 65,948 (57%) received ARVs for PMTCT respectively.

  24. Care and Treatment Services • Wide access to ARVs was initiated in the country in October 2004 • There are 1,047 Health facilities providing HIV care and treatment services; • By December 2010, a total of 740,040 PLHIV were enrolled into care and treatment clinics • Of these, 384,816 (52%) were initiated on ART, out of which 29,457 (7.7%) were children below 15 years.

  25. Partnerships URT STRATEGIES AND PRIORITIES

  26. Partnership FrameworkSix Strategic Goals • Service maintenance and scale-up • Prevention • Leadership and management • Sustainable and secure HIV drug and commodity supply • Human resources • Evidence-based and strategic decision making

  27. Our work in Tanzania:a district approach

  28. In partnership EGPAF supports the Tanzania HIV/AIDS program in partnership with: • Donor partners: • CDC • USAID • Implementing partners: • National MOHSW • Regional Health Management teams • Council Health Management teams • Faith Based Organizations and Private hospitals • Pediatric Association of Tanzania (PAT)

  29. Partners cont… • Collaborative partners: • University of California San Francisco (UCSF) • Baylor University • John Snow Inc (JSI): • Affiliate Partner: AGPAHI: • Local organization established by EGPAF, starting 2011 in Shinyanga (transitioning)

  30. the District Approach • Working “through” the district • Main characteristics: • Focus on building technical capacity at district level • Emphasis on financial sustainability • Create mechanisms for ongoing supportive supervision and mentoring Photo: James Pursey

  31. the Value of the District Approach • Building local capacity, ownership and sustainability • Enabling rapid scale-up of services • Facilitating health system strengthening and integration and supporting quality Photo: James Pursey

  32. Essential ingredients for success • Consistency with national policies and guidelines • Customized to local setting • Services integrated • Strengthens the general health system • The ‘human’ factor

  33. Sequential steps for implementation • Conduct initial assessment • Engage district administration • Involve community leaders • Establish training capacity in the district • Integrate supportive supervision into district routine • Facilitate exchange of experiences • Involve district stakeholders in M&E • Make cost sharing explicit • Help build district leadership • Ensure linkages in continuum of care

  34. Achievements • Rapid expansion of both PMTCT and Care and Treatment (C&T) Programs. • PMTCT services at 1,065 facilities • 97 % of RCH services have PMTCT services • 87% of pregnant women counseled and tested • 99% of HIV+ women on ARV prophylaxis • C&T services at 165 facilities • 151,588 patients have ever been enrolled in HIV care, Including 13,009 children (8.6%) • 82,492 patients have ever been initiated on ART Including 7,463 children (9.7%) *March 2011 program data

  35. Rapid PMTCT Expansion • . Photo: James Pursey

  36. C&T Expansion2004-2011 Photo: James Pursey

  37. Programmatic Challenges • Less direct control over program outcome • Lack of financial management capacity • Difficulty determining readiness districts to operate independently • Multiple constraints within HIV/AIDS sector

  38. Health & HIV/AIDS sector constraints • Human Resources for Health: inadequate, but also high staff turnover • Pediatric HIV –Inadequate capacity • Challenges with Supply Chain Management - stock out of test kits, CD4 reagents etc • Governance and leadership • Budget allocation at district level • Community linkages Challenges that affect access and quality of services...

  39. Key challenges towards reaching virtual elimination of pediatric AIDS

  40. Challenges in … • Primary prevention of HIV among women of childbearing age • Preventing unintented pregnancies among women living with HIV • Preventing HIV transmission from a woman living with HIV to her infant • Providing appropriate treatment, care and support to mothers living with HIV and their children and families

  41. Coverage: ANC, PMTCT, Facility delivery and ART Even though geographical coverage is high, only 76% of women come for one visit, 46% deliver at facility Towards Universal Access, 2010, WHO/UNAIDS/UNICEF World Health Statistics, 2010, WHO

  42. Knowledge on HIV preventionTanzania demographic health survey 2010 Preliminary report

  43. Percentage of those with>1 partner last 12 months using CondomsUNGASS country update 2010

  44. HIV testing womenTHMIS 2008

  45. Challenges in ... • Primary prevention of HIV among women of childbearing age • Preventing unintented pregnancies among women living with HIV • Preventing HIV transmission from a woman living with HIV to her infant • Providing appropriate treatment, care and support to mothers living with HIV and their children and families

  46. Prevention of unwanted pregnancies among HIV positive women

  47. Challenges in ... • Primary prevention of HIV among women of childbearing age • Preventing unintented pregnancies among women living with HIV • Preventing HIV transmission from a woman living with HIV to her infant • Providing appropriate treatment, care and support to mothers living with HIV and their children and families

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