1 / 17

Innovative Models of Care for Paediatric HIV in Malawi: Progress and Challenges

In response to the HIV/AIDS epidemic affecting children, UNICEF's 2005 call to action emphasized four areas: preventing infections among adolescents, preventing mother-to-child transmission, providing paediatric treatment, and supporting affected children. By 2007, significant progress was made with increased access to ART for children and improved maternal health services. However, challenges persist in the continuum of care, late diagnosis, and human resource constraints. This overview highlights Malawi's ongoing efforts and partnerships to combat paediatric HIV and improve lives.

brooke-levy
Download Presentation

Innovative Models of Care for Paediatric HIV in Malawi: Progress and Challenges

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Models of Care for Paediatric HIV Miriam Chipimo MD MPH Reproductive Health & HIV&AIDS Manager, UNICEF, Malawi

  2. Global Context • In 2005 UNICEF raised a call to action to all working to protect children from the AIDS epidemic • Based on the UN General Assembly Special session on HIV & AIDS in 2001 to attain the MDGs • Call to Action set targets for 2010 in four key areas: P1 –Prevent infections among adolescents & young people P2 – Prevent Mother To Child Transmission of HIV P3 – Provide paediatric treatment P4 – Protect and support children affected by HIV & AIDS

  3. Global Estimates Following the call to action in 2005: • documentation on pART improved • number of children on ART increased • 75,000 by end 2005 • 127,300 by end 2006 (60% in East & Southern Africa region) • 198,000 by 2007 By end 2007: • 2.1 million (6%) of 33.2 million people with HIV were children under 15 years • 420,000 children were newly infected mostly through MTCT • 290,000 children had died • Number of deaths had started to fall due to scale up of PMTCT

  4. Global Programming Framework for scale up of HIV related prevention, diagnosis, care & treatment for infants & children Published in 2008 by WHO & UNICEF & reviewed by IATT: Outlines the following strategies: • Government leadership, ownership and accountability • Integrated & decentralised delivery of HIV services for children • Enhanced early identification of infants exposed to HIV • Reliable procurement & supply management • Laboratory capacity to support HIV services • Community based capacity to support those infected and affected by HIV • Strengthening M&E systems to enhance quality of care

  5. Children and AIDS in Malawi

  6. HIV Prevalence by Age Among Pregnant Women2007 Sentinel Surveillance Source: Malawi Sentinel Surveillance

  7. POLICY, PROGRAMMING & FUNDING ENVIRONMENT • Strong political will to fight HIV/AIDS • National AIDS Policy, 2004 & HIV/AIDS Action Framework 2005- 2009 are in place • Global Funds & Development Partners provide financial & technical contributions coordinated by NAC • Strengthening of drug & supply management, laboratory and diagnostic services ongoing • Strong ART and HTC programmes • PMTCT & Paediatric Guidelines updated • Accelerated scale up of PMTCT services • Roll out of Early Infant Diagnosis programme has started • Strengthening the continuum of care from various entry points into ART

  8. Tools to improve adherence in children on ART • Children are provided with a take home booklet to support adherence to ART that provides: • clear explanation, • reinforcement and documentation of dosing using pill count, • asking for missed doses • appointment schedule for follow up visit • Parent/guardian is counselled on paediatric ART and use of the booklet using the National Paediatric HIV Flipchart

  9. UNDER FIVE CLINICSPAEDIATIC WARDSNUTRITION WARDS 75% PITC NUTRITION COUNSELLING Testing for family Early Infant Diagnosis Rapid HIV Test PMTCT Negative 15% 10% CPT Initiation of ART

  10. STAND ALONE AND INTEGRATED PAEDIATRIC ART CLINICS FEW DEDICATED PAEDIATRIC ART CLINICS Community mobilisation Teen Club MAJORITY ARE INTEGRATED ADULT & PAEDIATRIC ART CLINICS FEW FAMILY CENTRED ART CLINICS • FIXED DRUG COMBINATION – SPLIT ADULT TABLETS AT ALL ART SITES- 2 month supplies given • CHILD FORMULATIONS AT 10 HIGH BURDEN SITES FOR CHILDREN BELOW 1 YEAR • CD4 COUNTS CAN BE MONITORED AT ALL SITES AND VIRAL LOAD AT A FEW CLINICS • VERY FEW DEDICATED SOCIAL WORKERS AT ART SITES

  11. Achievements • Increased number of children accessing HIV testing including DBS PCR from 6 weeks after birth – in total over 5,000 children tested in 2007 • No. of children receiving ART increased dramatically from 2000 in 2005to 11,865 in 2007 • Strong political will and leadership by the government of Malawi in the fight against HIV and AIDS • Strong partnership between UNICEF, Baylor, Lighthouse, WHO, CDC and Clinton Foundation to support MOH • Asteady supply of quality AIDS drugs, strengthening of lab services for CD4 counts and EID • Revised registers for M&E and job aides for PMTCT & pART

  12. Challenges • Weak continuum of care of PMTCT services from ANC, & maternity to under five clinics • Low coverage of more efficacious regimens for PMTCT and Cotrimoxazole Preventive Therapy • Late diagnosis of HIV+ children • Long turnaround time from HIV+ diagnosis to starting ART • M&E system does not monitor outcomes pART • Relatively poor access to ART services (30% of facilities) • Human resource constraints • Community not well sensitised on PMTCT & Paediatric HIV care • Psychosocial support for teenagers living with HIV • Disclosure to the child • Disclosure to family, friends and school

  13. Finally a short movie & thank you for your attention

More Related