1 / 27

UNTG Children and AIDS Working Group meeting 联合国艾滋病专题组 - 儿童与艾滋病小组会议 26 May 2009

MSF’s Experience Providing Pediatric HIV Care and Treatment in Nanning 无国界医生广西南宁项目为 HIV 儿童提供关怀与治疗的经验. UNTG Children and AIDS Working Group meeting 联合国艾滋病专题组 - 儿童与艾滋病小组会议 26 May 2009. Peter Saranchuk, MD, CCFP, DTMH Medical Referent 医疗负责人. Clinical case 临床案例.

rae
Download Presentation

UNTG Children and AIDS Working Group meeting 联合国艾滋病专题组 - 儿童与艾滋病小组会议 26 May 2009

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. MSF’s Experience Providing Pediatric HIV Care and Treatment in Nanning无国界医生广西南宁项目为HIV儿童提供关怀与治疗的经验 UNTG Children and AIDS Working Group meeting 联合国艾滋病专题组-儿童与艾滋病小组会议 26 May 2009 Peter Saranchuk, MD, CCFP, DTMH Medical Referent 医疗负责人

  2. Clinical case 临床案例 • Child born in January 2009 小孩于2009年1月出生 • Admitted to hospital in April 2009 于2009年4月住院 • Shortness of breath 气紧 • Mother diagnosed with HIV in February 2009 (after delivery) 母亲在2009年2月诊断HIV(产后) • No PMTCT 无母婴阻断 • Breastfeeding initially 产后母乳喂养

  3. Clinical case (contd) 临床案例(续) • Diagnoses 诊断 • Pneumonia (PCP?) 肺炎 • Liver problem 肝脏问题 • Anaemia 贫血 • DNA PCR sent 14 April 2009 于2009年4月14日送血样查DNA PCR

  4. Clinical case (contd) 临床案例(续) • Diagnoses 诊断 • Pneumonia (PCP?) 肺炎 • Liver problem 肝脏问题 • Anaemia 贫血 • DNA PCR sent 14 April 2009 于2009年4月14日送血样查DNA PCR • Result this week: HIV positive 结果这周回报: HIV阳性 • Still sick and requiring hospitalization 仍病重,需住院

  5. Clinical case (contd) 临床案例(续) Problems 问题: • Diagnosis of HIV in mother too late 母亲诊断HIV太晚

  6. Clinical case (contd) 临床案例(续) Problems 问题: • Diagnosis of HIV in mother too late 母亲诊断HIV太晚 • Initial uncertainty of diagnosis in child (HIV-exposed) 小孩(暴露于HIV病毒)HIV最初诊断不明确

  7. Clinical case (contd) 临床案例(续) Problems 问题: • Diagnosis of HIV in mother too late 母亲诊断HIV太晚 • Initial uncertainty of diagnosis in child (HIV-exposed) 小孩(暴露于HIV病毒)HIV最初诊断不明确 • Life-threatening opportunistic infection now 现在出现危及生命的机会性感染

  8. Clinical case (contd) 临床案例(续) Problems 问题: • Diagnosis of HIV in mother too late 母亲诊断HIV太晚 • Initial uncertainty of diagnosis in child (HIV-exposed) 小孩(暴露于HIV病毒)HIV最初诊断不明确 • Life-threatening opportunistic infection now 现在出现危及生命的机会性感染 • When to start ARVs? 何时开始抗病毒治疗?

  9. Clinical case (contd) 临床案例(续) Problems 问题: • Diagnosis of HIV in mother too late 母亲诊断HIV太晚 • Initial uncertainty of diagnosis in child (HIV-exposed) 小孩(暴露于HIV病毒)HIV最初诊断不明确 • Life-threatening opportunistic infection now 现在出现危及生命的机会性感染 • When to start ARVs? 何时开始抗病毒治疗? • Cost of hospitalization 住院费用

  10. MSF in Nanning 无国界医生在南宁 • Since December 2003 自2003年12月 • HIV/ART project 艾滋病项目 • In collaboration with: 与以下机构合作 • Guangxi PHB 广西卫生厅 • Guangxi CDC = our operational partner 广西疾控中心=执行合作方 • AIDS Care China (Red Ribbon Center) 中国爱之关怀(红丝带活动中心) • All services are free and confidential 所有服务是免费及保密的

  11. Project Activities in Nanning 在南宁开展的项目活动 • Outreach to high-risk populations 针对高危人群开展宣传活动 • HIV care and treatment at CDC/MSF project 广西疾控中心/无国界医生艾滋病关怀与治疗合作项目 • Diagnosis of infections 感染的诊断 • Treatment of infections 感染的治疗 • Antiretroviral therapy (ART) 抗病毒治疗 • Counselling and adherence support 咨询及依从性支持

  12. HIV Care 艾滋病关怀 Between Dec 2003 and 21 May 2009: 2003年12月至2009年5月21日之间: • 1663 people enrolled 收治1663名患者 • 174 children (10.5%) 174名儿童(10.5%) • 39 HIV-negative 39名HIV阴性 • 91 HIV-positive 91名HIV阳性 • 44 not yet determined (HIV-exposed) 44名结果待查(暴露于HIV)

  13. Factors contributing to morbidity/mortality in children 影响儿童发病率及死亡率的因素 • Delayed presentation 来诊晚 • Opportunistic infections (OIs) 机会性感染 • Unavailability of pediatric formulations of essential drugs 主要药物没有儿童剂型 • Side effects to ART 抗病毒药物的副作用

  14. 1. Delayed presentation 来诊晚 • > 50% of children presenting for the first time do so in the late stages of HIV infection with low CD4 counts 50% 的儿童首诊时处于HIV感染的晚期及CD4较低

  15. 2. Opportunistic infections (OIs) 机会性感染 • Tuberculosis (TB) • Penicilliosis (PM) • Pneumocystis pneumonia (PCP) • Meningitis

  16. 2. Opportunistic infections (OIs) 机会性感染 • Tuberculosis (TB) • Penicilliosis (PM) • Pneumocystis pneumonia (PCP) • Meningitis Plus an increased number of ‘regular’ infections

  17. Problem:Treating childhood TB with pills designed for adults问题: 儿童的结核治疗用药使用的是成人剂型

  18. 3. Solution: Fixed dose combinations (FDCs)解决办法: 固定剂量复合制剂(FDCs)

  19. HIV Treatment (ART) 艾滋病治疗(抗病毒治疗) Between Dec 2003 and 21 May 2009: 2003年12月至2009年5月21日之间: • 1045 people initiated on ART 共用1045名患者开始了抗病毒治疗 • 79 children (7.6%) 儿童79名(7.6%) • 66 continue to receive treatment 66名儿童仍在治疗 • 9 have died 9名死亡 • 3 have been transferred to other ART sites 3名转出到其他抗病毒治疗点 • 1 has been lost to follow-up 1名失访

  20. HIV Treatment (ART)艾滋病治疗(抗病毒治疗) • 1st line regimen: 一线组合 • AZT + 3TC + NVP • 2nd line regimen: 二线组合 • ABC + ddI + Kaletra • Need paediatric formulations 需儿童剂型 • FDCs 固定剂量复合制剂 • Kaletra syrup 克力芝糖浆

  21. Problem: ARV pill burden for a 15 kg child 问题: 一名15kg重的儿童面临的药片负荷 Solutions: Lots of adherence support 很多依从性支持 解决方式: Pillboxes 药盒 FDCs 固定剂量复合制剂

  22. Paediatric formulations儿童剂型: • 2-in-1 TB FDC for children • 儿童结核2合一固定剂量复合制剂 • Kaletra syrup 克力芝糖浆

  23. Successes 成功经验 • PMTCT is good 母婴阻断效果好 • Availability of DNA PCR testing 可以获得DNA PCR 检测 • Provincial and national programs provide free medical interventions 国家及省级项目提供免费的药物干预 • Red Ribbon Centre counselors 红丝带活动中心咨询员

  24. Free for HIV+ children living in Guangxi广西HIV阳性儿童可以获得的免费服务 • Testing 检测 • TB testing, including culture 结核检测,包括培养 • CD4 counts CD4计数 • Viral loads 病毒载量 • Medication 药物 • Common OI meds (including antibiotics and anti-fungals) 常见的机会性感染药物(包括抗生素及抗真菌药物) • Cotrimoxazole 复方磺胺甲恶唑片 • ARVs 抗病毒药物 • Nutritional support twice/year 营养支持,2次/年 • Transportation 交通费用

  25. Ongoing Challenges 持续的挑战 • Decrease late presentations 降低晚来诊案例 • Cost of HIV care can be unaffordable 可承受HIV关怀的费用 • Cost of hospitalization 住院费用 • Stigma and discrimination 耻辱和歧视 • Need quality-assured paediatric formulations 需要优质的儿童剂型药物 • Need FDCs (ARV and TB) 需要固定剂量复合制剂(抗病毒药物及结核药物)

More Related