State of National Guidelines Paediatric HIV Care Survey 2008 Martina Penazzato ATC HIV/AIDS Department WHO Geneva.

State of National GuidelinesState of National GuidelinesPaediatric HIV CarePaediatric HIV Care

Survey 2008

Martina PenazzatoATC HIV/AIDS Department

WHO Geneva

MethodsMethods

40 countries with burden of diseaseQuestionnairePhone interviewWHO HIV/AIDS country officersAppointed experts within the country

CountriesCountries• Botswana• Brazil• Burkina Faso• India• Jamaica• Malawi• Morocco• Mozambique• Nigeria• Pakistan • South Africa• Sudan • Tanzania• Thailand• Tunisia • Uganda• Zambia• Zimbabwe

African 12

South American 2

Asian 2

Middle East 2

National GuidelinesNational Guidelines National guidelines available All

Currently updating or updated within the 2007 10/18

Stand alone guidelines 13/18

Distribution to health facilities All butPakistan Sudan

PMTCTPMTCT PMTCT Coverage

high i.e. Thailand 93.9% reported by National Department of Health

mid South africa 30%low Uganda 10%

PMTCT Regimen» sdNVP 6» AZT+sdNVP 8» AZT+sdNVP+1week AZT/3TC 2» sdNVP+1week AZT/3TC 2» AZT/3TC/NVP intrapartum Burkina» NVP regimen in pregnancy 4» LPV regimen in pregnancy 2

» sdNVP 6» sdNVP+AZT (1, 4 or 6 weeks) 9 infants

mothers

ART Starting CriteriaART Starting Criteriain infants in infants

WHO 8 countries

WHO + viral threshold Tunisia Brazil (tend to start in all <1year)

All Jamaica Botswana South Africa (Official reccomandation:

symptomatic or CD4<35% and <1500 absolute count)

First Line RegimenFirst Line Regimen

• All NNRTI based regimenSouth Africa either NNRTI or PI

• Backbone preferred D4T/3TC

• Switch from1st to 2nd line 13/18 reporting 0%-15%

Distribution of first line regimens in Distribution of first line regimens in childrenchildren

42%

29%

11% 9%

91%

0%

20%

40%

60%

80%

100%

D4T + 3TC +NVP

ZDV + 3TC +NVP

ZDV + 3TC +EFV

D4T + 3TC +EFV

total

Lab facilitiesLab facilitiesVirological tests available: DNA PCR 6

RNA PCR 5

DNA PCR and RNA PCR 7

DNA PCR, RNA PCR and Agp24 1

- Dried Blood Spots available in 10/18 countries

- Number of Lab performing Brazil 30

Tunisia 15 (10 private)

South Africa all province covered by NHLS

Thailand, Burkina, Uganda and Tanzania >3

Others 1 or 2

- Health facilities offering In patients, Out patients, PMTCT sites and ART sites

CD4% and CD4 count available in all the countries reporting

CARE PACKAGECARE PACKAGE

Element Specified Fee

HIV antibody test All  

HIV virological test 15  

ART All  

Cotrimoxazole prophylaxis All but Tunisia  

Isoniazid prophylaxis 9 (3 IPT) 1

Follow up visit All  

Pneumococcal vaccine 1 (Brazil)  

Management OI All  

Counselling 17  

Social support 14  

Transport 2  

Other Nutritional Support Home visits

32

Is Nationally Specified?

All but Malawi

ChallengesChallenges Feasibility of recommendations Need of human resources dedicated to infants care Need of specifically trained lab staff Implementation at different health service levels Tools and dissemination activities Monitoring of quality and outcomes of service

provided. Suitable formulation Long term care implications Sustainability

Thank you!Thank you!

Acknowledgements:WHO Regional and Country officers

WHO HIV/AIDS country officers

Elisabeth Lowenthal

Jorge Pinto

GenevièveOnadja

Rakesh Lodha

Po-Lin Chan

Russell Pierre

Peter Kazembe

Soumia Benchekroun Taoufik

Paula Vaz

Velephi Okello

Eiaz Khan

Brian Eley

Mark Cotton

Tammy Meyers

Nour Elhouda Ata Alla

Roland Swai

Bhakeecheep Sorakij

Mohammed Chraknoun

Israel Kalyesubula

Anthony Mutiti

Filda Mutsawashe

Francis Onyango

Myrto Schaefer

Evgeny Voronin