Global issues in the prevention and treatment of childhood AIDS Dr. - - PowerPoint PPT Presentation

Global issues in the prevention and treatment of childhood AIDS

• Dr. Shaffiq Essajee

World Health Organization

In 2005, global paediatric HIV treatment seemed an impossible dream

The past

• <30,000 children on

treatment worldwide (<5% of children in need of ART)

• Very few women were

accessing services to prevent vertical transmission

• Syrups were the only option

for children, the cost was around $500/child/year and dosing was very complex

• Infant diagnosis using PCR

testing was impossible to access

• Very few clinicians had the

knowledge and skills to care for children with HIV and paediatric treatment was only available at select tertiary clinics

Five years later, we have made significant progress

The past

• <30,000 children on

treatment worldwide (<5% of children in need of ART)

• Very few women were

accessing services to prevent vertical transmission

• Syrups were the only option

for children, the cost was around $500/child/year and dosing was very complex

• Infant diagnosis using PCR

testing was impossible to access

• Very few clinicians had the

knowledge and skills to care for children with HIV and paediatric treatment was only available at select tertiary clinics The present

• >275,000 children on

treatment worldwide (40% of children in need of ART)

• Overall about 200,000

pediatric infections have been prevented

• 5 new paediatric fixed dose

combination tablets are now available, cost $60/child/year with very simple dosing

• Infant diagnosis is more

readily available ~150,000 tests per year performed

• Thousands of nurses and

doctors have been trained, and paediatric treatment is now available at most ART centers

Each year, over 100,000 newly diagnosed children start ART

Source: UNICEF stocktaking report 2009

Combined paediatric treatment numbers from 20 countries with highest burden of disease

But…global progress masks individual country performance: some lag far behind

5

Many countries have achieved >50% of need met. BUT….many are far from there

20,000 40,000 60,000 80,000 100,000 120,000

Unmet Need for ART (WHO/UNAIDS) Started on ART in 2009 On ART up to sept 2008

CHAI/UNITAID data Dec 2009

And although we start 100,000 children per year on ART, there are 430,000 new infections

6

50,000 100,000 150,000 200,000 250,000

Exposed Infants Untested, 2008 (WHO/UNAIDS) PCR Tests, 2009 PCR Tests in 2008 Pregnant Women Receiving ARVs for PMTCT (WHO/UNAIDS)

CHAI/UNITAID data Dec 2009

As prevention efforts improve, we must look beyond PMTCT to find infected children

Source: Kellerman & Essajee, PLOS, 2010 K N O W N C A S E S U N K N O W N C A S E S All pregnant women HIV+ pregnant women HIV exposed infants HIV infected children

Positive women not tested in ANC are not identified and get no PMTCT services A significant number of infected infants never receive their PCR results and are lost to follow-up

PCR testing PMTCT Testing

Strategies to identify unknown infected children First tier Second tier

• Routine offer of testing in

inpatient wards, TB clinics and malnutrition units

• Proactive testing of children
• f adult patients enrolled in

HIV care programs

• Testing

children in HIV+ social networks and families

• Testing infants and children
• f unknown status at

vaccine or U5 clinics

• Door-to-door

testing focused on children

A l s e t i n g s H i g h p r e v

“Need” is relative. In reality almost all children would benefit from ART

2006 WHO guidelines: “Treat the sickest” 2010 WHO guidelines: “Treatment saves lives” 2010 US guidelines: “Treat almost all”

And today, Universal Access faces the most serious global economic crisis since 1930's…

$11.3 $8.8 $7.9 $6.1 $5.0 $3.2 $1.6 $1.4 $13.8 10 20 30

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

USD billion Resources Available for HIV services Resource needs for country defined UA

Resource needs Available resources

So what can we do together, as advocates, policy makers and clinicians to turn the wheel

National Programs and partners

Must adopt testing & treatment policies set ambitious targets and encourage USE

• f priority products

Clinicians

Must document experience and engage in

• perational

research to drive policy based on best practice

WHO

Must develop the policy guidance to encourage suppliers to make cheaper child friendly products as a priority