Survey of Service Delivery Orgs Reveals Current State of Pediatric HIV AIDS

Current State of Pediatric HIV/AIDS and the Failure to Treat Children Vincent DeGennaro University of Miami School of Medicine State of Pediatric HIV/AIDS 2.3 million children under the age of 15 living with HIV/AIDS  570,000 children died of AIDS in 2005  700,000 new pediatric infections  Children account for… 15% of new HIV infections  6% of total HIV infections  18% of all AIDS deaths  Effectiveness of ART in Children 80% of HIV-positive children die by age 5 without treatment, 80% of HIVpositive children are alive at age six with antiretroviral therapy (ART) Photo attribution: Photographs courtesy of Stephen Shames, for Keep A Child Alive. Obstacles to Pediatric Treatment Lack of pediatric formulations  Cost of pediatric formulations  Lack of diagnostic tests  Few pediatric-trained workers  No treatment guidelines  Poor data collection  Methods     Surveys sent via email or mail to 25 nongovernmental organizations (NGO) and 35 governments Surveys were distributed on electronic listserves Information on internet used to answer surveys Most responses to the surveys received personally from organization or government Survey Questions Treatment  How many people are receiving ARVs through your programs this year?  How many of these are children under 15? _______Infants under 2?_______  How many HIV-positive people are receiving medical care?_________  How many of these patients in medical care are children under 15?_______ Infants under 2?_________ PMTCT  How many HIV-positive expectant mothers do you have enrolled in PMTCT programs this year?__________________  How many HIV-positive expectant mothers do you have enrolled in PMTCT-plus programs this year?__________________  What is the approximate rate of vertical transmission in your PMTCT programs?  What services do you provide to HIV-positive mothers after the birth?  ___Education  ___Counseling  ___Family Planning  ___ARV Treatment Results  Information on 25 NGO’s and 13 national programs One-third of countries disaggregate data by age Response rate was 53%     28% of governments 84% of the NGO’s Results-Treatment Of 1.3 million on ART, 40,000 are children  4% of those on ART  9% of those in HIV-related care  6% of global need met  15% 12% 9% 6% 3% 0% Be ni Bo n ts wa na Br Ca azil m er oo n Et hi op ia In di a Ke ny a M al M aw oz i am bi qu e Rw So and ut a h Af ric a Ta nz an i Th a ai la nd Report Card of Countries % of total on ART that are children Results-Prevention    1.5 million HIV-positive mothers received PMTCT services last year  <10% of the those in need 20%- Mean rate of vertical transmission 17%- HIV-positive mothers enrolled in PMTCT programs received ARV prophylaxis  Thailand provided ARV prophylaxis to 75% PMTCT=Prevention of Mother to Child Transmission  Results-Prevention     Most programs provide mothers with education and counseling, and 75% provide ART for the mother after the birth 80% of PMTCT programs provide infants with cotrimoxazole 66% provide tuberculosis treatment 66% provide nutritional supplements Results-Prevention    Less than half use virological tests on infants, or perform HIV tests on the siblings Only 33% of PMTCT programs provide long-term ARV prophylaxis to infants. 40% of PMTCT programs provide ART to children born to participating mothers Conclusions    17% of adults in need receive treatment, only 6% of children in need are on ART Governments and NGOs with treatment programs do not do enough to treat children No stakeholder meets goal of having children comprise 15% of the total population on ART Conclusions   PMTCT programs are not being promoted or implemented effectively Most HIV-positive mothers go without PMTCT services like testing, counseling, and ARV prophylaxis  Infants born into the majority of these programs are not treated after birth. Conclusions   HIV-related care like cotrimoxazole and tuberculosis treatment is adequate in NGO programs, but governments do not provide these essential services Most national programs are unable to provide data on pediatric treatment Recommendations    Prevention! Increase family-centered care Family-centered care offers PMTCT, prompt diagnosis, ARV prophylaxis, cotrimoxazole prophylaxis, treatment of opportunistic infections, and long-term ART for the entire family in one location. Recommendations    Immediately scale up the treatment of children despite obstacles Create demand for pediatric formulations and lower prices on existing formulations Negotiate lower prices on drugs and diagnostics Recommendations   Disaggregate data by age Earmark donor funding for children and require recipients to have children be 15% of those on treatment A New Hope    Four generic pediatric drugs FDA approved in last six months Indian generics making pediatric triple therapy combination drugs Public/Private partnership for more pediatric formulations A New Hope   WHO report shows 27 countries disaggregate data by age WHO/UNICEF renew emphasis on PMTCT To download results paper, go to www.globalaidsalliance.org/Children_Left_Behind.cfm References                    1. WHO, “Improving Access to Appropriate Paediatric ARV Formulations,” November 3-4, 2004, Geneva, http://www.who.int/3by5/en/finalreport4Apr.pdf 2. UNAIDS/WHO, “AIDS Epidemic Update” December 2005, http://www.who.int/hiv/epi-update2005_en.pdf 3. MSF, “Untangling the web of price reductions, V.8”, June 2005. http://www.accessmedmsf.org/documents/untanglingtheweb%208.pdf 4. UNICEF/UNAIDS/WHO/MSF, “Sources and Prices of Selected Medicines and Diagnostics for People Living with HIV/AIDS,” Annex 1B, June 2005. 5. WHO, “Antiretroviral treatment of HIV infection in infants and children in resource-limited settings, towards universal access” October 2005. 6. Global AIDS Alliance, “Mobilizing a Comprehensive Response to Global AIDS and Addressing the Epidemic’s Impact on Children: 2005-2006 Strategic Plan,” June 6, 2005. 7. Mulenga, D. and N. Walker, UNICEF estimate, Inter-Agency Task Team on Orphans and Vulnerable Children, June 16, 2005. 8. 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Office of US Global AIDS Coordinator, “Second Annual Report to Congress”, February 2006. 17. Office of US Global AIDS Coordinator, “Focusing on our Future: Prevention, Diagnosis, and Treatment of Pediatric HIV/AIDS”, September 2005. http://www.state.gov/s/gac/rl/more/2005/pediatric/index.htm 18. AIDS Law Project, Treatment Action Campaign, “A short Assessment of Provision of Treatment and Care 18 months after the adoption of the Operational Plan” June 2005.