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Overview of Paediatric HIV Treatment and Prevention PowerPoint Presentation

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Description : Overview of Paediatric HIV Treatment and Prevention presentation talks about the plight of HIV infected children (1980s and 1990s), trends in new HIV infections and number of children treated, role of Global, Regional and National Efforts, sharing Uganda experience, New Challenges and looking to the future.

Tags : Pediatrics, Child Health, pediatric practice, pediatrician, health providers, Paediatric HIV, Paediatric HIV Treatment, HIV infected children

Published on : Jul 16, 2020 | Views : 2098 | Downloads : 0

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Slide 1-

Overview of Paediatric HIV Treatment and Prevention: From Then to Now Peter Mugyenyi, Joint Clinical Research Centre Kampala, Uganda
Slide 2-

Outline The plight of HIV infected children (1980s and 1990s) Trends in new HIV infections and number of children treated Role of Global, Regional and National Efforts Sharing Uganda experience New Challenges and looking to the future
Slide 3-

The plight of HIV infected children (1980s and 1990s) HIV access campaigns prioritized adults. High death rates of parents left up to 10 million orphans - many infected (UNAIDS) Initial access to ART reached only a tiny minority of adults and much fewer children Pharmaceutical companies did not invest much in paediatric ARV formulations
Slide 4-

Equity and moral imperative Continuing suffering and horror when effective therapy was available (but unaffordable).
Slide 5-

Significant Global Response Started late 2003: President Bush announces Presidents Emergency Program for AIDS relief (PEPFAR 2004: Global Fund to fight AIDS, Tuberculosis and Malaria
Slide 6-

Early HIV treatment studies were mainly among adults The children responded optimally to ART clinically, immunologically and virologically Just like in resource rich settings Similarly in urban and rural settings To both 1st and 2nd line ART
Slide 7-

Recently the face of HIV Infection has changed with ART Then Now
Slide 8-

Numbers of Children on ART in Uganda (2006 – 2014) Source: MOH: Status of ART services in Uganda – Dec 2014 5,000 7,800 8,532 13,413 17,278 26,699 35,443 43,481 58,884 13% 18% 20% 32% 22% 25% 35% 22% 32% 0% 5% 10% 15% 20% 25% 30% 35% 40% 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 2006 2007 2008 2009 2010 2011 2012 2013 2014 Number on ART % eligible on ART
Slide 9-

Trends in AIDS-related deaths 50 100 150 200 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 (Thousands) Estimated number of AIDS-related deaths, in 0 – 4yr age group, 2001-2014 250 Source: UNAIDS 2014 HIV and AIDS estimates, July 2015
Slide 10-

New Infection trends Source: UNAIDS. On the fast track to an AIDS free generation. 2016
Slide 11-

Trends in AIDS-related deaths 50 100 150 200 250 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 (Thousands) Estimated number of AIDS-related deaths, by 5-year age groups, 2001-2014 Age 0-4 Age 5-9 Age 10-14 Age 15-19 Age 20-24 Source: UNAIDS 2014 HIV and AIDS estimates, July 2015 s AIDS-related deaths are increasing in adolescent aged 10-19 years
Slide 12-

Disparities Between Adults And Children Percentage of ART Coverage Among Eligible Adults, Children and All Ages in the 22 Global Plan Priority Countries (2012) Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting. Note: Some numbers do not add up due to rounding. The coverage estimate is based on the estimated unrounded number of children receiving and eligible for ART.
Slide 13-

Strategy to end AIDS epidemic: how are children doing?
Slide 14-

Special issues and targets for ending Paediatric HIV Need for systematically addressing constraints peculiar to adolescents and children
Slide 15-

Implementation of Test and Treat: 74% increase in number of children newly initiated on ART Fig: Number of Children newly initiated on ART 5000 4000 3000 2000 1000 0 6000 7000 Source: MOH – Uganda, May 2015 Implementation of Test and Treat
Slide 16-

Viral Suppression in Test and Treat Era in Uganda Source: MOH – Uganda, May 2015
Slide 17-

Access To Virologic HIV Testing (Early Infant Diagnosis) 2012 *Lesotho data represents 2011 coverage data Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting, and UNAIDS modeling2012 HIV and AIDS estimates.
Slide 18-

Results of early infant HIV testing in Kampala Uganda MOH 2006
Slide 19-

Major issues to address Rate of Mother to Child transmission of HIV (6,100 infants are newly infected in 2015) remains unacceptably high, Number of children accessing timely EID services remains too low Retention on ART and viral suppression especially for under 5s (<70%) - low Uganda MOH
Slide 20-

Critical requirements to end Paediatric AIDS 99% Pregnant Mothers 99% EID for all children of HIV infected mums 99% ART drugs appropriate to age
Slide 21-

Finding the children: potential opportunities to offer HIV testing Sources: Fergusson et al, 2007; Hesseling et al. 2009; Ferrand et al. 2010; Cohen et al. 2010
Slide 22-

New challenge: Adolescents 600,000 500,000 400,000 300,000 200,000 100,000 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Children aged 0-14 Adolescents aged 15-19 Young people aged 20-24 New Infection trends: drop in adolescents not as sharp as for younger children Estimated number of new HIV infections among children aged 0–14, adolescents aged 15–19 and young people aged 20–24, Global, 2001–2014 Source: UNAIDS 2014 HIV and AIDS estimates, July 2015
Slide 23-

Adolescent specific interventions needed Adolescent friendly services Psychosocial support Peer counseling Sexual and reproductive health Skills training Community support Transition to adult clinics Photos: JCRC Stigmaless band; Adolescent peer support meetings
Slide 24-

Ending Paediatric AIDS epidemic achievable by identifying and addressing gaps Extend both ante-natal and EID coverage to all Maximize testing opportunities (e.g vaccination, clinics etc.) to cover children who missed out on EID Strengthen diagnostic, treatment and VL monitoring. Communication with policy makers and program partners to secure renewed commitment to 90-90-90
Slide 25-

Acknowledgements UNAIDS JCRC research database Uganda MOH AIDS control program Dr Victor Musiime; Joint Clinical research Centre/Makerere University
Slide 26-

Thank you!

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MarieAltmann

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