Assoc.Prof. Thanyawee Puthanakit, MD.Division of Infectious Diseases, Department of Pediatric

Faculty of Medicine, Chulalongkorn UniversityAND HIVNAT, Thai Red Cross AIDS Research Center

A clinician perspective’sWhy is treatment coverage in children so low?

Framework of HIV treatment and care

WHO Global update on HIV treatment 2013

1 2 3

ENTRY POINTS

PED ARV

CLINICS

UNDERSTAND DYNAMICS

Challenges in HIV diagnosis

1. Entry points of high risk infants• Infants born to HIV-positive mothers

– Depend on coverage of HIV-screening during antenatal care– Rate of infant follow-up after delivery and stop breast-feeding

• Sick child; malnourished, tuberculosis, hospitalized child e.g. severe pneumonia, severe diarrhea

2. Laboratory tests• Virological tests: dried blood spot• Point of care testing

3. Awareness and knowledge in the community

Cascade of PMTCT

WHO Global update on HIV treatment 2013

Challenges enrollment in care1. No. of ARV clinics that could provide pediatric care• Thailand: 1016 adult ARV clinics, 616 ped ARV clinics• Chiang Rai model: decentralized from tertiary care to community

hospital after initial viral suppression.

2. No. of trained personnel to provide pediatric careDifference between adult and children e.g. treatment initiation criteria, adherence rely on family/caretakers, skills to deal with adolescents

3. ART-Eligibility assessment Simplify guideline, in case of CD4-guided approach – access to lab tests

4. Treatment literacy in community

J International AIDS Society. 2012; 15: 17358.

Linkage into HIV care: Thailand experience

2007 2008 2009 2010 2011

81

118108 104

81

44

92 94

78

3732

65 6357

35

Number of infant positive at first PCR Total infant received CD4 count testTotal infant initiated ART

Mean age (days) at first CD4 517 429 379 269 176 Mean age (days) at ART 535 425 398 268 156

NAP database: 30 Jun 2012

d4T5

mg/ml

3TC10

mg/ml

NVP

10 mg/ml

=

GPOvir 60

tab/bottle

d4T (30 mg) +3TC (150 mg)+ NVP (200 mg)

5 cm

Challenges in ARV initation: ped formulation

Thai program: 2004

Challenges in ARV initiation

• Limited ARV formulations/supplies• Dosage calculation– per kg, per BSA body weight band

• Vulnerable periods– Infancy– Changes of caretaker– Adolescent

Our life By K-19 yr M/ Vocation Cert. in Architecture

“ For my future, I would like to have family, house, rice farm, job and money, which I earn for a living.”“I am on the promising way of hope.”