WHO Guidelines: 2010 d B d2010 and Beyond

Christian Pitter, MD MPHC s a e ,Director, Global Technical Policy

Elizabeth Glaser Pediatric AIDS FoundationElizabeth Glaser Pediatric AIDS Foundation

Eliminate Pediatric HIV Now.

EGPAF International Programs: 2000 8 sites in 6 countries

2010 >4865 sites in 16 countries2010 4865 sites in 16 countries

ChinaUnited States

India Rwanda

UgandaCote

Kenya

TanzaniaCameroon

Cote d’Ivoire

South

D.R. Congo Malawi

Mozambique

SouthAfrica

Zambia

ZimbabweSwazilandLesotho

*Program initiated with EGPAF support and transitioned to other implementers

60 00050 000

70 000Estimate of the annual number of infant infections averted 50 000

40 000

20 00030 000

10 000

through the provision of ARV prophylaxis to HIV-positive pregnant women, globally, 1996–2008

1996 1998 2000 2002 2004 2006 20080

10 000

70,000 infections averted in 2008

Estimated number of new pediatric infections with and without PMTCT prophylaxis globally, 1996-2008

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What the New Guidelines RepresentRepresent

• Progress of knowledge in provision of g g pHIV services

Th fi t t i dif i k l d• The first step in codifying knowledge into standards of care

• Opportunity to improve approaches, service delivery, and outcomesy,

• A relatively rare “leverage point” to f i d fffocus attention and effort

Overall Major Changes

• ↑ logis cal and supply‐chain needs

• ↑ need for long‐term follow‐up and integration between PMTCT and HIV care gand treatment

• ↑ need for treatment↑ need for treatment

• Advancement of monitoring and evaluationevaluation

If implemented at scale, the virtual If implemented at scale, the virtualelimination of pediatric HIV

Guidelines as a Leverage PointGuidelines as a Leverage PointElimination of Pediatric HIV

Concerted Efforts

National Systems Partners and Communities Current 

ImplementationAdvocacyResearch Concerted Efforts

I l iNational Systems, Partners and Communities Success

WHO 

ImplementationAdvocacyResearch 

Guidelines

8

What We Need to Do: Be of ServiceBe of Service…

1. To our host countries’ HIV response1. To our host countries  HIV response o Assist/Advise in adaptationo Assist/Advise in implementation

2. To districts and facilities we serveo Implementation planning and supporto Implementation planning and support

3. To our MissionS 1 & 2 bo See 1 & 2 above

o Evaluate  o Document & Shareo Document & Share

Supporting Guideline Adaptation & Implementation& Implementation

• Toolkits phases I, II, and IIIp , ,

• Technical advocacy/support at national l llevel

• Technical support at implementation levelTechnical support at implementation level

• Inter‐country support 

• Global sharing and leadership

• DOCUMENT, EVALUATE, DOCUMENT

Phase 1 ToolkitToolkit

Phase 2: District Implementation Planning ToolsPlanning Tools

• Site profiling/ mapping tools

• Programming cost estimate tools

i i i fl l i• District patient flow analysis

• District work planning

• Assessment staffing training needs

• Planning standard tool revision

• Partnership landscape analysisp p y

• Package of BCC/IEC planning tools

Phase 2: Facility Implementation Planning ToolsPlanning Tools

• Site Patient Flow Analysis

• Linkage and Integration Site Assessment Tool

• Standard Operating Procedures Templatesp g p

• Site Transitioning Mentoring Tool

T l t A I t f N ti l G id li• Tool to Assess Inventory of National Guidelines Currently Available at Sites

• Facilitator’s Guide for Briefing Healthcare Workers on Content of Revised WHO Guidelines

• M&E Implementation Planning Tools 

Phase 3 Overview

• Ongoing planningg g p g

• Monitoring and evaluationg

• Quality improvementQ y p

Continuing the Cycle

• Revisions planned for 2012p

• What direction for the next revisions?

• What do we need to know to inform the decisions?

• Who will do the research?

Continuing the Cycle

• Revisions planned for 2012p

• What direction for the next revisions?

• What do we need to know to inform the decisions?

• Who will do the research?

Final Thoughts• Challenges

o Accelerate scale‐up and improve quality

o Fundamental changes to health system functioning (Integration! Supply chain! Funding! Human resources!)

o Monitoring & evaluation

• Opportunities

o Collaborate in a new wayo Collaborate in a new way

o Move closer to elimination: believe, plan, communicate & executecommunicate & execute

o Bring non‐clinical elements to the fore

Thank You

• US Centers for Disease Control and 

Thank You

Prevention• USAID• Johnson & Johnson• ViiV Healthcare• Host Governments• EGPAF Country Teamsy• International and local partners

Eliminate Pediatric HIV Now.