Children and AIDS

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Children and AIDS

• Ruth Nduati MBChB, MMed, MPH
• Associate Professor of Paediatrics
• University of Nairobi

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The Global Impact of HIV on children

• Children constitute
• 14 percent (700,000 of 4.9 million) of new global
  HIV/AIDS infections
• 18 percent (570,000 of 3.1 million) of HIV/AIDS
  deaths annually
• 5.6 percent (2.3 million of 40.3 million) of the
  persons living with HIV
• 14 million orphans by the end of 2005

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Global distribution of under-five mortality
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38
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Efficacy of ARVs for PMTCT in breastfed African
infants (1995-2004)
Transmission Rate ()
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Overall survival by infection status
HIV-infected HIV-uninfected
Cumulative dead 12 m 24
m HIV-uninfected 4.9
7.6 HIV-infected 35.2 52.5
Ghent IAS IHMA study group, Lancet 2004
Age at last visit/death (months)
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Clinical predictors of HIV disease progression
and death in children

• Maternal factors
• High plasma viral load
• Low CD4 count
• Sick mother
• Mothers death

• Infant factors
• Viral load
• CD4 lt 15
• Prematurity
• Early onset of failure to thrive
• Lack of breastfeeding

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Plasma Viral load in Kenyan HIV infected children
and adults Richardson et al. J Vir
2003777120-7123
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• The risk of death for HIV-1 infected and
  uninfected children is halved if the mother stays
  alive

Ghent IAS IHMA study group, Lancet 2004
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(No Transcript)
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Cotrimoxazole reduces mortality by 43Children
with HIV Antibiotic (CHAP) Trialin Lusaka,
Zambia(Chintu et al Lancet 2004)
1.00
HR0.57 0.43-0.77 p0.0002
0.80
Proportion alive
0.60
0.40
0
.5
1
1.5
2
Years from randomisation
265
232
177
106
47
Cotox
269
211
143
72
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Placebo
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Response to 2 years of treatment HIV-1 infected
children with PI based HAART in Ivory Coast
(Fassinou 2004)
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Adherence to ART (Wamalwa 2006 in press)
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Mortality in HIV-infected children increases when
fat-free mass (FFM) is decreased
(Fontana 1999)
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25 years into the HIV epidemic

• lt 10 of pregnant women offered PMTCT services
• lt 10 of OVCs receive public support or services
• lt 1/3 women aged 15-24 years in sub Sahara Africa
  understand how to avoid HIV infection
• HIV infected children are not accessing treatment

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Estimates of children in need of ARV treatment
and cotrimoxazole (UNAIDS/UNICEF 2005)
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Probability of survival under HAART in relation
with CD4 percentage before treatment
Abidjan Msellati 2003
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Diagnostic tools for paediatric HIV

• Clinical Algorithms
• Antibody tests
• CD4
• Virological tests
• PCR
• P24 antigen

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• PCR technology available mostly in research
  institutions

• PCR 2 section- Master mix preparation

PCR 3 Amplification and detection of the
amplified products
PCR 1- sample preparation area
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PCR network-how it works
Packaging
1 day
4 days
Sample Collection
2 Week turnaround to receipt of results
ART/PMTCT centre
Courier Samples
Testing lab
1 day
1 day
5 days
CDC/KEMRI-Kisumu CDC/KEMRI-Nairobi KEMRI-Kilifi
Courier Results
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Barrier to paediatric HIV diagnosis

• Laboratory infrastructure
• Lack of policies for testing children
• Skills gap in health workers
• Challenges of disclosure
• Exclusion of children from existing testing
  services

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Uptake of provider initiated testing
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Routine offer of HIV testing in MCH
Data from 12 Districts in Kenya NARESA 2006
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A Framework for Comprehensive Care for Children
Affected by HIV/AIDS their Families
Source Handbook for Pediatric AIDS in Africa,
2004
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10-Point Package for Comprehensive Care of an
exposed/infected child

• Early infant diagnosis
• Growth and development monitoring.
• Routine health maintenance
• Prophylaxis for OIs
• Early diagnosis and treatment of infections
• Nutrition counseling
• HIV disease staging
• ART for eligible children
• Psychosocial support to the child and family
• Referral for additional care

Source Handbook for Pediatric AIDS in Africa,
2004
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Service delivery gap for children
NASCOP Kenya 2006
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• Distributed in over 15 countries in Africa
• Translated into French
• Companion training curriculum available
• Handbook available on www.rcqhc.org

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HIV/AIDS and the human resources crisis

• Shortage of 4.3 million doctors, nurses,
  midwives, nurses and support workers world wide
• Brain drain of qualified health personnel
  crippling health care provision
• Sub-Sahara Africa requires 620,000 nurses to
  deliver effective HIV care and to cope with other
  health emergencies

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• A joint initiative of
• African Network for the Care of Children Affected
  by AIDS (ANECCA), Kampala, Uganda
• Institut de Santé Publique, Epidémiologie et
  Développement (ISPED), Bordeaux, France

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• No matter what your level of resources, there is
  always something that can be done for
  HIV-affected children

African Network for Care of Children Affected by
HIV/AIDS
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Acknowledgements
Dorothy Mbori-Ngacha Dalton Wamalwa Diana
Gibb Peter Haven Jane Muita Chewe Luo Nathan
Tumwesigye Robert Ayisi