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

Transcription

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

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

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

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

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

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 1 st and 2 nd line ART

7 Recently the face of HIV Infection has changed with ART Then Now

8 5,000 7,800 8,532 17,278 13,413 26,699 35,443 43,481 58,884 Numbers of Children on ART in Uganda ( ) 70,000 60,000 32% 35% 32% 40% 35% 50,000 40,000 18% 20% 22% 25% 22% 30% 25% 20% 30,000 13% 15% 20,000 10% 10,000 5% % Number on ART % eligible on ART Source: MOH: Status of ART services in Uganda Dec 2014

9 (Thousands) Trends in AIDS-related deaths 250 Estimated number of AIDS-related deaths, in 0 4yr age group, Source: UNAIDS 2014 HIV and AIDS estimates, July 2015

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

11 (Thousands) Trends in AIDS-related deaths Estimated number of AIDS-related deaths, by 5-year age groups, Age 0-4 Age 5-9 Age Age Age AIDS-related deaths are increasing in adolescents aged years Source: UNAIDS 2014 HIV and AIDS estimates, July 2015

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.

13 Strategy to end AIDS epidemic: how are children doing?

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

15 Implementation of Test and Treat: 74% increase in number of children newly initiated on ART Fig: Number of Children newly initiated on ART Implementation of Test and Treat Q Q Q Q Q Q Q Q yr yr <2 yr Source: MOH Uganda, May 2015

16 Viral Suppression in Test and Treat Era in Uganda Proportion of children initiated on ART during the test and treat implementation who are viral suppressed by age Age ( years) Number received viral load test Number with suppressed viral load % with suppressed viral load < % % % % Overall % Source: MOH Uganda, May 2015

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.

18 Results of early infant HIV testing in Kampala PMTCT exposure Test status Number Percent Yes No Negative Positive Total Negative Positive Total Uganda MOH 2006

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

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

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

22 New challenge: Adolescents 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 and young people aged 20 24, Global, ,000 Children aged 0-14 Adolescents aged Young people aged , , , , , Source: UNAIDS 2014 HIV and AIDS estimates, July 2015

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

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

25 Acknowledgements 1. UNAIDS 2. JCRC research database 3. Uganda MOH AIDS control program 4. Dr Victor Musiime; Joint Clinical research Centre/Makerere University

26 Thank you!