Global Pediatric AIDS: at the Tipping Point. Mark W. Kline, M.D. Professor of Pediatrics Chief, Retrovirology President and Chair, BIPAI

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1 Global Pediatric AIDS: at the Tipping Point Mark W. Kline, M.D. Professor of Pediatrics Chief, Retrovirology President and Chair, BIPAI

2 Objectives Describe the impact of HIV/AIDS on the health of children globally Discuss barriers to provision of pediatric HIV/AIDS care and treatment Outline strategies for expanding access of HIV-infected children to care and treatment 2

3 New Pediatric AIDS Cases, U.S

4 Global HIV Prevalence 4

5 HIV/AIDS: The Global Picture More than 95% of the 13,400 new HIV infections and 8500 HIV/AIDSassociated deaths that occur each day are in developing countries Children account for 14% of all new infections and 18% of all deaths (1560/day) 5

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8 Deaths Under Five Years of Age Attributable to HIV/AIDS Global 4.0% Botswana 57.7% Zimbabwe Swaziland Namibia Zambia 42.2% 40.6% 36.5% 33.6% 0% 10% 20% 30% 40% 50% 60% 70% 8

9 The AIDS Orphan Crisis More than 15 million African children have been orphaned by HIV/AIDS There may be 20 million AIDS orphans by

10 In the instance of antiretroviral therapy, the scenario for children is, quite simply, doomsday. Stephen Lewis January 18,

11 Pediatric HIV/AIDS Treatment: The Global Picture Children are underrepresented among those accessing treatment in virtually every setting worldwide Currently, no more than 60,000 children receive antiretroviral treatment, fewer than 3% of all HIVinfected children globally 11

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13 Barriers to Pediatric HIV/AIDS Care and Treatment Lack of infrastructure Lack and loss of human capacity Expense Lack of commitment to treatment of children Perceived complexity of pediatric treatment 13

14 The Baylor International Pediatric AIDS Initiative (BIPAI) Established 1996 Committed to improving the health and lives of HIV-infected children and families globally Currently active in Romania, Ukraine, Mexico, China and 20 countries in Africa 14

15 Facts About HIV/AIDS in Romania Romania accounts for over half of all European pediatric HIV/AIDS cases Children account for 90 percent of all HIV/AIDS cases in Romania 15

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28 Annual Pediatric HIV/AIDS Death Rate: Constanta, Romania 15% 13% 10% 7% 5% 3% 0% 1%

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35 Annual Pediatric HIV/AIDS Death Rate: Botswana COE 5% 4.7% 4% 3% 2% 1% 2.1% 1.1% 0.3% 0%

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37 The Children s Clinical Centers of Excellence Network Established January, 2004 Committed to high quality, high impact, highly ethical pediatric and family HIV/AIDS care and treatment, health professional training and clinical research Designed to catalyze pediatric HIV/AIDS care and treatment globally 37

38 The BIPAI Children s Clinical Centers of Excellence Network 38

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41 Defining Characteristics of the Centers of Excellence Collaborative Comprehensive Family-centered Care and treatment focused Provide support for regional and national scale up of pediatric and family HIV/AIDS care and treatment 41

42 Spin-off Benefits of the Centers of Excellence Build capacity for pediatric health care and clinical research generally (collateral benefit) Help to reverse brain drain Serve as impetus for HIV testing Help to destigmatize HIV/AIDS 42

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45 Pediatricians/100,000 Children (<15 years) U.S.A. Botswana Swaziland Lesotho Malawi 45

46 Potential Sources of Pediatricians for United Kingdom 16, Malawi Africa Nigeria Non-Baylor Pediatricians U.S.A. 90, ,175 Ghana , Kenya 12 Malawi Baylor Alumni Malawian Pediatricians South Africa Regional African Pediatricians U.S./Foreign Pediatricians 2 4, Baylor Pediatric AIDS Corps 46

47 The Pediatric AIDS Corps Recruits BE/BC pediatricians, internists and family doctors Assignments to nine countries in Africa Minimum one-year commitment Training in tropical medicine and HIV Living stipend Housing Student loan debt repayment 47

48 Goal of the Pediatric AIDS Corps To dramatically expand access of African children to HIV/AIDS care and treatment by: Providing primary pediatric and HIV/AIDS care and treatment directly to at least 100,000 African children Training hundreds of African health professionals in the care and treatment of pediatric HIV/AIDS 48

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52 BIPAI Network Activity 20,000 15,000 10,000 5,000 0 Dec '06 Feb '07 Apr '07 Jun '07 Aug '07 Oct '07 Dec '07 Feb '08 Active patients Patients receiving HAART 52

53 HIV-Infected Children Receiving Care and Treatment 21,951 20,000 15,000 10,000 11,000 15,000 5,000 4,000 0 U.S.A. Western Europe U.S. + Western Europe BIPAI Network 53

54 Areas of Focus for 2008 and Beyond Prevention of mother-to-child HIV transmission Hospital-based HIV testing Expansion of the Pediatric AIDS Corps Satellite and outreach services 54

55 LERATO: Lesotho Expansion of Rural AIDS Treatment and Outreach 55

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64 Summary Providing lifesaving care and treatment to HIV-infected children in Africa and around the world is a test of our ingenuity, our commitment and our compassion We have a unique opportunity to change the world for hundreds of thousands of HIV-infected children and their families 64