Integrating Paediatric HIV/AIDS services into exisitng adult ART

services

 

Key Questions

1. What are the key entry points to HIV care for children and adolescents?

2. What are the Essential Elements for the continuum of care for children?

Introduction

To be effective, paediatric care and treatment interventions need to become an integral part of infant and child survival and health Programmes.

Family centered care model should be promoted

Essential elements for the continuum of care for children

1. Mechanism of Identifying HIV infected and exposed infants

2. Effective referral system

3. A defined care package

4. A functional care team

5. Staff supportive services

6. Logistics management systems

7. Health management information systems

1. Mechanism of Identifying HIV infected and exposed infants

Ensure all entry points

are identifying and

testing children– Train them– Provide test kits and

all materials– Provide registers

Entry points• Paed ward• ANC• Maternity• YCC• TFC• OPD• Community• Adult wards

Organize “Know Your Child Status day” (KYCSD)campaigns in the existing Adult ART

clinics

• Campaign aimed at testing children of clients.

• Set a date and venue for the activity.

• Prepare necessary logistics ( test kits , personnel etc…)

• Conduct mobilization during clinic days.

• Conduct the activity and refer all exposed and infected children for care.

2. Establish an Effective Referral System

Intra facility referrals(inter departmental referrals)– YCC to ART clinic– ANC to ART– ART clinic-Lab.– ART clinic-Wards

Inter facility Referrals

Community-Facility referrals

Referral must be written NOT word of mouth

3. A defined care package- ten point care package

1. Early infant diagnosis

2. Cotrimoxazole prophylaxis for OI prevention

3. Growth and development monitoring

4. Immunization, nutritional education, supplementation, and support, including multivitamins and iron

5. Routine quarterly deworming with Mebendazole

6. Aggressive management of acute illnesses

7. Psychosocial support and palliative care

8. Adolescent care and support

9. Family-focused care including PMTCT

10. ART when indicated and available

4. A functional care TEAM with a strategic direction and a leader

A functional care TEAM

Must be a dedicated multidisciplinary team– Clinician, nurse/midwife, lab tech, dispensor,

counselor and Records clerk, cleaners

Defined roles and responsibilities of each team member

Clear Management structure

Facility specific SOP’s

Regular multi-disciplinary team meetings

(MCH/inpatients/CTC)

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5. Staff Supportive ServicesCapacity Building– Formal/didactic Training– CME

Multi-disciplinary Team Meetings

Management-support

Support supervision/mentorship frame work

Exchange programs/attachments

Prevention and Management of Staff burn-out

6. Logistics management systems

Must have Stock cards

ARV Bi- monthly report and order forms

ARV dispensing logs

Good storage facilities for the drugs

What tools are recommended for data collection andreporting?

Data collection tools

EID register

Pre ART register

ART register

ART dispensing log

Reporting tools

Quarterly ART report books

Bimonthly Logistics report

7. Health management information systems

Family centered care approach should be encouraged

HIV infected Children and their parents should be care for in the same clinic.

Paediatric HIV/AIDS care and treatment services should therefore be integrated into existing adult ART care services.

Parallel care clinics for children should therefore not be initiated at sites that already have adult care clinics

Integration of paediatric services into adult HIV clinics

Involves: Creation of a ‘child-friendly’ clinic environment• play materials, elementary pictorial

books and arts/craft materials

Ensure availability of child friendly drug formulations (ARV’s and OI drugs)

Re align appointment with adult caregiver seen in the same clinic.

Integration of paediatric services into adult HIV clinics

Involves:

Introduce family-focused approach to adults in care• Build capacity among staff to care for the children• Active identification of children of the same household• focus on pregnant women

Introduce capacity to do routine infant diagnosis

Continuous mentoring by experienced clinicians

Challenges of integrating Paediatric HIV care into adult HIV clinic

• Lack of personnel trained in Paedaitric care

• Resistance among adult staff to deal with children

• Poor Paedaitric and adolescent approach

• Lack of ‘child-friendly environment’

• Risk of indirect and inadequate disclosure

• weak referral system between Paedaitric services and adult HIV clinic

•  

Summary

To successfully set up Comprehensive care for

children with HIV one must be define systems

for Clear mechanisms for identifying and enrolling

children into care Define and provide a comprehensive care package Have a committed team Use family centered care model to Integrate

paediatric care into adult care clinics