WHO Guidelines: 2010 and Beyond

Christian Pitter, MD MPHElizabeth Glaser Pediatric AIDS Foundation

Eliminate Pediatric HIV Now.

EGPAF International Programs: 2000 8 sites in 6 countries

2010 >5,400 sites in 16 countries

India

China

SouthAfrica

Rwanda

Uganda

Kenya

D.R. Congo Malawi

Tanzania

Zambia

ZimbabweSwaziland

Cameroon

Mozambique

Cote d’Ivoire

Lesotho

*Program initiated with EGPAF support and transitioned to other implementers

United States

1996 1998 2000 2002 2004 2006 2008

60 00050 00040 000

20 000

0

30 000

10 000

70 000Estimate of the annual number of infant infections averted through the provision of ARV prophylaxis to HIV-positive pregnant women, globally, 1996–2008

70,000 infections averted in 2008

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

UNAIDS/WHO/UNICEF 2010

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Four Linked Guidelines

ARVs for Vertical

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Pediatric ART

Adult & Adolescent

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What the 2010 Guidelines Represent

• Progress of knowledge in provision of HIV services

• The first step in codifying knowledge into standards of care

• Opportunity to improve approaches, service delivery, and outcomes

• A relatively rare “leverage point” to focus attention and effort

Overall Major Changes

• ↑ logistical and supply-chain needs

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

• ↑ need for treatment

• Advancement of monitoring and evaluation

If implemented at scale, the virtual elimination of pediatric HIV

8

Guidelines as a Leverage PointElimination of Pediatric HIV

National Systems, Partners and Communities Current Success

Concerted EffortsImplementation

AdvocacyResearch

WHO Guidelines

National Systems, Partners and Communities

Concerted EffortsImplementation

AdvocacyResearch

What We Need to Do: Be of Service…

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

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

3. To our Missiono See 1 & 2 aboveo Evaluate o Document & Share

Supporting Guideline Adaptation & Implementation

• Phase I, II, and III Toolkits

• Technical advocacy/support at national level

• Technical support at implementation level

• Inter-country support

• Tracking and sharing country progress on adaptation and implementation for four technical areas

• DOCUMENT, EVALUATE, DOCUMENT

Phase 1 Toolkit

Phase 2: Program, District and Facility-Level Planning for Implementation

• Revised National Guideline Implementation Planning Tools

• District Implementation Roll-Out Planning Tools

• Costing Implementation of the Revised PMTCT Guidelines Tool

• Site Implementation Roll-out Planning Tools

• Linkage and Integration of PMTCT and HIV Care and Treatment Site Assessment Tool

Phase 2: Program, District and Facility-Level Planning for Implementation Con’t.

• Development of Standard Operating Procedures Tools

• Slide sets on the 2010 Revised WHO Guidelines/ Adapted National Guidelines

• Monitoring and Evaluation Tools• Partnership Planning Tools

* All tools available on website

Phase 3: Measuring Impact and Implementation of the Revised WHO

Guidelines

• PMTCT Indicator Matrix to monitor the revised WHO guidelines

• Q&A Interview on Revising M&E Systems at the Country Level

• Using EZQI PMTCT to measure clinical quality of care.

Status of Guideline Adaptation and Implementation for PMTCT (1)

Country/Indicator

Revised national guidelines

Roll-out of trainings

Distribution of tools/job aids to health facilities

Drugs forecasted Revision of national indicators

Revision of registers/national reporting forms

Implementation at facilities

Cameroon

China

Côte d’Ivoire

DRC

India

Kenya

Lesotho

Malawi

Status of Guideline Adaptation and Implementation for PMTCT (2)

Country/Indicator

Revised national guidelines

Roll-out of trainings

Distribution of tools/job aids to health facilities

Drugs forecasted Revision of national indicators

Revision of registers/national reporting forms

Implementation at facilities

Mozambique

Rwanda

South Africa

Swaziland

Tanzania

Uganda

Zambia

Zimbabwe

Status of guideline revision at national level

15

1PMTCT guidelines

Yes countriesNo countries

12

3

1

Prophylaxis regimen adopted

Option A countriesOption B countriesOther*

Continuing the Cycle

• Revisions planned for 2012

• 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

• Opportunitieso Collaborate in a new way

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

o Bring non-clinical elements to the fore

• Host Governments• EGPAF Country Teams• International and local partners• US Centers for Disease Control and

Prevention• USAID• Johnson & Johnson• CIFF• ViiV Healthcare

Thank You

Eliminate Pediatric HIV Now.