1. EGPAF experience in scaling up pediatric HIV testing and treatment
Francesca Celletti

2. Our Contribution to Pediatric ART Coverage)
1 in 6 children on ART in the countries where we have C&T programs were provided treatment by EGPAF

3. Number of children newly initiated on ART
Number of children newly initiated on ART has doubled in the last three years.
*Cameroon and Ariel are excluded from this figure

4. Differentiated models for testing, care and treatment
Differentiation by clinical and VL suppression
Differentiation by demographics (age)
0-5
POC and PITC
Higher rates of failure and death
More intensive care (e.g. frequent VL monitoring)
5-12
PITC, community
Relatively lower failure rates
May consider care simplification/decentralization
12-18
Adolescent friendly HIV testing
Increased failure – social change, non-adherence
Focus on social adjuncts to care
Entry into care
Care package stable patients
Care package: Clinically unstable patients
On ART
Care package suppressed
Care package detectable

5. Source: HIV/AIDS Diagnostics Technology Landscape, UNITAID, 2015
POC NAT pipeline
ZIVA™
Cavidi
2015
2014
2016
SAMBA II EID
DRW
Kenya, Uganda
Alere™ q HIV-1/2 Detect
Alere
CE Mark
Xpert® HIV-1 Qual
Cepheid
LYNX HIV p24
NWGHF
Micronics
Iquum/Roche
Lumora
Under development
QuantumDx
Ustar
DFA
TaqMan® HIV-1 Qual v2.0
Roche
DBS CE Mark
RealTime Qual HIV-1
Abbott
DBS CE Mark (2011)
SAMBA I Semi-Q EID
* Reported November timeline and sequence may change
no specific market launch date; DBS assay CE Mark noted for laboratory products
** In addition, open polyvalent platforms are currently available for HIV VL and EID testing
GeneXpert
Omni
Cepheid
Conventional EID – POC EID
Alere Q and Cepheid 1
Source: HIV/AIDS Diagnostics Technology Landscape, UNITAID, 2015 5

6. EGPAF/UNITAID POC EID project
Goal: to increase the number of HIV-exposed infants whose HIV status is known and facilitate early initiation on treatment.
Scale:
9 countries
4 years (2015 – 2019)
$63 million
Targets:
320,000 infants
13,562 HIV+ (4.2%)
Results within 2 day
EID coverage 20%
ART initiation by 14 days
Market shaping for POC

7. Overall Testing Summary
Overall testing summary and yield among children and adolescents supported through EGPAF-Kenya CDC project (Oct 2015-May 2016)
Overall Testing Summary
0-9 Years
10-14 Years
15-19 Years
Tested
86,327
53,223
69,439
Positive
708
317
800
Yield
0.8%
0.6%
1.1%
Yield per testing point / strategy by age group for children and adolescents 0-19 years
What do we do differently for adolescents in ANC and labour and vct (women come with the children)
Source: EGPAF, Kenya, Children and Adolescent Testing and Yield Data

8. Neonatal/Infant ART Choices
Liquid formulations:
5 NRTIs (3TC and ZDV) liquids
1 NNRTI (NVP)
1 boosted PI (LPV/rtv) – starting at 14 days of age and 42 weeks gestational age
Sprinkles and powder:
1 Integrase Inhibitor (RAL) powder – starting at 4 weeks of age
1 boosted PI (LPV/rtv) sprinkles – starting at 3 months of age

9. Decentralization for delivery of pediatric
ART in 5 countries
Primary health facility
Secondary and
tertiary health facility
D. Innovative service delivery model such as decentralization, task shifting, and pediatric HIV treatment in the context of the family centered approach.
Promote decentralized service delivery models – we can see in this 2013 study that when children were initiated in a decentralized facility as compared to secondary and tertiary facility LTFU and mortality decreased.
Lost to follow-up/ 100 PY on ART
Mortality rate/100PYs on ART
Fayorsey et al. Aquir Immune Defic Syndr, 2013

10. Viral suppression on ART EGPAF programs, 2015
Do these samples reflect general population on ART or are they biased toward more adherent patients and those retained in care – ie, falsely high rate of viral suppression? Or could they be biased toward those showing more signs of clinical failure, ie, falsely low rate of viral suppression?
Source: EGPAF Kenya country data review, May EGPAF Malawi country data review, Oct 2015
* Malawi data refer to viral load <1000 c/mL

11. Treatment failure and drug resistance Mozambique Ariel, 2013-14
Vaz P, et al., 7th HIV Pediatric Workshop, 2015,Vancouver, Abs. P- 31
6 facilities in Maputo
713 children on ART for median of 60 mo
256 (36%) treatment failure
Aug 2013-Mar 2014
Also, the issue of drug resistance and its impact on treatment outcomes is not well studied. One good study in Mozambique by our Ariel colleagues revealed very high rates of drug resistance among children experiencing treatment failure. This will have implications for long-term outcomes and reinforces the need to enhance treatment adherence and retention in care.

12. Continuous investment in R&D Increased investment
Getting to 1.6M
Find the children
Start them on ART early
Continuous investment in R&D
Increased investment

13. At this time in history, there is an urgent need to unify everybody’s effort under a common and cohesive umbrella to have more impact, improve efficiency and effectiveness along with quality of HIV services, and overall save more children’s lives.
We know that appropriately and adequately addressing pediatric HIV can be complex – it requires organization, commitment and attention to detail. Yet if appropriately treated, monitored, and supported, HIV-positive children will not only survive, but will thrive. Although young children cannot pass on HIV and do not contribute to the spread of the epidemic, they are individuals with a right to care and treatment and should be given the priority that, like all children, they deserve.
With sustained and increased commitment and financial resources and a paradigm change on how to deliver HIV testing, treatment and retention services, the global HIV/AIDS community will end pediatric AIDS. Because children do not have the voice to advocate for themselves, we must all speak on their behalf if pediatric AIDS is to be addressed and ultimately, brought to an end.
And we really should be able to think that when the story of these times gets written, we want it to say that we did all we could, and it was more than anyone could have imagined.
When the story of these times gets written, we want it to say that we did all we could, and it was more than anyone could have imagined