1. Gaps & obstacles Priorities & Solutions
Group 4
Gaps & obstacles
Priorities & Solutions

2. Key Issues Ideal paediatric regimens Dosing & pharmacokinetics
Programmatic evaluation

3. Ideal paediatric regimens
FDC-based
Clinical & pK evaluation
Can start with adult formulations
Rapid development of paediatric formulations
NVP-exposed infants (& mothers) – develop a strategy now
?4drugs
ABC & TFV
More work on PI’s
D4T endgame? – long term toxicity?

4. Dosing & Pharmacokinetics
Rifampicin – NVP/EFV interactions
EFV <3y/10kg
X1 daily dosing regimens
Incl 3TC, ddI, EFV, D4T, NVP, TFV
Validating weight-band based tables
At extremes of bands
Efficacy & toxicity
Dose clarification 3TC & NVP & ZDV

5. Programmatic: Longitudinal outcome cohorts in resource-constrained settings
Model program definition (for replication)
Decentralized
Nurse-managed
Community & family based with good referral network
Chronic care
Systems for surveillance
Clinical outcome (incl drop-out rate)
Resistance
Toxicity
Program evaluation
Forecasting evaluation

6. Who should do & who should fund?
Should WHO, UNICEF, UNAID & partners co-ordinate process?
Support from Regulatory authorities
National programs must endorse & support appropriate research
Funding - PEPFAR, GATES, USAID, Research networks, Academic institutions
Manufacturers (Innovator & Generic)
NGO – MSF, others

7. Other priorities Early diagnosis Improved PMTCT interventions
Virological
Clinical
Improved PMTCT interventions
Training & guidelines
Strategies
When to start ART?
Can ART be stopped? CD4 guided STI