1. Group III: Demand Forecasting

2. Demand forecasting Objectives Minimum requirements Tools Gaps
Recommendations

3. Demand forecasting Objectives
Global level:
Advocacy for inclusion of children in treatment initiatives, including setting targets for children
Advocacy for price reduction on pediatric ARV formulations for both high and low prevalence countries
Market development by the industry
National/Provincial/District level
Advocacy with national/provincial/district leadership for inclusion of children in treatment plans
Planning purposes

4. Demand forecasting Minimum information requirements
Pediatric treatment goals/targets:
Estimated number of CLWHA needing RX
Country capacity to treat
Programming approach
Recommended drug regimens
Profile of children to be treated

5. Demand forecasting Minimum information requirements
The number of CLWHA in need of RX:
Current estimates of number of CLWHA
Projected annual birth and death rates
HIV prevalence in ANC settings
MTCT rates
Breastfeeding practices
HIV-related morbidity and mortality rates
CD4%, TLC (Risk of under-estimation)
Existing care practices: CTX, nutrition etc…

6. Demand forecasting Minimum information requirements
Programming approach:
entry points: PMTCT, pediatric wards, OPD, nutrition programs etc…
Implementation plan: where to start, expansion plan etc…
Expected uptake
Capacity to treat at all levels:
Human resources
Financial resources and price of drugs (generics versus brand names)
Systems and infrastructure, including laboratory capacity

7. Demand forecasting Minimum information requirements
The recommended drug regimens:
National guidelines:
First line
Second line
Change in case of toxicity, TB etc…
Generics versus brand names
Patients’ profile:
Age and weight groups
% on first and second lines,
toxicity rate,
TB co-infection rate etc…

8. Demand forecasting Special considerations for procurement of pediatric formulations
Lead time
Storage and distribution capacity
Generics versus brand names
Number of manufacturers to deal with
Buffer stock

9. 2005 Target Current CLWHA (Countries, districts etc…)
Projected annual births, deaths, HIV infections
Total CLWHA in 2005
CLWHA needing RX
Capacity to treat
e.g. 50%

10. Tools Age-specific quantification of disease burden tool
ART capacity assessment tool
Drug quantification tool (e.g. Clinton Model)
MIS tool to monitor program uptake, drug consumption and treatment outcomes,

11. Gaps
Knowledge:
Age and weight distribution of HIV-infected children
Predictors of disease progression in resource-poor countries
Capacity to treat children
Laboratory diagnostic technologies in young infants below 18 months
Pediatric treatment goals not defined on many initiatives and programs
Current MIS do not include treatment outcomes
Age and weight-specific burden of disease ill-defined
Limited number of demand forecasting tools

12. Advocacy statement
Of the estimated 1.9m children living with HIV/AIDS in sub-Saharan Africa approx 0.5m need treatment, which is about 16% of the adults who need treatment
Therefore of the 3m by 2005 to be put on treatment 450,000 should be children
This would also hold true in a national setting
Of particular importance are the infants under 1 yr, one-third of whom will die in the first year

13. Recommendations
User friendly tool on CD to assess the child needs in ARV Tx which acknowledges that for planning purposes the first year is different from other years of enrollment
Need to improve diagnostic facilitgies, Access to antibody, PCR test to increase access to Tx
Drug supply chain
Communication

14. Capacity Set the minimum standards for the site to be able provide ART
Adapt adult ART sites assessment tools by adding pediatric part
Political will to create the requested capacity for ped ARV
Characteristic of the clinical sites
Training need
Prescription of the drugs
Family centered care cites, link child ARV and parent ARV
PMTCT, malnutrition clinics entry point

15. Community involvement
IMCI, home based care to identify children in need
pediatric ART adherence support

16. Agencies responsible for implementation
UNICEF – coordinate the work on development of forecasting model for ped TX, age specific burden of disease, capacity assessment tool, MIS tool in collaboration with other UN agencies
WHO – clinical diagnostic tool, facility assessment tool
AMDS – technical support
USAID funded FHI, JSI