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WHO Guidelines: 2010 and Beyond

WHO Guidelines: 2010 and Beyond. Christian Pitter, MD MPH Elizabeth Glaser Pediatric AIDS Foundation. Eliminate Pediatric HIV Now. EGPAF International Programs: 2000  8 sites in 6 countries 2010  >5,400 sites in 16 countries. China. India . Rwanda . Uganda. Cote d’Ivoire.

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WHO Guidelines: 2010 and Beyond

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  1. WHO Guidelines: 2010 and Beyond Christian Pitter, MD MPH Elizabeth Glaser Pediatric AIDS Foundation

  2. Eliminate Pediatric HIV Now.

  3. EGPAF International Programs: 2000  8 sites in 6 countries 2010  >5,400 sites in 16 countries China India Rwanda Uganda Cote d’Ivoire Kenya Cameroon Tanzania D.R.Congo Malawi Mozambique South Africa Zimbabwe Swaziland Zambia Lesotho United States *Program initiated with EGPAF support and transitioned to other implementers

  4. 70 000 60 000 50 000 40 000 30 000 20 000 10 000 0 1996 1998 2000 2002 2004 2006 2008 Estimate 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

  5. Four Linked Guidelines Community Health System (MCH,TB, etc.) Comprehensive HIV Response ARVs for Vertical Transmission Pediatric ART IYCF Adult & Adolescent ART

  6. 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

  7. 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 Point Elimination of Pediatric HIV Concerted Efforts Implementation Advocacy Research WHO Guidelines Current Success Concerted Efforts Implementation Advocacy Research National Systems, Partners and Communities National Systems, Partners and Communities

  9. What We Need to Do: Be of Service… • To our host countries’ HIV response • Assist/Advise in adaptation • Assist/Advise in implementation • To districts and facilities we support • Implementation planning and support • To our Mission • See 1 & 2 above • Evaluate • Document & Share

  10. 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

  11. Phase 1 Toolkit

  12. 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

  13. 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

  14. 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.

  15. Status of Guideline Adaptation and Implementation for PMTCT (1)

  16. Status of Guideline Adaptation and Implementation for PMTCT (2)

  17. Status of guideline revision at national level

  18. 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?

  19. Final Thoughts • Challenges • Accelerate scale-up and improve quality • Fundamental changes to health system functioning (Integration, Supply chain, Funding, Human resources) • Monitoring & Evaluation • Opportunities • Collaborate in a new way • Move closer to elimination: believe, plan, communicate & execute • Bring non-clinical elements to the fore

  20. Thank You • Host Governments • EGPAF Country Teams • International and local partners • US Centers for Disease Control and Prevention • USAID • Johnson & Johnson • CIFF • ViiV Healthcare

  21. Eliminate Pediatric HIV Now.

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