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Assoc.Prof . Thanyawee Puthanakit , MD. Division of Infectious Diseases, Department of Pediatric

A clinician perspective’s Why is treatment coverage in children so low?. Assoc.Prof . Thanyawee Puthanakit , MD. Division of Infectious Diseases, Department of Pediatric Faculty of Medicine, Chulalongkorn University AND HIVNAT, Thai Red Cross AIDS Research Center.

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Assoc.Prof . Thanyawee Puthanakit , MD. Division of Infectious Diseases, Department of Pediatric

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  1. A clinician perspective’s Why is treatment coverage in children so low? Assoc.Prof. ThanyaweePuthanakit, MD. Division of Infectious Diseases, Department of Pediatric Faculty of Medicine, Chulalongkorn University AND HIVNAT, Thai Red Cross AIDS Research Center

  2. Framework of HIV treatment and care 1 2 3 PED ARV CLINICS ENTRY POINTS UNDERSTAND DYNAMICS WHO Global update on HIV treatment 2013

  3. Challenges in HIV diagnosis 1. Entry points of high risk infants • Infants born to HIV-positive mothers • Depend on coverage of HIV-screening during antenatal care • Rate of infant follow-up after delivery and stop breast-feeding • Sick child; malnourished, tuberculosis, hospitalized child e.g. severe pneumonia, severe diarrhea 2. Laboratory tests • Virological tests: dried blood spot • Point of care testing 3. Awareness and knowledge in the community

  4. Cascade of PMTCT WHO Global update on HIV treatment 2013

  5. Challenges enrollment in care 1. No. of ARV clinics that could provide pediatric care • Thailand: 1016 adult ARV clinics, 616 ped ARV clinics • Chiang Rai model: decentralized from tertiary care to community hospital after initial viral suppression. 2. No. of trained personnel to provide pediatric care Difference between adult and children e.g. treatment initiation criteria, adherence rely on family/caretakers, skills to deal with adolescents 3.ART-Eligibility assessment Simplify guideline, in case of CD4-guided approach – access to lab tests 4. Treatment literacy in community J International AIDS Society. 2012; 15: 17358.

  6. Linkage into HIV care: Thailand experience NAP database: 30 Jun 2012

  7. d4T 5 mg/ml GPOvir 60 tab/bottle 3TC 10 mg/ml d4T (30 mg) + 3TC (150 mg)+ NVP (200 mg) NVP 10 mg/ml Challenges in ARV initation: ped formulation = 5 cm Thai program: 2004

  8. Challenges in ARV initiation • Limited ARV formulations/supplies • Dosage calculation • per kg, per BSA  body weight band • Vulnerable periods • Infancy • Changes of caretaker • Adolescent

  9. Our life By K-19 yr M/ Vocation Cert. in Architecture “ For my future, I would like to have family, house, rice farm, job and money, which I earn for a living.” “I am on the promising way of hope.”

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