1. WHO Guidelines:
2010 and Beyond
2010 d B d
C s a
Christian Pitter, MD MPH
e,
Director, Global Technical Policy
Elizabeth Glaser Pediatric AIDS Foundation
Elizabeth Glaser Pediatric AIDS Foundation

2. Eliminate Pediatric HIV Now.

3. EGPAF International Programs:
2000 8 sites in 6 countries
2010 >4865 sites in 16 countries
4865
United China
States
India
Rwanda
Uganda
Cote
d’Ivoire
Kenya
Cameroon Tanzania
D.R. Congo Malawi
Mozambique
South
Africa Zimbabwe
Swaziland
Zambia Lesotho
*Program initiated with EGPAF support and transitioned to other implementers

4. 70 000
60 000 Estimate of the annual number
50 000 of infant infections averted
40 000 through the provision of ARV
30 000 prophylaxis to HIV-positive
20 000 pregnant women, globally,
10 000 1996–2008
0
1996 1998 2000 2002 2004 2006 2008
70,000
Estimated number of infections
averted in
new pediatric infections 2008
with and without
PMTCT prophylaxis
globally, 1996-2008

5. Four Linked Guidelines
nse
etc.)
ARVs for
ARVs for
Respon
H,TB, e
Vertical Pediatric ART
Transmission
e HIV R
ealth Sy m (MCH
mprehensive
ystem
Adult &
IYCF
Com
Adolescent ART
Ad l t ART
He

6. What the New Guidelines
Represent
• Progress of knowledge in provision of
g g p
HIV services
• Th fi t t i
The first step in codifying knowledge
dif i k l d
into standards of care
• Opportunity to improve approaches,
y,
service delivery, and outcomes
• A relatively rare “leverage point” to
focus attention and effort
f i d ff

7. Overall Major Changes
• ↑ logis cal and supply‐chain needs
• ↑ need for long‐term follow‐up and
integration between PMTCT and HIV care
g
and treatment
• ↑ need for treatment
↑ need for treatment
• Advancement of monitoring and
evaluation
If implemented at scale, the virtual
If implemented at scale, the virtual
elimination of pediatric HIV

8. Guidelines as a Leverage Point
Guidelines as a Leverage Point
Elimination of
Pediatric HIV
Concerted Efforts
Implementation
Advocacy
Research
Concerted Efforts Current
National Systems, Partners and Communities
National Systems Partners and Communities
Implementation
I l i Success
Advocacy
Research
WHO
Guidelines
8

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

10. Supporting Guideline Adaptation
& Implementation
& Implementation
• Toolkits phases I, II, and III
p , ,
• Technical advocacy/support at national
level
l l
• Technical support at implementation level
Technical support at implementation level
• Inter‐country support
• Global sharing and leadership
• DOCUMENT, EVALUATE, DOCUMENT

11. Phase 1
Toolkit

13. Phase 2: District Implementation
Planning Tools
Planning Tools
• Site profiling/ mapping tools
• Programming cost estimate tools
• District patient flow analysis
i i i fl l i
• District work planning
• Assessment staffing training needs
• Planning standard tool revision
• Partnership landscape analysis
p p y
• Package of BCC/IEC planning tools

14. Phase 2: Facility Implementation
Planning Tools
Planning Tools
• Site Patient Flow Analysis
• Linkage and Integration Site Assessment Tool
p g p
• Standard Operating Procedures Templates
• Site Transitioning Mentoring Tool
• T lt A
Tool to Assess Inventory of National Guidelines
I t f N ti l G id li
Currently Available at Sites
• Facilitator’s Guide for Briefing Healthcare
Workers on Content of Revised WHO Guidelines
• M&E Implementation Planning Tools

15. Phase 3 Overview
• Ongoing planning
g gp g
• Monitoring and evaluation
g
• Quality improvement
Q y p

16. Continuing the Cycle
• Revisions planned for 2012
p
• What direction for the next revisions?
• What do we need to know to inform
the decisions?
• Who will do the research?

17. Continuing the Cycle
• Revisions planned for 2012
p
• What direction for the next revisions?
• What do we need to know to inform
the decisions?
• Who will do the research?

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

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

20. Eliminate Pediatric HIV Now.