7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)


MOSA03 Closing the Treatment Gap for Children Living with HIV
  Non-Commercial Satellite
Venue: Mini Room 3
Time: 01.07.2013, 18:30 - 20:30
Co-Chairs: Greg Perry, Switzerland
Mark Cotton, South Africa
Organiser: UNITAID, Drugs for Neglected Diseases Initiative (DNDi) and the Medicines Patent Pool (MPP)
In 2011, an estimated 3.4 million children below the age of 15 were living with HIV globally. In 2011 alone, 230,000 children were estimated to have died from AIDS-related causes. While antiretroviral treatment for children with HIV has come a long way, treatment coverage in children remains at 28% and lags far behind that of adult coverage at 57%. Recently, there has been a shift in attention from treatment to prevention, as the international community has called to end paediatric HIV by 2015. This commitment was long-awaited and well-received, but a gap remains in the already very low treatment coverage for children currently living with HIV and for those who will continue to be infected before elimination strategies kick in. This satellite session aims to look at the bottlenecks in getting treatment to children, such as availability of point-of-care early infant diagnosis, availability of most efficacious and adapted paediatric formulations for use in resource-poor settings, healthcare workers’ perceptions of challenges in treating children, intellectual property rights and trends in paediatric formulation markets. The session will focus on what is required for closing the treatment gap.

18:30
Introduction
G. Perry, Switzerland
M. Cotton, South Africa

18:40

Powerpoint
The burden of paediatric HIV and the impact of the new 2013 WHO Guidelines on the treatment of children with HIV
M. Penazzato, WHO

18:50

Powerpoint
A clinician's perspective: Why is treatment coverage in children so low?
T. Puthanakit, Thailand

19:00

Powerpoint
How to increase testing in children?
J. Cohn, United States

19:10
Q&A

19:20

Powerpoint
A new and improved first-line formulation for infants and young children
M. Lallemant, Switzerland

19:25

D. Video, Switzerland

19:30

Powerpoint
Licensing technology and intellectual property for the development of paediatric formulations
S. Juneja, Switzerland

19:40

Powerpoint
Examining the paediatric antiretroviral market landscape and factors relating to product adoption
E. Hannay, Switzerland

19:50
Q&A

20:00
Panel discussion: how do we implement the right 'tools' to close the treatment gap in children with HIV?
P. Clayden, United Kingdom
G. Ross Quiroga, Bolivia
T. Mutasa-Apollo, Zimbabwe
R. Simonds, United States
S. Essajee, United States

20:20
Summary and closing remarks

20:28
Struggling with LPV/r liquid formulation
M. Lallemant, Switzerland

Powerpoints presentations
The burden of paediatric HIV and the impact of the new 2013 WHO Guidelines on the treatment of children with HIV - Martina Penazzato

A clinician's perspective: Why is treatment coverage in children so low? - Thanyawee Puthanakit

How to increase testing in children? - Jennifer Cohn

A new and improved first-line formulation for infants and young children - Marc Lallemant
A new and improved first-line formulation for infants and young children - Marc Lallemant

Licensing technology and intellectual property for the development of paediatric formulations - Sandeep Juneja

Examining the paediatric antiretroviral market landscape and factors relating to product adoption - Emma Hannay



Rapporteur report

Track B report by Jason Brophy


This symposium focused on obstacles and potential solutions to allow increased coverage of testing and treatment for children living with HIV.  

 

The slow progress in initiation of children on ART is a clear problem.  ART coverage remains low, at approximately 34% in the 22 priority African countries in 2012, compared 29% in 2011.  This lags far behind adult coverage rates and is much lower than the Global Plan 2015 target of providing ART to all children in need.  Part of the problem lies in lack of diagnosis.  PMTCT as an entry point works for those whose mothers are diagnosed and/or engaged during pregnancy, but data suggests a minority of children enter care through EID, with most entering care at older ages on referral from hospitals.  This underscores the need for improved PMTCT coverage as well as better EID and paediatric HTC to detect children earlier before they become ill.  And while the 2013 WHO guidelines will provide many advantages to allow greater prevention through PMTCT and earlier treatment for children, new challenges may arise with respect to the effects of maternal ART on virologic test results and empiric ART on child confirmatory serologic results; new testing modalities and algorithms may be needed to resolve these new problems.

 

The Drugs for Neglected Diseases initiation (DNDi) described exciting work on bringing new paediatric LPV/rtv formulations (including granule based fixed dose combinations) to market, which will be essential to implementation of the new WHO recommendations.  A timeline was described which will hopefully see LPV/rtv+3TC+AZT/ABC FDC granule formulations as well as ritonavir granules (needed for ritonavir super-boosting in tuberculosis co-treatment) available for routine clinical use within the next 2 years.  

 

Finally, UNITAID described the complex market considerations involved in paediatric ARV manufacturing and procurement.  The market share for these formulations is a small fraction of the total ARV market, and accurate forecasting is essential to ensure manufacturers can keep up with program needs; transparency from programs regarding anticipated order volumes has been important in this regard.  UNITAID will continue in its focus on building and safeguarding market access for paediatric medicines (as well as HIV diagnostics), in collaboration with implementing partners like CHAI, PEPFAR, and Global Fund.




   

    The organizers reserve the right to amend the programme.