Since the program began in 2004, paediatric HIV and ART services have been offered at all sites providing adult care and treatment. At present, approximately 7,5% percent of all new enrollees are less than 16 years of age. Over 7500 children have been enrolled and approximately 4500 already started on antiretroviral therapy (ART). ART available in paediatric formulations include: zidovudine (AZT), lamivudine (3TC), didanosine (ddI), abacavir (ABC), stavudine (d4t),nevirapine (NVP), efavirenz (EFV)and kaletra (Lop/r). Paediatric fixed dose combinations should be available in the next year.
The greatest challenges to scale-up remain shortage of trained personnel, failure to identify HIV infected infants/ children early and poor adherence to care and treatment. Funding is provided to cover overtime shifts and task shifting has been encouraged to help meet the overwhelming staffing deficits. Routine testing has been introduced at most public paediatric in-patient units and thus the number of children being referred has increased. CIDRZ is presently working with the MoH to formalize this policy. Additionally, we are focusing more on utilizing TB programs, malnutrition units and siblings as index cases to access other children for VCT. The aim of the rogram is to increase the percentage of children enrolling to at least 9% overall before 2008. Most clinics have specified paediatric clinic days but will see children on any other days if necessary. Each site has at least 2 trained paediatric peer educators. These are lay counselors, trained in paediatric adherence, disclosure counseling, adolescent counseling and bereavement counseling. Several of the clinics already have established paediatric support groups providing separate services to children who are aware of their status, adolescents and care givers. A standardized curriculum is presently being developed to assist staff in setting up and managing paediatric support groups at all sites.