Paediatric HAART where there is no paediatrician - Way forward for a paediatric primary HIV care and treatment plan

The Objectives of the meeting were to:

1. Identify key issues in Paediatric HIV/AIDS Treatment, internationally and in South Africa, for which advocacy or other action may be required, based on what we know and what more needs to be done.
2. Consult on how to take up these issues
3. Reach Agreement on a way forward

Some of the major gaps and challenges identified were:

1. A limited number of sites providing treatment to children in South Africa. Most of those in existence are at tertiary and academic institutions.
2. Less than 3 000 children currently on HAART in South Africa
3. Lack of appropriate diagnostics and ARV formulations
4. Limited service provision to children who are often pushed to the back of queues by or in favour of adults
5. Non-accreditation of HAART sites to provide treatment to children
6. Potentially setting unattainable standards for the treatment of children in a context of too few inequitably distributed staff.
7. Difficulties in attracting staff, particularly Pediatricians, to rural areas
8. A general lack of Pediatricians in the public sector who give attention to HIV and AIDS

Some of the possible actions which could promote participation of children included:

1. Raising awareness at various levels of current problems and the need to move rapidly to include children in implementation of the Operational Plan
2. Review of implementation of PCR diagnostics at Primary Health Care level, integrated with IMCI, MTCT programmes allowing earlier identification of children
3. Lack of child friendly approach to Primary health Care. Review of training approaches to ensure children are included in the health system as well as broader social system.
4. Development of child size tablets and the development of innovative medicine formulations and methods of application at affordable prices
5. Improvement of reporting mechanisms within the broader health system as to the progress of implementing the Operational Plan specifically highlighting the participation of children
6. Improvement in deliver of social services to children in the context of the family.