Access to HIV/AIDS Treatment:

Pediatrics

Clare Dougherty
Senior Public Policy Officer
Elizabeth Glaser Pediatric AIDS Foundation
Foundation is Worldwide Leader in Fight
Against Pediatric AIDS
Foundation at a Glance

• Working in 18
countries

• Largest provider of
PMTCT services under
PEPFAR

• One of the largest

providers of care and
treatment services to
children and adults
under PEPFAR
 EGPAF International Programs:
2000  8 sites in 6 countries
2008  3,400 sites in 18 countries

Russia

United Georgia* China

States

India Thailand*
Dominican Rwanda
Republic*

Jamaica* Uganda
Cote
Honduras* d’Ivoire
Kenya

Cameroon Tanzania

D.R. Congo Malawi

Mozambique
Angola*
South
Africa Zimbabwe
Swaziland
Zambia Lesotho 4
*Program initiated with EGPAF support and transitioned to other implementers
Three Areas of Focus, Working in Concert

Program
Implementation

Advocacy Research
Domestic and Global Advocacy
 Achieving Global Eradication of
Pediatric HIV/AIDS
• Pediatric HIV is preventable.
– Over 90% of infections are caused
by mother-to-child transmission
– Near eradication of pediatric
HIV/AIDS in the US

• HIV/AIDS is treatable.
– Without treatment, more than half
of infected children die by age two
– Less than 1/5 of children in need
receive treatment
7
 Global Impact of HIV/AIDS on Children

Pediatric HIV/AIDS Global Estimate* United States

(2007) (2006)

Children Living with

2.0 million 6,700
HIV/AIDS

New Pediatric
370,000 100-200
HIV Infections

Deaths in Children
270,000 50
with HIV/AIDS

* 90+% of child HIV infections and deaths occur in Sub-Saharan Africa

8
UNAIDS Global Report, 2008 and Centers for Disease Control and Prevention, 2008
 Pediatric Treatment - Barriers

Providing HIV care and treatment to children

presents special challenges, including:

• Limited access to reliable HIV testing for the youngest

children;

• Difficulty in identification;

• Lack of provider training and confidence in treating

children;

• The need for additional, low-cost pediatric formulations

of HIV/AIDS medications.
The Foundation & PEPFAR Reauthorization:
Our Experience
 To impact the policy process:
1. Decide what you want to achieve
• Identify priorities internally
• PEPFAR Reauthorization Working Group
• Assess implementation experience
• Build case for priorities
- Policy reports
• Mobilize resources

2. Identify key decision makers and champions

 Our Experience Continued…

3. Identify other stakeholders with common goals

• NGOs
• Implementers
• Executive Branch

4. Work in coalition

5. Maintain focus on priorities

 Foundation Priorities

• PMTCT Target

• Pediatric Treatment Target

• Removal of Budget Allocations/ Allow for Country

Flexibility

• Removal of 33% Abstinence Set-Aside

• Operations Research

• Sustainability
 PEPFAR 2: Final Key Provisions
• $ 48 Billion authorization level

• Removal of budget allocations (except for 10%OVC)

• Requires that more than 50% of funds go to care and

treatment

• PMTCT, pediatric treatment targets added

• Increased focus on Operations Research

• Addresses sustainability by focusing on country-driven

national strategies
 Next Steps: Post PEPFAR Reauthorization

• Must effectively engage with OGAC/ USG

Agencies to ensure that legislative directives are
reflected in implementation guidance and impact
operations in the field

• As with reauthorization, need stakeholder input

on how legislative mandates are translated into
implementation guidelines and policies

• Engage strategically in building framework

Beyond PEPFAR: GLOBAL ADVOCACY

• The Foundation will continue to work to

develop consensus around pediatric
treatment at all levels:

• Policymakers- U.S. & International

• Funders
• National governments
• Implementers
• Other NGOs
 Moving Forward
• Ensure implementation and funding of PEPFAR
as related to pediatric treatment.
• Expand national/international awareness and
support for pediatric treatment
• Enhance country policy and advocacy capacity
• Partner with global and national organizations to
increase focus on Foundation priorities,
including pediatric treatment.
 ELIZABETH GLASER
PEDIATRIC AIDS FOUNDATION

“What became apparent immediately was that

there was nothing out there for children. And as a
mother, that was just unacceptable.”
--Elizabeth Glaser