Grandir

Thank you for your support !

Many of you have reacted positively to the publication of the first issue of Growing Up Info. We were deeply touched by your support. Please keep sending comments and sharing experiences with us so that Growing Up Info may also be a liaison newsletter between all stakeholders involved in care and support to children living with HIV in Africa.

More information on GROWING UP available at: www.sidaction.org/pro/
international/grandir

More information on Initiative Développement at:
www.id-ong.org

Fixed dose combinations for children: efficient and safe

Single-pill fixed dose combination ARV therapies (FDC) have played a major role in increasing access to treatment in adults. FDCs cut in halves or three-quarters are prescribed for children because they are easier to administer by the caregiver than are pediatric liquid formulations. Several studies from Thailand (1), Uganda (2), Rwanda (3) and an MSF cohort of 1184 children spread out over 8 resource-limited countries (4) have recently shown the clinical and immunological efficiency as well as the safety of this method. It also increases adherence and lowers treatment cost. Ranbaxy's scored Triviro seems easier to administer than Cipla's Triomune. Administrating fractions of adult FDC tablets did not lead to NVP underdosage. However for infants weighing less than 10kg, for whom quarter adult tablets would be required, fractioning is not recommended because of the poor dosage accuracy (5). While waiting for several fixed-dose pediatric formulations to appear on the market (Baby Pedimune: d4T 6mg + 3TC 30mg + NVP 50mg and Junior Pedimune: d4t 12mg + 3TC 60mg + NVP 100 mg expected from Cipla), giving children who weigh more than 15kg fractions of adult FDC appears to be a reasonable alternative.

To find out more:
(1) Chokephaibulkit K et al.
AIDS 19: 1495-1499, 2005.
 
(2) Barlow-Mosha L. et al.
Third IAS Conference, Rio;
abstract WeOa0103, 2005.
 
(3) Médecins Sans Frontières.
14th ICASA, Abuja;
abstract WeOrC109, 2005.
 
(4) Médecins Sans Frontières.
14th ICASA, Abuja;
abstract WeOrC110, 2005
 
(5) Corbett A et al.
45th ICAAC, Washington DC;
abstract H-1106, 2005.
 

 

 

 


Corresponding to full dosage after initiation phase is over: D+15 (confirmation of
NVP tolerance).

International Conferences: recognizing pediatrics !

The 14th International Conference on AIDS and STIs in Africa (ICASA), in Abuja, Nigeria last December, devoted considerable attention to children's health. A summary of main data presented:
 
Pediatric classification and ARV therapy (ART)
WHO launched a new 4-stage pediatric classification for HIV (as opposed to 3 previously) and treatment guidelines. It will be the focus of an upcoming issue of the Growing Up Info newsletter...
 
Reduction of mother to child transmission (MTCT)
Highly sensitive tests revealed resistance to NVP in 75% of women tested after taking a single dose. Adding 4 days of bi-therapy (AZT+3TC) to single dose NVP brought the resistance detection down to 25%. Both the Mitra study in Tanzania as well as the Dream study in Mozambique confirmed that it was better and more feasible to use triple therapies early on in pregnancy and then to follow up with breastfeeding. But access to ARVs remains poor in sub-Saharan Africa: 9% of HIV+ pregnant women receive ARVs for the prevention of MTCT (11% East Africa and only 1% in West and Central Africa!). According to Professor Ruth Nduati (University of Nairobi), single dose NVP, a simple and quick regimen, needs to be kept in place where the best prophylactic measures are not yet feasible.
 
Counseling
Psychological support, from disclosure to adherence counseling is not adequately taken into account. Practical training for health practitioners as well as the involvement of the entire family are necessary. Innovative experiences were presented: an educational "pill game" where children aged 4 and upwards, identify pictures of the pills they are supposed to take and draw pictures of them (Maragua, Kenya); and in Nigeria a vast adherence support program that uses pictograms and visual tools.

To learn more
Visit the ICASA website www.icasa2005.org.ng
 
To see the revised WHO recommendations for initiating pediatric ARV therapy www.who.int/hiv/pub/guidelines/
arv/en/index.html
 
Pictograms used in adherence support (subscription required) www.usp.org/audiences/
consumers/pictograms
http://www.usp.org/audiences/
consumers/pictograms/form.html
 
A few days before ICASA, the NGO Kidzpositive organized in Cape Town the first conference on Pediatric AIDS Treatment in Africa (PATA): scaling up access to pediatric care and enhancing adherence to ART were discussed. Visit PATA's blog now and look out for a fascinating and committed initiative! www.patafrica.org/
www.kidzpositive.org/

The best answer to last month's case study

Last month a case study was presented to the Growing Up Info readers. Here is the best answer we received:
1. The child's hands present fingernails which "curve outwards like a wristwatch crystal" otherwise known as finger clubbing.
2. The pulmonary condition from which this child most likely suffers is Lymphocytic Interstitial Pneumonia (LIP). Reasons:
-Age : 7 years (a pathology often seen in children over 2)
-Country of origin or race (LIP is often seen in children from Africa and the Caribbean)
-Chronic cough lasting more than a year that does not respond to antibiotics
-Finger clubbing
-Lymphoproliferative Syndrome characterized by splenomegaly and parotitis.
3. There are enough reasons to start cotrimoxazole prophylaxis: in fact LIP is an indication of ARV treatment. This child is immunocompromised predisposing him/her to other infections. While waiting for the test results to confirm HIV infection, cotrimoxazole prophylaxis should be started.
4. This child would be in stage 3 of the WHO's new pediatric classification

And this month's new case…

Growing Up Info is posting a new practical case study based on testing a child this time. Counsellors, doctors, nurses, parents… have a go! The best answer will be published in the next issue.
A woman brings her 12 year old niece to your centre. The child's mother passed away and her father, who is working abroad, has put her under the care of her aunt temporarily. The aunt would like her niece to be tested for HIV. She says the child is often sick and presents symptoms that she associates with HIV. What would you do?

Almost all the answers we received were correct but we selected Dr Alice Gougounon from "ONG Racines" in Cotonou, Benin, because hers was the most complete.
Congratulations Alice!
 
To learn more
Zar HJ, Hussey G:
Finger clubbing in children with HIV infection.
Ann Trop Paediatr
2001 Mar. 21(1): 15-19.
 
Explanations and pictures:
Reimer S E, Berlin S C: Lymphocytic Interstitial Pneumonitis: Pediatric Imaging Teaching Files, 2001
www.uhrad.com/pedsarc/
peds036.htm

Send your answers to: grandir@sidaction.org
A book to win!

Publications: how to talk to kids and adolescents about AIDS?

How can we help them understand the illness, protect themselves, live better lives with it, respect others, support them? Many of us, parents and people working in HIV, wonder about this without always being able to find the right words to start a conversation about these critical subjects.
 
To help you better respond to their thirst for knowledge and to better take care of HIV+ children and children at risk, we invite you to take a look at the collection entitled " Junior African Writers " published by Heinemann. The collection includes 24 educational interactive volumes on health oriented around HIV/AIDS. 11 are fiction and 13 are non-fiction addressing 10 different themes (stigma and discrimination, treatment and help, feelings, prevention, etc.) They are designed for four age groups: 5-9, 8-12, 11-15 and 14-18. Each book includes notes for adults and suggestions of activities.

To find out more
PYou can find the complete presentation of this collection (in French and English) at:
www.heinemann.co.uk/shared/
Resources/NonSecure/
00000000/JAWS%20HIVAIDS%20leaflet.pdf
 
You can also consult:
www.aidsteaching.com/