Right to Care’s Paediatric HIV Programme was established in March 2008 in order to prioritise paediatric care in the organisation.

The programme is headed by Dr Leon Levin, a paediatrician with many years experience in treating infants and children with HIV. Dr Levin’s oldest patient, who has had HIV since birth, is now 22 years old and is healthy. Traditionally, treatment for children with HIV has lagged behind that of adults, a trend which Dr Levin intends reversing.

By the end of September 2008, just six months after programme launch, the number of children on antiretroviral therapy (ART) increased to 3249, an achievement of more than double the original target. A year later, 6840 children were on ART at Right to Care supported sites.
We have shied away from creating separate paediatric units at most of our sites, preferring to integrate paediatrics into the general HIV clinic, that is, a family-centred clinic. The primary goal of our Paediatric HIV programme is to increase the number of paediatric patients on ART at all supported treatment sites. A secondary goal is to improve the quality of paediatric care in the districts we support. These goals are being achieved with a multipronged approach, which includes:

• Paediatric ART telephone helpline
• Teaching and lecturing
• The development of paediatric training centres of excellence
• Paediatric ARV site assessments and the provision of a site-specific implementation toolkit
• ARV site on-site training and mentorship programmes
• Strengthening paediatric ART clinical quality assurance
• Paediatric TherapyEdge
• Paediatric social worker

The Paediatric ART helpline is manned weekdays during office hours and allows healthcare workers (HCWs) nationwide to access on-the-spot clinical advice from a paediatric HIV expert. This helpline is not only used by our own HCWs but by many other HCWs as well. In the year to end September 2009, over 140 requests for help were handled.
In the year under review, Leon Levin delivered 109 lectures. Mostly these lectures and workshops took place at the ARV clinics. Full day paediatrics and PMTCT conferences were delivered in the various provinces. A total of 285 people received training at the full day conferences.
Three sites have been earmarked to provide paediatric training for our staff. Eventually all new staff members will receive hands on training at a paediatric training centre. Two centres will be in Gauteng and one in Mpumalanga. In late 2009, Dr Namakula Semakula-Katenda received hands on training at Rahima Moosa Hospital and training from Dr Leon Levin so that she could establish a Paediatric Training Centre at Shongwe Hospital in rural Mpumalanga. The centre should be able to start training staff members from other centres in early 2010.
Paediatric ARV site assessments were used to systematically assess site requirements. Each site is furnished with a paediatric implementation kit, which contains most of the documentation needed to run a paediatric ARV site. On-site training is provided in the form of workshops and lectures. Mentoring is provided by having a paediatric expert sit in the clinics while the staff members are seeing patients. In the review year, 18 clinics were visited, some more than once.
Once the sites are comfortable treating paediatric patients with HIV, an ongoing programme of training and monitoring ensures that excellent standards of care are maintained.
For TherapyEdge, Dr Pippa MacDonald has contributed to developing a paediatric module. A pilot version was launched in April 2009. The module offers clinical guidelines for management of paediatric HIV and TB. The final version will be become operational in 2010.
A paediatric social worker, Eve Matshili, joined us in June 2009. She is responsible for ensuring counsellors at the sites we support have adequate training in paediatrics. She will also be involved in setting up adolescent groups at our clinics to deal with the increasing number of children who are surviving to adolescence.
PMTCT is a priority. A dedicated PMTCT coordinator, Sr Busi Seroke, started at Right to Care in January 2009. She supports all sites’ PMTCT efforts and provides training. This will be an integrated programme largely using existing staff.
The DoH has recently launched an Accelerated PMTCT Plan (A-Plan) at 18 priority districts in SA. We support two sites in those districts and we are actively participating in the A-Plan.