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amfAR TREAT Asia

Photo courtesy of Kevin Tachman/TREAT Asia

Impact so far

Support from the Paediatric Innovation Seed Fund has opened up new and innovative research directions for studying the outcomes and co-morbidities of children and adolescents with HIV in Asia. This unique partnership has allowed TREAT Asia network investigators and clinicians to initiate research, receive training and promote optimal antiretroviral therapy regimens for their patients.

Though the initiative is still underway, progress has already been achieved in three core areas:

1. Research:

While much of our research is ongoing or just now getting underway, here’s a snapshot of some of the things we’ve accomplished thus far:

  • Approximately 300 patients have been enrolled at eight sites in Indonesia, Thailand and Vietnam in our study to monitor treatment failure and drug resistance.
  • Two initial pharmacokinetic studies in Thai children have been completed, providing new insights on optimal dosing of second-line ARVs for Asian infants and children.
  • We’ve completed a pilot study using computer-assisted technology to evaluate adherence and risk behaviours among adolescents with HIV. The pilot was conducted among 50 adolescents in Thailand and Malaysia. Although carried out among a small group of adolescents, investigators were able to use the pilot phase to learn how to best implement this type of study in TREAT Asia network sites, and we have expanded the study to 9 centres with a plan to enrol 300 HIV-positive and HIV-negative adolescents in Malaysia, Thailand, and Vietnam.
Annette Sohn4

2. Education:

Our research has been quite innovative, but the reality is that results from research take time – typically several years. One of the more gratifying aspects about this programme is that while we’re conducting research and waiting for findings, we’re also training clinicians about what we know now. As a result, we’re having an immediate impact and changing their approach to managing children with HIV for the better.

For example, following the training that we implemented on lipodystrophy (a side effect of long-term treatment where fat is abnormally lost or accumulated in certain parts of the body), we started to see our network members reducing use of a common medicine known to cause it. This wasn’t the case in all countries, particularly those where treatment options are limited, but this educational programme – combined with data coming out of Thailand showing that it was safe to switch children off of this medicine, and the World Health Organization’s interest in transitioning national programmes away from use of the drug – contributed to more children in the region being transitioned onto other medicines with fewer side effects.

To date we’ve conducted regional paediatric treatment failure and lipodystrophy management workshops, as well as country-level workshops on one or both of these topics in Cambodia, China, Indonesia, Malaysia, Thailand, and Vietnam. In total more than 400 physicians and nurses have participated in these educational workshops thus far.

This is not to suggest that the problem is solved. Although the situation with regards to both paediatric and adult HIV care in the region has improved, we still remain far behind where we want to be and this has consequences for the most vulnerable members of a family – the children. We remain committed to continuing to use education as a means to further improve HIV care in Asia-Pacific.

3. Advocacy:

We’ve also advocated for community-based treatment literacy on the occurrence of lipodystrophy and access to life-long care. For example, the programme is acting as a bridge between community groups across various countries in the region on treatment access issues, and between community members and providers to share about the challenges each other face in caring for children and adolescents.

By turning innovative research into best practices, this programme is shaping paediatric HIV care in the region, pushing the boundaries of paediatric HIV research and making a difference in the lives of children living with HIV across Asia.

Key Facts

Project: A multi-year partnership designed to optimise the quality of healthcare for infants, children and adolescents living with HIV across Asia.

Run by: TREAT Asia/amfAR

Region: Asia-Pacific

Population: Infants, children and adolescents living with HIV

Challenges: High first-line antiretroviral therapy (ART) failure rates among children; Limited availability of ART regimens that can be dosed and delivered to newborns and young children, and that are safe to use during growth and development; Poor access to once-daily fixed-dose combination medicines and third-line options for adolescents; Gaps in research capacity and higher-level training for paediatric HIV providers.

Activities: Conducting integrated and innovative programmes in research, provider education and global advocacy, with a focus on treatment failure, the emergence of drug-resistance and optimising antiretroviral sequencing for children living with HIV, among other important considerations for paediatric populations in the region and across the globe.