Group III: Demand Forecasting
Demand forecasting

Objectives

Minimum requirements

Tools

Gaps

Recommendations
Demand forecasting
Objectives

Global level:
Advocacy for inclusion of children in treatment initiatives,
including setting targets for children
Advocacy for price reduction on pediatric ARV formulations for
both high and low prevalence countries
Market development by the industry


National/Provincial/District level
Advocacy with national/provincial/district leadership for
inclusion of children in treatment plans
Planning purposes

Demand forecasting
Minimum information requirements

Pediatric treatment goals/targets:
Estimated number of CLWHA needing RX
Country capacity to treat
Programming approach


Recommended drug regimens

Profile of children to be treated
Demand forecasting
Minimum information requirements
The number of CLWHA in need of RX:

Current estimates of number of CLWHA
Projected annual birth and death rates
HIV prevalence in ANC settings
MTCT rates
Breastfeeding practices
HIV-related morbidity and mortality rates
CD4%, TLC (Risk of under-estimation)
Existing care practices: CTX, nutrition etc…

Demand forecasting
Minimum information requirements

Programming approach:
entry points: PMTCT, pediatric wards, OPD, nutrition programs
etc…
Implementation plan: where to start, expansion plan etc…
Expected uptake


Capacity to treat at all levels:
Human resources
Financial resources and price of drugs (generics versus brand
names)
Systems and infrastructure, including laboratory capacity

Demand forecasting
Minimum information requirements

The recommended drug regimens:
National guidelines:

First line
Second line
Change in case of toxicity, TB etc…

Generics versus brand names

Patients’ profile:

Age and weight groups
% on first and second lines,
toxicity rate,
TB co-infection rate etc…

Demand forecasting
Special considerations for procurement of
pediatric formulations
Lead time
Storage and distribution capacity
Generics versus brand names
Number of manufacturers to deal with
Buffer stock

2005 Target
Current
CLWHA
(Countries
, districts
etc…)
Projected
annual
births,
deaths,
HIV
infections
Total
CLWHA in
2005
CLWHA
needing
RX
Capacity
to treat
e.g. 50%
Tools

Age-specific quantification of disease burden
tool

ART capacity assessment tool

Drug quantification tool (e.g. Clinton Model)

MIS tool to monitor program uptake, drug
consumption and treatment outcomes,
Gaps

Knowledge:



Age and weight distribution of HIV-infected children
Predictors of disease progression in resource-poor countries
Capacity to treat children

Laboratory diagnostic technologies in young infants below 18 months

Pediatric treatment goals not defined on many initiatives and programs

Current MIS do not include treatment outcomes

Age and weight-specific burden of disease ill-defined

Limited number of demand forecasting tools
Advocacy statement




Of the estimated 1.9m children living with
HIV/AIDS in sub-Saharan Africa approx 0.5m
need treatment, which is about 16% of the
adults who need treatment
Therefore of the 3m by 2005 to be put on
treatment 450,000 should be children
This would also hold true in a national setting
Of particular importance are the infants under
1 yr, one-third of whom will die in the first
year
Recommendations




User friendly tool on CD to assess the child
needs in ARV Tx which acknowledges that for
planning purposes the first year is different
from other years of enrollment
Need to improve diagnostic facilitgies, Access
to antibody, PCR test to increase access to Tx
Drug supply chain
Communication
Capacity








Set the minimum standards for the site to be able
provide ART
Adapt adult ART sites assessment tools by adding
pediatric part
Political will to create the requested capacity for ped
ARV
Characteristic of the clinical sites
Training need
Prescription of the drugs
Family centered care cites, link child ARV and parent
ARV
PMTCT, malnutrition clinics entry point
Community involvement


IMCI, home based care to identify
children in need
pediatric ART adherence support
Agencies responsible for
implementation




UNICEF – coordinate the work on
development of forecasting model for ped TX,
age specific burden of disease, capacity
assessment tool, MIS tool in collaboration
with other UN agencies
WHO – clinical diagnostic tool, facility
assessment tool
AMDS – technical support
USAID funded FHI, JSI