amfAR, The Foundation for AIDS Research

Pediatrics Initiative Moves Forward With New Network

Research Tops Agenda at Second Annual Meeting


February 2007—TREAT Asia’s Pediatrics Initiative took major steps toward forging a regional network and setting up a pediatric observational database at the group’s second annual meeting, held in Phuket, Thailand, 2–4 November.

Dr. Virat
Dr. Virat Sirisanthan of Chiang Mai, Thailand (above), along with Dr. Annette Sohn, who is based in Ho Chi Minh City, Viet Nam, were elected to represent the Pediatrics Initiative on the TREAT Asia Steering Committee. (Photo: Tavitphun Lumliengal)

More than 70 participants convened for the meeting, including doctors and data managers from 35 health-care sites in Cambodia, China, India, Indonesia, Laos, Malaysia, Thailand, and Viet Nam. The meeting was also attended by representatives of major international health organizations such as the Australasian Society for HIV Medicine; Family Health International; Médecins Sans Frontières; the National Centre in HIV Epidemiology and Clinical Research at the University of New South Wales in Australia; UNICEF; UNAIDS; and U.S. the National Institutes of Health, including the National Institute of Child Health and Human Development and the National Institute of Allergy and Infectious Diseases.

In order to unify the nascent Pediatrics Initiative with the larger adult-focused TREAT Asia Network, two pediatric investigators were elected during the Phuket meeting to represent the Pediatrics Initiative on the TREAT Asia Steering Committee: Dr. Virat Sirisanthana from Chiang Mai University, Chiang Mai, Thailand, and Dr. Annette Sohn, who is primarily affiliated with the University of California, San Francisco, but whose research is conducted at Children’s Hospital #1, Ho Chi Minh City, Viet Nam.

“The Pediatrics Network is unique in that it is made up of clinicians who are on the front lines of pediatric HIV treatment and clinical research in Asia,” said Dr. Sohn. “Some of us have had years of experience with antiretroviral [ARV] treatment, while others lack access to these drugs, but all of us are committed to providing care and treatment to children with HIV. By coming together, we have an opportunity to develop our regional capacity to conduct multinational research and share clinical expertise.”

“Children need antiretroviral regimens that can last a lifetime,” she continued. “Their situation is very different from those who acquire their infections as adults. And when our patients become adolescents, we will face new challenges in maintaining adherence, and providing support for reproductive and sexual health.”

The Pediatrics Initiative meeting featured discussions on issues such as mission and governance, as well as workshops on data collection and treating HIV/AIDS among infants and children. Highlights included:

Mission—Participants agreed that the Initiative’s goal should be “building capacity and advocating for safe and effective HIV treatment and care for children.” Primary areas of activity will be:

  • research that is specific and responsive to the needs of children in the region;

  • education and training of health-care professionals committed to the treatment and care of children;

  • communications and policy activities that address issues surrounding pediatric treatment and care; and

  • strengthening civil society’s understanding of pediatric HIV/AIDS and its capacity for the safe and effective treatment of children with the virus.

Managing Pediatric HIV—Myo Zin Nyunt from UNICEF’s regional office for South Asia provided a detailed overview of the treatment of HIV infection among infants and children in South-east Asia. Treatment guidelines from the recently released WHO/UNICEF clinical manual Management of HIV Infection and Anti-retroviral Therapy in Infants and Children were reviewed and discussed.

Observational Database—One of the main goals of the meeting was to create a pediatric observational database that could potentially yield insights into the best treatment for HIV-positive children in Asia. To that end, several presentations were made on data collection, in particular on the workings of the TREAT Asia HIV Observational Database (TAHOD) and the International Epidemiologic Databases for the Evaluation of AIDS (IEDEA). Dr. Matthew Law, who heads the Biostatistics and Databases Program at the University of New South Wales’s National Center in HIV Epidemiology and Clinical Research, described TAHOD’s function and methods. Data collection strategies, data management, and quality assurance were discussed, as well as ethical considerations, patient selection, and study variables.

Sites from the eight countries now involved in the Pediatrics Initiative represent over 6,000 HIV-positive children currently receiving care. Over the next few months, clinicians from the Initiative, with support from TREAT Asia staff and National Centre statisticians, will develop and implement a protocol to guide data collection, submission, and analyses for the TREAT Asia Pediatric Observational Database.

Dr. Annette Sohn (left) and Dr. Nia Kurniati (right) have been involved in organizing the new Pediatrics Initiative since the program was conceived in 2005. (Photos: Tavitphun Lumliengal)

Research Agenda—Led by TREAT Asia Director Kevin Frost, the group listed complex and unanswered questions about pediatric treatment, among them: When is the best time to start treatment? What are the most effective and safest formulations for pediatric medications? How can adherence among children be improved? Are the same long-term toxicities found among Asian adults applicable among Asian children? How does drug resistance play out among children? These and many other urgent questions will be considered for future research studies.

Community Partnership —The Pediatrics Initiative will support clinical sites and health-care professionals in developing close working relationships with the families and communities of the children they treat. TREAT Asia Program Manager Jennifer Ho led a discussion of two existing community partnerships—Kohn Kaen in northeast Thailand and HIV Alliance in India. Building bridges between pediatricians and their young patients’ communities, the two groups provide a comprehensive range of services, including home visits, family counseling, play and art therapy, assistance with schooling, nutritional counseling, and referrals. In the coming months, Ms. Ho will work closely with the Pediatrics Initiative to develop a model for community partnership.

Members of the Pediatrics Initiative will join with the full TREAT Asia group at its next annual meeting later this year. The joint meeting will involve pediatric- and adult-specific tracks.