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 Projected Total CLWHA Capacity
CLWHA annual CLWHA in needing to treat
(Countries births, 2005 RX e.g. 50%
, districts deaths,
etc…) HIV
infections
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