Team PATA

PATA Conferences - Rwanda 2008

APPLICATIONS ARE NOW CLOSED

UPDATE OCTOBER 2008: New venue

PATA 2008 Rwanda will be held from 25 to 29 November in Kigali, Rwanda. The conference will be held at Novotel and participants will be staying at La Palisse Hotel and Novotel, both in Kigali.

Details for Hotel Novotel:

Boulevard de l'Umuganda, BP 874, 0 KIGALI, RWANDA,
Tel (+250)585816, Fax (+250)582957

Details for La Palisse Hotel

Clubhouse La Palisse, PO Box 2387, Kigali
Tel: 08305505/ 08434390

Important visa reminder: It is very important that all teams take responsibility for organizing their own visas. Teams that do not have Rwandan embassies within their home countries, can apply to obtain a visa on entry into Rwanda online at http://www.migration.gov.rw/services.php#visa

What can you expect at PATA 2008? Our gathering in Kigali promises many firsts for the PATA network:

• 11 first-time attending teams
• Nutritionists will be attending this year’s PATA forum
• A Larger Francophone contingent than ever before with 16/ 40 teams being French-speaking
• Field trip to Rwinkwavu Training centre on Day 3 of the conference
• Specialised, optional masterclasses in a variety of fields, including skin rashes in HIV, PATA adolescent workshop recommendations, the Mother 2 Mothers To Be programme, the technical aspects of nutrition for children with HIV/AIDS and the findings of the CHER study.

Conference Themes

'Care of the very young infant' and 'Nutrition' are the themes for PATA 2008 forum. Dr Paul Roux from the Groote Schuur Hospital explains why these themes were chosen:

Nutrition

"This is an over-arching issue affecting response to ARVs and care of HIV/AIDS at any age. It is a universal problem in Africa. It is an issue that needs to be addressed at clinic level and could result in many worthwhile clinic tasks being taken on. The world is facing a food crisis that can only make things worse. Partners in Health ran a three day nutrition conference in Boston in August 2007. Nigel Rollins (South Africa) and Tom Heijkens (Malawi) - both highly regarded paediatric nutrition experts - will attend the PATA 2008 forum."

Care of the very young infant

"Groundbreaking research done in Cape Town and Johannesburg by Mark Cotton and Avi Violari has showed that early access to ARVs for very young infants diagnosed with HIV infection has a 30% lower mortality rate than if you wait for their immune status or clinical condition to deteriorate. This work is referred to as the CHER study - Children with HIV Early Antiretroviral Therapy. Mark Cotton has provisionally agreed to come to Rwanda in November."

We also spoke to Dr James Nuttall, University of Cape Town based paediatrician, about the relevance of this year's forum themes.

PATA: In your experience, why is it important to draw people's attention to, specifically, the treatment of very young children?

Dr Nuttall: PATA is about expanding access to high-quality care and treatment for HIV-infected children and their families. This includes infants (children <12 months of age). In many treatment programmes, infants (and adolescents whom we focused on at the last PATA forum) are under-represented and seem to lie at the margins of treatment access. The stark reality is that without early initiation of antiretroviral treatment, up to 50% of infants with HIV infection will not survive the first year of life. More importantly, recent research has shown that early ARV initiation can reduce mortality of infants by 75%. It's about survival and making a difference.

Is it a formerly neglected part of treatment rollout?

Dr Nuttall: Yes, certainly. For various reasons, including lack of access to diagnostic testing, ARV dosing difficulties, and doubt amongst health care workers and families about when to start and the effectiveness of ARV treatment in infants, treatment programmes have tended to focus on older children. In the same way that children's access to ARV treatment lags behind that for adults, the treatment of very young children lags significantly behind that for older children. Until recently, treatment of infants has mostly been initiated at hospital level. This needs to move to community clinic level.

Has it been misunderstood in the past, and even still now?

Dr Nuttall: There are misconceptions that very young children and infants cannot be treated with ARVs or that ARVs are more toxic in infants than in older children and adults. On the medical side, both clinical staging and interpretation of CD4 counts in infants are problematic and unreliable markers of disease progression and risk of death. There have also been frequent changes to guidelines on when to start ARV treatment in infants. Recent proposals are recommending early treatment for all HIV-infected infants regardless of clinical stage and CD4 count.

Is it particularly difficult re dosages for infants?

Dr Nuttall: There is less data to guide dosing of ARVs in infants, but there is some and there is ongoing research. In older children ARV dosage recommendations based on the child's weight are available. But for infants and children with body weight less than 5 kg dosages for many ARV drugs (including Zidovudine, Kaletra and Nevirapine), must be calculated according to the body surface area of an individual child. This usually requires that both the weight and the length (height) of the child are accurately measured at each clinic visit. So, the dosing for infants needs to be a bit more careful but unfortunately the perception is that it's impossibly complex.

At a forum such as PATA 2008, what would you like to see happen? If you had a dream-list of things clinics from all over Africa could take home re infant treatment, what would it be?

Dr Nuttall: As has been the case with previous PATA forums, I hope to see PATA teams and delegates reflecting on their current practices with regard to the treatment of infants and that they will explore practical ways of extending access to treatment for infants. This will generate more of the legendary PATA 'ripple effect' that carries us and the people we work with through another year of caring for children. The dream-list includes a commitment to reaching and up-scaling the numbers of infants in our treatment programmes and a practical know-how of infant treatment including diagnosis, counselling of caregivers, drug prescribing and follow-up.

The provisional guest speaker list includes the following:

Opening night : Keynote addresses by Dr Agnes Abinagwaho (National Centre for HIV/AIDS Control, Rwanda) and Dr Joia Mukherjee (PIH).

Day 1 - Care of the Very young infant with HIV (26th November)
Plenary input from James Nuttall, Leon Levin, Simone Honikman, Mark Cotton, Mitch Besser and others on the following:

1. Diagnosing HIV infection in infants and young children
2. Maternal and child health issues
3. Linking care at birth with medical care of the infant
4. Findings of the CHER study
5. Anti-retroviral therapy for the infant
6. The psycho-social consequences of raising a child with chronic illness

In the profession-specific workshops on day 1, participants will discuss their experiences of HIV/AIDS in children under 1 year of age and try to establish what obstacles currently hamper quality care to this age group.
Treatment teams will then workshop what interventions could be implemented within each clinic to improve the quality of care to children under 1 year of age.

Day 2 - Nutrition (27th November)
Plenary input from Tom Heikens, Agnes Malamule, Charlotte Adamczick and others on the following:

1. Translating the World Health Organisation's Ten Steps in the Care of HIV/AIDS
2. Drug interactions and pharmacokinetics in different stages of HIV/AIDS
3. Anti-microbials
4. Shock management and intravenous fluids
5. The role of F 75, F100, RUTF, weaning foods and mixed diets (composing energy dense weaning foods and mixed meals from local foods)
6. What and when to counsel and the counsellors' role with orphans
7. The psycho-social consequences of poverty and malnutrition

In professional groups, participants will discuss what the opportunities and constraints in respect of nutritional interventions are, and how we can measure the state of nutrition and responses to intervention at clinic, district and national level.

Following this, treatment teams will identify steps that can be implemented to improve the nutritional state of children seen in clinics.

Day 3 - Making Changes (28th November)
Day 3 will be held at the Partners in Health (PIH)'s Rwinkwavu Training centre which is approximately 2 hours from Kigali. Staggered clinic visits will be built into the programme.
Plenary input from Stephen Rollnick, Shaffiq Essajee and others on the following:

1. How does one go about implementing change?
2. What management styles are best suited to implementing change?

PATA Rwanda Visa Information

Teams attending ATA Rwanda are required to organize and pay for their visas for visiting Rwanda. To find out whether or not you require a visa to enter Rwanda, and for a list of Rwandan embassies in Africa, please download the PATA Rwanda Visa information.

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Conference Venue: Rwinkwavu Training Centre, Rwanda