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Increasing Coverage & Quality of PMTCT Services Beyond 2010
 

Increasing Coverage & Quality of PMTCT Services Beyond 2010

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    Increasing Coverage & Quality of PMTCT Services Beyond 2010 Increasing Coverage & Quality of PMTCT Services Beyond 2010 Presentation Transcript

    • Photo Credit: Nigel Barker LLC
      Increasing Coverage & Quality of PMTCT Services Beyond 2010
      Laura Guay MD
      Elizabeth Glaser Pediatric AIDS Foundation
      June 17, 2010
    • WE HAVE ONLY JUST BEGUN….
      Goal: Elimination of pediatric HIV
      Universal access and uptake of services
      Cost effective, efficient, integrated services
      Call To Action was a major springboard for the rapid expansion of PMTCT programs throughout Africa
      and C&T programs!
      and HIV research!
      Great progress, but still a long way to go; many challenges remain
      2
    • HIV Testing of Pregnant Women
      3
    • 55% of pregnant womennot receiving PMTCT drugs
      68% of HIV-exposed infantsnot receiving PMTCT drugs
      Provision of ARVs for PMTCT
      WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 2009
      4
    • PEARL Study
      5
      Stringer et al.
      Cote D’Ivoire, South Africa, Zambia, Cameroon
    • Most Critical Thing for PMTCT is Number of Women Completing Cascade
      100 HIV+ mothers
      Overall Program
      Effectiveness
      (early MTCT)
      Enter into program
      Missed - no PMTCT
      Attend ANC clinic 92%
      8
      92
      sdNVP alone: 22.5% tx
      sdNVP +ART: 19.5% tx
      Counseled & tested for HIV, CD4 75%
      AZT/sdNVP: 17.5% tx
      68
      32
      HAART: 17.1% tx
      Get ARVs
      (pre- & perinatal) 50%
      34
      66
      No ARV
      (25% MTCT):
      16.5 infected
      P. Barker, WHO Mtg Nov 2008
      6
    • Change Cascade Efficiency
      100 HIV+ mothers
      Overall Program
      Effectiveness
      (early MTCT)
      Enter into program
      Missed - no PMTCT
      Attend ANC clinic 95%
      5
      95
      sdNVP alone: 17.3% tx
      sdNVP +ART: 10.4% tx
      Counseled & tested for HIV, CD4 95%
      AZT/sdNVP: 6.1% tx
      90
      10
      HAART: 5.2% tx
      Get ARVs
      (pre- & perinatal) 95%
      86
      14
      No ARV
      (25% MTCT):
      3.5 infected
      P. Barker, WHO Mtg Nov 2008
      7
    • Long and bumpy roads lead to great places
      8
    • Where do we go from here?
      The CTA laid the first stones in the path to elimination of pediatric HIV
      Completing the path requires GLOBAL action
      Mobilization of resources to expand PMTCT programs:
      Effective HIV prevention!
      PMTCT = MNCH
      Contributes to multiple MDGs
      Embodies a woman- and family-centered approach
      Supports health system strengthening
      9
    • WHO’s 4-Component Strategy for MTCT Prevention
      Prevention of unintended pregnancies in HIV-infected women
      Prevention of transmission from an HIV infected woman to her infant
      Prevention of HIV in women, especially young women
      Support for HIV infected women, their infant, and family
      Component
      1
      Component
      2
      Component
      3
      Component
      4
      10
    • Requirements for Achieving Scale-up
      Global advocacy
      Strong government leadership and prioritization of PMTCT in the country’s HIV/AIDS plan
      Public health approach to PMTCT
      Ensure universal access to high-quality PMTCT services
      Provision of PMTCT in all health services that offer HIV/AIDS care and treatment
      Universal access to treatment for all eligible HIV-infected pregnant women
      11
    • Requirements for Achieving Scale-up
      Decentralize PMTCT to district and sub-district levels
      Build capacities for leadership, management, planning and budgeting, M&E
      Strengthen MCH capacity (staff, infrastructure)
      Supportive national policies on level of health facilities/workers allowed to provide PMTCT services
      Greater coordination and collaboration among implementing agencies, international organizations & government entities
      12
    • Program-Level Activities
      Country-level integration of PMTCT, HIV care & treatment, MNCH, FP programs
      Increase reach of PMTCT programs:
      Focus resources on women outside the “cascade”
      Prioritize the inclusion of male partners, family members & community in PMTCT service delivery
      Address stigma within health workforce
      Facility program ownership with feedback of program results to support QA/QI activities
      13
    • Implementation Research
      Optimal strategies for cost-effective implementation of PMTCT programs and maximal retention along the PMTCT cascade
      Models of integration of MNCH, PMTCT, and comprehensive care and treatment services to optimize maternal, infant and child health and survival
      14
    • Conclusion
      2009 WHO Guidelines for PMTCT: Framework for Elimination
      • Blurs the lines between MCH, PMTCT, and HIV CST
      • Complexity requires renewed intensity, integration, and innovation
      15
    • Tunaweza
      Together, We Can … Eliminate Pediatric HIV
      Photo Credit: Nigel Barker LLC
      16
      DISCLAIMER: This program was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief, as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Private donors also supported costs of activities in many countries. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.