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Increasing Coverage & Quality of PMTCT Services Beyond 2010

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  • 1. Photo Credit: Nigel Barker LLC
    Increasing Coverage & Quality of PMTCT Services Beyond 2010
    Laura Guay MD
    Elizabeth Glaser Pediatric AIDS Foundation
    June 17, 2010
  • 2. 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
  • 3. HIV Testing of Pregnant Women
    3
  • 4. 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
  • 5. PEARL Study
    5
    Stringer et al.
    Cote D’Ivoire, South Africa, Zambia, Cameroon
  • 6. 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
  • 7. 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
  • 8. Long and bumpy roads lead to great places
    8
  • 9. 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
  • 10. 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
  • 11. 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
  • 12. 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
  • 13. 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
  • 14. 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
  • 15. Conclusion
    2009 WHO Guidelines for PMTCT: Framework for Elimination
    • Blurs the lines between MCH, PMTCT, and HIV CST
    • 16. Complexity requires renewed intensity, integration, and innovation
    15
  • 17. 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.

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