PMTCT Implementation and the Importance of Male Involvement


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  • Consistent with the long interval between HIV seroconversion and symptomatic disease, annual HIV-related mortality appears to have peaked in 2004, when 2.2 million deaths occurred. The estimated number of AIDS-related deaths in 2008 is roughly 10% lower than in 2004.The number of children younger than 15 years living with HIV also increased from 1.6 million in 2001 to 2 million in 2007, although the number of newly infected children has been declining since 2003, probably due to the global stabilization of HIV prevalence among women and increasing coverage of programs for PMTCT. In 2007, children accounted for 6% of all people living with HIV, 17% of the people newly infected and 14% of all HIV-related mortality worldwide.
  • We next evaluated the role of male partners in relation to HIV free survival An outcome which represents the composite risk of infant infection and mortality there by being a more comprehensive measure of impact on infant healthThe results displayed in the left had KM plot for attendance illustrate that approximately 90% of infants of women with male partner attendance, were alive and uninfected through the first year of life the blue dashed curve, as compared to approximately 75% of infants of mothers lacking attendance The red solid curve A proportional difference which was statistically significant The role of the second predictor, previous male hiv testing is depicted in the right hand KM plot These curves show that approximately 85% of infants of women who reported that their male partners had been previously tested for HIV, were alive and uninfected through the first year of life represented by the blue dashed curve as compared to approximately 75% of those infants of mothers who reported that their partners had not been tested the red solid curve Again, representing a proportional difference between the two groups that was statistically significant(NOTE: there were also 13 infant infected < 48 h pp which died but were not used in the analysis and 7 still born infants) (In this population there were 90 events, 50 deaths among which 15 were HIV-infected and 40 HIV-1-infected infants alive through the first 12 months postpartum)
  • PMTCT Implementation and the Importance of Male Involvement

    1. 1. PMTCT Implementation and the Importance of Male Involvement<br />Christian Pitter, MD, MPH<br />Director, Global Technical Policy<br />Elizabeth Glaser Pediatric AIDS Foundation<br />
    2. 2. Trends of the HIV epidemic(in millions)<br />New pediatric HIV Infections:<br />2001: 520,000<br />2008: 430,000<br />2<br />
    3. 3. Impact of AIDS on child mortality rates <br />Selected African countries, 2010<br />withAIDS<br />per 1000 live births<br />250<br />200<br />150<br />100<br />50<br />0<br />without AIDS<br />Botswana<br />Kenya<br />Malawi<br />Tanzania<br />Zambia<br />Zimbabwe<br />US Bureau of the Census, 2005<br />
    4. 4. Mother-to-child transmission<br />Accounts for over 90% of pediatric infections<br />Approximately 1.4 million HIV+ pregnant women annually need PMTCT services (2008)<br />Over 90% in Sub-Saharan Africa<br />70% in Eastern/Southern Africa<br />30% in Western/Central Africa<br />Global PMTCT scale-up begins 1998-99<br />
    5. 5. EGPAF Mission<br />The Elizabeth Glaser Pediatric AIDS Foundation seeks to prevent pediatric HIV infection and to eradicate pediatric AIDS through research, advocacy, and prevention and treatment programs.<br />
    6. 6. WHO’s 4-Component Strategy for MTCT Prevention<br />Prevention of unintended pregnancies in HIV-infected women<br />Prevention of transmission from an HIV infected woman to her infant<br />Prevention of HIV in women, especially young women<br />Support for HIV infected women, their infant, and family<br />Component<br />1<br />Component<br />2<br />Component<br />3<br />Component<br />4<br />
    7. 7. EGPAF International Programs: 2000  8 sites in 6 countries 2010  >4865 sites in 16 countries<br />China<br />India <br />Rwanda <br />Uganda<br />Cote d’Ivoire<br />Kenya<br />Cameroon <br />Tanzania<br />D.R.Congo<br />Malawi <br />Mozambique <br />South<br />Africa<br />Zimbabwe<br />Swaziland<br />Zambia<br />Lesotho<br />United States<br />
    8. 8. PMTCT Components<br />Primary Prevention of HIV infection<br />Prevention of unwanted pregnancy in HIV-infected women<br />Maternal HIV Counseling and Testing<br />Maternal HIV Counseling<br />Maternal Antiretroviral Prophylaxis or Treatment<br />Infant Antiretroviral Prophylaxis<br />Nutrition Counseling and Support<br />Care, Support and Treatment for women, children, and families<br />Early infant diagnosis<br />
    9. 9. Access to ARV Drugs for PMTCT<br />55% of pregnant womennot receiving PMTCT drugs<br />68% of HIV-exposed infantsnot receiving PMTCT drugs<br />WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 2009<br />
    10. 10. 70 000<br />60 000<br />50 000<br />40 000<br />30 000<br />20 000<br />10 000<br />0<br />1996<br />1998<br />2000<br />2002<br />2004<br />2006<br />2008<br />Estimate of the annual number of infant infections averted through the provision of ARV prophylaxis to HIV-positive pregnant women, globally, 1996–2008<br />70,000 infections averted in 2008<br />Estimated number of new pediatric infections with and without PMTCT prophylaxis globally, 1996-2008<br />
    11. 11. New 2009 WHO Guidelines<br />PMTCT:<br />Treat all pregnant women eligible for ART (eligibility expanded to CD4 < 350)<br />Start ARV drugs earlier (2nd trimester)<br />Continue ARVs through breastfeeding period<br />Breastfeed for 12 months (exclusive for 6 mo)<br />HIV Treatment:<br />Start treatment earlier (CD4 count < 350)<br />Treat all children < 2 years of age<br />
    12. 12. Male Partner HIV Testing and Antenatal Clinic Attendance Associated with Better HIV-Free Survival in InfantsAluisio A et al. IAS, Capetown, South Africa, July 2009, Abs. TuAC105<br />Proportion of infants alive & HIV-1 negative<br />Log rank P = <0.001<br />Yes (- - -)<br />Log rank P = 0.015<br /> No (____)<br />