Good morning, I am proud and honored to be here today to share some of the results over the past 8 years of the USAID-funded Call to Action project. I am also honored to be here with so many esteemed colleagues from USAID, other donor, partner organizations, MOH counterparts and colleagues from the EGPAF. So many of the individuals in this room are leaders in the elimination of pediatric HIV. We have much to be proud of and much to do. My presentation today will focus on some of the key results from the CTA project over the LOP.
EGPAF’s “Call to Action” initiative was launched in 1999 with the help of a Foundation commitment of $1 million, which initially funded eight sites in several African nations and Thailand through private Foundation funds.In September 2002, USAID/Washington awarded EGPAF a $100 million global Cooperative Agreement for a multi-country, service-based program to increase access to and to scale up PMTCT services.
Some results from these OR studies will be presented later today. Some of the policy changes will be discussed by my fellow panelists.
14 countries total received funding from USAID over the LOP. Some of the first countries that were part of the CTA program were Rwanda, South Africa, Swaziland, Tanzania, Uganda and Zambia. Countries that joined CTA between 2004-2006 were: Cameroon, Cote d’Ivoire, Lesotho, Malawi, Mozambique, Kenya, Russia and Zimbabwe. In 2010 the countries remaining under the USAID funding were Swaziland, Lesotho, Malawi and Uganda. Fortunately, there has been good program continuity and those programs not funded through the USAID CTA agreement were maintained from a variety of sources, USAID bilaterals, through our global CDC-funded Project HEART, as well as several private, multi-lateral and other donor contributions.
Currently there are over 2,600 sites that have received support under the CTA award. Cumulatively, as of Dec 31st, 2009 almost 4 million women accessed PMTCT services through this support. That is pregnant women attending ANC and/or L&D at facilities supported by EGPAF.
To get a sense of how this contribution compares to national PMTCT programs, we have a graph that compares the number of EGPAF-supported sites relative to the total number of PMTCT sites in Cameroon, Kenya, Swaziland, Uganda and Zimbabwe in 2007. Contributions in terms of sites, vary from 30-60% in just these countries.
If you look cumulatively across countries over the life of the project, considering the country breakdown, the countries that had the highest numbers of women eligible, counseled, tested and received results were: Uganda, Tanzania and Kenya (with eligible women at 1.9m, 386,000 and 260,250 women respectively). For HIV-positive Uganda and then South Africa and Swaziland are in the top three (98,000 in Uganda, 61,000 in SA and 31,000 in Swaziland).
Similarly, the countries with the largest number of women receiving maternal and infant ARVs is Uganda, South Africa and Swaziland with 98,000 women and 54,000 infants receiving ARV prophylaxis in Uganda, 62k and 37k in South Africa and 35k and 36k in Swaziland)
Uptake along the cascade for the calendar year 2009 for CTA showed 97% counseling uptake, 92% accepted testing and 99% received HIV test results. 88% of HIV+ women received ARV prophylaxis, including women on treatment and 61% of infants received ARV prophylaxisI should caveat that this is not longitudinal, cohort data and therefore we use aggregate numbers as a proxy for uptake of services, but we know and we are actively addressing instances of double counting, though with women accessing services at multiple facilities at multiple points in time capturing exact data, without a longitudinal patient tracking system is not possible.
Even with the caveats, the results are pretty good. If you compare overall testing of pregnant women across all programs in Africa, in 2008 access to PMTCT was about 30%, just over 40% of women received prophylaxis and less than 40% of infants received prophylaxis, according to the UNICEF, UNAIDS, WHO, and UNFPA. Children and AIDS: Fourth StocktakingReport, 2009. UNAIDS and WHO. AIDS Epidemic Update December 2009.
We have seen a clear upward trend across the cascade over time, with the exception of HIV prevalence, which has decreased appreciably over time when you look at cumulative data. This graph shows percentage uptake, with each bar representing one year from 2003 to 2009, reading from left to right.
Finally, we will hear more about this in later sessions, but there has been an upward trend in the move from sd-NVP from less than 10% in 2006 to over 60% by the end of 2009. We will end the day discussing what the Foundation is doing to accelerate the implementation of the new WHO recommendations, since we (as an organization and the broader community) have learned a lot about how to make this happen more effectively and efficiently. Thank you
Cumulative Results from the Call to Action Project (2002 - 2010)
CUMULATIVE RESULTS FROM THE CALL TO ACTION PROJECT (2002 – 2010)<br />Nicole Buono, MPH<br />Elizabeth Glaser Pediatric AIDS Foundation<br />
Project Background & Context<br />EGPAF’s “Call to Action” initiative was launched in 1999 with the help of a Foundation commitment of $1 million, which initially funded 8 sites<br />Presidential Initiative preceded PEPFAR, focused on PMTCT<br />In Sept 2002, USAID/Washington awarded the Foundation a $100 million grant for a multi-country, service-based program to increase access to and to scale up PMTCT services<br />2<br />
Project Background & Context<br />Since 2002, USAID funds have enabled the implementation of programs in 14 countries as well as operations research studies on topics such as:<br />Integrating PMTCT into MCH services<br />Improving the use of combination prophylaxis regimens<br />Improving postnatal care<br />USAID funds also facilitated the identification of, advocacy for changing of key policies related to PMTCT:<br />Opt-out testing<br />Take-home ARV prophylaxis<br />Ipdatingthe child health card<br />HIV counseling and testing in L&D<br />3<br />
CTA Expansion<br />The number of sites assisted by EGPAF has grown tremendously since the year 2002 with a cumulative total of over 2,600 individual sites having received Foundation support under CTA<br />As of December 31, 2009, the CTA project had provided nearly 4 million women with access to PMTCT services<br />5<br />
6<br />52%<br />63%<br />42%<br />30%<br />31%<br />Number of PMTCT sites in select CTA countries & the percentage supported by EGPAF (2007) <br />
PTMCT Cascade for the CTA Project(2003-2009)<br />7<br />
PMTCT Cascade for the CTA Project(2003-2009)<br />8<br />
Uptake of Services<br />By the end of 2009, program data showed:<br /><ul><li>97% of pregnant women were counseled on HIV/AIDS testing
92% accepted testing and 99% received HIV test results
88% of HIV-positive women received ARV prophylaxis for PMTCT (including those on HAART)
61% of HIV-exposed infants received ARV prophylaxis</li></ul>9<br />
Comparison of PMTCT Cascade Performance: All Africa programs vs. EGPAF CTA programs, 2008<br />10<br />
Type of PMTCT regimen provided to women in CTA-supported sites (2006-2009)<br />12<br />
Thank you!<br />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. <br />13<br />