Better Diagnostics Are Needed to Achieve an AIDS-Free Generation
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This document discusses improving diagnostics to achieve an AIDS-free generation. It notes that while the number of children receiving antiretroviral treatment has increased, only 28% of those in need receive it due to challenges with testing exposed newborns. Point-of-care diagnostics hold promise to expand access at lower-level clinics for pregnant women and infants. However, diagnostics alone are not enough - investment is also needed in strengthening follow-up care. The document advocates assessing bottlenecks, prioritizing solutions, and scaling them up as part of broader maternal and child health services, including HIV testing, CD4 and ART coverage, and early infant diagnostic technologies coupled with supportive systems.
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Better Diagnostics Are Needed to Achieve an AIDS-Free Generation
- 1. 6th International AIDS Society Conference Better Diagnostics Are Needed to Achieve an AIDS-Free Generation UNITAID Satellite Event 18 July 2011 Jimmy Kolker Chief, HIV/AIDS Section UNICEF Programme Division New York
- 2. Percentage of pregnant women living with HIV receiving ARVs for PMTCT 2005, 2008 and 2009
- 3. Distribution of antiretroviral regimens provided to pregnant women, in 2007 (59 countries) and 2009 (86 countries)
- 5. Ideally, this would be done as soon after delivery as possible.
- 6. Developing a test that would do this is one of UNICEF and partners’ top goals.
- 10. 8 Maximizing Impact of Early Infant Diagnosis BOTTLENECK: Less than 1/3 of infants tested for HIV at birth receiving treatment after one year Without investment through the entire follow-up continuum, the maximum impact of Early Infant Diagnosis (EID) will not be realized. 48% 131 76% 34% 68 29% 45 32 Receive Results HIV+ infants Enrolled in counseling & treatment Infants still active after 1 year Of those who enroll in HIV services, almost 1/3 are no longer tracked at the site. 48% of HIV+ infants never received results. Several died prior to receiving results. Not all infants were on CTX. Follow up of infants testing HIV+ Jinia Regional Hospital, Zambia Jan 1, 2008 – December 1, 2009
- 13. Cost – No SMS cost for clinic staff
- 14. Scale – Easier scalability using clinic staff’s own phones
- 16. Investing in diagnostics in eMTCT and Paediatric care Assess where there is the greatest unmet need Involve providers and clients to assess key bottlenecks Identify evidence-informed solutions and investments Scale-up priority intervention as component of MNCH services HIV testing and counseling CD4 and ARVS including ART for HIV positive pregnant wowen Early Infant Diagnostic technologies and supportive system responses such as SMS
Editor's Notes
- Similarly, in Namibia 15% of EID sites collected >93% of all samples. Why do mothers so strongly prefer higher-level sites for EID testing of their children? One reason is probably that they prefer to have their infants tested at sites that also offer ART. In supporting Zimbabwe to roll-out POC PIMA CD4, UNICEF has similarly observed that POC CD4 assays have a big impact on improving uptake of ART when they are employed at sites that offer ART, but less impact in increasing maternal ART enrolment if they are employed at sites that have to out-refer to other sites for ART. Take home point: testing and treatment should be decentralized to sites together for optimal impact in improving ART uptake.
- This shows the process of an M-Health project UNICEF has supported in Malawi and Zambia called results 160 to expedite return of EID results. The project has improved turn-around time by more than 50% at pilot sites in very remote areas, and enabled several sites that had never received a result before to do so. It has also enabled tracking of EID testing progress by program managers at a national and subnational level
- This is an example of an aggregated web report. The system also sends real-time alerts for poor performance which are useful as a management and quality improvement tool. Key point: we need to expedite POC but we also need to continue to support promising avenues to improve existing systems too.
- UNICEF’s organization-wide emphasis on equity has from the start placed a high priority on elimination of mother-to-child transmission of HIV as an important target which will be missed unless extraordinary efforts are made to reach those currently not served.“Elimination” means <5% transmission and 90% reduction in new paediatric infections● Provide technical support to governments for eMTCT though the IATT,Equity-focused bottleneck assessmentsCosted national eMTCT plans and Strengthened district management teams.Integrate eMTCT and MDG 3, 4, 5 and 6 = MNCH; Address the impact of stigma and discrimination and the important role women living with HIV and AIDS in the response.●Innovatepoint of care diagnostics, EID care points and mHealth applications Even in countries where scale-up has been good, integration of PMTCT into MNCH programmes has been limited, loss to follow-up is a widespread problem and poor collection and use of data at facility and district levels is a barrier to best outcomes rather than just coverage. The Elimination of MTCT (eMTCT) provides a strategic opportunity for UNICEF to identify synergies and maximize the contribution of health (HIV, MNCH, SRH, FP and community health workers) and non-health constituencies toward the eMTCT goal. UNICEF itself can provide leadership, as well as motivate champions at global, national and community level, to integrated and link HIV and immunization programmes to maternal and neonatal care. Treatment for own health: prevent orphaning When a mother dies, mortality risk in her infants increases 3x compared to infants whose mothers are alive!HIV response cannot function in isolation