2,100,000 Number of pregnant women with HIV/AIDS

200,000 Number of pregnant women receiving PMTCT

630,000 Number of MTCT new infections

2,000,000 Number of children needing ART

315,000 Number of infections that could be averted with PMTCT

490,000 Child deaths due to AIDS (under age 14)

2.7% Percent of U5M due to AIDS

7 Countries where AIDS accounts for more than 10% of U5M

17% Percent of AIDS deaths among children

Global estimates relevant to Pediatric AIDS (excluding high income countries)

Projections of Needs

• If coverage of MTCT does not increase, there will be an additional 600,000 children infected with HIV each year

• Even once we reach goal of 50% coverage of MTCT (assuming short course) there will be 300,000 new pediatric infections per year

Age structure of children living with HIV/AIDS in a stable epidemic state (MTCT)

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

0.18

0.2

1 2 3 4 5 6 7 8 9 10 11 12 13

Age

1,700,000 Number of pregnant women with HIV/AIDS

86,000 Number of pregnant women receiving PMTCT

550,000 Number of MTCT new infections

1,900,000 Children needing ART?

275,000 Number of infections that could be averted with PMTCT

440,000 Child deaths due to AIDS (under 14)

5.75% Percent of U5M due to AIDS

Estimates relevant to Pediatric AIDS In sub-Saharan Africa

50,000 Number of pregnant women with HIV/AIDS

18,000 Number of pregnant women receiving PMTCT

12,500 Number of MTCT new infections

50,000 Children needing ART

6,700 Number of infections that could be averted with PMTCT

11,000 Child deaths due to AIDS (under 14)

1.68% Percent of U5M due to AIDS

Estimates relevant to Pediatric AIDS In Latin America - Caribbean

150,000 Number of pregnant women with HIV/AIDS

12,000 Number of pregnant women receiving PMTCT

47,000 Number of MTCT new infections

160,000 Children needing ART

23,000 Number of infections that could be averted with PMTCT

34,000 Child deaths due to AIDS (under 14)

0.57% Percent of U5M due to AIDS

Estimates relevant to Pediatric AIDS In South/Southeast Asia

26,000 Number of pregnant women with HIV/AIDS

500 Number of pregnant women receiving PMTCT

8,400 Number of MTCT new infections

21,000 Children needing ART

4,200 Number of infections that could be averted with PMTCT

5,000 Child deaths due to AIDS (under 14)

0.54% Percent of U5M due to AIDS

Estimates relevant to Pediatric AIDS In North Africa – Middle East

20,000 Number of pregnant women with HIV/AIDS

9,000 Number of pregnant women receiving PMTCT

1,500 Number of MTCT new infections

8,000 Children needing ART

750 Number of infections that could be averted with PMTCT

900 Child deaths due to AIDS (under 14)

0.25% Percent of U5M due to AIDS

Estimates relevant to Pediatric AIDS In Eastern Europe – Central Asia

10,300 Number of pregnant women with HIV/AIDS

300 Number of pregnant women receiving PMTCT

3,300 Number of MTCT new infections

8,000 Children needing ART

1,600 Number of infections that could be averted with PMTCT

2,000 Child deaths due to AIDS (under 14)

0.04%% Percent of U5M due to AIDS

Estimates relevant to Pediatric AIDS In East Asia - Pacific

Zambia Profile on AIDS in children

• 84,000 children (under 14) living with HIV/AIDS

• 20,000 Deaths (under 14)

• 9,000 under five deaths

• AIDS explains 11% of U5M in Zambia

• 48,000 pregnant women with HIV per year, 5% coverage of PMTCT

Viet Nam Profile on AIDS in children

• 3,000 children (under 14) living with HIV/AIDS

• 470 Deaths (under 14)

• 64,000 under five deaths from all causes

• AIDS explains 0.7% of U5M in Viet Nam

• 2,900 pregnant women with HIV per year, 1% coverage of PMTCT

Bangladesh Profile on AIDS in children

• 64 children (under 14) living with HIV/AIDS

• 40 Deaths (under 14)

• 40 under five deaths

• AIDS explains 0.02% of U5M in Bangladesh

• 75 pregnant women with HIV per year, 1% coverage of PMTCT?

Issues to consider

• Target by country, region, locale, population, etc.

• Relative effectiveness of improved PMTCT and ART and

complementarities of the two

• Comparison of ART to other child interventions (e.g., bed

nets, Zinc, Vitamin A, nutrition, W & S)

• Equity Issues, both by wealth and disease

Estimating U5M due to HIV/AIDS

• For generalized epidemics– Measure prevalence among pregnant women in ss sites, urban and

rural

– Use curve fitting to derive a best fit for urban and rural (or additional areas)

– Weight curve point by population (also can adjust for under-representation in rural) to get national prevalence among pregnant women

– Apply transmission probability (0.32) to get number of newly infected children each year

– Apply mortality function (both AIDS and non-AIDS) to get AIDS deaths for each cohort

– Use birth cohort to get deaths under five due to AIDS

Estimating U5M due to HIV/AIDS

• For low-level or concentrated epidemics– Develop estimate of adults based on combination of groups at higher

risk (e.g., MSM, sex workers & clients, IDU)

– Assume some transmission to spouses/regular partners

– For each group, estimate male and female ratio so that we have an estimate of women (15-49) who are living with HIV/AIDS

– Derive population prevalence for women (with age structure)

– Adjust fertility rates for women HIV positive

– Now have prevalence rate among pregnant women

– Then same steps: apply transmission and then mortality rates