kuantan fms elimination vertical transmission 060713

7/27/2019 Kuantan FMS Elimination Vertical Transmission 060713

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ELIMINATION OF VERTICAL HIV TRANSMISSION

ARE WE READY?

BYSHAARI NGADIMAN,

MD, MPH, EIP, AM

MINISTRY OF HEALTH MALAYSIA

[email protected]


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1. Each day 1,500 under 15 infected with HIV

2. Majority due to vertical transmission

3. 25 30 % dies before their 1st birthday

CURRENT SITUATION - GLOBAL


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4 ways to minimise infant HIVUNGASS Declaration of Commitment, June 2001

1. Prevention of HIV in women of reproductive age

2. Prevention of unintended pregnancy in HIV+ women

3.

PMTCT of HIV through a) antiretroviral therapy (ART) during pregnancy

b) safer delivery practices

c) counselling and support on infant feeding methods

4. Care, treatment and support to

HIV-infected parents, infants and families

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FALL-BACK

POSITION


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Definition of terms

eMTCT of HIV

Number of new child HIV infections


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COUNTRY NEED:

1. Put priority to eliminate pediatric HIV 2. Allocate adequate resources 3. To build capacity

Training staff Development of guidelines

4. To improve coverage and quality of antenatal care 5. To ensure regular supply of lab reagents for diagnosis and

drug for treatment including pediatric prophylaxis6. Have a policy of infant feeding 7. To establish a system for surveillance, monitoring and

evaluation

TO ACHIEVE THE GOAL OF ELIMINATION


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Target of NSP on AIDS 2011-15

80% MARPs reached prevention

programmes 60% of MARPs use condoms consistently.

60% of IDUs use clean injecting

equipment.

Able to eliminate vertical HIV transmission

80% ARV coverage for eligible PLHIV,


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12

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Screened 161,087 275,640 286,390 343,030 387,208 361,152 377,016 349,922 384027 380346 394673 403287 413862 443453 449013

ANC 162960 323902 347979 394534 393173 374388 388037 365352 377735 381686 396951 410980 415427 443453 458213

% positif 0.035 0.032 0.030 0.022 0.036 0.047 0.035 0.031 0.044 0.050 0.051 0.042 0.057 0.070 0.060

0.000

0.100

0.200

0.300

0.400

0.500

0

100,000

200,000

300,000

400,000

500,000

600,000

ANTENATAL HIV SCREENING (MOH)1998 - 2012

HIV antenatal screening coverage 2012= 98%

56 89 85 79 141 177 138 110

%p

ositive

3 3 15 5 8 2 5

No of babies positive for HIV

No of HIV positive mothers

170

3

2012 Rate of HIV vertical transmission to newborn baby = 1.1%

190

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200 171 239

5 9 7

No 309

3 3

270


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eMTCT in the context of Malaysia


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STRATEGIES FOR Prevention Mother To

Child HIV Transmission -PMTCT

Services at Private Clinics / Hospitals

Close monitoring of positive cases

Miss opportunitylabour rooms Quality assurance

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ELIMINATION BY 2015

Enhanced towards


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Objectives

To compile existing data/indicators on MTCT of HIV andsyphilis in Malaysia

To select and test the eMTCT criteria/ indicators/ processfor validation of eMTCT of HIV and syphilis

To test the flowchart for diagnosing congenital syphilis To discuss on assessment of eMTCT of HIV and syphilis,

availability of data and data quality, and data gaps tovalidate eMTCT

To document process of validation of eMTCT, identify issues

and challenges and make recommendations To summarize lessons learned and make recommendations

for the global guidance

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Conceptual framework of PMTCT in

Malaysia


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Methodology

Study location:

Study sites were chosen based on highest , middle and lowestpercentage of HIV+ mothers in 2011 .as well as logisticreasons

Site 1: AIDS/HIV Section, Primary Care, Surveillance Unit, MOH,Putrajaya

Site 2: Selangor, medium percentage of HIV+ mothers in 2011

Site 3: Negeri Sembilan, with one of the lowest HIV+ mothers in2011

Site 4: Kelantan, highest percentage of HIV+ mothers in 2011

Site 5: IMR, the national referral centre for confirmation of HIV+ forbabies through PCR

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Methodology

Data collection methods:

Records, discussions with program managers andimplementors at sites

Data collection process

Qualitative and quantitative

Verification of data via performa in Likert scale

data at sites and MOH

Verification of work process as from CPG,

Evaluation and monitoring process

Discussions with stakeholders

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Team criteria validated

Program definition Data flow and management

Screening tests

Defaulter tracing

Contact tracing Treatment of mothers with

ARV Treatment of babies with

ARV

timely Subsequent management of

mother and baby

Innovative mechanism

Management infrastructure-

Identified overallmanager/coordinator

Involvement of privatepractices

Involvement of NGO/

societal

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FINDINGS OF VALIDATION PROCESS


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FINDINGS : Strength

Most of teams criteria were fulfilled

Good program coverage for HIV

Coordinated, integrated

Regular monitoring and evaluation at different levels

The coverage of PMTCT, including HIV screening, ARV

for PMTCT, non-breast feeding, high across the country

in 2011 There are policies, guidelines and integrated of PMTCT

implementation at different levels in the country

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FINDINGS : Strength

Most of teams criteria were fulfilled

National AIDS Registry

Good system built in with ways to monitor the data as well

as the staff at the end users, clear, coordinated Reminders

Verifiable and well-functioning data flow for services of

ANC, HIV screening, treatment and prophylaxis and

follow up from community to health centers up to the

state and national level

Some data not within control of MOH

Makes periodic reporting complicated

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FINDINGS : Strength

Clinical Practice Guidelines, SOPs are in place to

ensure proper treatment and follow up

Regular updates/discussions between clinicians in

the management of the HIV+ mothers and children Checking of flow is possible at various points with

accountable personnel

Screening facilities Available

Free at all KKs

A designated laboratory for Confirmatory PCR at IMR

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FINDINGS : Treatment of mother and child

Up to date

Following guidelines

Available

Free

Efforts to home deliver

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FINDINGS : Gaps

Discordant data at states with IMR

The HIV + babies results from IMR are as follows:

o A total of 39 positive babies reported in 2011

o 28 captured from the missed opportunities (non-PMTCT)

o 8 carry forward from 2010.

o 3 from PMTCT

Rate of PMTCT could be different if the IMR data is considered.

Vertical transmission rate (VTR) n from

PMTCT: non PMTCT is then (3/228: ?28/228+28); 228 are HIV+ mothers from NAR

VTR then 1.32% or 10.93% TOTAL VTR 12.1%

The effectiveness of PMTCT is considered good.

Number of mothers who did not participate (non-PMTCT) is also big resulted with the

number of children under this category (missed opportunity) about 28.

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Findings :Gaps

Illegal immigrants:

The service and data gap is another barrier for PMTCT in Malaysia. Theservice to illegal immigrants is an issue within a bigger picture, given thesize and complexity, mobility of this population, and potential threat to theHIV prevention and care programme in the country in general, and toPMTCT of HIV and syphilis in particular.

Immigrant: Legal - data captured may have inaccuracy(. Usually Isverified at private clinics under FOMEMA) and monitoring is alwaysdifficult due to the size and mobility.

Illegal immigrantno data on the previous status and they are not obligedto follow the government procedures.

currently we have, stillbirths are not diagnosed with causes, in particular tothose (especially the immigrants)

loss to follow up a big issue

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Gaps

Smart partnership with NGOs

the active participation of communities through

intensified information campaigns.

No feedback mechanisms/targets given to them?

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Conclusion

Utilizing the existing National PMTCT Programme, it

appears that Malaysia has great potential to

reduce and ultimately eliminate PMTCT in 2015.

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kuantan fms elimination vertical transmission 060713

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