PMTCT around the world

Where are we?

PMTCT Experts Roundtable

Geneva, 23-34 June 2008

WHO protocol: women in need of ARTtreat

For the newbornAZT for 1 or 4 weeks (depending on the time on ART of the mother)

Women not needing ART

Infant feeding• When replacement feeding is acceptable, feasible,

affordable, sustainable and safe (AFASS), avoidance of all breastfeeding by HIV+ mother is recommended.

• Exclusive breastfeeding is recommended for HIV+ women for the first 6 months unless replacement feeding is AFASS for them and their infant.

• Continue beyond 6 months (add complementary food) if RF still not AFASS

US Guidelines• Ante-partum HAART (avoid EFV, TDF,

NFV, d4T+ddI) started after 1st trimester (before if for her own health).

• Elective C/S for women with HIV RNA >1,000

• IV AZT during delivery

• Avoidance of breastfeeding

• AZT 6 weeks for the newborn

IMPLEMENTATION

From

Toward Universal Access

Progress Report 2008

HIV testing and Counselling

• 18%18% of the total estimated number of pregnant of pregnant womenwomen in low- and middle-income countries (20.6 million of 115 million pregnant women) received received an HIV testan HIV test in 2007 (from 16% in 2006 and 10% in 2004)

• Testing coverage varies between 4% in Nigeria and 65% in Zambia

• Antenatal care is relatively high in most of low- and middle income countries (75%) but PICT is still not implemented

Antiretrovirals for PMTCT

• 33% of HIV+ pregnant women received 33% of HIV+ pregnant women received ARV for PMTCTARV for PMTCT (491.000/1.5 mil). From 23% in 2006 and 10% in 2004.

• Some dramatic success in reducing transmission: – From 30.5% to 11.4% (2001-2007) in Cambodia

– From 30.5% to 8.9% (2001-2007) in Rwanda

Coverage for ARV in PMTCT - 2007

Big differences among countries

Coverage of infant prophylaxis• 20% by the end of 200720% by the end of 2007 (7% in 2004, 18% in

2006)• Widening gap between coverage of antiretroviral

for mothers and for infants

Antiretroviral regimens used for PMTCT - 2007

• 60 countries provided disaggregated data (accounting for 60% of the total estimated HIV+ pregnant women):

– 49% of women received single dose NVP49% of women received single dose NVP– 26% received a combination of 2 ARV– 8% receiving a combination of three ARV

– Only 7% received ARV for their own health Only 7% received ARV for their own health in SSAin SSA

Availability of CD4 testing in ANC 2007

Infant feeding

• Difficult to have reliable data

• Exclusive breastfeeding worldwide (< 6 months) increased of 5-6 percentage points in the last 15 years (!)

• 39% in 2005 (?)

Infant management

• Only 8% Only 8% of the 715.000 children born to HIV+ women in 2007 were tested within 2 were tested within 2 months of birth months of birth (data from 77 (71%) countries)..

• OOnnly 4% ly 4% of exposed children (1.5 Millions) received CTX prophylaxisreceived CTX prophylaxis within 2 months of birth

Conclusions

• Big differences in the recommended protocol between countries

• Implementation of PMTCT program in low and middle income countries:– Low coverage of testing in ANC, but

improving – Sd NVP still widely used– ANC/PMTCT not used as entry point for access

to treatment