Prevention of Mother-to-Child Transmission of HIV infection in Sri Lanka

Dr Sujatha Samarakoon

Consultant Venereologist / Focal Point ECS & PMTCT – National STD/AIDS Control Programme, Ministry of Health

Adult HIV prevalence rate <0.1% - Sri Lanka has a low level HIV epidemic

Number reported as at end September 2010 = 1285 ( females=518)

Male :female ratio = 1.5:1 Cumulative AIDS deaths =212 Estimated PLHIV by 2009 = 3000 Estimated of number of Pregnant women with HIV (2010) =

50 Estimated number of pregnant women in need of ART

(2010)=42 Number of reported cases of Vertical Transmission =44

Prevention of transmission from an HIV positive woman to her infant

Care and support for the mother & her family

Prevention of transmission of HIV in young people & women

of childbearing age

Prevention of unintended pregnancies in HIV + women

Girl child – PMTCT included in the school education programme of SP

Women in child bearing age – Preconception package of Family Health Bureau (FHB) included PMTCT & ECS, Work plan of women’s health of FHB

Antenatal mothers Antenatal care package of FHB includes PMTCT& ECS PHC staff training includes PMTCT & ECS ( PHNS, PHI, PHM, Labour

room staff) should be now included in the curriculum Male partner – Parent craft classes Sensitization meeting for VOG/SR/SHO - 4 meetings NSACP member of the Perinatal Mortality Review Committee of DMH

70% of pregnant mothers accepting VCT, 60% of HIV 70%infected mothers detected, and 80% of infants born to HIV infected mothers free from HIV

Antenatal syphilis screening for all pregnant women attending antenatal services

In three selected areas, pilot programs are being carried out

One of the leading Maternity Hospitals is offering routine HIV testing as Standard of Care

One hospital offering – Opt out One MOH area offering Opt out

(62,000 samples tested 2004-2009 and only 6 were positive giving a rate of 0.02%)

YearNumber tested

Number

positive

Percent

2000 30,906 3 0.01

2001 20,409 0 0

2002 17,601 0 0

2003 20,286 1 0.01

2004 14,529 2 0.01

2005 14,476 0 0

2006 13225 0 0

2007 8648 1 0.01

2008 12239 3 0.02

2009 13,475 2 0.02HIV prevalence among AN mothers very low

Optimize HIV positive woman’s physical and psychological well being

Prevent vertical transmission of HIV Minimize maternal risks

Optimize neonatal well being

Prepare for or prevent next pregnancy

Routine obstetric care – PHC/ VOG/Hospital staff Clinical and immunological assessment of HIV infection –

Venereologist/MO-STD

Provision of ART – Venereologist/MO-STD/VOG

Provision of safe delivery practices – VOG/ anesthetist

Provision of safe feeding practices- paediatrician/VOG/MO-STD

For her own health or as prophylaxis as per new WHO guidelines

Prophylaxis – Option A or B ?

ARV in Pregnancy

As per new WHO guidelines

ARV for infant

Replacement feeding –

If no AFASS then exclusive breastfeeding for 6 months

Preparation in progress