Scaling up Prevention of Mother to Child Transmission of HIV (PMTCT):

What Will it Take to Eliminate MTCT?

Jessica RodriguesPresentation for UNICEF Written Test

04 May 2012

Photograph courtesy of EGPAF and NPR

Where We Are: Global Progress to Date

• More pregnant women counseled and tested for HIV

• Uptake of PMTCT services improving....

Follow up care for HIV exposed infants is poor

•35-42% pregnant women (PW) receive HIV testing and counseling•Significant increase in East and Southern Africa

•52-61% PW receive most effective regimens BUT ONLY•5 of 22 priority countries reached 80% coverage

•42% infants received antiretroviral (ARV) medicine for PMTCT•28% HIV exposed infants diagnosed early•23% children in need receive antiretroviral therapy (ART)

Smart Scale-Up

Source: Towards Universal Access, WHO, 2011

Focus on Countries With Highest MTCT Burden!

High PMTCT Coverage &

Low Rates of MTCT Country Adult HIV

Prevalence

HIV Prevalence in Pregnancy

PMTCT Coverage

ART Children Coverage

Nigeria 3% 2.4-4% 10% 12%

South Africa 18% 29% 73% 61%

US and UK 0.3-0.6% 0.06% >95% >95%

Source: Towards Universal Access, WHO, 2011 and Besser, 2011

Where We’re Going: Global Targets

MTCT accounts for 90%

of new infections

1,000 children infected

with HIV everyday

48% of pregnant women received ARV medicine for PMTCT

Reduce number of pediatric infections by 90%

Reduce number of AIDS related maternal deaths by 50%

Today 2015EffectivePMTCT

Source: Global Plan for the Elimination of Pediatric HIV and UNDP

Reduce HIV incidence

among women 15-49 yrs by 50%

Reduce unmet family

planning need to zero

MTCT to 5%

90% of eligible

pregnant women

ART

PrimaryInfection

Unintended Pregnancy

ARV prophylaxis

Care, Treatment & Support

Source: WHO, UNAIDS, UNICEF 2010

ANDMDGs 3-6

(Gender Equity, Infant Mortality, Maternal Health, Infectious Diseases)

Antenatal Care•HIV Counseling and Testing •ARV prophylaxis for PMTCT•Treatment Eligibility•Access to Antiretroviral Treatment if needed•Linkages to family planning, ART

Labor and Delivery•Safe Delivery•Infant prophylaxis for PMTCT•Early infant diagnosis •Safe feeding practices•Follow up care and treatment for mother and child until 18 months

Why Aren’t We There Yet?Missed Opportunities

PMTCT ServicesWe Know What to Do

Persistent GapsMORE THAN HALF OF PREGNANT WOMEN IN NEED:•Do not receive ARV medicine for PMTCT•Are not assessed for treatment eligibility

LESS THAN HALF OF PREGNANT WOMEN IN NEED:•Receive antiretroviral therapy for their own health in the 22 priority countries

MORE THAN HALF OF INFANTS IN NEED:•Do not receive ARV medicine for PMTCT

Attend ANC clinic 95%

Counseled and Tested for HIV,

74%

Receive ARVs (pre and perinatal)

50%

Source: Guay, 2011 and P Barker, 2008

Challenges to Scaling Up PMTCT

• Quality

• Pre and post test, pre-ART, adherence counseling

• Limited diagnostic capacity

• Fragmented services

• Access

• Poverty (Long distances, transport, opportunity costs)

• Stigma and discrimination

• Low or late ANC attendance and home deliveries

• Health system bottlenecks

• Stock outs of tests, drugs and consumables

• Human resource shortages and high turnover

• Monitoring and evaluation tools and registers

HIGH ATTRITION

& POOR ADHERENCE

COMPROMISED RESPONSE

LATE IDENTIFICATIO

N

The Many Roads AheadHospital

Promote service integration (FP, MCH)

Increase uptake of more efficacious regimensImprove diagnostic

capacity with point of care technologyTask shifting for

counseling and testingExpand provider initiated

testing and counseling

Community Expand community

based testingStrengthening

community support, patient led support

groupsEncourage male

involvementIncrease patient

voice and feedback

Health SystemProduce, train and

retain health workers

Innovative financing

mechanismsStrengthen supply chain management

Improve data quality and use

CommitmentRamp up global

advocacy & resource

mobilizationCoordinated

technical assistancePromote

government accountability to

scale upIncrease private

sector involvement