washington d.c., usa, 22-27 july 2012 preventing mother to child hiv transmission through community...
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Washington D.C., USA, 22-27 July 2012www.aids2012.org
Preventing Mother to Child HIV Transmission through Community Based
Approach in Nepal
Nafisa Binte Shafique
Chief, HIV and AIDS Section
UNICEF Nepal
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Washington D.C., USA, 22-27 July 2012www.aids2012.org
About Nepal• Total Population – 28,810,000• Estimated annual births – 780,000• Maternal mortality ratio – 380 per 100,000
live births• Contraceptive prevalence rate – 48%• Unmet need for family planning – 24.6%• ANC coverage (at least 1 visit) - 87%• ANC coverage (4 or more visits) – 50%
Washington D.C., USA, 22-27 July 2012www.aids2012.org
About Nepal
• Skilled attendant at delivery – 29%• Institutional delivery – 28%• Exclusive breastfeeding for infant <6
months – 53%• Infant mortality rate (per 1,000 live births) -
39• Under 5 mortality rate (per 1,000 live
births) - 48
Washington D.C., USA, 22-27 July 2012www.aids2012.org
HIV situation in Nepal – a brief overview• First HIV case reported in 1988• Evolved from low prevalence to ‘concentrated epidemic’ among the most at
risk population IDU, FSW, MSM and TG, Labour migrant • Estimated HIV infections – 55,626• Identified cases – 18,396• Adult (15 – 49) HIV prevalence – 0.33%(one of the highest in South Asian
Region)• Proportion of women 15 – 49 living with HIV – 28%• Proportion of young girls(15 – 24) living with HIV – 6.2%• Average number of new infections per day – 6• Average number of new infections amongst children (0 – 14) per year – 460• Average number of average deaths among children (0 – 14) per year – 284• Estimated number of children affected by AIDS - 24,000+
Washington D.C., USA, 22-27 July 2012www.aids2012.org
PMTCT Situation
• Government of Nepal initiated PMTCT services in 2005 however, only at district level hospitals
• Accessibility by most disadvantaged pregnant women living in remote areas remained as a challenge
• In 2009, GoN with UNICEF’s support and in collaboration with CBOs introduced a community based PMTCT service integrated with MNCH, in one of the highest HIV burden districts of Nepal.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
MethodWhere
• The CB-PMTCT model uses the government’s existing MNCH structures
Who
• Trained Volunteers provide HIV information to pregnant women and refer them for ANC services
When
• During ANC visits pregnant women are encouraged to take HTC services
What
• If positive, the pregnant woman is referred for further treatment and support
How
• During the pregnancy she is provided with counseling on delivery preparedness and treatment adherence. HIV-positive women are encouraged for institutional delivery
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Results
ANC Coverag
e
HTC uptak
e
ARV rece
ived by +
ve preg
nant w
omen
Infant A
RV cove
rage
Institutional
delive
ry
.000%10.000%20.000%30.000%40.000%50.000%60.000%70.000%80.000%90.000%
2008 - 2009
2011
2008 - 20092011
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusions
• Utilization of PMTCT by pregnant women dramatically increased by taking services at the community level
• The volunteers and WLHIV created demand for PMTCT services and care practices
• The integration of PMTCT in MNCH services is an efficient, cost effective and sustainable approach
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusions
• Because of the proven efficacy of the intervention Government is keen to scale up the model in 7 districts with GFATM funding
• In order to improve the service utilization, HTC services should be decentralized up to the community level
• It is also imperative to address stigma and discrimination and change social norms to ensure equitable access to services by KAP
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Thank youAny Question?