www.aids2014.org emtct validation in the africa region: regional overview and candidate countries
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EMTCT Validation in the Africa Region: Regional Overview and Candidate Countries
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Outline
• Overview of PMTCT Progress in the Africa region (and in the 21 countries)
• Analysis of PMTCT programme performance, typologies• Closer look at countries leading the way in PMTCT
progress: very low prevalence, 21 GP country• Comment on EMTCT validation criteria applicability in
the region –BF and data quality is key• Next Steps
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Primary Prevention: Unmet Target
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Pregnant Women Knowing Their HIV Status
From WHO HIV Report 2014. Based on WHO/UNICEF/UNAIDS Health Sector GARPR Data and 2013 HIV estimates
AFRO ESA WCA0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
9%
16%
3%
34%
52%
20%
41%
62%
26%
45%
67%
29%
51%
74%
35%
2005 2009 2011 2012 2013
35%
74%
51%
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PMTCT Progress in the Africa Region: ARV coverage
From WHO HIV Report 2014. Based on WHO/UNICEF/UNAIDS Health Sector GARPR Data and 2013 HIV estimates
AFRO ESA WCA0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
13%16%
4%
21%
27%
8%
31%
39%
11%
40%
51%
15%
48%
58%
23%
48%
59%
19%
57%
69%
27%
63%
76%
30%
68%
79%
39%
2005 2006 2007 2008 2009 2010 2011 2012 2013
68%79%
39%
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Business as usual will only take us to 46% reduction in new HIV infections among children by 2015
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150
100,000
200,000
300,000
400,000
500,000
600,000
Source: Preliminary UNAIDS 2013 Estimates
46% reduction
Business as usual, assuming 2013 ARV coverage
Global Plan Target
Slide 8
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EID in 21 African Global Plan Priority Countries
South A
frica
Swaziland
Botswana
Namibia
Zambia
Zimbabwe
Kenya
Uganda
Leso
tho
Moza
mbique
Ghana
United Republic
of Tanza
nia
Cameroon
Ethiopia
Angola
Burundi
Côte d'Iv
oire
Malawi
Democratic R
epublic of t
he Congo
NigeriaChad
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
94% 89%
58% 56% 55%50%
42%36% 36% 35%
30% 26% 24% 21% 17% 17% 15% 15%10%
4% 4%
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We are failing children living with HIV
Note the percentage is based on all children ages 0-14 living with HIV and is not limitedto those eligible for ART.
Source: Preliminary UNAIDS 2013 Estimates
Treatment gap 2009
92%
Treatment gap 2013
77%
2.6 million children living with HIV in the 21 countries. Only 23% are on HIV treatment in 21 Global Plan countries in 2013
Slide 10
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Global Plan and EMTCT Validation Criteria
Impact• Case Rate of 50 paediatric HIV cases due
to PMTCT out of 100,000 live births
AND• MTCT Rate of <5% (breastfeeding
populations)
Process
ANC>95%
Testing (Know Status) > 95%
PMTCT ARV > 90%
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Are we close to the Process targets?
• ANC > 95%: • 17 countries• (5 countries between 80-95%)
• Pregnant women with known HIV status > 90%:
• 12 countries• (3 countries between 80-95%)
• PMTCT ARV Coverage> 90%: • 8 countries• (2 countries between 80-95%)
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Are we close to the Impact target?
• Impact:< 50 MTCT cases per 100,000 live births
Based on 2013 estimated new HIV infections and live births:
– <50: Mauritania and Mauritius– <100: Niger, Rwanda, Senegal, Cape Verde, Eritrea
– Botswana: 560 MTCT cases per 100,000 live births
(has dropped from case rate of ~ 2130 in 2009)– Namibia: 1,760 MTCT cases per 100,000 live births
(has dropped from case rate of ~ 2500 in 2009)
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Some key issues
Data Quality Assessment- Purpose: to determine if systems are “validation quality”- Are sentinel sites OK? Data accounts for what % of HEI?
- How to address modeled denominator for coverage?- Estimate of private sector share of market? Private sector data required- MTCT rate measured 6 week after cessation of BF, or outcomes at a standard age, e.g. 18mths?- ARV to include some retention or post-partum coverage assessment? - What general principles for quality, completeness, accuracy, consistency, timeliness?
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Next steps
• Obtain possible candidate countries for MTCT elimination validation for the year 2015.– Provide support countries to be prepared –
Botswana, Namibia, South Africa, Swaziland, Tanzania(Zanzibar), and Zimbabwe.
– Support other countries towards possible validation (M&E framework, data quality and processes and skills).
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• Need to continue to work towards GP targets (all 4 prongs)
• Reach high coverage of quality and integrated MNCH interventions including HIV and syphilis
• Most countries do not have a mechanism to collect MTCT rate from real data.
• Verifying final outcome status is important for EMTCT validation. (Will help to verify modelling assumptions as well.)
• Retention is key.
Take home messages
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Acknowledgements
• Chika Hayashi – WHO• Priscilla Idele - UNICEF• Tyler Porth – UNICEF• Isseu Diop-Tourre – WHO• Karusa Kiragu - UNAIDS
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Thank you