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Jessica Rodrigues Presentation for UNICEF Written Test 04 May 2012

Scaling up Prevention of Mother to Child Transmission of HIV (PMTCT): What Will it Take to Eliminate MTCT?. Photograph courtesy of EGPAF and NPR. Jessica Rodrigues Presentation for UNICEF Written Test 04 May 2012. 35-42% pregnant women (PW) receive HIV testing and counseling

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Jessica Rodrigues Presentation for UNICEF Written Test 04 May 2012

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  1. Scaling up Prevention of Mother to Child Transmission of HIV (PMTCT):What Will it Take to Eliminate MTCT? Photograph courtesy of EGPAF and NPR • Jessica Rodrigues • Presentation for UNICEF Written Test • 04 May 2012

  2. 35-42% pregnant women (PW) receive HIV testing and counseling • Significant increase in East and Southern Africa • 42% infants received antiretroviral (ARV) medicine for PMTCT • 28% HIV exposed infants diagnosed early • 23% children in need receive antiretroviral therapy (ART) • 52-61% PW receive most effective regimens • BUT ONLY • 5 of 22 priority countries reached 80% coverage 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

  3. Smart Scale-Up High PMTCT Coverage & Low Rates of MTCT Focus on Countries With Highest MTCT Burden! Source: Towards Universal Access, WHO, 2011 and Besser, 2011 Source: Towards Universal Access, WHO, 2011

  4. MDGs 3-6 (Gender Equity, Infant Mortality, Maternal Health, Infectious Diseases) Reduce HIV incidence among women 15-49 yrs by 50% Reduce number of pediatric infections by 90% Reduce number of AIDS related maternal deaths by 50% 90% of eligible pregnant women ART Reduce unmet family planning need to zero MTCT to 5% • MTCT accounts for 90% • of new infections • 1,000 children infected • with HIV everyday • 48% of pregnant women received ARV medicine for PMTCT Where We’re Going: Global Targets Today 2015 Effective PMTCT Care, Treatment & Support Primary Infection Unintended Pregnancy ARV prophylaxis AND Source: WHO, UNAIDS, UNICEF 2010 Source: Global Plan for the Elimination of Pediatric HIV and UNDP

  5. Receive ARVs (pre and perinatal) 50% Counseled and Tested for HIV, 74% PMTCT Services We Know What to Do Attend ANC clinic 95% Persistent Gaps Why Aren’t We There Yet?Missed Opportunities • 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 • MORE 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 Source: Guay, 2011 and P Barker, 2008

  6. Challenges to Scaling Up PMTCT HIGH ATTRITION & POOR ADHERENCE LATE IDENTIFICATION COMPROMISED RESPONSE • 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

  7. Health System Produce, train and retain health workers Innovative financing mechanisms Strengthen supply chain management Improve data quality and use Community Expand community based testing Strengthening community support, patient led support groups Encourage male involvement Increase patient voice and feedback Commitment Ramp up global advocacy & resource mobilization Coordinated technical assistance Promote government accountability to scale up Increase private sector involvement Hospital Promote service integration (FP, MCH) Increase uptake of more efficacious regimens Improve diagnostic capacity with point of care technology Task shifting for counseling and testing Expand provider initiated testing and counseling The Many Roads Ahead

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