Unite for Children, Unite against AIDS.

1. PMTCT Unite for Children, Unite against AIDS. Dr. Doreen Mulenga Senior Advisor, HIV/AIDS UNICEF New York

2. UNAIDS epidemic update November 2007 Children continue to be infected mainly through MTCT despite having tools to eliminate this infection • 2.1 Million children living with HIV • Increase from 1.5 million reported in 2001 • 420,000 new HIV infections • Decline from 460,000 reported in 2001 • 290,000 children died

3. Commitments have been made 2001 United Nations Global Assembly Special Session on HIV/AIDS Reduce the proportion of infants infected with HIV by 20% by 2005 and 50% by 2010, by: • Ensuring that 80% of pregnant women accessing antenatal care receive information, counseling and other HIV prevention services • Providing access for HIV-infected women and babies to effective treatment to reduce MTCT of HIV…

4. 2 1 3 4

5. Evidence Based Packaging of PMTCT Services Prong I HIV/PMTCT education targeting families, couples, young people, high risk populations STI screening and Rx in MCH services Condom promotion and use in the context of PMTCT targeting MCH couples, young people, VCT clients, ART clients, STI clients Provider initiated HIV testing and counselling in key service points – PMTCT, STI, family planning Adolescent life skills education Prong II Integrated FP services in PMTCT 2. Expansion of FP services in the context of PMTCT to ART, STI, VCT, youth friendly reproductive health services.

6. Evidence Based Package of PMTCT Services Prong III HIV/PMTCT education / on going prevention counselling Provider initiated testing and counselling ARV prophylaxis – more efficacious combination treatment for PMTCT/HAART for women in need Safe delivery practices – avoidance of invasive procedures and prolonged rupture of membranes; C/S IF counseling and systematic and institutionalised support to mothers Condom promotion and use during pregnancy and lactation Prong IV HIV prevention during lactation Early Initiation and exclusive BF Cotrimoxazole preventive treatment for + mothers in need and for exposed infants Bednets and IPT for pregnant women CD4 screening for positive mothers ART pregnant and lactating mothers in need Rx Psychosocial Support Nutritional support including provision of food rations Integrated HIV and IMCI screening and management at primary facility level Human rights and legal protection

7. Programme CoverageReporting modality • Annual national data (Jan to Dec) through UNICEF and WHO country offices • 2007 data collected end Jan 2008 – being analysed. • Validated by Ministry of Health in collaboration with in country partners • Analysed by UNICEF in collaboration with WHO and UNAIDS • Global data bases used as denominators to ensure standardisation • Data as good as what is reported • In some of the countries data collecting mechanisms very weak

8. Reporting status 2004-2006 108 countries reported in 2006

9. 16% of all pregnant women and 21% of women attending at least 1 ANC visit were HIV tested in 2006

10. Increase in PMTCT ARV coverage to 23%; notable increase in East and Southern Africa to 31%(denominator is all estimated positive pregnant women)

12. Regional coverage of paediatric ART2006

13. Failure to Deliver Co-trimoxazole prophylaxis for HIV-exposed children in 2006

14. Key Achievements

15. Remaining challenges and gaps • Limited human resources and infrastructure for scale up • Inadequate integration into maternal and child health • Goal is HIV-free child survival • PMTCT is still viewed as a vertical programme • PMTCT not included in the basic MCH package of services • Prong 1 and 2 are the weakest components • Inadequate follow-up of women and children for HIV care, support and treatment • Weak counseling, monitoring and support of Infant Feeding

16. SummaryWe are gaining momentum • Most countries have national strategies • Access is going up nearly everywhere • In 2006, 16% , compared with 11% in 2005, of the total estimated number of women giving birth tested for HIV • The proportion of HIV positive pregnant women who received ARVs for PMTCT has increased from 10% in 2004 to 15% in 2005 to 23% in 2006 • In all regions, more HIV-infected children have greater access to ART with over 50% increases • HIV testing in young children using dry blood spots increasing • Improved scientific evidence on moreeffective ARV regimens; infant feeding to guide program implementation • We need to do more to build the evidence for models of SRH/PMTCT integration scale up.

17. What can you do? • Link up with the national technical working group • National policies and plans • Standard operating procedures • Training and networking opportunities • Procurement policies • National tracking of progress • Identify the priority entry points based on the access and utilisation of services and the characteristics of your countries epidemic; MNCH services, HIV care and treatment services, STI and VCT services. Additionally under five and support groups of women living with HIV.

18. Policies Making Pregnancy Safer Strategy Mother-Baby Package:Implementing safe motherhood in countries Health Systems Global action for skilled attendants Tools Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants Individuals,families and communities