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Prévention de la transmission mère-enfant du VIH

Prévention de la transmission mère-enfant du VIH L’apport des recherches en sciences sociales dans les pays du Sud Paris, 14 janvier 2011. Prévention de la transmission mère-enfant du VIH L’apport des recherches en sciences sociales dans les pays du Sud … et si on partait quand même

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Prévention de la transmission mère-enfant du VIH

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  1. Prévention de la transmission mère-enfant du VIH L’apport des recherches en sciences sociales dans les pays du Sud Paris, 14 janvier 2011

  2. Prévention de la transmission mère-enfant du VIH L’apport des recherches en sciences sociales dans les pays du Sud … et si on partait quand même de l’approche biomédicale ? François Dabis Avec le concours de Renaud Becquet et Didier Ekouevi INSERM U 897, ISPED, Bordeaux

  3. Percentage of pregnant women who received an HIV test in low- and middle-income countries by region2005, 2008 and 2009

  4. Estimated number of women living with HIV needingand receiving antiretrovirals for PMTCTin low- and middle-income countries, 2009

  5. Percentage of pregnant women living with HIV receiving antiretrovirals to prevent mother-to-child transmission of HIV in 25 countries with the highest HIV burden, 2009

  6. Percentage distribution of various antiretroviral regimens provided to pregnant women in low- and middle-income countries in 2007 (59 countries) and 2009 (86 countries)

  7. New HIV recommendations to improve health, reduce infections and save lives 2009 - 2010 • Antiretroviral therapy for HIV infection in adults and adolescents • Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants • WHO principles and recommendations on infant feeding in the context of HIV • Antiretroviral therapy for HIV infection in children 2009 PMTCT ARV Guidelines

  8. 2009 PMTCT ARV Guidelines

  9. Women (including pregnant women) in need of ARV for their own health should get life-long ART Antenatal CD4 is critical for decision-making about ART eligibility Interventions should aim to maximize reduction of vertical transmission, minimize side effects for mothers and infants, and preserve future HIV treatment options Effective postpartum ARV-based interventions for all women will allow safer breastfeeding practices Simple, unifying principles needed for different country settings ART and ARV prophylaxis 2010 PMTCT guiding principles

  10. Women with CD4 <350 regardless of clinical stage Women with clinical stage 3 or 4 (symptomatic) regardless of CD4 Start ART as soon as feasible regardless of gestational age and continue for life Strong recommendation Antiretroviral therapy (ART) 2010 PMTCT ART / ARV Guidelines

  11. ART for eligible mothersand prophylaxis for exposed infants • Strong recommendation 20010 PMTCT ART/ARV Guidelines

  12. For women not eligible for ART or unknown eligibility Beginning as early as 14 weeks of gestation (2nd trimester) or as soon as possible thereafter Strong recommendation ARV prophylaxis to prevent MTCT 2010 PMTCT ART / ARV guidelines

  13. What ARV prophylaxis to giveto non-eligible pregnant women? 2 possible options: • Maternal AZT mono-prophylaxis • Maternal triple ARV prophylaxis (NVP-based regimens are not recommended) Strong recommendation 2009 PMTCT ARV Guidelines

  14. ARV Prophylaxis options for women and infants *sd-NVP and AZT+3TC can be omitted if mother receives > 4 wks AZT antepartum 2009 PMTCT ARV Guidelines

  15. New 2009 key recommendation 2009 PMTCT ARV Guidelines

  16. Le défi du passage à large échelle des interventions de PTME Femmes en âge de procréer Prévention primaire Seules 35% des femmes enceintes ont été testées pour le VIH en Afrique en 2009 Femmes infectées par le VIH Accès au dépistage et aux interventions de PTME La couverture des interventions de PTME déjà existantes reste faible en Afrique (54% en 2009) Taux de PTME : 40% Taux de PTME : 5% à 12% 11

  17. Projet PEARL, Côte d’Ivoire570 femmes VIH+ (9650 cordon ombilical) 98% 59% 52% 40% Centre PTME : 40% des femmes VIH connaissent leur statut

  18. Prise effective de nevirapine Etude menée chez 29,103 couples mère-enfant VIH+ dans 4 pays 51% 75% Cam 59% Zam 54% SA 16% CI

  19. Two Dimensions Needed to Improve PMTCT (courtesy of A. Ciaranello and K. Freedberg) No PMTCT sdNVP Option A Option B “Option B+” Improve PMTCT Uptake (95%?) Improve along both axes

  20. Prévention de la transmission mère-enfant du VIH • L’apport des recherches en sciences sociales dans les pays du Sud • - Comment dépister toutes les femmes enceintes et qui accouchent ? • - Comment révéler leur statut VIH à toutes les femmes dépistées ? • - Comment lier services de SMI, interventions ARV de PTME, promotion de l’allaitement maternel et services de prise en charge VIH adultes et enfants ? • Comment porter un diagnostic d’infection pédiatrique à temps pour tous les enfants à risque ? • …

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