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PMTCT around the world

PMTCT around the world. Where are we? PMTCT Experts Roundtable Geneva, 23-34 June 2008. WHO protocol: women in need of ART treat. For the newborn  AZT for 1 or 4 weeks (depending on the time on ART of the mother). Women not needing ART. Infant feeding.

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PMTCT around the world

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  1. PMTCT around the world Where are we? PMTCT Experts Roundtable Geneva, 23-34 June 2008

  2. WHO protocol: women in need of ARTtreat For the newbornAZT for 1 or 4 weeks (depending on the time on ART of the mother)

  3. Women not needing ART

  4. Infant feeding • When replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS), avoidance of all breastfeeding by HIV+ mother is recommended. • Exclusive breastfeeding is recommended for HIV+ women for the first 6 months unless replacement feeding is AFASS for them and their infant. • Continue beyond 6 months (add complementary food) if RF still not AFASS

  5. US Guidelines • Ante-partum HAART (avoid EFV, TDF, NFV, d4T+ddI) started after 1st trimester (before if for her own health). • Elective C/S for women with HIV RNA >1,000 • IV AZT during delivery • Avoidance of breastfeeding • AZT 6 weeks for the newborn

  6. IMPLEMENTATION From Toward Universal Access Progress Report 2008

  7. HIV testing and Counselling • 18% of the total estimated number of pregnant women in low- and middle-income countries (20.6 million of 115 million pregnant women) received an HIV test in 2007 (from 16% in 2006 and 10% in 2004) • Testing coverage varies between 4% in Nigeria and 65% in Zambia • Antenatal care is relatively high in most of low- and middle income countries (75%) but PICT is still not implemented

  8. Antiretrovirals for PMTCT • 33% of HIV+ pregnant women received ARV for PMTCT (491.000/1.5 mil). From 23% in 2006 and 10% in 2004. • Some dramatic success in reducing transmission: • From 30.5% to 11.4% (2001-2007) in Cambodia • From 30.5% to 8.9% (2001-2007) in Rwanda

  9. Coverage for ARV in PMTCT - 2007

  10. Big differences among countries

  11. Coverage of infant prophylaxis • 20% by the end of 2007 (7% in 2004, 18% in 2006) • Widening gap between coverage of antiretroviral for mothers and for infants

  12. Antiretroviral regimens used for PMTCT - 2007 • 60 countries provided disaggregated data (accounting for 60% of the total estimated HIV+ pregnant women): • 49% of women received single dose NVP • 26% received a combination of 2 ARV • 8% receiving a combination of three ARV • Only 7% received ARV for their own health in SSA

  13. Availability of CD4 testing in ANC 2007

  14. Infant feeding • Difficult to have reliable data • Exclusive breastfeeding worldwide (< 6 months) increased of 5-6 percentage points in the last 15 years (!) • 39% in 2005 (?)

  15. Infant management • Only 8% of the 715.000 children born to HIV+ women in 2007 were tested within 2 months of birth (data from 77 (71%) countries). • Only 4% of exposed children (1.5 Millions) received CTX prophylaxis within 2 months of birth

  16. Conclusions • Big differences in the recommended protocol between countries • Implementation of PMTCT program in low and middle income countries: • Low coverage of testing in ANC, but improving • Sd NVP still widely used • ANC/PMTCT not used as entry point for access to treatment

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