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Effectiveness of the PMTCT program in Swaziland

Effectiveness of the PMTCT program in Swaziland. Nomsa Mulima 17 th July 2011. Country background. Country Population 1,018,449 (M=481428; F=537021) Pop 0-4 yrs=127859 (13%) Pop 15-49 yrs= 510738 (50%) HIV Prevalence (Extreme) Generalized epidemic in all 4 regions

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Effectiveness of the PMTCT program in Swaziland

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  1. Effectiveness of the PMTCT program in Swaziland Nomsa Mulima 17th July 2011

  2. Country background • Country Population • 1,018,449 • (M=481428; F=537021) • Pop 0-4 yrs=127859 (13%) • Pop 15-49 yrs= 510738 (50%) • HIV Prevalence (Extreme) Generalized epidemic in all 4 regions • Pregnant women (41.1%) • General population (19%) • 15-49 age group (26%) • MMR =589 • IMR= 78 in 1997 to 107 in 2007 • Under 5 MR= 106 in 1997 to 167 in 2007

  3. PMTCT in Swaziland- country Information • PMTCT program implementation & expansion • PMTCT Implementation since 2003 • 4 Sites initially; increase to 73 by 2005; 137 by 2008 and 150 (88%) by 2010 • Expansion in sites providing treatment including ART • ART implementation since 2003 • 6 sites initially; 17 in 2005; 70 by 2008 and 116 (43%) by 2010 • EID • Started in late 2007 • Increase from 58 sites in 2008; 107 end of 2009 &127/157 (81%) of CW clinics by 2010 • DBS done centrally- 1 DNA-PCR machine • Some tests done in South Africa due to insufficient capacity

  4. PMTCT Country background Cont....... EID Coverage: Policy= test all exposed infants >6wks (for HIV+ initiate ART immediately) Estimated exposed infants=11,528 Tested within 2 mnths= 4,902(42%) still most infants test after 2 mnths. Improvement compared to previous years (as graph shows)

  5. EID Coverage(HIV prevalence vs time DBS done) Decline in % infants testing HIV+ (from estimated 21%- +- 14%) Within <8wks (4%) Notable difference for those testing>8wks (unknown causes) Transmission through breast milk/that DBS confirms test for those testing HIV + through Antibody testing????

  6. Existing data on PMTCT Impact _cont....... Currently available data • PMTCT program data-improvement in access to ARVs & EID uptake Gaps • Still Impact of PMTCT is unknown (country relies on modelling _ not country specific_ generalized to regional assumptions • No linkages btwn ANC & CWF data (cannot link and measure transmission rates)

  7. Current PMTCT impact evaluation: Methods • Evaluation of the effectiveness of the national PMTCT programme at 6 – 8 weeks post-partum in Swaziland • Protocol submitted and approved nationally • Awaiting approval from IRB/CDC • Method chosen and why: • Immunization clinics survey (+83% EPI-DPT1 coverage) • Mother-infant-pairs to be recruited from a random sample of about 55 child welfare clinics providing EID, • All mother-infant pairs attending selected facilities during the 4-month data collection period will be offered an opportunity to participate in the evaluation. • Consenting mothers will be interviewed using a structured questionnaire to obtain demographics, uptake of ANC and PMTCT interventions-Testing & ARVs.

  8. Method chosen and why cont..... • Why the study & method selection? • Country target: reduction of MTCT to 5% by 2014 (country specific Baseline not available) • Program data not of good quality • CWF register already in cohorts, but issues of LTF (infants <6wks in 1st visit not coming back) • No link of CWF data to mom’s regimen/ PMTCT intervention • Current STD: Infants tested if mother’s HIV+ status known> all infants selected will be tested regardless of mom’s HIV status • Data triangulation done on infant mortality, declines noted but not clear of attributing factors

  9. Other proposed studies • Follow-up of breastfeeding infants • To be part of the above mentioned study –Evaluation of the effectiveness of PMTCT program • Follow-up selected infants whose DNA is negative at 6-8wks until cessation of breast milk to determine late HIV transmission (breast milk) • Still to develop protocol • NVP Adherence for infants- study to assess routine collection of adherence data to assess uptake of new PMTCT guidelines and use as input to adjust model ( WHO collaboration) • DHS 2012 to consider infant/child testing • Triangulation of PMTCT programme scale-up and infant mortality • Continuous triangulation to determine impact of PMTCT

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