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Roll - out of AZT and Nevirapine in Operational Programs

Roll - out of AZT and Nevirapine in Operational Programs. Siripon Kanshana M.D.,M.P.H. The “ Treat 3 Million by 2005” Initiative. Goal. To make the greatest possible contribution to prolonging the survival and restoring the quality of life of individuals with HIVAIDS

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Roll - out of AZT and Nevirapine in Operational Programs

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  1. Roll - out of AZT and Nevirapine in Operational Programs Siripon Kanshana M.D.,M.P.H.

  2. The “ Treat 3 Million by 2005” Initiative Goal To make the greatest possible contribution to prolonging the survival and restoring the quality of life of individuals with HIVAIDS Access to antiretroviral therapy for those in need of care , as a human right and within the context of a comprehensive response to HIVAIDS

  3. UNGASS Target (1) • Reduce proportion of infants • infected with HIV • - 2005 by 20 % • - 2010 by 50 %

  4. UNGASS Target (2) • By : • ensuring that 80 % of pregnant women • accessing antenatal care have: information • counseling and HIV prevention services available • increasing the availability of and by providing access • for HIV-infected women and babies to: • - effective treatment to reduce MTCT • - effective interventions include • - VCT • - ARV • - breast milk substitute • - provision of continuum care

  5. Strategies for prevention of MTCT All women Prevent HIV infection Prevent unintended pregnancy HIV infected women Prevent HIV transmission to infants HIV infected pregnant women HIV infected pregnant women and family Treatment and care

  6. Prevention of MTCT of HIV HIV Infected pregnant women Children

  7. The risks of transmission in infants at 6-8 weeks in several trials conducted in Africa

  8. AZT Trial S-S

  9. PHPT 2 Mother Infant NVP-NVP NVP-Plac. Plac.-Plac. ZDV 2.0 2.8 ZDV ZDV 6.3 NVP dosing: Mother = 200 mg po at onset of labor Infant = 6 mg po 48-72 hrs after birth ZDV regimen: Pregnancy = 300mg bid from 28 wks’ gestation or as soon as possible thereafter Labor = 300mg po every 3 hours Infant = 2mg/kg for 1 wk(6 wks if <4 wks in mother) No breastfeeding Perinatal HIV Prevention Trial, Thailand

  10. How will countries meet the UNGASS and WHO goal - in prevention of MTCT of HIV - Continuous Care and Treatment of HIV+ Mother and Family

  11. PMTCT Thailand Experience

  12. Selected Health Indicators, Thailand Maternal mortality ratio 35/100,000 live birth infant mortality rate 21 / 1,000 live births Access to safe water - urban 89 % - rural 77 % Adult literacy 94 % 4 ANC visit 83 % Initiating breastfeeding 87 %

  13. Nationally-Supported Mother-Child HIV Prevention Program, Thailand, 2004 • VCT for all pregnant women • AZT will be given to HIV infected pregnant women at 28 wks until delivery • Single dose of Neverapine will be given for HIV infected pregnant women during lobor and to newborns after birth • Infant formula for 12 mos to replace breastfeeding • HIV test for infant at 12 mos. ; re-test at 18 mos. • Continuous care and ARV treatment after delivery for HIV infected mothers , partners and children

  14. Thailand’s National PMTCT Program2001-2003 Number of women who gave birth : 1,744,095 -- with ANC 1,691,919 ( 97 %) -- with HIV test result 1,669,273 (95.7 %) -- HIV positive 19,234 (1.2%) -- took AZT 14,599 (75.9%) Ministry of Public Health, Thailand

  15. Thailand’s National PMTCT Program2001-2003 Number of LBs born to HIV+ : 18,888 -- took AZT syrup 17,904 (94.8%) -- took formula at birth 15,765 (83.5%) Ministry of Public Health, Thailand

  16. Thailand’s National PMTCT ProgramNumber of Infections Prevented,2001-2003 • Number of births to HIV-infected women 18,888 • Number of infants infected: • With no intervention TR = 30% 5,666 • With MOPH program TR = 8%,75.9% HIV+ women participate 1,147 Estimated Infections Being Prevented : 4,519

  17. National Sentinel Surveillance Pregnant Women at First Antenatal Care, Thailand HIV Prevalence (%) Year Division of Epidemiology, MOPH

  18. Number of AIDS Cases of Children 0 - 4 years from Vertical Transmission Epidemiology Division, Oct 2003.

  19. Care for HIV infected mothers & family

  20. 6 weeks post partum +ve Husband +ve women Test for CD 4 Count CD4>200 - ongoing counseling (HP & FP) - Prevention and Care (National Guideline) - Recheck CD4 every 6 months CD4<200 - Provide ARV - ongoing counseling - Prevention and Care (National Guidline) - Recheck CD4 every 6 months

  21. Target provinces (pilot Project) 1. Ubonrajathani 2. Udonthani 3. Lampang 4. Yala

  22. Implementation of CARE Program in pilot provinces No. HIV infected women 454 joint in the program 80 % CD4 < 200 or develop symptom 34 % ARV treatment 88 %

  23. Implementation of CARE Program in pilot provinces No. HIV infected husband 191 joint in the program 78 % CD4 < 200 or develop symptom 28 % ARV treatment 92 %

  24. Implementation of CARE Program in pilot provinces No. Child born to HIV infected 18 joint in the program 83 % CD4 < 20% or develop symptom 47 % ARV treatment 71 %

  25. Lesson Learned • Policy • Training • Provision of Test Kit ARV and formula • Monitoring & supervision

  26. Conclusion 1. Proven ARV Regimens to Prevention of MTCT are available 2. Continuation From Prevention of MTCT to Treatment and Care is possible 3. Implementation varies from country to country 4. How will Country achieved their goals Targets for both PMTCT and 3 X 5 ??

  27. ขอบคุณค่ะ

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