Global View of the Management of Mother to Child Transmission in HIVAIDS

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Global View of the Management of Mother to Child
Transmission in HIV/AIDS

• Dr Betzabé Butrón on behalf of Dr Gina Watson,
• PAHO/WHO Representative for Barbados and the
  Eastern Caribbean

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HIV Epidemic

• Globally, progress in many countries
• Increase in financing
• Decreasing number of deaths and new cases
• Civil society groups joined governments
• But
• Progress in uneven
• Future of epidemic still uncertain
• Effects on country development to be determined
• Sustained/Increased efforts are needed

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Children and HIV/AIDS

• Everyday about 1200 children under 15 years of
  age become infected with the virus
• It is estimated that by 2010, approximately 20
  Million children will be orphaned by AIDS.
• The majority acquire the virus before birth,
  during pregnancy, delivery or when breastfed.
• Over 90 of new infections in infants occur
  through MTCT.
• Globally children below 15 years living with HIV
  increased from 1.6M in 2001 to 2.0M in 2007.

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New HIV infections among children, 19902007
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Children and HIV/AIDS

• In 2007 UNAIDS estimated that 290,000 children
  under 15 years died of HIV related diseases.
• HIV/AIDS is particularly aggressive in children
• 50 of those infected and without treatment, die
  before their second birthday.
• Only 9 of HIV pregnant women in low/ middle
  income countries received ARV prophylaxis in
  2005. (1/ 10).
• Only 7 countries provided ARV prophylaxis to more
  than 40 of pregnant women in 2005 (Brazil,
  Argentina, Jamaica)

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PMTCT Global view

• At most 1/25 children born to HIV mothers
  receives cotrimoxazole prophylaxis for life
  threatening opportunistic infections.
• High income countries have reduced infection
  rates at birth to less than 2.
• Cost for pediatric ARVs has been reduced to less
  than US0.16 or US 60.00 per year.
• Annual mortality rates due to AIDS among children
  began to fall since 2003 due to scale up
  treatment and PMTCT.

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PMTCT Strategies and Goals

• PMTCT directly affects the achievement of three
  MDGs (to be met by 2015)
• - 4th MDG Reduce by two thirds the mortality
  rate among children under five
• - 5th MDG Reduce by three quarters the maternal
  mortality ratio
• - 6th MDG Halt and begin to reverse the spread
  of HIV/AIDS
• Universal Access of Prevention, Treatment and
  Care
• The G8 nations at the Gleneagles Summit in July
  2005 called for the development and
  implementation of "a package for HIV prevention,
  treatment and care, with the aim of as close as
  possible to universal access to treatment for all
  those who need it by 2010."
• Abuja Call to Action
• In 2005, representatives of governments,
  multilateral agencies, development partners,
  research institutions, civil society and people
  living with HIV assembled at the PMTCT High Level
  Global Partners Forum in Abuja, Nigeria which
  resulted in a 'Call to Action for the
  elimination of HIV infection in infants and
  children and an HIV- and AIDS-free generation.

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PMTCT Strategies and Goals

• UNGASS
• The Declaration of Commitment of UNGASS in June
  2001 has set the goal of reducing the proportion
  of infants infected with HIV by 20 by the year
  2005 and by 50 by the year 2010, by means of
• Ensuring that 80 of pregnant women accessing
  antenatal care receive information, counseling
  and other HIV-prevention services
• Increasing the availability of and providing
  access for HIV-infected women and babies to
  effective treatment to reduce MTCT, as well as to
  voluntary and confidential counseling and
  testing, breast milk substitutes and the
  provision of a continuum of care.
• United Nations Comprehensive Approach
• The UN four-pronged strategy for PMTCT addresses
  a broad range of HIV-related prevention, care,
  and treatment and support needs of pregnant
  women, mothers, their children and families.

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The UN PMTCT response

• A comprehensive four-pronged strategy was
  released in 2003, and recommends key
  interventions to be implemented as an integral
  component of essential maternal, newborn and
  child health services
• The first prong promotes the delivery of primary
  prevention interventions within services related
  to reproductive health such as antenatal care,
  postpartum/natal care and other health and HIV
  service delivery points, including working with
  community structures.
• The second prong underscores the importance of
  providing appropriate counseling and support to
  women living with HIV to enable them make an
  informed decision about their future reproductive
  life, with special attention to preventing
  unintended pregnancies.

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The UN PMTCT response

• The third prong of the strategy targets pregnant
  women already infected and demands that HIV
  testing be integrated in maternal child health
  units where ARVs are provided to prevent
  infection being passed on to their babies and
  also the woman s own health and adequate
  counseling is provided on the best feeding option
  for the baby.
• Finally, the fourth prong calls for better
  integration of HIV care, treatment and support
  for women found to be positive and their
  families.

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UNICEF and WHO The Four Ps

• Unite for Children, Unite against AIDS
  provides a framework for nationally owned AIDS
  programmes around the Four Ps
• the urgent imperatives of preventing
  mother-to-child transmission of HIV
• providing pediatric treatment
• preventing infection among adolescents and young
  people, and
• protecting and supporting children affected by
  HIV/AIDS
• It will contribute towards MDG 6 to halt and
  begin to reverse the spread of HIV/AIDS by 2015
  as well as towards the other MDGs.

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Overall Strategic Approach

• Decentralized approaches
• Sub national teams are responsible for the
  planning, implementation and monitoring of PMTCT
  services, including the training of service
  providers
• Continuous political commitment
• Incorporating whole family care with models such
  as MTCT Plus a package of HIV prevention, care,
  support and treatment for mothers, children and
  their families.

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Initiatives already in place

• Integrating pediatric HIV treatment into adult
  treatment sites
• Early identification of HIV-infected infants
  through routine testing of sick children
• Adopting innovative new testing technologies for
  early diagnosis in children

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Challenges/Gaps

• Limited number of skilled and motivated human
  resources
• Weak ME systems
• limited community and male partner involvement in
  PMTCT
• Stigma and discrimination still prevalent
• More emphasis is need on primary prevention,
  especially among youth
• More integration is needed HIV and MCH/FP/Mens
  health/Youth services

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Global View of the Management of Mother to Child
Transmission in HIV/AIDS

• PAHO/WHO and the PWR-ECC

Thank you