Nick Hellmann, MD EVP, Medical and Scientific Affairs
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1 Building on the Zimbabwe Experience to Achieve Global Elimination of New HIV Infections in Children Nick Hellmann, MD EVP, Medical and Scientific Affairs
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Building on the Zimbabwe Experience to Achieve Global Elimination of New HIV Infections in Children. Nick Hellmann, MD EVP, Medical and Scientific Affairs. Global Impact of HIV/AIDS on Children. Together We Will End AIDS (UNAIDS, July 2012). - PowerPoint PPT Presentation
Transcript of Nick Hellmann, MD EVP, Medical and Scientific Affairs
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Building on the Zimbabwe Experience to Achieve Global Elimination
of New HIV Infections in Children
Nick Hellmann, MDEVP, Medical and Scientific Affairs
Global Impact of HIV/AIDS on Children
Pediatric HIV/AIDS Global Estimate2011 (% of total*)
Children living with HIV/AIDS 3.4 million (10%)
New HIV Infections in children 330,000 (13%)
Deaths in children with HIV/AIDS
230,000 (14%)
Together We Will End AIDS (UNAIDS, July 2012)
* Denominators for percentage calculations are global adult+children estimates
Global Plan for elimination of new HIV
infections in children and keeping their mothers alive
2011-2015 Goals Goal 1: >90% reduction in new HIV infections in children Goal 2: >50% reduction in AIDS- related maternal/child deaths
Launched at UN General Assembly
Special Session, June 2011
India
SouthAfrica
Uganda
Kenya
D.R. Congo
Malawi
Tanzania
Zambia
Zimbabwe
Swaziland
Cameroon
Mozambique
Cote d’Ivoire
Lesotho
Ethiopia
Angola
Botswana
Chad
Nigeria
Ghana
Global Plan: 22 Priority Countries
Burundi
Namibia
India Rwanda
SouthAfrica
Uganda
Kenya
D.R. Congo
Malawi
Tanzania
Zambia
Zimbabwe
Swaziland
Cameroon
Mozambique
Cote d’Ivoire
Lesotho
Ethiopia
Angola
Botswana
Chad
Nigeria
Ghana
Burundi
Namibia
EGPAF INTERNATIONAL PROGRAMS: 2011 5,932 SITES IN 15 COUNTRIES
EGPAF Strategy: ThreeIntegrated Areas of Focus
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Global Program Implementation
Global Advocacy
Global Research
PMTCT
STRATEGIES FOR ELIMINATING HIV/AIDS IN CHILDREN
WomenBecome HIV-positive
Stay HIV-negative1
Pregnant
Not intending pregnancy Not pregnant2
Slide 7
Prevent HIV infection in women
Prevent unintended pregnancies in HIV+ women
Prevent mother-to-child HIV transmission
Infectedinfants
4
Early diagnosis,care and ART,
supportHIV testingARV drugs
Infant feeding3 Uninfected
infants
Country Program Approach
• Strategic partnering– Government, implementing partners, community
• Increase access to PMTCT/Care &Treatment– Integrated within public facilities and MCH/RH services
• Optimize program services/interventions– Increase quality, innovation, monitoring, evaluation to
improve effectiveness and efficiency of services
• Strengthen health systems– Capacity building for local ownership and sustainability
• Address policy and advocacy gaps– Eg, national strategies/guidelines, task shifting/sharing
• Engage and support community– Drive service demand, uptake, adherence, retention
EGPAF International Programs2000 – 2011*
• PMTCT access – EGPAF-supported sites– Reached 14.2 million pregnant women
(nearly 2.5 million in 2011)– Accounted for nearly 20% of pregnant women
who received ARV for prophylaxis in low/middle income countries in 2010
• Care and Treatment – EGPAF-supported sites– Enrolled 1,600,000 in HIV care programs– Initiated antiretroviral treatment (ART) in
860,000 adults & children*EGPAF data through Dec 2011
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PMTCT Cascade Challenges
Antenatal clinic
Counseling and testing
Receive test results
HIV Infection
No infection
PMTCT services/drugs,
CD4 test,ART,
partner testing
Prevention services
Delivery inhealth facility
Infant PMTCT drugs, breastfeeding support,
family planning, infant HIV diagnosis/ART
Attend ANC 92%
Counseled and tested for HIV
80%
Get ARVs (pre- and perinatal)
70%
100 HIV+ mothers
92
74
52
Enrolled in PMTCT
program
8
26
48
Lost from PMTCT
program
PMTCT: Most Critical Determinant of Effectiveness is Number of Women Completing PMTCT Cascade
Modified from P. Barker:WHO Mtg Nov 2008
Infants infected 1 – 3 12 13 – 15
TOTAL
Common cascadeefficiency
(80-90%)
LOSS-TO-FOLLOW-UP ON ART (SOUTH AFRICA)Trend consistent across all sites
0.00
0.05
0.10
0.15
0.20
0.25
0 1 2 3 4 5 6 7 8 9 10 11 12Months after ART initiation
Not pregnant Pregnant
Kaplan-Meier failure estimates: LTFU after ART initiation
p<0.001
L Myer, et al: Loss to follow-up and mortality among pregnant and non-pregnant women initiating ART across South Africa. CROI - Seattle Mar 2012
LTFU by 12 months after ART initiation among women:
• 19% if pregnant• 11% if not
pregnant
(N=29,653 women initiating ART at6 sites in Johannesburg, Cape Town, Durban, and Hlabisa from 2002-9)
WHO 2010 PMTCT Guideline Scale-up:EGPAF/Kapnek/OPHID/ZAPP approach
Partner-supported PMTCT sites of na-
tional total
Sites providing WHO 2010 PMTCT
services
Eligible HIV+ pregnant women
on ART
0%
20%
40%
60%
80%
100%
52%
9%17%
86%
99%
37%
End 2010 End 2011
2011: 1344 program-supported sites enrolled nearly 370,000 pregnant women
Key 2011 interventions:• National training• Supportive supervision• District-level managers• POC CD4 testing• ART initiation in ANC• Community engagement
GLOBAL HIV/AIDS RESPONSE: Progress Report 2011
A progress report on the Global Plan, 2012
New HIV infections among children (0-14 years old):2001-2011 and target for 2015
Global eliminationof pediatric HIV/AIDS
can be achieved!
Thank you!
