Y. GEBRE, N.JACK, S.CAFFE, A. DEL RIEGO , P. EDWARDS PAN AMERICAN HEALTH ORGANIZATION

Washington D.C., USA, 22-27 July 2012www.aids2012.org

IS HIV MOTHER TO CHILD TRANSMISSION AND CONGENITAL SYPHILIS ELIMINATION BY 2015 A

REALITY IN THE ENGLISH CARIBBEAN?

Y. GEBRE, N.JACK, S.CAFFE, A. DEL RIEGO, P. EDWARDS

PAN AMERICAN HEALTH ORGANIZATION


Elimination Initiative Goal and Impact Indicators in the Caribbean

“Elimination of vertical transmission of HIV and Syphilis in all countries and territories in the

Caribbean by the year 2015”

Percentage of infants born to HIV infected mothers who are infected is ≤ 2% or less

Incidence of MTCT of HIV is ≤ 0.3 cases per 1000 live births

Incidence of congenital syphilis is ≤ 0.5 cases per 1000 live births


Elimination CriteriaInterruption of transmission through timely identification and appropriate treatment of pregnant women infected with HIV or syphilis, their male partners, and their infants.

Reduction of the number of HIV and syphilis infections among pregnant women.


Tools of the Elimination InitiativeCLINICAL GUIDELINES

M&E REGIONAL STRATEGY

CONCEPT

DRAFTField Guideline

for theImplementation

of the EI

BaselineProtocol

DRAFTCosting Tool

DRAFTLaboratory

Requirements

IN PROGRESSValidation

Tool


Study objectivesTo assess the effectiveness and impact of the national programmes towards elimination of MTCT HIV and congenital syphilis.

To assess the national coverage of PMTCT interventions in the country.


STUDY METHODS Sub regional analysis of the health systems HIV response and progress to the elimination initiative (EI) was conducted for selected countries in the English Caribbean.

Data on the monitoring events ( 7 output, 5 outcome & 3 impact indicators) for the EI were collected.

2009-2010 data on the HIV health sector progress towards universal access were analysed.


TaCountry Number of pregnant women attending ANC at least once during the reporting period

Number of HIV positive pregnant women giving birth

Antigua & Ba BahamasBelizeBarbadosGuyanaJamaica St. VincentSt. LuciaSurinameTrinidad and Tob.

9743850725818641321525265215568281281950682,897

5776541913311851002481044


EMTCT Indicators


Fig 1. Percentage of pregnant women who were tested for HIV and received their results – and percentage of HIV Prevalence by country, 2010

Bahamas Belize

Barbados

Guyana

Jamaica

Suriname

Trinidad and Tobago

st. Kits

0tan28a566028

0tan29a566029

0tan1a56601

0tan28a566028

0tan9a56609

0tan19a566019

0tan29a566029

0tan9a56609

0tan19a566019

0tan29a566029

0tan9a56609

0tan19a566019

0tan29a566029

0tan10a566010


Fig 2. Percentage of Pregnant women tested for syphilis among those receiving ANC and prevalence of gestational

syphilis by country, 2010

Antigua B

Baham

asBelize

Barbad

os

Guyana

Jamaic

a

St. Vince

nt

St. Lu

cia

Surin

ame

Trinidad

and Tobag

o.000%.200%.400%.600%.800%

1.000%1.200%1.400%1.600%1.800%

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0tan19a566019

0tan9a56609

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Fig 3. Percentage (%) of child infections from HIV-infected women and percentage of infants receiving

virological test with in 2 months in the Caribbean, 2010

Baham

as Belize

Barbad

os

Guyana

Jamaic

a

St. Vince

nt

St. Lu

cia

Surin

ame

Trinidad

and Tobag

o

Antigua B

0tan28a566028

0tan19a566019

0tan9a56609

0tan29a566029

0tan19a566019

0tan10a566010

0tan30a566030

.000%

500.000%

1000.000%

1500.000%

2000.000%

2500.000%

3000.000%

Infant with PCR test 2months child infected


Table 2. Number of infants born to HIV-infected women assessed for and whose infant feeding practices were recorded at DTP3 visit, by country, 2010

Country # Infants Born To HIV + women

Exclusive Breast Feeding

ReplacementFeeding

Uncategorized

Bahamas 78 0 78(100%) 0Belize 54 54(100%)Barbados 23 17 (73.9%) 6(26.1%)Guyana 117 0 114(97.4%) 3(2.6%)Jamaica 336 331(98.5%) 5(1.5%)St. Vincent 33 28(84.8) 5 (15.2%)St. Lucia 3 3 (100%)St. Kits 3 3(100%)


Fig 4. Percentage of infants born to HIV-infected women (HIV-exposed infants) who received ARV and percentage of HIV

MTCT rate by country, 2010

Antigua B

Baham

asBeli

ze

Barbad

os

Guyana

Jamaic

a

St. Vincen

t

St. Lu

cia

Surin

ame

Trinidad

and To

bago0tan28a566028

0tan19a566019

0tan9a56609

0tan29a566029

0tan19a566019

0tan10a566010

0tan30a566030

0tan28a566028

0tan4a56604

0tan9a56609

0tan14a566014

0tan19a566019

0tan24a566024

95


Fig 5. Percentages of HIV-infected pregnant women assessed for ART eligibility; positive for syphilis and HIV who received

treatments by country, 2010-2011

Antigua B

Baham

asBelize

Barbad

os

Guyana

Jamaic

a

St. Vince

nt

St. Lu

cia

Surin

ame

Trinidad

and Tobag

o0tan28a566028

0tan19a566019

0tan9a56609

0tan29a566029

0tan19a566019

0tan10a566010

0tan30a566030

Syphilis Treat ARV Treat Assessed ARV Eligibility

95


Impact Indicators Summary Countries with Percentage of infants born to HIV infected mothers who are infected is ≤ 2% or less

Incidence of MTCT of HIV is ≤ 0.3 cases per 1000 live births

Incidence of congenital syphilis is ≤ 0.5 cases per 1000 live births

1. Antigua & Barbuda

2. Barbados

1. Antigua and Barbuda

1. Jamaica, 2. Bahamas 3. Trinidad &

Tobago


Conclusion • With increase quality service coverage and

strengthened commitment, it now seems feasible by 2015 to eliminate new HIV infections and CS among children in some countries of the Caribbean.

• Challenges include the continued access of ARVs, other essential supplies and human resources and lack of quality surveillance data and clear case definition for CS.


The EMTCT cascade

PREVENTION

Prevent new infection in women and partners.Reduce unintended pregnancy.

TREATMENT

Timely Treatment of infected Pregnant women and partners.

>95%

ELIMINATION

Infection In infants <2% Incidence & Prevalence

Incidence Prevalence

M&E VALIDATION

2009 2010 2015 Beyond 2015


Acknowledgements• The National AIDS Programmes

(Caribbean)• The Caribbean EI working group • PAHO HIV Caribbean Office • Monica Alonso, PAHO/WHO HIV/FCH• EC/OCT HIV project-PHCO• The Chief Medical Officers -MoHs

Y. GEBRE, N.JACK, S.CAFFE, A. DEL RIEGO , P. EDWARDS PAN AMERICAN HEALTH ORGANIZATION

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