CD4 assessment among newly diagnosed HIV-infected pregnant women in India’s National Prevention of Parent to Child Transmission Programme (PPTCT)
Implications for a ‘Test and Treat’ Approach
1Reproductive and Child Health Division, Ministry of Health and Family Welfare, New Delhi, India
2National AIDS Control Organisation, Ministry of Health and Family Welfare, New Delhi, India
3HIV/AIDS Division, San Francisco General Hospital, UCSF, San Francisco, USA
1. S. K. Mohammed1
2. R.S. Gupta2
3. R. Rao2
4. V. Joseph2
5. P. Srikantiah3
Importance of CD4 assessment in HIV-infected pregnant women
WHO 2010 Guidelines
Strongly recommend initiation of lifelong ART for all HIV+ pregnant women with CD4 ≤350 cells/mm3
Highlight importance of prompt CD4 assessment and linkage to
treatment for HIV-infected pregnant women
Globally, estimated that 20-60% of HIV+
pregnant women require lifelong ART
Data from large national programme settings in low and middle income
countries are limited
HIV among pregnant women in India
Estimated 2.4 million people live with HIV in India • ANC prevalence 0.42%
India ranks as one of the 10 “highest burden” countries for MTCT • 27 million pregnancies/year• Estimated 43,000 HIV+ pregnant
women per year• MTCT accounts for 5.2% of new HIV
infections
PPTCT Programme in India
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
8,000,000
9,000,000
Year
Pregnant Women Who Receive Antenatal HIV Testing, 2001-2011
Num
ber P
regn
ant W
omen
Tes
ted
PPTCT Guidelines - India, 2010
CD4 < 350 CD4 > 350
Specimen transport for
those who cannot travel
HIV+ pregnant woman detected
Referred for HIV clinical assessment and CD4 testing at
nearest ART centre
Lifelong ART sd-NVP
Objectives of the Study
Evaluate CD4 testing practices and results among newly diagnosed HIV+ pregnant women identified through the national programme in 2009 and 2010
Examine strength of linkages between PPTCT and HIV treatment services
Use data to guide programme policy regarding the selection of a revised national PPTCT ARV regimen in India
Methods
Antenatal HIV testing data were routinely collected from HIV Integrated Counselling and Testing Centres (ICTCs)
ICTC and ART centre records abstracted to evaluate: • Proportion of HIV-infected pregnant women who received CD4
testing• Proportion with CD4 count <350 cells/mm3,• Number of women initiated on lifelong ART
ResultsIndicator 2009 2010Number of HIV testing sites 6,297 7,548
Pregnant women screened for HIV 5,807,778 6,877,617
HIV+ pregnant women detected (%) 18,692 (0.32%) 16,024 (0.24%)
Pregnant HIV+ women received CD4 assessment (%)
10,192 (54.5%) 9,917 (61.2%)
HIV+ pregnant women with CD4 < 350 cells/mm3 ( %)
3,082 (30.2%) 3,934 (39.7%)
Number HIV+ pregnant women started lifelong ART
2,154 2,292
Conclusions
Among those tested, close to 40% of pregnant women diagnosed HIV+ve require ART for their own health
This underscores importance of ANC settings as key entry point for HIV care/treatment for women
Highlights importance of pursuing universal antenatal HIV testing even in concentrated epidemic setting
Universal testing is officially endorsed by Indian National Programme since August 2010
Conclusions & Policy Implications
Almost 40% of detected HIV+ pregnant women did not receive CD4 assessment or linkage to treatment
In light of this data, the national programme selected a single maternal triple ARV prophylaxis regimen (Option B) :
• To be used in all detected HIV+ pregnant women, irrespective of CD4 count
• Can be started before CD4 results known• A “Test and Treat” Approach• Prevent delays in ART initiation• Help reduce loss to follow up
Conclusions & Policy Implications
Continued expansion of prompt CD4 assessment still remains a priority• CD4 results will be used to decide
duration of triple ARVs (lifetime vs. through breastfeeding period)
India has committed to working towards elimination of new pediatric HIV infections • Implementation of universal
antenatal HIV screening that is integrated with MCH services
• Strengthening CD4 assessment and linkages between ANC and ART services
Thank You
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