A Call to Action Children The missing face of AIDS

Transcription

1 A Call to Action Children The missing face of AIDS

2 PMTCT Towards an AIDS free generation

3 BACKGROUND: Current reality Mother-to-child transmission of HIV accounts for over 90% of HIV infection in children. Other sources of infection include exposure to infected blood / products and child abuse 2.3 million births by HIV-infected women annually 2.2 million children living with HIV Last year alone: 640,000 children were newly infected 510,000 children died of HIV

4 Percent of adults (15 49) living with HIV : Feminisation of the epidemic Percent female (%) Sub-Saharan Africa Caribbean Latin America Eastern Europe and Central Asia Asia Year Source: UNAIDS/WHO, 2004 AIDS epidemic update, December Fig. 2.

5 CURRENT COVERAGE needs by 2010 Intervention Current Coverage Number in need in 2010 Costs in US$ (through 2008) Care and support for OVC 15%* 19.7 million 6 Billion PMTCT (prong 3) 3% 2.9 million 800 million Cotrimoxazole prophylaxis 1% 5.1 million ART for children 2% 1.2 million All prevention 29 billion VCT 1% 51.5 million 1.7 billion Harm Reduction 4% 7.2 million 440 million SW interventions 16% 17.6 million 1.6 billion MSM interventions 11% 21.8 million 1.2 billion Youth in school 50% 122 million 313 million Youth out of school <10%? 145 million 2.8 billion * Estimated to receive some services, not full package

6 Where are we in scaling up PMTCT? Despite progress in rolling out PMTCT, access to PMTCT remains low 8% are offered the service 3% receives ART component Translates in ,000 infections averted; Target was 130,000 for 2005 (20%) Most good progress observed among countries that have small numbers of pediatric infections (Botswana, Thailand, Malaysia, Belarus, Ukraine and Mauritius) PMTCT implementation has not been prioritized enough in high burden countries; only 4 of the initial pilot projects were in top 10 countries with highest numbers of child infections

7 Where are the high burden populations? Country 1. Nigeria 2. South Africa 3. Ethiopia 4. Tanzania 5. DR Congo Annual Births to HIV + women 263, , , , ,000 Estimated MTCT 87,000 71,000 58,000 42,000 37, ,000 / 640,000 (46%)

8 Where are the high burden populations? Country 6. India 7. Zimbabwe 8. Kenya 9. Mozambique 10. Zambia Annual Births to HIV + women 208, , ,000 95,000 75,000 Estimated MTCT 62,400 34,000 33,000 32,000 25, ,400 / 640,000 (75%)

9 Next steps: Scale up Prevention and Care. Intensified efforts, priority focus on high burden countries, moving from pilot to national programme How many mother baby pairs will have access to PMTCT? Exclusive Breastfeeding, Breastfeeding or Exclusive replacement feeding? Cotrimoxazole prophylaxis? Will we scale up diagnostics capacity..

10 Efficacy of Short-Course ARV Regimens for Prevention of MTCT 100% Formula-fed % Efficacy 80% 60% 40% 20% 62% 63%68% 50% 50% 28% 33% 37% 40% 42% 42% 18% 0% Petra Arm Iv Coast Petra Arm Iv Coast 012 Petra Arm 012 DITRAME CDC DITRAME Petra Arm PACTG B (18 mo) (18 mo) A (18 mo) (3 mos) (18 mo) B (6 wk) (6 wk) 1.0 Thai 1.1 A (6 wk) 076 AZT/ AZT AZT/ AZT NVP AZT/ NVP AZT+ AZT AZT/ AZT/ AZT 3TC 3TC 3TC SD NVP 3TC+ 3TC SD NVP

11 PROGRAMME CONCLUSIONS There are a number of short, less expensive regimens that are effective in reducing MTCT. HAART for ill mothers is a priority to decrease maternal morbidity and mortality; an added benefit will be decrease in MTCT. An effective strategy that can reduce in utero / intrapartum/early breast milk MTCT to 2-4% is: HAART for women who require therapy Short AZT + SD NVP for women who don t. Safety and efficacy of maternal HAART used solely to prevent MTCT (including breast milk MTCT) needs further research in resource-limited settings.

12 PROGRAMME CONCLUSIONS Identification of the HIV positive mother remains a major challenge; most people are unaware of their status

13 Procurement and Supplies Management PMTCT Scale Up What tools do we have?

14 WHO PMTCT guidelines 2006: SUPPLY OPTIONS MOTHER BABY nvp 200mg - single dose nvp susp 0,6ml single dose zdv 300mg - from 28 weeks zdv oral liquid for 7 days zdv/3tc - intrapartum and then for 7 days zdv oral liquid for 28 days

15 FORMULATIONS TO PROVIDE PMTCT SERVICES : Key challenges Nevirapine tablets: Commercially available as pack of 60 tablets Blister packs facilitate dispensing to some extent For PMTCT, need 1 tablet stat, often to take home? Nevirapine suspension (10mg/ml): Commercially available as 240ml Donation programmes supply 20ml or 25ml For PMTCT, need 0,6ml per day? Commercial bottles are adapted with fitted caps to facilitate dispensing, donation to decant? Dispensing syringe : BAXA Donation

16 FORMULATIONS TO PROVIDE PMTCT SERVICES : Key challenges zidovudine tablets: bd from 28 weeks Commercially available as pack of 60 tablets Blister packs facilitate dispensing to some extent zdv 300mg/3TC 150mg tablets: intrapartum, bd 7 days Commercially available as pack of 60 tablets Blister packs facilitate dispensing to some extent For PMTCT, need tablets per week, 20 s pack? zidovudine oral liquid (10mg/ml) Commercially available as 100ml, 200ml, 240ml bottle For PMTCT, need approximately ml per week, or 150ml per month ( if mom had no ART )?

17 FORMULATIONS TO PROVIDE PMTCT SERVICES : Key challenges Need to collaborate with industry to obtain better formulations Need to phase in more appropriate formulations Programme implications Cost implications Need to scale up testing, to create volume for negotiations

18 WHO ADVISORY COMMITTEE recommended priority products (Oct 06) Priority Products for infant MTCT prevention URGENT: Innovative formulations containing AZT16mg ( 7day and/or 28 day packs 2 x daily dosing ) NVP6mg ( single dose ) Sachets with granules might be an option

19 UNICEF WISH LIST. Mother / Baby pack to facilitate scale up beyond health facility service delivery points

20 Forging the Way Towards an HIV-Free Generation Courtesy E. Abrams We Have the Tools to Prevent MTCT. Do We Have the Will to Implement Them?

21 Thank You