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EMTCT in Europe

EMTCT in Europe. 50. 100. 45. 90. 40. 80. 35. 70. MTCT rate (%). 30. 60. % of women on ART. Percent of women on ART. MTCT rate (%). 25. 50. 20. 40. 15. 30. 10. 20. 5. 10. 0. 0. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 00. 01. 02. 03. 04. n=. (32). (42).

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EMTCT in Europe

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  1. EMTCT in Europe

  2. 50 100 45 90 40 80 35 70 MTCT rate (%) 30 60 % of women on ART Percent of women on ART MTCT rate (%) 25 50 20 40 15 30 10 20 5 10 0 0 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 n= (32) (42) (45) (39) (57) (51) (86) (82) (120) (192) (312) (452) (594) (802) (797) Year of birth MTCT rates, UK and Ireland, 1990-2011 3703 diagnosed women, 1990-2004 • Low rates of MTCT from diagnosed women 2000-2006 • Townsend et al. AIDS 2008; 22:973-81 • Overall MTCT 1.2% (61/5151, CI 0.9-1.5%) • 0.8% among 4864 women who received >14 days ART • Only 3 transmissions (0.1%) among 2117 women delivering with undetectable viral load CROI 2007 Poster 761, Townsend et al Current MTCT rate 2007-11 <1% All available at www.nshpc.ucl.ac.uk

  3. MTCT rates based on ELISA testing at 18 months, Ukraine, 2001-2009,

  4. Level of Validation Validation criteria to be met among: • General population • Key populations – additional studies and indicators to assess service coverage and impact

  5. MTCT rates among IDU in ECS cohort study, Ukraine, 2000-09

  6. Measuring impact of Thai National EMTCT programs ,2000-2012 couples HIV counseling and testing HAART for all CD4 >350 stop ARV • HAART for mother CD4<200,symptoms and AZT/NVP for CD4 > 200 cell/mm3 • - tail regimen (AZT+3TC) • AZT + single dose nevi rapine (NVP) • CD4 antepartum and every 6 month - Partner HIV testing - CD4 post partum and linkage to HIV care for mother and family -Short course zidovudine (AZT) -Voluntary counseling and testing (VCT) for all pregnant women -Formula feeding -HIV antibody testing for HIV-exposed infants at 12, 18 months 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 PHIMS version 1-2 ….........................................V 3 PHIMS version 3.1 PHOMS “Perinatal HIV outcome monitoring system” (4 provinces (2001), 14 provinces (2004) EID NAP ,NHSO Develop by Sarawut boonsuk ,DOH,MOPH,Thailand 2012

  7. PHIMSv3.1(update)Web-based ,Online system Community Hospital Provincial Health Office BMA - DMS Provincial Hospital Regional Hospital RHPC DOH -server/ analysis • System development & maintenance • Country data analysis Data utilization/analysis supervision Data entry /Utilization

  8. National Electronic Data base National AIDS Program, Outcome and impact monitoring Developed by National Health Security Office with technical support for PMTCT outcome report by GAP Thailand – U.S.CDC Since 2007 PMTCT menu

  9. Malawi (1) • N/A • Challenges in measuring PMTCT impact: • How to gain an accurate reflection of the national program impact while intervening to track “lost” patients and get them back into care • Estimating loss-to-follow-up across the cascade: Appropriate tools to track women from ANC to L&E to follow-up ART; • Tracking infants from delivery (live discharge) to follow-up care and final diagnosis • Study information for program improvement: • Identifying “holes” in the program: Where are we losing most ground in our EMTCT effort?

  10. Malawi (2) • Key gaps in current evaluation approach: • Connecting expanded VL and DNA-PCR services for the study to the broader National Lab strategy • EFV toxicity monitoring; separate study being considered • Future impact evaluation approaches: • WHO/CIDA funded evaluations starting soon • Impact of service delivery models on uptake, retention and adherence (ie. ART provided in ANC or ART clinic?) • Other evaluations planned but not yet underway by partners: UNC, Dignitas International

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