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EMTCT Validation in the Africa Region: Regional Overview and Candidate Countries

EMTCT Validation in the Africa Region: Regional Overview and Candidate Countries. Outline. Overview of PMTCT Progress in the Africa region (and in the 21 countries) Analysis of PMTCT programme performance, typologies

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EMTCT Validation in the Africa Region: Regional Overview and Candidate Countries

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  1. EMTCT Validation in the Africa Region: Regional Overview and Candidate Countries

  2. Outline • Overview of PMTCT Progress in the Africa region (and in the 21 countries) • Analysis of PMTCT programme performance, typologies • Closer look at countries leading the way in PMTCT progress: very low prevalence, 21 GP country • Comment on EMTCT validation criteria applicability in the region –BF and data quality is key • Next Steps

  3. Primary Prevention: Unmet Target

  4. Pregnant Women Knowing Their HIV Status From WHO HIV Report 2014. Based on WHO/UNICEF/UNAIDS Health Sector GARPR Data and 2013 HIV estimates

  5. PMTCT Progress in the Africa Region: ARV coverage From WHO HIV Report 2014. Based on WHO/UNICEF/UNAIDS Health Sector GARPR Data and 2013 HIV estimates

  6. Business as usual will only take us to 46% reduction in new HIV infections among children by 2015 46% reduction Business as usual, assuming 2013 ARV coverage Global Plan Target Source: Preliminary UNAIDS 2013 Estimates

  7. EID in 21 African Global Plan Priority Countries

  8. We are failing children living with HIV 92% Treatment gap 2009 77% Treatment gap 2013 2.6 million children living with HIV in the 21 countries. Only 23% are on HIV treatment in 21 Global Plan countries in 2013 Source: Preliminary UNAIDS 2013 Estimates Note the percentage is based on all children ages 0-14 living with HIV and is not limited to those eligible for ART.

  9. Global Plan and EMTCT Validation Criteria Impact • Case Rate of 50 paediatric HIV cases due to PMTCT out of 100,000 live births AND • MTCT Rate of <5% (breastfeeding populations) Process ANC>95% Testing (Know Status) > 95% PMTCT ARV > 90%

  10. Are we close to the Process targets? • ANC > 95%: • 17 countries • (5 countries between 80-95%) • Pregnant women with known HIV status > 90%: • 12 countries • (3 countries between 80-95%) • PMTCT ARV Coverage> 90%: • 8 countries • (2 countries between 80-95%)

  11. Are we close to the Impact target? • Impact:< 50 MTCT cases per 100,000 live births Based on 2013 estimated new HIV infections and live births: • <50: Mauritania and Mauritius • <100: Niger, Rwanda, Senegal, Cape Verde, Eritrea • Botswana: 560 MTCT cases per 100,000 live births (has dropped from case rate of ~ 2130 in 2009) • Namibia: 1,760 MTCT cases per 100,000 live births (has dropped from case rate of ~ 2500 in 2009)

  12. Some key issues • Data Quality Assessment • - Purpose: to determine if systems are “validation quality” • - Are sentinel sites OK? Data accounts for what % of HEI? - How to address modeled denominator for coverage? • - Estimate of private sector share of market? Private sector data required • - MTCT rate measured 6 week after cessation of BF, or outcomes at a standard age, e.g. 18mths? • - ARV to include some retention or post-partum coverage assessment? • - What general principles for quality, completeness, accuracy, consistency, timeliness?

  13. Next steps • Obtain possible candidate countries for MTCT elimination validation for the year 2015. • Provide support countries to be prepared – Botswana, Namibia, South Africa, Swaziland, Tanzania(Zanzibar), and Zimbabwe. • Support other countries towards possible validation (M&E framework, data quality and processes and skills).

  14. Take home messages • Need to continue to work towards GP targets (all 4 prongs) • Reach high coverage of quality and integrated MNCH interventions including HIV and syphilis • Most countries do not have a mechanism to collect MTCT rate from real data. • Verifying final outcome status is important for EMTCT validation. (Will help to verify modelling assumptions as well.) • Retention is key.

  15. Acknowledgements • Chika Hayashi – WHO • Priscilla Idele - UNICEF • Tyler Porth– UNICEF • Isseu Diop-Tourre – WHO • KarusaKiragu - UNAIDS

  16. Thank you

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