1 / 11

Effectiveness of the PMTCT program in Swaziland

Effectiveness of the PMTCT program in Swaziland. Nomsa Mulima 17 th July 2011. Country background. Country Population 1,018,449 (M=481428; F=537021) Pop 0-4 yrs=127859 (13%) Pop 15-49 yrs= 510738 (50%) HIV Prevalence (Extreme) Generalized epidemic in all 4 regions

fritz-wells
Télécharger la présentation

Effectiveness of the PMTCT program in Swaziland

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Effectiveness of the PMTCT program in Swaziland Nomsa Mulima 17th July 2011

  2. Country background • Country Population • 1,018,449 • (M=481428; F=537021) • Pop 0-4 yrs=127859 (13%) • Pop 15-49 yrs= 510738 (50%) • HIV Prevalence (Extreme) Generalized epidemic in all 4 regions • Pregnant women (41.1%) • General population (19%) • 15-49 age group (26%) • MMR =589 • IMR= 78 in 1997 to 107 in 2007 • Under 5 MR= 106 in 1997 to 167 in 2007

  3. PMTCT in Swaziland- country Information • PMTCT program implementation & expansion • PMTCT Implementation since 2003 • 4 Sites initially; increase to 73 by 2005; 137 by 2008 and 150 (88%) by 2010 • Expansion in sites providing treatment including ART • ART implementation since 2003 • 6 sites initially; 17 in 2005; 70 by 2008 and 116 (43%) by 2010 • EID • Started in late 2007 • Increase from 58 sites in 2008; 107 end of 2009 &127/157 (81%) of CW clinics by 2010 • DBS done centrally- 1 DNA-PCR machine • Some tests done in South Africa due to insufficient capacity

  4. PMTCT Country background Cont....... EID Coverage: Policy= test all exposed infants >6wks (for HIV+ initiate ART immediately) Estimated exposed infants=11,528 Tested within 2 mnths= 4,902(42%) still most infants test after 2 mnths. Improvement compared to previous years (as graph shows)

  5. EID Coverage(HIV prevalence vs time DBS done) Decline in % infants testing HIV+ (from estimated 21%- +- 14%) Within <8wks (4%) Notable difference for those testing>8wks (unknown causes) Transmission through breast milk/that DBS confirms test for those testing HIV + through Antibody testing????

  6. Existing data on PMTCT Impact _cont....... Currently available data • PMTCT program data-improvement in access to ARVs & EID uptake Gaps • Still Impact of PMTCT is unknown (country relies on modelling _ not country specific_ generalized to regional assumptions • No linkages btwn ANC & CWF data (cannot link and measure transmission rates)

  7. Current PMTCT impact evaluation: Methods • Evaluation of the effectiveness of the national PMTCT programme at 6 – 8 weeks post-partum in Swaziland • Protocol submitted and approved nationally • Awaiting approval from IRB/CDC • Method chosen and why: • Immunization clinics survey (+83% EPI-DPT1 coverage) • Mother-infant-pairs to be recruited from a random sample of about 55 child welfare clinics providing EID, • All mother-infant pairs attending selected facilities during the 4-month data collection period will be offered an opportunity to participate in the evaluation. • Consenting mothers will be interviewed using a structured questionnaire to obtain demographics, uptake of ANC and PMTCT interventions-Testing & ARVs.

  8. Method chosen and why cont..... • Why the study & method selection? • Country target: reduction of MTCT to 5% by 2014 (country specific Baseline not available) • Program data not of good quality • CWF register already in cohorts, but issues of LTF (infants <6wks in 1st visit not coming back) • No link of CWF data to mom’s regimen/ PMTCT intervention • Current STD: Infants tested if mother’s HIV+ status known> all infants selected will be tested regardless of mom’s HIV status • Data triangulation done on infant mortality, declines noted but not clear of attributing factors

  9. Other proposed studies • Follow-up of breastfeeding infants • To be part of the above mentioned study –Evaluation of the effectiveness of PMTCT program • Follow-up selected infants whose DNA is negative at 6-8wks until cessation of breast milk to determine late HIV transmission (breast milk) • Still to develop protocol • NVP Adherence for infants- study to assess routine collection of adherence data to assess uptake of new PMTCT guidelines and use as input to adjust model ( WHO collaboration) • DHS 2012 to consider infant/child testing • Triangulation of PMTCT programme scale-up and infant mortality • Continuous triangulation to determine impact of PMTCT

More Related