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Reconnecting PMTCT

Reconnecting PMTCT. James McIntyre Anova Health Institute, Johannesburg, South Africa. “We have effective drugs. There is no reason why any mother should die of AIDS. There is no cause for any child to be born with HIV

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Reconnecting PMTCT

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  1. Reconnecting PMTCT James McIntyre Anova Health Institute,Johannesburg, South Africa

  2. “We have effective drugs. There is no reason why any mother should die of AIDS. There is no cause for any child to be born with HIV If we work hard enough we can virtually eliminate mother-to-child transmission.” Ban Ki MoonNY, September 2009

  3. Number and percentage of HIV-positive pregnant women receiving antiretroviral prophylaxis, 2004–2008 700 000 Number of HIV-positive pregnant women receiving antiretrovirals In 25 African countries, median PMTCT coverage rose from 31% in 2007 to 40% in June 2008 In Eastern and Southern Africa – where regional HIV prevalence is the highest in the world – PMTCT coverage averaged 58% in 2008 45 40 600 000 % of HIV-positive pregnant women receiving antiretrovirals 35 500 000 30 400 000 25 300 000 20 15 200 000 10 100 000 5 0 0 2008 2004 2005 2006 2007 Year Source: UNAIDS, UNICEF & WHO, 2008; data provided by countries. 4.13

  4. PEARL Study on PMTCT effectiveness 3,244 HIV positive pregnant women at health centres offering PMTCT services in Cameroon, Côte d’Ivoire, South Africa and Zambia Stringer, E.M., JAMA. 2010 Jul 21;304(3):293-302.

  5. Coverage and linkages • PMTCT Programme effectiveness is related more to coverage and the losses at each part of the PMTCT cascade than to the efficacy of the PMTCT regimen. • HIV-infected women need to be identified during (or prior to) pregnancy, in order to provide appropriate PMTCT interventions. • PMTCT interventions must reach and be accepted by the woman. • Interventions to prevent breastmilk transmission are critical to success of PMTCT programmes .

  6. Areas for improvement • Improving coverage of PMTCT services • Improving access to more efficacious regimens • Starting ART in symptomatic women or those with CD4 < 350 • Providing prophylaxis through breastfeeding – either as extended daily nevirapine to babies or as triple ARVto mothers • PMTCT services remain key to achieving MDGs 4 & 5

  7. Prevention of new infections in women Family planning & reproductive health services Nutrition Support services PMTCT services Prevention of transmission to sexual partners Prevention of transmission to infants Infant diagnosis and care Men’s health care Pre-ART care Circumcision Antiretroviral therapy PMTCT Program linkages

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