DR. Nicholas Muraguri OGW, MD,MPH, MBA, PhD (c) Director , Global P l an Secretariat
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Transcript of DR. Nicholas Muraguri OGW, MD,MPH, MBA, PhD (c) Director , Global P l an Secretariat
Global Plan towards the elimination of new HIV infections among children by 2015 and
keeping their mothers alive
DR. Nicholas MuraguriOGW, MD,MPH, MBA, PhD (c)
Director,
Global Plan Secretariatwww.zero-hiv.org
Global Plan launched at UN High Level Meeting on AIDS in July 2011 as part of Political Declaration on AIDS
Global Task Team co-chaired by Michel Sidibé and Ambassador Eric Goosby
Membership of 40 countries, 30 civil society and private sector organizations, and 15 international and regional bodies/organizations
The Creation of the Global Plan
There are 22 priority countries for the Global Plan
1. Angola
2. Botswana
3. Burundi
4. Cameroon
5. Chad
6. Côte d’Ivoire
7. DR Congo
8. Ethiopia
9. Ghana
10. India
11. Kenya
FRAME IT
12. Lesotho
13. Malawi
14. Mozambique
15. Namibia
16. Nigeria
17. South Africa
18. Swaziland
19. Tanzania
20. Uganda
21. Zambia
22. Zimbabwe
89%of all HIV-positive pregnant women in low- and middle-income countries in 2011
These countries accounted for
The gap in treatment and prophylaxis coverage is uneven among low- and middle-income countries
Source: UNAIDS 2012
Nigeria29%
Mozambique, 7%
Uganda, 8%
India, 6%Ethiopia, 5%
Dem. Rep. of Congo, 5%
Zimbabwe, 5%
Malawi, 5%
Kenya, 5%
Tanzania, 4%
Cameroon, 2%Chad, 2%
Zambia, 2%
Lesotho, Côte d'Ivoire, Angola, Chad, Botswana,
Swaziland, Ghana, Rwanda, Namibia,
Brazil, South Sudan, South Africa, 3%
Other low- and middle-income countries, 13%
The share of each low- and middle-income country in the total shortfall in providing antiretroviral medication to HIV-positive pregnant women to prevent new HIV infections among children.
FRAME IT
Reduce the number of new HIV infections among children by 90% from a baseline of 2009
2- Specific targets for 2015
maternaldeaths
50%reduction inAIDS-related90
%
A four-pronged approach is requiredto prevent new HIV infections among children and keep mothers alive
1. Prevent HIV among womenof reproductive age
2. Prevent unintended pregnancies among women living with HIV
3. Prevent HIV transmission through antiretroviral treatment during pregnancy and breastfeeding
4. Treatment, care and support for mothers living with HIV, their children, partners and families
DO IT
Progress Toward Global Plan Targets
Source: Towards Universal Access, 2011; Global Report, UNAIDS, 2012
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline
28%
34%
16%
1%
Baseline
26%21%
61%
48%
21%
28%
90%
5%
90% 90%
50%
100%
2009 Baseline
20112015 Target
Number of new child infections, 21 priority countries
20002001
20022003
20042005
20062007
20082009
20102011
20122013
20142015
0
100,000
200,000
300,000
400,000
500,000
600,000
Source: UNAIDS Estimates 2012
New HIV infections among children, 2009–2011
Note: The baseline year for the Global Plan is 2009. Some countries had already made important progress in reducing the number of new HIV infections among children in the years before 2009, notablyBotswana which by 2009 already had 92% coverage of antiretroviral regimens among pregnant women and a transmission rate of 5% (see table pp122–123). In countries with high coverage, furtherdeclines are much harder to achieve.
Will reach the target if the2009–2011 decline of more than30% continues through 2015.
Can reach the target if thedecline in 2009–2011 of20–30% is accelerated.
In danger of not reaching thetarget, with a decline in 2009–2011 of less than 20%.
Source: UNAIDS Estimates 2012
Slight decline in new HIV infections among women 15-49, 21 priority countries
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
200000
400000
600000
800000
1000000
1200000
Source: UNAIDS Estimates 2012
Reduction in unmet need for family planning is slow, countries with available data
Zimbab
we 2005-10
Nigeria
2003-08
Namibia
2000-06
Lesotho 2004-09
Tanzan
ia 2004-10
Kenya
2003-08
Malawi 2
005-2010
Ethiopia
2005-11
Zambia
2002-07
Uganda 2
006-11
Ghana 2
003-0805
10152025303540
Survey 1Survey 2
Perc
ent
Source: Demographic and Health Surveys 2000-2011
… As a results the number of women in need of PMTCT services remains flat
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
Source: UNAIDS Estimates 2012
New child HIV infections and PMTCT coverage, 21 priority countries
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 -
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
-
10
20
30
40
50
60
70
80
90
100
14 23
33 43 48 50
61
470,000 450,000
420,000 400,000
370,000
320,000
280,000
37,000 Num
ber o
f new
child
infe
ction
s
Cove
rage
Percent of HIV+ pregnant women receiving any ARV medicines (including SdNVP)
Percent of HIV+ pregnant women receiving effective ARV medicines (excluding SdNVP)
Before the Global Plan
Source: UNAIDS Estimates 2012
PMTCT coverage, 21 priority countries
High coverage66+ %
BotswanaCôte d’IvoireGhanaKenya NamibiaSwazilandSouth AfricaTanzania Zambia
Medium coverage 33-65%
BurundiCameroonLesothoMalawiMozambiqueUgandaZimbabwe
Low coverage <33%
AngolaChadDR CongoEthiopiaNigeria
Source: UNAIDS Estimates 2012
Prophylaxis coverage: the other half of the picture
During pregnancy During breastfeeding0
200000
400000
600000
800000
1000000
1200000
1400000
Nonesd NVPDualOption A/BART
Number of women/infant pairs receiving prophylaxis, 2011, 21 priority countries
Source: UNAIDS Estimates 2012
As a result … MTCT transmission rates are still high
BotswanaNamibiaZambia
SwazilandSouth Africa
KenyaUganda
ZimbabweUnited Republic of Tanzania
BurundiLesotho
CameroonMalawiGhana
Cote dIvoireMozambique
EthiopiaNigeria
ChadAngola
Dem Rep of Congo
0% 5% 10% 15% 20% 25% 30% 35% 40%
MTCT rate (percent)
Source: UNAIDS Estimates 2012
Looking to the (near) Future: B+Evidence Needs for WHO 2013 GuidelinesEvidence and Lessons for Other Countries
• Acceptability to women• Adherence and retention• Linkages with ART• Implementability• Impact --
– Mother’s health– Vertical transmission– Prevention of sexual transmission
Prong 4: Care and treatment for the family
Early Infant diagnosis is still unacceptably low: 35% in 21 countries
High coverage66+ %
KenyaLesothoSouth Africa
Medium coverage 33-65%
Botswana Côte d'IvoireNamibiaSwaziland
Low coverage <33%
Angola BurundiDR CongoEthiopiaGhanaMozambiqueNigeriaTanzaniaUgandaZambiaZimbabwe
Source: Global AIDS Progress Reporting 2012
Maternal survival is important for child growth and development.
Increasing ART results in substantial declines in pregnancy-related deaths
IndiaChad
DR Congo
Ethiopia
Angola
Burundi
Ghana
Nigeria
Cameroon
Côte d'Ivoire
Tanzan
iaKenya
Uganda
Mozambique
Malawi
Zambia
Zimbab
we
Leso
tho
Botswan
a
Namibia
South Afric
a
Swazi
land
01020304050607080
Percent change in pregnancy-related deaths to women living with HIV between 2005 and 2010
Source: WHO, 2012. Trends in Maternal Mortality 1990-2010
TOGETHER WE WILL END AIDS
Actions needed to reach zero
• Strengthen efforts to reduce unmet need for family planning
• Limited data on unmet need among women living with HIV
• Increase coverage of prophylaxis during breastfeeding
• Ensure eligible children receive ART• Increasing early infant diagnosis from 35% to
higher levels will improve ART uptake
• Integrating PMTCT into maternal and child health services.
Thank you