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

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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

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Primary Prevention: Unmet Target

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Pregnant Women Knowing Their HIV Status

From WHO HIV Report 2014. Based on WHO/UNICEF/UNAIDS Health Sector GARPR Data and 2013 HIV estimates

AFRO ESA WCA0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

9%

16%

3%

34%

52%

20%

41%

62%

26%

45%

67%

29%

51%

74%

35%

2005 2009 2011 2012 2013

35%

74%

51%

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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

AFRO ESA WCA0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

13%16%

4%

21%

27%

8%

31%

39%

11%

40%

51%

15%

48%

58%

23%

48%

59%

19%

57%

69%

27%

63%

76%

30%

68%

79%

39%

2005 2006 2007 2008 2009 2010 2011 2012 2013

68%79%

39%

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Business as usual will only take us to 46% reduction in new HIV infections among children by 2015

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150

100,000

200,000

300,000

400,000

500,000

600,000

Source: Preliminary UNAIDS 2013 Estimates

46% reduction

Business as usual, assuming 2013 ARV coverage

Global Plan Target

Slide 8

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EID in 21 African Global Plan Priority Countries

South A

frica

Swaziland

Botswana

Namibia

Zambia

Zimbabwe

Kenya

Uganda

Leso

tho

Moza

mbique

Ghana

United Republic

of Tanza

nia

Cameroon

Ethiopia

Angola

Burundi

Côte d'Iv

oire

Malawi

Democratic R

epublic of t

he Congo

NigeriaChad

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

94% 89%

58% 56% 55%50%

42%36% 36% 35%

30% 26% 24% 21% 17% 17% 15% 15%10%

4% 4%

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We are failing children living with HIV

Note the percentage is based on all children ages 0-14 living with HIV and is not limitedto those eligible for ART.

Source: Preliminary UNAIDS 2013 Estimates

Treatment gap 2009

92%

Treatment gap 2013

77%

2.6 million children living with HIV in the 21 countries. Only 23% are on HIV treatment in 21 Global Plan countries in 2013

Slide 10

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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%

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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%)

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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)

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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?

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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).

 

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• 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.

Take home messages

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Acknowledgements

• Chika Hayashi – WHO• Priscilla Idele - UNICEF• Tyler Porth – UNICEF• Isseu Diop-Tourre – WHO• Karusa Kiragu - UNAIDS

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Thank you