Situation analisys on HIV
vertical transmission
Dr Zhanna Trumova
Republican HIV/AIDS center
The Republic of Kazakhstan
Number of HIV-infected people detected in Kazakhstan (per year)
4 3 4 4 2 5 6 2 548
437299
185
347
1175
735
531
0
200
400
600
800
1000
1200
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 8 ???2003
number of HIV infected
137 cл. 56сл.
58 сл.
73 сл.
38 сл.
185сл.
12 сл.
110 сл.
62 сл.
1210 сл.
705 сл.196 сл.
7 сл. 19 сл.
368 сл.
59 сл.
3788 HIV-cases are registered in Kazakhstan
Spread of HIV/AIDS in Kazakstan (as of 01.09.03)
Ways and factors of HIV transmission
0,40%
0,32%8,9%
7,1%
0,1%
0,1%
0,12%
83,2%
heterosexual through drugs homo- and bisexualnot identified hemotransmission intrauterusin hospital
Prevalence of HIV - infected women by Prevalence of HIV - infected women by age groupsage groups
0 1 0 1 0
13
2
14
30
19
3732
41
113
78
14 1212
45
28
0
20
40
60
80
100
120
< 15 years 15-19 20-29 30-39 years
9899200020012002
Growth rates of HIV-positive women
13 100 168 207 289520
700 812
78
516817
10001347
2522
3257
3788
1996 1997 1998 1999 2000 2001 2002 8 ??? 2003
women total of HIV infected
Number of pregnant women tested for HIV (per year)
126942
82466
110027
30832
4706438874 46020
20847
0
50000
100000
150000
1996 1997 1998 1999 2000 2001 2002 2003
Number of detected HIV-infected pregnant women
05
8 814
20
75 76
5 5 6 74
17
34
0
10
20
30
40
50
60
70
80
1996 1997 1998 1999 2000 2001 2002 8 ???2003
Pregnancies Deliveries
Prevalence of HIV-infected pregnant women by region
Актюб.обл.; 3
ЮКО; 11
Костан.обл.; 12
ЗКО; 8
Павлодар.обл.; 46
Алматы; 13
Акмол.обл.; 3
ВКО; 5
СКО; 2
Жамбыл.обл.; 1
Астана; 3
Мангист.обл.; 1
Алмат.обл.; 1
Караганд.обл.; 96
Total - 205
Risk factors for HIV-infected pregnant women
75,40%
74%
73,0%
74,0%
75,0%
76,0%
intravenous drug usage frequent intercourses )
Co-factors for HIV-infected pregnant women
54,60%
13,10%
15,40%35%
0%
10%
20%
30%
40%
50%
60%
virus hepatits B,C
STIs, includingsyphilis
Chronicconcommitant
diseases
syphilis
-
Pregnancy outcomes
73
6
99
13
11
3
0 10 20 30 40 50 60 70 80 90 100
Undalying deliveries
Immature deliveries
Abortions caused byhealth/social status
Miscarriage
Under control
migrated abroad
Spread of children by regionn=75
48
11
41 1
1
41 1
3 14
1
0
5
10
15
20
25
30
35
40
45
50
Health status of children born to HIV-infected mothers
7
7
8
14
28
39
0 5 10 15 20 25 30 35 40 45
HIV infection
Respiratory diseases(pneumonia)
Intrauterus Hypotrophy
Hypotrophical
hypox.-eschemicencephalopatia
Constant perinatal care
Antiretroviral therapy of newborn, begun in 2002
47
28
0
5
10
15
20
25
30
35
40
45
50
???????? ?????
Feeding of newborn , n=81
3
78
0 10 20 30 40 50 60 70 80
breasfeeding
artificial
Proposed preventive treatment schemes
Scheme 1 – ZDV (Protocol 076: from 14th week of pregnancy to delivery (II and III trimesters of pregnancy) 600 mg/pd; from the beginning of labour to delivery 2 mg/kg, then 1 mg/kg intravenous per hour; to the child – suspension ZDV 2 mg/kg every 6 hours in the course of 6 weeks)
Scheme 2 – short-term treatment ZDV from 36th week
Scheme 3 –Nevirapin: the pregnant – 200 mg once in delivery, the child – nevirapin suspension 2 mg/kg once within 72 hours (HIVNET 012, Uganda)
Current activities• A Government Dicree # 1207 «Programme on AIDS prevention in
Kazakhstan from 2001 till 2005» dated from 14 september 2001 was developed and aproved in Kazakhstan.
• Preventive Programmes aare being intriduced with the assistance of international organizations.
• Access to counselling and HIV voluntary testing
• Pregnant women and children are provided with antiviral medicine and child nutrition free of charge from public funds
• Quality medical care and preventive interventions are provided to HIV- infected women during pregnancy and deliveries
Challenges
Lack of information and educational materials on «HIV and pregnancy»
Difficulties related to timely detection, registration, examination of people from risk-groups (drug addicts, RKS, etc) including pregnant women
Weak VCT services network in health care, including PHC, obs -genecologi , in particular lack of professional training for health workers in HIV/AIDS consultation
Lack of financing for equipment, test-systems, antiviral medications
Possible solutions
Primary prevention among pregnant women, access to HIV/AIDS info, promotion of safe sex, prevetion of unwanted pregnancy, availability of contraceptives, STIs treatment
Introduction of voluntary consultation and testing for target-groups (IDU, CSW, married couples, youth) as a supplement to ongoing prevention programmes
Prevention of mother-to-child HIV transmisstion in antenatal, intranatal and postnatal periods
Access to antiretroviral medications Artificial feeding Care and support of HIV-infected women, their children and family
members
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