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PMTCT overview: current-scale up efforts and challenges in operations and implementation

PMTCT overview: current-scale up efforts and challenges in operations and implementation. Dr Angela Mushavi National PMTCT and Pediatric HIV Care and Treatment Coordinator: Zim IAS 2011, Rome: Italy 17/07/2011. Outline of Presentation. Background and epidemiology of HIV in Zimbabwe

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PMTCT overview: current-scale up efforts and challenges in operations and implementation

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  1. PMTCT overview: current-scale up efforts and challenges in operations and implementation Dr Angela Mushavi National PMTCT and Pediatric HIV Care and Treatment Coordinator: Zim IAS 2011, Rome: Italy 17/07/2011

  2. Outline of Presentation • Background and epidemiology of HIV in Zimbabwe • PMTCT Program performance in 2010 • Current scale-up efforts and challenges with implementation • And so wither Zimbabwe?

  3. Background of Zimbabwe Population: ~12 million Adult HIV prevalence: 13.7% ANC sero-prevalence : 16.1% An estimated 1,1 mil Zimbabweans are HIV positive* Of these, 151, 749 are children 0-14 years* New pediatric HIV infections are estimated at 14,976* (90% from MTCT) 1,090 patients dying weekly due to AIDS Source: DHS 2005/6 & MOHCW HIV estimates 2009*

  4. Background of Zimbabwe • 94% of pregnant women received ANC (ZDHS 05/06) • 68% of pregnant women delivered in Health Institutions (ZDHS 05/06) • MNCH indices of Zimbabwe • 398,889 expected pregnancies in 2010; of these, 47,494 are to HIV infected pregnant women • In the last 10 years, MMR has increased • 555/1000,000: ZDHS 2005/6 • 725/100,000: MOHCW 2007 Maternal and Perinatal Mortality Study • HIV/AIDS is leading contributor to high MMR (26%) • 21% of the Under 5 Mortality Rate (<5MR) is attributed to HIV/AIDS (MIMS 2009)

  5. National PMTCT Program • PMTCT started as a 3 site pilot in 1999 • PMTCT program rolled-out in 2002 • Initially using only SD NVP for both the HIV infected mothers and their HIV exposed infants • Piloted the use of more efficacious regimens (MER) as per 2006 WHO Guidelines in 2007 • Roll-out of MER only started in 2009 • Zimbabwe has officially adopted the 2010 WHO guidelines (Option A) and roll-out is in progress

  6. Current geographic coverage of PMTCT • Total # of health facilities: 1643 • Total # of ANC providing PMTCT: 1560 (95%) • Comprehensive PMTCT 1200 (77%) (Both on site HIV testing & ARV prophylaxis) • Minimum PMTCT sites 360 (No on-site HIV testing but have ARV prophylaxis) • 883 sites (57%) of all ANC sites in the 62 districts offer MER while 366 sites (23%) collect DBS for HIV DNA PCR (EID)

  7. Comprehensive PMTCT sites

  8. Estimated pregnancies versus actual seen in ANC

  9. Maternal and Infant ARV prophylaxis

  10. Importance of partner support

  11. CTX prophylaxis to HEI

  12. DNA PCR for Early Infant Diagnosis of HIV

  13. PMTCT: Achievements • Strong PMTCT partnership forum (PPF) that supports scale-up • Transitioning to more efficacious regimens for PMTCT (moving to Option A) • Revised IMAI/IMPAC curriculum with on-going training and support supervision of staff • HIV DNA PCR for early infant diagnosis of HIV (EID) available since 2007 • Support from government, donors and partners to provide resources for PMTCT scale-up; including GFATM and the National AIDS Trust Fund (AIDS levy)

  14. Achievements of the PMTCT program • Elimination campaign officially launched in January of 2011 • Strengthened efforts towards SRH/HIV integration targeting Prongs 1 and 2 • Receiving increasing funding commitments from MOHCW through NAC, GFATM, EGPAF and other donors to scale-up towards elimination of new Pediatric HIV infections • Deploying Point of Care CD4 machines

  15. Point of Care (POC) CD4 machines • MOHCW has given official go-ahead to procure and deploy these devices • Roll out and evaluation of the machines under field conditions on-going • Evaluation of Point of Care CD4 machines: end 2009-2010 • No significant difference between POC and laboratory based CD4 machines • Nurses able to operate as well as lab scientists

  16. PMTCT: Challenges Some progress yes; but much more needed to increase quality and coverage towards universal access. In fact, much more needed to attain elimination of Pediatric HIV by 2015 Community mobilization and demand generation: some effort but how much is enough? Stigma and discrimination? Low male participation Late booking, user fees and home deliveries: a missed opportunity for PMTCT Lack of tracking of mother-infant pairs in PMTCT; and slow scale-up of EID and early treatment of HIV positive infants M&E; including revision of tools and data quality and issues

  17. PMTCT: Challenges • Challenge with human resources for health (HRH): • High staff attrition rates; with constant need to train and retrain (IMAI/IMPAC) • No official task sharing policies/strategies • Few health care workers trained in the revised 2010 WHO guidelines for: • Infant feeding in the context of HIV • PMTCT • Antiretroviral treatment

  18. Challenges: PMTCT • Procurement, supply chain management for PMTCT in the face of an under-resourced health care system • Inadequate resources for ARVs, EID and other lab support(e.g. HR, CD4 machines and consumables) • Shortages of other commodities: Cotrimoxazole, HIV Test kits and essential equipment for the delivery of quality and comprehensive ANC and MCH services • Minimal integration of PMTCT within the broader sexual and reproductive & maternal newborn and child health agenda: critical to helping us attain MDGs 4, 5 and 6 by 2015

  19. And so do we give up? • A most emphatic no! • Understanding these challenges allows us to design innovative and creative solutions • And with support from government, multilateral and bilateral agencies including PEPFAR, GFATM, and others, we will truly reach the goal of elimination of new HIV infections in children by 2015

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