1. Photo Credit: Nigel Barker LLC Increasing Coverage & Quality of PMTCT Services Beyond 2010 Laura Guay MD Elizabeth Glaser Pediatric AIDS Foundation June 17, 2010

2. WE HAVE ONLY JUST BEGUN…. Goal: Elimination of pediatric HIV Universal access and uptake of services Cost effective, efficient, integrated services Call To Action was a major springboard for the rapid expansion of PMTCT programs throughout Africa and C&T programs! and HIV research! Great progress, but still a long way to go; many challenges remain 2

3. HIV Testing of Pregnant Women 3

4. 55% of pregnant womennot receiving PMTCT drugs 68% of HIV-exposed infantsnot receiving PMTCT drugs Provision of ARVs for PMTCT WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 2009 4

5. PEARL Study 5 Stringer et al. Cote D’Ivoire, South Africa, Zambia, Cameroon

6. Most Critical Thing for PMTCT is Number of Women Completing Cascade 100 HIV+ mothers Overall Program Effectiveness (early MTCT) Enter into program Missed - no PMTCT Attend ANC clinic 92% 8 92 sdNVP alone: 22.5% tx sdNVP +ART: 19.5% tx Counseled & tested for HIV, CD4 75% AZT/sdNVP: 17.5% tx 68 32 HAART: 17.1% tx Get ARVs (pre- & perinatal) 50% 34 66 No ARV (25% MTCT): 16.5 infected P. Barker, WHO Mtg Nov 2008 6

7. Change Cascade Efficiency 100 HIV+ mothers Overall Program Effectiveness (early MTCT) Enter into program Missed - no PMTCT Attend ANC clinic 95% 5 95 sdNVP alone: 17.3% tx sdNVP +ART: 10.4% tx Counseled & tested for HIV, CD4 95% AZT/sdNVP: 6.1% tx 90 10 HAART: 5.2% tx Get ARVs (pre- & perinatal) 95% 86 14 No ARV (25% MTCT): 3.5 infected P. Barker, WHO Mtg Nov 2008 7

8. Long and bumpy roads lead to great places 8

9. Where do we go from here? The CTA laid the first stones in the path to elimination of pediatric HIV Completing the path requires GLOBAL action Mobilization of resources to expand PMTCT programs: Effective HIV prevention! PMTCT = MNCH Contributes to multiple MDGs Embodies a woman- and family-centered approach Supports health system strengthening 9

10. WHO’s 4-Component Strategy for MTCT Prevention Prevention of unintended pregnancies in HIV-infected women Prevention of transmission from an HIV infected woman to her infant Prevention of HIV in women, especially young women Support for HIV infected women, their infant, and family Component 1 Component 2 Component 3 Component 4 10

11. Requirements for Achieving Scale-up Global advocacy Strong government leadership and prioritization of PMTCT in the country’s HIV/AIDS plan Public health approach to PMTCT Ensure universal access to high-quality PMTCT services Provision of PMTCT in all health services that offer HIV/AIDS care and treatment Universal access to treatment for all eligible HIV-infected pregnant women 11

12. Requirements for Achieving Scale-up Decentralize PMTCT to district and sub-district levels Build capacities for leadership, management, planning and budgeting, M&E Strengthen MCH capacity (staff, infrastructure) Supportive national policies on level of health facilities/workers allowed to provide PMTCT services Greater coordination and collaboration among implementing agencies, international organizations & government entities 12

13. Program-Level Activities Country-level integration of PMTCT, HIV care & treatment, MNCH, FP programs Increase reach of PMTCT programs: Focus resources on women outside the “cascade” Prioritize the inclusion of male partners, family members & community in PMTCT service delivery Address stigma within health workforce Facility program ownership with feedback of program results to support QA/QI activities 13

14. Implementation Research Optimal strategies for cost-effective implementation of PMTCT programs and maximal retention along the PMTCT cascade Models of integration of MNCH, PMTCT, and comprehensive care and treatment services to optimize maternal, infant and child health and survival 14

16. Complexity requires renewed intensity, integration, and innovation15

17. Tunaweza Together, We Can … Eliminate Pediatric HIV Photo Credit: Nigel Barker LLC 16 DISCLAIMER: This program was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief, as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Private donors also supported costs of activities in many countries. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.