20th International AIDS Conference - Melbourne, Australia


WEAD0401 - Oral Abstract Session

Balancing ART access for pregnant women living with HIV and follow-up care for HIV exposed infants: a four country assessment of key PMTCT interventions

Presented by Priscilla Idele (United States).

P.A. Idele1, J. Rodrigues2, C. Luo3, A. Fakoya4, R. Ekpini5, C. Omeogu6

1UNICEF, Data and Analytics, New York, United States, 2IATT Secretariat, HIV and AIDS, New York, United States, 3UNICEF, HIV and AIDS, New York, United States, 4Global Fund, Geneva, Switzerland, 5UNICEF, Health Section, New York, United States, 6IATT Secretariat, New York, United States

Background: The 2010 WHO PMTCT guidelines include two options:
1) Lifelong ART for HIV infected pregnant women in need of treatment for their own health, also effective in reducing MTCT (Option B+) and
2) Two options for ARV prophylaxis (Option A and B) to prevent MTCT for HIV infected pregnant women not eligible for treatment.
A review in Lesotho, Malawi, Tanzania and Zambia was conducted between October 2011 and January 2012 to assess performance across six PMTCT interventions.
Methods: Data were analysed from registers and clinical records at 10 health facilities in each country. Key policies and reports were reviewed and interviews conducted with service providers.
Results: Nationally, PMTCT services were available in all health facilities in Lesotho, 95% in Malawi, 93% in Tanzania and 65% in Zambia. Figure 1 shows HIV testing rates in ANC in sites reviewed were 79%, 99%, 62% and 87% in Malawi, Lesotho, Tanzania and Zambia respectively. HIV testing rates in labour and delivery were lower in Malawi and Lesotho and higher in Tanzania and Zambia. Provision of ART in HIV+ pregnant women in need was 71%, 31%, 5% and 20% in Malawi, Lesotho, Tanzania and Zambia respectively. National ART access for HIV+ pregnant women nearly doubled in Malawi from 26% in 2010 to 51% in 2011, following the implementation of Option B+. The proportion of HIV exposed infants (HEI) who were EID tested was 45%, 83%, 58% and 49%, while the provision of cotrimoxazole prophylaxis (CPT) was 17%, 83%, 80% and 57% in Malawi, Lesotho, Tanzania and Zambia respectively. In all four countries, staff trained in paediatric care was lower compared to PMTCT.

Figure 1
[Figure 1]

Conclusions: Although implementation of Option B+ in Malawi increased ART access for HIV+ pregnant women, data from select facilities indicate low coverage of EID testing or uptake of CPT for HIV exposed infants. Improving longitudinal care for mother-infant pairs until confirmed HIV diagnosis at 18 months is critical regardless of PMTCT option.

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