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PMTCT Implementation and the Importance of Male Involvement,[object Object],Christian Pitter, MD, MPH,[object Object],Director, Global Technical Policy,[object Object],Elizabeth Glaser Pediatric AIDS Foundation,[object Object]
Trends of the HIV epidemic(in millions),[object Object],New pediatric HIV Infections:,[object Object],2001: 520,000,[object Object],2008: 430,000,[object Object],2,[object Object]
Impact of AIDS on child mortality rates  ,[object Object],Selected African countries, 2010,[object Object],withAIDS,[object Object],per 1000 live births,[object Object],250,[object Object],200,[object Object],150,[object Object],100,[object Object],50,[object Object],0,[object Object],without AIDS,[object Object],Botswana,[object Object],Kenya,[object Object],Malawi,[object Object],Tanzania,[object Object],Zambia,[object Object],Zimbabwe,[object Object],US Bureau of  the Census, 2005,[object Object]
Mother-to-child transmission,[object Object],Accounts for over 90% of pediatric infections,[object Object],Approximately 1.4 million HIV+ pregnant women annually need PMTCT services (2008),[object Object],Over 90% in Sub-Saharan Africa,[object Object],70% in Eastern/Southern Africa,[object Object],30% in Western/Central Africa,[object Object],Global PMTCT scale-up begins 1998-99,[object Object]
EGPAF Mission,[object Object],The Elizabeth Glaser Pediatric AIDS Foundation seeks to prevent pediatric HIV infection and to eradicate pediatric AIDS through research, advocacy, and prevention and treatment programs.,[object Object]
WHO’s 4-Component Strategy for MTCT Prevention,[object Object],Prevention of unintended pregnancies in HIV-infected women,[object Object],Prevention of transmission from an HIV infected woman to her infant,[object Object],Prevention of HIV in women, especially young women,[object Object],Support for HIV infected women, their infant, and family,[object Object],Component,[object Object],1,[object Object],Component,[object Object],2,[object Object],Component,[object Object],3,[object Object],Component,[object Object],4,[object Object]
EGPAF International Programs: 2000   8 sites in 6 countries 2010   >4865 sites in 16 countries,[object Object],China,[object Object],India ,[object Object],Rwanda ,[object Object],Uganda,[object Object],Cote d’Ivoire,[object Object],Kenya,[object Object],Cameroon ,[object Object],Tanzania,[object Object],D.R.Congo,[object Object],Malawi ,[object Object],Mozambique ,[object Object],South,[object Object],Africa,[object Object],Zimbabwe,[object Object],Swaziland,[object Object],Zambia,[object Object],Lesotho,[object Object],United States,[object Object]
PMTCT Components,[object Object],Primary Prevention of HIV infection,[object Object],Prevention of unwanted pregnancy in HIV-infected women,[object Object],Maternal HIV Counseling and Testing,[object Object],Maternal HIV Counseling,[object Object],Maternal Antiretroviral Prophylaxis or Treatment,[object Object],Infant Antiretroviral Prophylaxis,[object Object],Nutrition  Counseling and Support,[object Object],Care, Support and Treatment for women, children, and families,[object Object],Early infant diagnosis,[object Object]
Access to ARV Drugs for PMTCT,[object Object],55% of pregnant womennot receiving PMTCT drugs,[object Object],68% of HIV-exposed infantsnot receiving PMTCT drugs,[object Object],WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 2009,[object Object]
70 000,[object Object],60 000,[object Object],50 000,[object Object],40 000,[object Object],30 000,[object Object],20 000,[object Object],10 000,[object Object],0,[object Object],1996,[object Object],1998,[object Object],2000,[object Object],2002,[object Object],2004,[object Object],2006,[object Object],2008,[object Object],Estimate of the annual number of infant infections averted through the provision of ARV prophylaxis to HIV-positive pregnant women, globally, 1996–2008,[object Object],70,000 infections averted in 2008,[object Object],Estimated number of new pediatric infections with and without PMTCT prophylaxis globally, 1996-2008,[object Object]
New 2009 WHO Guidelines,[object Object],PMTCT:,[object Object],Treat all pregnant women eligible for ART (eligibility expanded to CD4 < 350),[object Object],Start ARV drugs earlier (2nd trimester),[object Object],Continue ARVs through breastfeeding period,[object Object],Breastfeed for 12 months (exclusive for 6 mo),[object Object],HIV Treatment:,[object Object],Start treatment earlier (CD4 count < 350),[object Object],Treat all children < 2 years of age,[object Object]
Male Partner HIV Testing and Antenatal Clinic Attendance Associated with Better HIV-Free Survival in InfantsAluisio A et al.  IAS, Capetown, South Africa, July 2009, Abs. TuAC105,[object Object],Proportion of infants alive & HIV-1 negative,[object Object],Log rank P = <0.001,[object Object],Yes (- - -),[object Object],Log rank P = 0.015,[object Object], No  (____),[object Object]

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PMTCT Implementation and the Importance of Male Involvement

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Notes de l'éditeur

  1. Consistent with the long interval between HIV seroconversion and symptomatic disease, annual HIV-related mortality appears to have peaked in 2004, when 2.2 million deaths occurred. The estimated number of AIDS-related deaths in 2008 is roughly 10% lower than in 2004.The number of children younger than 15 years living with HIV also increased from 1.6 million in 2001 to 2 million in 2007, although the number of newly infected children has been declining since 2003, probably due to the global stabilization of HIV prevalence among women and increasing coverage of programs for PMTCT. In 2007, children accounted for 6% of all people living with HIV, 17% of the people newly infected and 14% of all HIV-related mortality worldwide.
  2. We next evaluated the role of male partners in relation to HIV free survival An outcome which represents the composite risk of infant infection and mortality there by being a more comprehensive measure of impact on infant healthThe results displayed in the left had KM plot for attendance illustrate that approximately 90% of infants of women with male partner attendance, were alive and uninfected through the first year of life the blue dashed curve, as compared to approximately 75% of infants of mothers lacking attendance The red solid curve A proportional difference which was statistically significant The role of the second predictor, previous male hiv testing is depicted in the right hand KM plot These curves show that approximately 85% of infants of women who reported that their male partners had been previously tested for HIV, were alive and uninfected through the first year of life represented by the blue dashed curve as compared to approximately 75% of those infants of mothers who reported that their partners had not been tested the red solid curve Again, representing a proportional difference between the two groups that was statistically significant(NOTE: there were also 13 infant infected &lt; 48 h pp which died but were not used in the analysis and 7 still born infants) (In this population there were 90 events, 50 deaths among which 15 were HIV-infected and 40 HIV-1-infected infants alive through the first 12 months postpartum)