EMTCT Validation in the Africa Region: Regional Overview and Candidate Countries

Outline Overview of PMTCT Progress in the Africa region (and in the 21 countries) Analysis of PMTCT programme performance, typologies Closer look at countries leading the way in PMTCT progress: very low prevalence, 21 GP country Comment on EMTCT validation criteria applicability in the region –BF and data quality is key Next Steps

Primary Prevention: Unmet Target

Pregnant Women Knowing Their HIV Status From WHO HIV Report Based on WHO/UNICEF/UNAIDS Health Sector GARPR Data and 2013 HIV estimates

PMTCT Progress in the Africa Region: ARV coverage From WHO HIV Report Based on WHO/UNICEF/UNAIDS Health Sector GARPR Data and 2013 HIV estimates

Business as usual will only take us to 46% reduction in new HIV infections among children by 2015 Source: Preliminary UNAIDS 2013 Estimates 46% reduction Business as usual, assuming 2013 ARV coverage Global Plan Target Slide 8

EID in 21 African Global Plan Priority Countries

We are failing children living with HIV Note the percentage is based on all children ages 0-14 living with HIV and is not limited to those eligible for ART. Source: Preliminary UNAIDS 2013 Estimates Treatment gap % Treatment gap % 2.6 million children living with HIV in the 21 countries. Only 23% are on HIV treatment in 21 Global Plan countries in 2013 Slide 10

Global Plan and EMTCT Validation Criteria Impact Case Rate of 50 paediatric HIV cases due to PMTCT out of 100,000 live births AND MTCT Rate of <5% (breastfeeding populations) Process ANC>95% Testing (Know Status) > 95% PMTCT ARV > 90%

Are we close to the Process targets? ANC > 95%: 17 countries (5 countries between 80-95%) Pregnant women with known HIV status > 90%: 12 countries (3 countries between 80-95%) PMTCT ARV Coverage> 90%: 8 countries (2 countries between 80-95%)

Are we close to the Impact target? Impact:< 50 MTCT cases per 100,000 live births Based on 2013 estimated new HIV infections and live births: –<50: Mauritania and Mauritius –<100: Niger, Rwanda, Senegal, Cape Verde, Eritrea –Botswana: 560 MTCT cases per 100,000 live births (has dropped from case rate of ~ 2130 in 2009) –Namibia: 1,760 MTCT cases per 100,000 live births (has dropped from case rate of ~ 2500 in 2009)

Some key issues Data Quality Assessment - Purpose: to determine if systems are “validation quality” - Are sentinel sites OK? Data accounts for what % of HEI? - How to address modeled denominator for coverage? - Estimate of private sector share of market? Private sector data required - MTCT rate measured 6 week after cessation of BF, or outcomes at a standard age, e.g. 18mths? - ARV to include some retention or post-partum coverage assessment? - What general principles for quality, completeness, accuracy, consistency, timeliness?

Next steps Obtain possible candidate countries for MTCT elimination validation for the year –Provide support countries to be prepared – Botswana, Namibia, South Africa, Swaziland, Tanzania(Zanzibar), and Zimbabwe. –Support other countries towards possible validation (M&E framework, data quality and processes and skills).

Need to continue to work towards GP targets (all 4 prongs) Reach high coverage of quality and integrated MNCH interventions including HIV and syphilis Most countries do not have a mechanism to collect MTCT rate from real data. Verifying final outcome status is important for EMTCT validation. (Will help to verify modelling assumptions as well.) Retention is key. Take home messages

Acknowledgements Chika Hayashi – WHO Priscilla Idele - UNICEF Tyler Porth – UNICEF Isseu Diop-Tourre – WHO Karusa Kiragu - UNAIDS

Thank you