PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV WHAT’S NEW Prepared by Dr. Debbie Carrington National HIV/AIDS Prevention & Control Programme Ministry of Health, Jamaica November 2007

Population of Jamaica 2.6 M Sero-prevalence among adults 1.5% Estimated No. with HIV/AIDS25,000 Est. No. unaware of HIV status15,000 No. of persons in need of ARV 6,000 No. of persons currently on ARV 3,651 HIV/AIDS IN JAMAICA

AIDS Cases & Deaths Reported Annually in Jamaica (1982 to 2006)

Annual AIDS Case Rates by Sex Reported in Jamaica:

AIDS Case Rates in Jamaica by Age and Sex (per 100,000 population) AIDS definition includes advanced HIV disease in 2005 and 2006

HIV Seroprevalence Among Antenatal Clinic Attendees in Jamaica:

Paediatric AIDS Cases & Deaths ( )

Reference: Ministry of Health, National HIV/STI Prevention and Control Program,Facts and Figures, HIV/ AIDS Epidemic Update, January to December 2006 Website Paediatric AIDS Cases per 100,000 population (1986 – 2006)

PMTCT in Jamaica Protocol Routine HIV and Syphilis Screening of all pregnant women. CD4 tests for all HIV positive women. Mothers: CD4<250: AZT+3TC plus NVP CD4 >250: AZT + 3TC plus LPV/r Infants: Single dose NVP plus AZT for four weeks. Replacement formula provided for at least the first six months of life.

Percentage of ANC clients tested for HIV ANC2003 (1 st Year) No. of HIV tests 11,89828,11328,65128,446 No. of 1 st time visits 30,52428,75029,74129,943 Percentage

Prevention of MTCT 2005 and No. ANC attendees tested28,65128,446 No. ANC attendees HIV +ve No. of HIV +ve women given ARV No. of HIV +ve women delivered Percentage of women getting pMTCT74%84% No. of HIV exposed infants No. HIV exposed infants getting ARV353 (87%)403(93%) Percentage of HIV infected infants born to HIV infected women 8-10% (estimated) ?

PMTCT in Jamaica Goal: To reduce perinatal transmission of HIV to below 5% through provision of universal access to quality PMTCT care and support services. Objectives: To test 100% of all antenatal clients for HIV To ensure that all HIV positive pregnant women receive antiretroviral therapy to reduce the risk of HIV transmission to their unborn child. To ensure that all infants born to HIV positive women receive a prophylactic course of antiretroviral medication. To ensure the availability of formula feed for all HIV-exposed infants for at least the first six months of life.

Benefits of Early Diagnosis of Infants by PCR Testing Efficiently monitor PMTCT program Facilitates medical Rx, improve outcome PCP prophylaxis ARV Mental benefit (especially for uninfected results) Family can make proper plan for the child and caretakers

PMTCT in Jamaica Threats to the programme: Prevalence of stigma and discrimination leading to reluctance among HIV+ women to disclose their status at the point of delivery and limiting the ability of health care workers to administer appropriate prophylaxis to prevent MTCT. Cultural practices eg. Early first sex, young girls and older men, low condom use, perpetuation of myths Gender inequity Social vulnerability.

PMTCT in Jamaica Lessons Learned. Universal HIV testing of antenatal mothers is a must. Innovative ways of ensuring this must be found in resource limited settings, for example mobile phlebotomy teams where there are no lab services. Decentralization of services and increased accessibility greatly increases adherence to care. Centres that had dedicated staff had better client follow-up and outcomes. Clients require continued support especially in adherence to selected infant feeding method. Buy-in of implementers essential to success of the programme.