6th International AIDS Society Conference Better Diagnostics Are Needed to Achieve an AIDS-Free Generation UNITAID Satellite Event 18 July 2011 Jimmy Kolker Chief, HIV/AIDS Section UNICEF Programme Division New York

Percentage of pregnant women living with HIV receiving ARVs for PMTCT 2005, 2008 and 2009

Distribution of antiretroviral regimens provided to pregnant women, in 2007 (59 countries) and 2009 (86 countries)

Paediatric HIV Treatment In 2009, about 356,400 children under 15 received antiretroviral treatment, an increase from only 75,000 in However, this is only 28% of the 1.27 million children in need of ART under the new guidelines are receiving it. The key entry point is widespread testing of HIV-exposed newborns. Ideally, this would be done as soon after delivery as possible. Developing a test that would do this is one of UNICEF and partners’ top goals. EID can also be routine during 6-week immunization visits, hospital admissions or as part of family-based care for parents and older children.

Point of Care Diagnostics in PMTCT and Paediatric Care and Treatment POC assays hold promise to help expand ART to lower-level clinics and reach the unreached – This is especially important for access to HAART for pregnant women (CD4) and infants (EID) POC assays are not a solution alone to the poor follow-up of mothers and infants – The goal is to strengthen access to and quality of the needed continuum of care

Compelling argument for investing low cost technologies to bring CD4 screening in less capacitated ANC facilities to treat more pregnant mothers with ART. Zimbabwe is working on a national approach to scale up point of care CD4 machines. Expanding CD4 Testing in low-level facilities

Low utilization EID testing at lower-level clinics:15% of EID sites in Namibia collected >93% of all samples

8 Receive Results HIV+ infants Enrolled in counseling & treatment Infants still active after 1 year 76% 48% of HIV+ infants never received results. Several died prior to receiving results. Not all infants were on CTX. Of those who enroll in HIV services, almost 1/3 are no longer tracked at the site. Without investment through the entire follow- up continuum, the maximum impact of Early Infant Diagnosis (EID) will not be realized. Maximizing Impact of Early Infant Diagnosis Follow up of infants testing HIV+ Jinia Regional Hospital, Zambia Jan 1, 2008 – December 1, 2009 BOTTLENECK: Less than 1/3 of infants tested for HIV at birth receiving treatment after one year 48% 68 34% 29%

10 Benefits Speed – Wait time for results is cut in half Cost – No SMS cost for clinic staff Scale – Easier scalability using clinic staff’s own phones Reporting – Web portal provides national view of clinic’s DBS usage RESULT: increased # of children correctly identified and enrolled to receive treatment

Aggregated Web Reports

Investing in diagnostics in eMTCT and Paediatric care Assess where there is the greatest unmet need Involve providers and clients to assess key bottlenecks Identify evidence-informed solutions and investments Scale-up priority intervention as component of MNCH services – HIV testing and counseling – CD4 and ARVS including ART for HIV positive pregnant wowen – Early Infant Diagnostic technologies and supportive system responses such as SMS