Scaling up HIV services for women and children achievements and challenges e-lluminate session e-lluminate session Yves Souteyrand 2 March 2010

Background In 2008, 1.4 million pregnant women living with HIV in low and middle income countries gave birth Without intervention, the risk of transmission ranges between 20% to 45% In 2008: children less than 15 newly infected with HIV in 2008, over 90% through mother to child transmission; 2.1 million children lived with HIV; died of HIV infection Without treatment, half infected children will die before 2 years of age Sub-Saharan Africa represent 90% of global PMTCT needs

Comprehensive approach of PMTCT Primary prevention of HIV infection among women of child bearing age Preventing unintended pregnancies among women living with HIV Preventing HIV transmission from a woman living with HIV to her infant Providing appropriate treatment, care and support to mothers living with HIV, their children and families

Purpose and scope of the report "WHO will monitor countries health-sector responses in scaling up efforts towards universal access, and progress will be reported on annually." 59th World Health Assembly, May 2006

Process Since 2006, WHO, UNICEF and UNAIDS monitor and report annually on global progress in the health sector response to HIV/AIDS. Reporting focuses on priority intervention areas in the health sector: HIV testing and counselling HIV prevention in health care settings Preventing sexual transmission of HIV and transmission through injecting drug use Managing sexually transmitted infections HIV care and interventions to address HIV/TB coinfection Antiretroviral therapy HIV interventions for women and children, including to prevent mother-to-child transmission Health systems 46 indicators, based on UNGASS and IATT Report Card on Prevention of Mother-to-Child Transmission of HIV and Paediatric HIV Care and Treatment in Low- and Middle-Income Countries.

Global highlights The year 2009 saw continued progress in expanding health sector interventions for HIV prevention, treatment and care in low- and middle- income countries. The volume and scope of data to measure progress improved substantially as compared with previous years. More than 4 million people received antiretroviral therapy at the end of 2008, reaching 42% of those in need. The availability and uptake of HIV testing and counselling increased. Around 45% of HIV-positive pregnant women received antiretrovirals to prevent HIV transmission to their children.

HIV services for women and children: main results (I) More countries are committed to expand HIV prevention, treatment and care services for women and children. In countries have a national scale up plan (from 34 in 2005). Around 21% of pregnant women received an HIV test in 2008, up from 15% in % of HIV-positive pregnant women received antiretrovirals to prevent mother- to-child transmission during 2008, compared with 35% in More women are receiving efficacious combination antiretroviral drug regimens to prevent mother-to-child transmission. Many HIV-positive pregnant women are not assessed for their eligibility to receive antiretroviral therapy for their own health – only 34% were assessed either clinically or through CD4 count in 2008.

Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, Sep 2009 Percentage of pregnant women who received an HIV test in low- and middle-income countries by region, 2004–2008 a

HIV services for women and children: main results (I) More countries are committed to expand HIV prevention, treatment and care services for women and children. In countries have a national scale up plan (from 34 in 2005). Around 21% of pregnant women received an HIV test in 2008, up from 15% in % of HIV-positive pregnant women received antiretrovirals to prevent mother-to-child transmission during 2008, compared with 35% in More women are receiving efficacious combination antiretroviral drug regimens to prevent mother-to-child transmission. Many HIV-positive pregnant women are not assessed for their eligibility to receive antiretroviral therapy for their own health – only 34% were assessed either clinically or through CD4 count in 2008.

Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, Sep 2009 Percentage of pregnant women with HIV receiving antiretrovirals for preventing mother-to-child transmission of HIV in low- and middle-income countries by region, 2004–2008

HIV services for women and children: main results (I) More countries are committed to expand HIV prevention, treatment and care services for women and children. In countries have a national scale up plan (from 34 in 2005). Around 21% of pregnant women received an HIV test in 2008, up from 15% in % of HIV-positive pregnant women received antiretrovirals to prevent mother- to-child transmission during 2008, compared with 35% in More women are receiving efficacious combination antiretroviral drug regimens to prevent mother-to-child transmission. Many HIV-positive pregnant women are not assessed for their eligibility to receive antiretroviral therapy for their own health – only 34% were assessed either clinically or through CD4 count in 2008.

Percentage distribution of ARVs regimens provided to pregnant women in 2007 and 2008 (based on available data)

HIV services for women and children: main results (I) More countries are committed to expand HIV prevention, treatment and care services for women and children. In countries have a national scale up plan (from 34 in 2005). Around 21% of pregnant women received an HIV test in 2008, up from 15% in % of HIV-positive pregnant women received antiretrovirals to prevent mother- to-child transmission during 2008, compared with 35% in More women are receiving efficacious combination antiretroviral drug regimens to prevent mother-to-child transmission. Many HIV-positive pregnant women are not assessed for their eligibility to receive antiretroviral therapy for their own health – only 34% were assessed either clinically or through CD4 count in 2008.

HIV services for women and children: main results (II) Coverage of infant ARV prophylaxis has increased from 20% in 2007 to 32% in 2008, but is still lower than maternal ARV prophylaxis Rates of early virological testing of HIV-exposed children remain low: 15% (in 41 countries) children born to HIV positive mothers received an HIV test within the two first months of life Coverage of cotrimoxazole prophylaxis remains very low even if increasing. In 31 countries reporting data in and 2008, coverage increased from 14% to 22% The number of children receiving antiretroviral therapy increased from in 2007 to in 2008, reaching 38% of children in need; yet many HIV-exposed infants are not being diagnosed and do not receive the necessary follow-up care.

Percentage of pregnant women living with HIV and infants born to them who received ARVs for preventing MTCT,

HIV services for women and children: main results (II) Coverage of infant ARV prophylaxis has increased from 20% in 2007 to 32% in 2008, but is still lower than maternal ARV prophylaxis Rates of early virological testing of HIV-exposed children remain low: 15% (in 41 countries) children born to HIV positive mothers received an HIV test within the two first months of life Coverage of cotrimoxazole prophylaxis remains very low even if increasing. In 31 countries reporting data in and 2008, coverage increased from 14% to 22% The number of children receiving antiretroviral therapy increased from in 2007 to in 2008, reaching 38% of children in need

Towards Universal Access – Scaling up priority HIV/AIDS interventions in the health sector. WHO/UNAIDS/UNICEF, Sep 2009 Percentage of children receiving antiretroviral therapy in low- and middle- income countries, 2005–2008

Conclusion Scaling up PMTC interventions is occuring in many low and middle income countries Drop of infections among children (less 18% in 2008 compared to 2001) suggest efforts are saving lives But most women and children don't yet access to essential life- saving services Along the needed continuum of care continued critical gaps between: access to ANC versus access to testing and counselling for pregnant women access to prophylaxis for PMTCT versus assessment of eligibility to ART for pregnant women versus provision of ARV prophylaxis to mothers versus provision of ARV prophylaxis to mothers infant prophylaxis versus infant diagnosis and co-trimoxazole prophylaxis

The way forward: WHO's PMTCT strategic vision Women and children alive and free of HIV Goal - to eliminate paediatric infections and improve maternal, newborn and child health and survival in the context of HIV Objectives: accelerate global and national scale-up of effective and comprehensive PMTCT services improve the quality and demonstrate the public health impact of PMTCT services Strengthen linkages between maternal, newborn and child health services, reproductive health services and HIV-related services to reduce overall maternal and child mortality