Prevention of Mother-to-Child Transmission of HIV infection in Sri Lanka Dr Sujatha Samarakoon Consultant Venereologist / Focal Point ECS & PMTCT – National STD/AIDS Control Programme, Ministry of Health

 Adult HIV prevalence rate <0.1% - Sri Lanka has a low level HIV epidemic  Number reported as at end September 2010 = 1285 ( females=518)  Male :female ratio = 1.5:1  Cumulative AIDS deaths =212  Estimated PLHIV by 2009 = 3000  Estimated of number of Pregnant women with HIV (2010) = 50  Estimated number of pregnant women in need of ART (2010)=42  Number of reported cases of Vertical Transmission =44

Prevention of transmission from an HIV positive woman to her infant Care and support for the mother & her family Prevention of transmission of HIV in young people & women of childbearing age Prevention of unintended pregnancies in HIV + women

 Girl child – PMTCT included in the school education programme of SP  Women in child bearing age – Preconception package of Family Health Bureau (FHB) included PMTCT & ECS, Work plan of women’s health of FHB  Antenatal mothers  Antenatal care package of FHB includes PMTCT& ECS  PHC staff training includes PMTCT & ECS ( PHNS, PHI, PHM, Labour room staff) should be now included in the curriculum  Male partner – Parent craft classes  Sensitization meeting for VOG/SR/SHO - 4 meetings  NSACP member of the Perinatal Mortality Review Committee of DMH

70% of pregnant mothers accepting VCT, 60% of HIV 70% infected mothers detected, and 80% of infants born to HIV infected mothers free from HIV Antenatal syphilis screening for all pregnant women attending antenatal services

 In three selected areas, pilot programs are being carried out  One of the leading Maternity Hospitals is offering routine HIV testing as Standard of Care  One hospital offering – Opt out  One MOH area offering Opt out (62,000 samples tested and only 6 were positive giving a rate of 0.02%)

Year Number tested Number positive Percent , , , , , , , HIV prevalence among AN mothers very low

 Optimize HIV positive woman’s physical and psychological well being  Prevent vertical transmission of HIV  Minimize maternal risks  Optimize neonatal well being  Prepare for or prevent next pregnancy

 Routine obstetric care – PHC/ VOG/Hospital staff  Clinical and immunological assessment of HIV infection – Venereologist/MO-STD  Provision of ART – Venereologist/MO-STD/VOG  Provision of safe delivery practices – VOG/ anesthetist  Provision of safe feeding practices- paediatrician/VOG/MO- STD

 For her own health or as prophylaxis as per new WHO guidelines  Prophylaxis – Option A or B ? ARV in Pregnancy

 As per new WHO guidelines ARV for infant

 Replacement feeding –  If no AFASS then exclusive breastfeeding for 6 months

 Preparation in progress