HIV and Infant feeding Report of 5 Country Rapid Assessment Dr. Arun Gupta, MD, FIAP Coordinator Dr J.P. Dadhich, MD Co -coordinator IBFAN Asia Pacific Working Group on HIV-Infant feeding

Outline Need and Relevance Need and Relevance Process Process ♠ Countries ♠ Countries ♠ Questionnaire ♠ Questionnaire ♠ National Consultation ♠ National Consultation Outcome Outcome Challenges Challenges

Need and Relevance To facilitate discussion and find out how HIV and infant feeding is being addressed in the PMTCT programmes as part of HIV AIDS Programmes, specifically to list the processes being followed by a country

Need and Relevance To raise awareness of the issues and particularly, the latest material on HIV/IF, especially UN materials To raise awareness of the issues and particularly, the latest material on HIV/IF, especially UN materials To create a solidarity/trusting relationship around each other's concerns To create a solidarity/trusting relationship around each other's concerns To network for cooperation to initiate some joint actions To network for cooperation to initiate some joint actions

Process Initiated a dialogue with IBFAN Focal points/Contacts in 6 countries,5 responded Initiated a dialogue with IBFAN Focal points/Contacts in 6 countries,5 responded –Afghanistan –Bangladesh –Indonesia –Malaysia –Nepal

Questionnaire Shared a common framework of questions for rapid country assessment Shared a common framework of questions for rapid country assessment Issues covered in the framework included Issues covered in the framework included –Policy and Guidelines at national level –PMTCT Strategies in vogue –Utilization of UN Guidelines –National Capacity, Training curriculum –Skills of Counselors

Process Country Specific Consultations involving stakeholders were held in 5 countries and reports received Country Specific Consultations involving stakeholders were held in 5 countries and reports received

Malaysia 25 participants, both breastfeeding groups and HIV community as well as Govt. UNICEF, WHO, medical association, consumer’s groups. 25 participants, both breastfeeding groups and HIV community as well as Govt. UNICEF, WHO, medical association, consumer’s groups. National MTCT program in place National MTCT program in place Govt. policy is to practice replacement feeding for all HIV positive mothers Govt. policy is to practice replacement feeding for all HIV positive mothers The mother is provided with free alternative feeding (formula) The mother is provided with free alternative feeding (formula) Govt. assumes AFASS criteria are fulfilled by the country Govt. assumes AFASS criteria are fulfilled by the country A joint task force is proposed A joint task force is proposed Joint statement to be issued Joint statement to be issued Several issues were raised including organizing a 3-4 day meeting to think forward. Several issues were raised including organizing a 3-4 day meeting to think forward.

Nepal 25 Participants, included govt. and non govt. organizations working in the field of child health and HIV, UNFPA, PSI, Save the children, breastfeeding group NEBPROF, health professionals 25 Participants, included govt. and non govt. organizations working in the field of child health and HIV, UNFPA, PSI, Save the children, breastfeeding group NEBPROF, health professionals Lack of program for PPTCT at national level Lack of program for PPTCT at national level Lack of national policy on HIV and Infant feeding Lack of national policy on HIV and Infant feeding Capacity building of the health workers is required Capacity building of the health workers is required Plan of action was developed at the meeting; addressing training, of health workers, establishing standards/guidelines, Code implementation, strengthening partnership Plan of action was developed at the meeting; addressing training, of health workers, establishing standards/guidelines, Code implementation, strengthening partnership

Indonesia 31 Participants,included breastfeeding groups, govt. agencies, UNICEF, WHO, National AIDS Commission, health professional organizations, Save the Children, John Hopkins. 31 Participants,included breastfeeding groups, govt. agencies, UNICEF, WHO, National AIDS Commission, health professional organizations, Save the Children, John Hopkins. National program on HIV/AIDS in place National program on HIV/AIDS in place Nodal agency on HIV present Nodal agency on HIV present Draft policy on PPTCT under consideration(VCT,ARV and Infant feeding counseling) Draft policy on PPTCT under consideration(VCT,ARV and Infant feeding counseling) Recommended first choice is Infant formula Recommended first choice is Infant formula FU Actions :Capacity building of health workers is being planned using WHO 2000 HIV Infant feeding module ; strengthening coordination, awareness programmes FU Actions :Capacity building of health workers is being planned using WHO 2000 HIV Infant feeding module ; strengthening coordination, awareness programmes

Bangladesh Participation in consultation widely representative, 23 participants Govt., UNICEF, WHO, Research instt., Nutrition instt. Participation in consultation widely representative, 23 participants Govt., UNICEF, WHO, Research instt., Nutrition instt. National AIDS/STD Program (NASP) supervises AIDS/HIV at national level National AIDS/STD Program (NASP) supervises AIDS/HIV at national level No national policy of HIV and Infant feeding No national policy of HIV and Infant feeding Utilize UN documents Utilize UN documents infant feeding and HIV not in curriculum infant feeding and HIV not in curriculum Capacity building of health workers is a major gap Capacity building of health workers is a major gap National policy to promote exclusive breastfeeding for all babies National policy to promote exclusive breastfeeding for all babies

Afghanistan 20 participants, included Govt. UNCEF, UNDP, WHO, National Aids Cell, TDh, Pediatrics body. 20 participants, included Govt. UNCEF, UNDP, WHO, National Aids Cell, TDh, Pediatrics body. Issue of HIV as such is not a priority area for the govt. agencies Issue of HIV as such is not a priority area for the govt. agencies No national policy on HIV/MTCT/HIV and Infant feeding No national policy on HIV/MTCT/HIV and Infant feeding No educational program or curriculum to train and orient health workers. No educational program or curriculum to train and orient health workers. Formation of a working group at the aim to look after different aspects of the program Formation of a working group at the aim to look after different aspects of the program

India : Some fresh news! We have finished combining BF, CF and HIV courses We have finished combining BF, CF and HIV courses Launched in 3 states with UNICEF and State governments Launched in 3 states with UNICEF and State governments NACO asked BPNI to integrated its PMTCT/PPTCT module with IYCF, accomplished NACO asked BPNI to integrated its PMTCT/PPTCT module with IYCF, accomplished Future training will be based on this module. Future training will be based on this module. October a TOT is planned in India October a TOT is planned in India

Challenges Lack of national policy, guidelines and initiatives for PPTCT in preventing infant HIV Lack of national policy, guidelines and initiatives for PPTCT in preventing infant HIV Lack of educational program or curriculum to train and orient health workers/counselors Lack of educational program or curriculum to train and orient health workers/counselors Lack of national policy on HIV and Infant feeding Lack of national policy on HIV and Infant feeding Lack of understanding of AFASS; being used to formulate blanket policies Lack of understanding of AFASS; being used to formulate blanket policies

Lessons Learnt Feasible activity in a short time Feasible activity in a short time Not very expensive. Not very expensive. Opportunity for various stakeholders to come together to discuss locally relevant action plan Opportunity for various stakeholders to come together to discuss locally relevant action plan Two sides (BF and HIV) can sit together at national level. Two sides (BF and HIV) can sit together at national level.

Recommendations Rapid assessment process may be expanded. Rapid assessment process may be expanded. Organize National colloquium on Infant Feeding and HIV to better understand guidelines and prepare a road map for implementation; UNICEF WHO could step up efforts Organize National colloquium on Infant Feeding and HIV to better understand guidelines and prepare a road map for implementation; UNICEF WHO could step up efforts Revisit AFASS, UN Guidelines and UN Framework ensure clarity. Revisit AFASS, UN Guidelines and UN Framework ensure clarity.