1. Pediatrics HIV/AIDS and PMTCT research in Barbados: lessons learned for monitoring the epidemic and evaluating the interventions.
ALOK KUMAR, MD.
Lecturer in Child Health
School of Clinical Medicine & Research,
UWI(Cave Hill)
Departments of Pediatrics,
The Queen Elizabeth Hospital,
BARBADOS

2. Background
Barbados is among the few developing countries, where PMTCT of HIV has received high priority.
Program for the surveillance of the MTCT has been in operation since early nineties has facilitated vast amount of research in this field.

3. Background
Surveillance of MTCT is useful for assessing the trends in HIV epidemics and effectiveness of the prevention programs.
It is also useful in studying the trend in the over all HIV epidemics in the population.

4. Objectives
Surveillance of MTCT is useful for assessing the trends in HIV epidemics and effectiveness of the prevention programs.
It is also useful in studying the trend in the over all HIV epidemics in the population.

5. Design and Methods focuses on the period from 2003 - 2006.
limited to the research in the field of PMTCT of HIV & Pediatrics HIV/AIDS
Need for future research and its directions were based on the ongoing program requirements and findings from the past research.

6. Design and Methods Studies covered in this presentation are those that
Studies covered in this presentation are those that
have been presented at various regional and international conferences or
have been published in international journal.

8. Design and Methods
surveyed all the women who gave birth at the QEH between April and September 2002 for the antenatal VCT service.
Data was collected from the antenatal records and a 5 min structured interview with these women during routine postnatal counseling session on day 2 of delivery.

9. Figure1. Pattern of HIV counseling and testing offered to the 1342 women who delivered in
Barbados during the study period, based on the documentation in their antenatal notes.

10. Conclusions Majority of the pregnant women get tested for HIV.
However, only in two thirds of these women HIV results are known at the time of delivery.
Most women counseled for HIV, accept the screening test.
Some women receive HIV testing without pretest.

12. Design and Methods A population based descriptive study.
Data for this report was collected prospectively.
This report is based on observation during
Kumar et al 2005

15. Conclusions
implementing programs for universal access to VCT and provision for antiretroviral prophylaxis is associated with high uptake of HIV screening.
decrease in the over all prevalence of HIV infection among pregnant women in Barbados is encouraging.

17. Methods
Includes all HIV infected women in Barbados, who delivered during 1996 through 2003.
Disclosure data was collected by one to one interview.
Data on health care uptake and sexual behavior were collected prospectively from ANC record and records at LRU.

18. Results A total of 139 (98%) HIV infected women were studied.
29% had self disclosed their HIV status to others.
71% had not disclosed their HIV status.

19. Reason for nondisclosure
Fear of stigmatization
30 (30%)
Fear of abnormal reactions
23 (23%)
Lack of reasons for disclosure
16 (16%)
Others
9 (9%)
No answer
21 (21%)

21. Conclusions
A substantial proportion of HIV-infected pregnant women never disclosed HIV status to others.
Fear of stigmatization and abnormal reaction from their partner were reasons given by majority for nondisclosure.

22. From: Departments of Paediatrics’ and Pathology2, Queen Elizabeth Correspondence: Dr A Kumar,
Queen Elizabeth Hospital and School of Clinical Medicine and Research,
The University of the West Indies, Cave Hill,
Barbados. Fax: (246) ,
West Indian Med J 2005; 54 (3): 167

23. Methods
based on all the long term survivors from a prospective cohort of HIV infected children born to HIV positive women in Barbados, during the
Infants born to HIV infected women were enrolled into this cohort at birth or at the time of diagnosis of HIV in the postnatal period and followed up at regular interval.

24. Table1. Demographic data on the cohort of HIV infected children born
during the period.
Nos. (%)
HIV infected children born during 19 25 44
Males
12 (63.1)
13 (52.0)
25 (56.8)
Females
7 (36.9)
12 (48.0)
19 (43.2)
Time of diagnosis of HIV in the mother
Antepartum/Intrapartum
8 (36.8)
21 (84.0)
29 (65.9)
Postpartum during first 6 months of life
11 (63.2)
4 (16.0)
15 (34.1)
Survival pattern
Survival to age less than 8 years
11 (57.9)
16 (64.0)
27 (61.4)
Survival to age of 8 years or more
8 (42.1)
9 (36.0)
17 (38.6)
Survival status at the time of this report
Alive
7 (36.8)
16 (36.4)
Deceased
12 (63.2)
28 (63.6)
Age range of the live LTS children (in years)
Median age of the live LTS children (in years)
15.4
9.3
12.0

25. Figure1. Disease progression among the long term surviving HIV infected children
who were alive at the time of this report.

26. Conclusions
In a small cohort of HIV infected children, in the absence of antiretroviral therapy only a little over one third survived beyond eight years of age.
On further follow up of these long terms surviving children over one third had a slow rate of disease progression.

27. Alok Kumar*, Krishna R Kilaru, Anne O Carter*, Sheila Forde,
Uptake of health care provisions and health status of the HIV infected women diagnosed from the antenatal VCT in Barbados during
Alok Kumar*, Krishna R Kilaru, Anne O Carter*, Sheila Forde,
Ira Waterman.
School of Clinical Medicine & Research*, University of the West Indies (Cave Hill)
and
Ladymeade Reference Unit, Ministry of Health, Barbados.

28. Objectives
study the utilization of the HIV related health care services and
describe the health status
of the HIV infected women diagnosed form the antenatal VCT.

29. Methods A retrospective descriptive study.
Study population - all women diagnosed to be HIV infected from VCT during the
Subdivided into three subperiods
1996 – 98; free VCT
1999 – 01: special follow up clinic
2002 – 04: HAART

30. Follow up status of the 163 HIV infected women.
Nos. (%)
Attendance at the HIV clinic for care and treatment
(n = 163)
Ever attended
102 (62.6)
Never attended
61 (37.4)
Current status
Living
134 (87.7)
Deceased
24 (9.8)
Not known
5 (1.5)
Follow up status
(n = 102)
Satisfactory follow up (atleast once in six months)
79 (77.4)
Median lag between diagnosis and follow up
16 mon

31. Trends in uptake of health services and health status
N (%)
Number of women diagnosed as HIV infected
68 (41.7)
58 (35.6)
37 (22.7)
Status at the time of this report
Deceased
13 (19.1)
9 (15.5)
2 (5.4)
Alive
53 (77.9)
46 (79.3)
35 (94.6)
Not known
2 (3.0)
3 (5.2)
0 (0.0)
Follow up at LRU/RU
Never had any follow up
30 (44.1)
23 (39.6)
8 (24.3)
Ever had a follow up
38 (55.9)
35 (60.4)
29 (75.7)
Quality of follow up those ever had follow up
Good follow up (at least once every 6 months)
19 (50.0)
23 (65.7)
21 (75.0)
Poor follow up
12 (34.3)
8 (25.0)

32. Summary Poor return for follow up. Long lag period for follow up
Advance stage of disease at presentation
Median lag time and the proportion of women with low CD4 counts have both declined significantly in

33. Conclusions
Despite the provision for free HAART, poor return for follow up could be a pointer to the high degree stigma and discrimination.
HIV diagnosis is not enough to ensure that all women with HIV will get adequate and timely health care.
Repeated counseling stressing the importance of follow.

34. Thank you