1. What Will It Take To End Pediatric AIDS
What Will It Take To End Pediatric AIDS? Lessons from the Emergency Plan
Dr. Nadia A. Sam-Agudu
Senior Technical Advisor, Pediatric and Adolescent HIV
Institute of Human Virology Nigeria, Abuja.
Assistant Professor of Pediatrics,
Institute of Human Virology,
University of Maryland School of Medicine, Baltimore.

2. Conflict of Interest
I have no conflicts of interest to declare.

3. Presentation Outline “State of the PMTCT”
The PMTCT Toolkit for Success
The Global Plan: Successes and Challenges
Next Steps Towards Ending Pediatric AIDS

4. 1. Lifelong ART for HIV-infected women in need of treatment
2. Short-term maternal ARV prophylaxis to prevent MTCT during pregnancy
Maternal postpartum ART
Infant postpartum ARVs
Nathan Shaffer, WHO; Lynne Mofenson, EGPAF
Kesho Bora Study Group, Lancet “Triple antiretroviral prophylaxis during pregnancy and breastfeeding is safe and reduces the risk of HIV
transmission to infants.”

5. Access to PMTCT antiretroviral drugs (ARVs) among pregnant women has increased globally
Percentage of pregnant women living with HIV receiving most effective antiretroviral medicines for PMTCT

6. 21 sub-Saharan African Global Plan countries, 2000-2015
Percentage of pregnant women living with HIV receiving most effective antiretroviral medicines for PMTCT
New HIV infections among children
(0-14y)
Global Plan

7. Key Toolkit Items for PMTCT
Policy: Expanded ART eligibility and duration
Drugs: Supply of, and access to potent regimens
Testing: Increased access, coverage for rapid tests
HRH, Service delivery: decentralized delivery of services and consistent access to interventions
Enhanced Monitoring and Evaluation systems: track progress and quality
Community Engagement: maximize advocacy and participation
IATT, UNICEF, WHO Toolkit, March 2013

8. The Global Plan:
The Global Plan Towards the Elimination of New HIV Infections among Children and Keeping Their Mothers Alive
Prioritized 22 countries for eMTCT
Main objectives:
Reduce new child HIV infections by 90%
ART to ≥90% of pregnant women living with HIV
Reduce mother-to-child HIV transmission rate
<5% among breastfeeding infants
<2% among non-breastfeeding infants
UNAIDS 2011, 2016

9. Global Plan Priority Countries: Successes and Challenges
UNAIDS 2016

10. Virtual eMTCT and syphilis: Validated Successes
Belarus
Moldova
Armenia
Cuba
Thailand

11. What is the “Secret”? Strong policy backed by sustained political will
Strong/strengthened health systems
Functional Monitoring and Evaluation
Operational research
Adequate and sustained financing
Advocacy & community participation

12. Global Plan Country Challenges: Pediatric AIDS “Hotspots”
UNAIDS 2016

13. Global Plan Country Challenges: Pediatric AIDS “Hotspots”
Inequitable funding for the HIV response
Weaker health systems
Conflict, instability, competing interests
Relatively lower HIV prevalence
More resources needed to find, test, treat
? Sense of urgency

14. Points to Consider “Hardware” “Software”: behavioral drivers
Drug regimens, test kits, funding, staff
“Software”: behavioral drivers
Issues 1: stigma, discrimination, denial, lack of education
Issues 2: HCWs, policy-makers, MOH
Impactful behavioral interventions
Sustained uptake and desired outcomes
In combination with hardware

15. Malawi, Option B+
21 sites, 1,269 women
SOC v Facility v Community PS
24 month retention: 66 v 80 v 83%
Nigeria, Option B
20 sites, 497 women
Unstructured v structured PS
6 month retention: 25 v 62%
Zimbabwe, Option B+
30 sites, 350 women
SOC v Facility-based mother support groups
12 month retention: Regular vs non-regular attendance 3x higher
JAIDS 2017; 75 INSPIRE Supplement

16. Next Steps: Post-Global Plan is Acceleration Plan
Politicians to champion political will
Increase allocation from domestic funding
Mobilize PLHIV in acceleration plan
Community education
Optimize software strategies
Target interventions to right places
Multicomponent interventions
Subnational level
Cohort-based data

17. https://data.unicef.org/topic/hivaids/emtct/

18. Acknowledgements International AIDS Society UNICEF- Geneva and Nigeria
Prof. Linda-Gail Bekker & Prof. Landon Myer
UNICEF- Geneva and Nigeria
Dr. Dorothy Mbori-Ngacha
UNAIDS, WHO Geneva & WHO AFRO
Dr. George Siberry, Office of the US Global AIDS Coordinator
IHV-Nigeria, Abuja and IHV Maryland, USA
PLHIV in Nigeria