1. Washington D.C., USA, 22-27 July 2012www.aids2012.org IS HIV MOTHER TO CHILD TRANSMISSION AND CONGENITAL SYPHILIS ELIMINATION BY 2015 A REALITY IN THE ENGLISH CARIBBEAN ? Y. GEBRE, N.JACK, S.CAFFE, A. DEL RIEGO, P. EDWARDS PAN AMERICAN HEALTH ORGANIZATION

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org Elimination Initiative Goal and Impact Indicators in the Caribbean “Elimination of vertical transmission of HIV and Syphilis in all countries and territories in the Caribbean by the year 2015” Percentage of infants born to HIV infected mothers who are infected is ≤ 2% or less Incidence of MTCT of HIV is ≤ 0.3 cases per 1000 live births Incidence of congenital syphilis is ≤ 0.5 cases per 1000 live births

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org Elimination Criteria Interruption of transmission through timely identification and appropriate treatment of pregnant women infected with HIV or syphilis, their male partners, and their infants. Reduction of the number of HIV and syphilis infections among pregnant women.

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org Tools of the Elimination Initiative CLINICAL GUIDELINES M&E REGIONAL STRATEGY CONCEPT DRAFT Field Guideline for the Implementation of the EI Baseline Protocol DRAFT Costing Tool DRAFT Laboratory Requirements IN PROGRESS Validation Tool

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org Study objectives To assess the effectiveness and impact of the national programmes towards elimination of MTCT HIV and congenital syphilis. To assess the national coverage of PMTCT interventions in the country.

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org STUDY METHODS Sub regional analysis of the health systems HIV response and progress to the elimination initiative (EI) was conducted for selected countries in the English Caribbean. Data on the monitoring events ( 7 output, 5 outcome & 3 impact indicators) for the EI were collected. 2009-2010 data on the HIV health sector progress towards universal access were analysed.

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org Ta Country Number of pregnant women attending ANC at least once during the reporting period Number of HIV positive pregnant women giving birth Antigua & Ba Bahamas Belize Barbados Guyana Jamaica St. Vincent St. Lucia Suriname Trinidad and Tob. 974 3850 7258 1864 13215 25265 2155 682 8128 19506 82,897 5 77 65 4 191 331 18 5 100 248 1044

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org EMTCT Indicators

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org Fig 1. Percentage of pregnant women who were tested for HIV and received their results – and percentage of HIV Prevalence by country, 2010

12. Washington D.C., USA, 22-27 July 2012www.aids2012.org Fig 2. Percentage of Pregnant women tested for syphilis among those receiving ANC and prevalence of gestational syphilis by country, 2010

13. Washington D.C., USA, 22-27 July 2012www.aids2012.org Fig 3. Percentage (%) of child infections from HIV- infected women and percentage of infants receiving virological test with in 2 months in the Caribbean, 2010

14. Washington D.C., USA, 22-27 July 2012www.aids2012.org Number of infants born to HIV-infected women assessed for and whose infant feeding practices were recorded at DTP3 visit, by country, 2010 Table 2. Number of infants born to HIV-infected women assessed for and whose infant feeding practices were recorded at DTP3 visit, by country, 2010

15. Washington D.C., USA, 22-27 July 2012www.aids2012.org Fig 4. Percentage of infants born to HIV-infected women (HIV-exposed infants) who received ARV and percentage of HIV MTCT rate by country, 2010 95

16. Washington D.C., USA, 22-27 July 2012www.aids2012.org Fig 5. Percentages of HIV-infected pregnant women assessed for ART eligibility; positive for syphilis and HIV who received treatments by country, 2010-2011 95

17. Washington D.C., USA, 22-27 July 2012www.aids2012.org Impact Indicators Summary Countries with Percentage of infants born to HIV infected mothers who are infected is ≤ 2% or less Incidence of MTCT of HIV is ≤ 0.3 cases per 1000 live births Incidence of congenital syphilis is ≤ 0.5 cases per 1000 live births 1.Antigua & Barbuda 2.Barbados 1.Antigua and Barbuda 1.Jamaica, 2.Bahamas 3.Trinidad & Tobago

18. Washington D.C., USA, 22-27 July 2012www.aids2012.org Conclusion With increase quality service coverage and strengthened commitment, it now seems feasible by 2015 to eliminate new HIV infections and CS among children in some countries of the Caribbean. Challenges include the continued access of ARVs, other essential supplies and human resources and lack of quality surveillance data and clear case definition for CS.

19. Washington D.C., USA, 22-27 July 2012www.aids2012.org The EMTCT cascade PREVENTION Prevent new infection in women and partners. Reduce unintended pregnancy. TREATMENT Timely Treatment of infected Pregnant women and partners. >95% ELIMINATION Infection In infants <2% Incidence & Prevalence Incidence P revalence M&E VALIDATION 2009 2010 2015 Beyond 2015

20. Washington D.C., USA, 22-27 July 2012www.aids2012.org Acknowledgements The National AIDS Programmes (Caribbean) The Caribbean EI working group PAHO HIV Caribbean Office Monica Alonso, PAHO/WHO HIV/FCH EC/OCT HIV project-PHCO The Chief Medical Officers -MoHs