1. 1 |1 | World Health Organization Western Pacific Region Regional Progress on Prevention of Mother-to-Child Transmission of HIV and Syphilis Ying-Ru Lo, MD, DTM&H World Health Organization Regional Office for the Western Pacific The 6 th National Scientific Conference on HIV/AIDS Hanoi, 24 November 2015

2. 2 |2 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Overview Progress on PMTCT of HIV Progress on PMTCT of syphilis Linking with hepatitis B control efforts Key operational issues and challenges Next steps

3. 3 |3 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Source: UNICEF analysis of UNAIDS 2014 HIV and AIDS estimates, July 2015. Current projections indicate we will not reach the Global Plan/UNGASS target of 40,000 new infections until 2030. 2000-2009 24% drop [14,000 per yr] 2009-2014 45% drop [36,000 per yr] New HIV infections Global New HIV infections 21 African Global Plan countries Annual number of new infections in children is falling rapidly

4. 4 |4 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Source: UNICEF analysis of UNAIDS 2014 HIV and AIDS estimates,. Rapid recent decline is due increased PMTCT coverage in Africa

5. 5 |5 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Source: UNICEF analysis of UNAIDS 2014 HIV and AIDS estimates,. 80% of 144 countries had adopted option B+ in national guidelines

6. 6 |6 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Source: How AIDS Changed Everything, MDG 6: 15 Years, 15 Lessons of Hope from the AIDS Response, UNAIDS 2015 <0.1% 0.1-<0.6% 0.6=1.1% HIV prevalence in adults (15+), Asia Pacific 2014 Low HIV prevalence rates in the general population but high and increasing HIV% among key populations

7. 7 |7 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS What is new in WHO 2015 guideline? Treat all (at any CD4) - people living with HIV across all ages The sickest remain a priority (symptomatic disease and CD4< 350) New age band for adolescents (age 10-19) Option B not taken forward; Option B+ as the new standard PrEP recommended as an additional prevention choice for all people at substantial risk of HIV infection (> 3% incidence)

8. 8 |8 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Source: WHO analysis slide courtesy of Andrew Hill 7.4 million PLHIV 105,500 infections in children 17.1 million PLHIV 107,000 infections in children Big difference in MTCT in low and high prevalence African countries Same phenomenon can be seen other regions

9. 9 |9 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Asia Pacific regional update Reduce new pediatric infections by 90% (from 2009 baseline) Reduce PTCT of HIV to <5% (from 2009 baseline) Reduce incidence of congenital syphilis to <0.5 cases/1,000 live births 9

10. 10 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Steady decline of new HIV infections in children, Asia Pacific 2000-2014 10 Source: How AIDS Changed Everything, MDG 6: 15 Years, 15 Lessons of Hope from the AIDS Response, UNAIDS 2015; UNICEF unpublished data Actual reduction: 27% since 2000 16% since 2009 Regional target for 2015 Regional target: 90% reduction from 2009 Number of new pediatric HIV infections

11. 11 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS New maternal HIV infections are levelling off in Asia Pacific, 2000-2014 11 Source: How AIDS Changed Everything, MDG 6: 15 Years, 15 Lessons of Hope from the AIDS Response, UNAIDS 2015; UNICEF unpublished data

12. 12 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS HIV testing coverage in pregnant women varies 12 Source: provided by UNICEF HQ, extracted by WHO from GARPR and UNAIDS Spectrum estimates, 2011 and 2014 data

13. 13 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Trend: PPTCT cascade of services - Progress from 2011 to 2014 in Asia Pacific 13 Source: Data provided by www.aidsdatahub.org based on UNAIDS “How AIDS Changed Everything. MDG 6: 15 Years and 15 Lessons of Hope from the AIDS Response”, Geneva 2015, and 2011 historical datawww.aidsdatahub.org Testing gap - only 42% identified in 2014 Gap is closing in treatment from 44% in 2011 to 88% in 2014

14. 14 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Early Infant Diagnosis: global & regional trends 2009 - 2014 14 Source: UNICEF Data: Monitoring the Situation of Children and Women, unpublished data for 2014; UNAIDS Spectrum Estimates, 2014

15. 15 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Pediatric ARV coverage remains low 15 Source: UNICEF Data: Monitoring the Situation of Children and Women, unpublished data for 2014; UNAIDS Spectrum Estimates, 2014

16. 16 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Overview Global progress on PMTCT of HIV Regional progress on PMTCT of HIV Progress on PMTCT of syphilis Linking with hepatitis B control efforts Key operational issues and challenges Next steps

17. 17 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Syphilis infects 1% or more of ANC attendees in 1 in 3 countries

18. 18 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Global reductions in maternal syphilis (2008 vs 2012) 18 Wijesooriya NS, Rochat RW, Kamb ML, Turlapati, Temmerman M, Broutet N, Newman LM, Unpublished data

19. 19 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Maternal syphilis in Asia is decreasing Estimated number of maternal syphilis infections and any associated adverse pregnancy outcome by World Health Organization region for 2008 and 2012 Wijesooriya N.S. et al, Lancet in print

20. 20 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Comparison of HIV testing & syphilis testing at ANC 20 Source: UNAIDS GARPR Online Reporting Tool, WHO Global Health Observatory unpublished 2014 data Data Countries with PICT recommended policy for both, 2014

21. 21 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Overview Global progress on PMTCT of HIV Regional progress on PMTCT of HIV Progress on PMTCT of syphilis Linking with hepatitis B control efforts Key operational issues and challenges Next steps

22. 22 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Highest hepatitis B burden, Asia Pacific Around 2 billion people infected globally 1 258 million chronic infections 2 686,000 annual deaths 1 Neonatal infection has highest risk of mortality Global mortality from Hepatitis B by Region 1 GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Jan 10;385(9963):117-71 2 Schweitzer, A, et al. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015 July 28.

23. 23 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS An opportunity to link HIV, syphilis to successful hepatitis B immunization efforts Today, 20 countries have reached < 1% HBV in children five years of age in the Western Pacific Source: WHO Regional Office for the Western Pacific

24. 24 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Operational issues Increasing treatment coverage among pregnant women and children requires active case detection and management  Universal and targeted HIV testing in low and concentrated epidemics depends on resources (political decision to allocate resources)  Striving towards elimination would require universal testing  Linking HIV to universal syphilis and possibly hepatitis B testing Getting babies diagnosed and treated Continuity of care for life for mothers and children and measuring it

25. 25 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Next steps Elimination – the endgame Integration of PPTCT of HIV, syphilis and Hep B into maternal child health Public financing (e.g. Government funds, universal health coverage benefit package) for interventions for HIV and syphilis and Hep B (with accrued benefits for PPTCT)

26. 26 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Conclusions HIV prevalence among pregnant women remained very low during the past decade Moving towards elimination in concentrated epidemics will need political commitment and innovative approaches Coverage of HIV testing among pregnant women and their babies have increased significantly since 2000 During 2009-2015 new paediatric HIV infections decreased by 16% Need for innovative mechanisms to not miss out on this unique opportunities to eliminate HIV and syphilis Elimination of PMTCT is a major priority to ensure healthy lives of children and mothers

27. 27 | World Health Organization Western Pacific Region The 6 th National Scientific Conference on HIV/AIDS Acknowledgements Wing-Sie Chen, Shirley Mark Prabhu, UNICEF EAPRO Annefrida Kisesa, UNICEF Regional Office for South Asia Naoko Ishikawa, WHO Regional Office for the Western Pacific Razia Pendse, WHO Regional Office for South-East Asia Saba Moussavi, Consultant, UNICEF EAPRO Tammy Meyers, Consultant, UNICEF/WHO Masaya Kato, Van Thi Thuy Nguyen, WHO Viet Nam Shaffiq Essajee, WHO HQ Melanie Taylor, Lori Newman, U.S. CDC