1 |1 | world health organization western pacific region regional progress on prevention of...

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 PacificThe 6th National Scientific Conference on HIV/AIDS

Hanoi, 24 November 2015

2 |



The 6th National Scientific Conference on HIV/AIDS

OverviewProgress on PMTCT of HIV

Progress on PMTCT of syphilis

Linking with hepatitis B control efforts

Key operational issues and challenges

Next steps

3 |




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.

2000-200924% drop

[14,000 per yr]

2009-201445% drop

[36,000 per yr]

New HIV infections GlobalNew HIV infections 21 African Global Plan countries

Annual number of new infections in children is falling rapidly

4 |




Source: UNICEF analysis of UNAIDS 2014 HIV and AIDS estimates,.

Rapid recent decline is due increased PMTCT coverage in Africa

5 |




Source: UNICEF analysis of UNAIDS 2014 HIV and AIDS estimates,.

80% of 144 countries had adopted option B+ in national guidelines

6 |



The 6th National Scientific Conference on HIV/AIDSSource: 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 |




What is new in WHO 2015 guideline? Treat all (at any CD4) - people living with

HIV across all agesThe 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 standardPrEP recommended as an additional

prevention choice for all people at substantial risk of HIV infection (> 3% incidence)

8 |




Source: WHO analysis slide courtesy of Andrew Hill

7.4 million PLHIV 105,500 infections in children

17.1 million PLHIV107,000 infections in children

Big difference in MTCT in low and high prevalence African countries

Same phenomenon can be seen other regions

9 |




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 |




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 200016% since 2009

Regional target for 2015

Regional target: 90% reduction from 2009

Num

ber o

f new

ped

iatr

ic H

IV in

fect

ions

11 |




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 |




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 |




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 data

Testing gap -only 42%

identified in 2014 Gap is closing in treatment

from 44% in 2011 to 88% in 2014

http://www.aidsdatahub.org/

14 |




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 |




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 |




OverviewGlobal progress on PMTCT of HIV

Regional progress on PMTCT of HIV




Next steps

17 |




Syphilis infects 1% or more of ANC attendees in 1 in 3 countries

18 |




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 |




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 |




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 |




OverviewGlobal progress on PMTCT of HIV

Regional progress on PMTCT of HIV




Next steps

22 |




Highest hepatitis B burden, Asia Pacific

Around 2 billion people infected globally1

258 million chronic infections2

686,000 annual deaths1

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):117-712 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. <doi:10.1016/S0140-6736(15)61412-X>

23 |




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 |




Operational issuesIncreasing 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 treatedContinuity of care for life for mothers and children and

measuring it

25 |




Next stepsElimination – the endgameIntegration 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 |




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 |




AcknowledgementsWing-Sie Chen, Shirley Mark Prabhu, UNICEF EAPROAnnefrida Kisesa, UNICEF Regional Office for South AsiaNaoko Ishikawa, WHO Regional Office for the Western

PacificRazia Pendse, WHO Regional Office for South-East AsiaSaba Moussavi, Consultant, UNICEF EAPROTammy Meyers, Consultant, UNICEF/WHOMasaya Kato, Van Thi Thuy Nguyen, WHO Viet NamShaffiq Essajee, WHO HQMelanie Taylor, Lori Newman, U.S. CDC

1 |1 | world health organization western pacific region regional progress on prevention of...

Documents