Global Plan towards the elimination of new HIV infections among children by 2015 and

keeping their mothers alive

DR. Nicholas MuraguriOGW, MD,MPH, MBA, PhD (c)

Director,

Global Plan Secretariat

www.zero-hiv.org

Global Plan launched at UN High Level Meeting on AIDS in July 2011 as part of Political Declaration on AIDS

Global Task Team co-chaired by Michel Sidibé and Ambassador Eric Goosby

Membership of 40 countries, 30 civil society and private sector organizations, and 15 international and regional bodies/organizations

The Creation of the Global Plan

There are 22 priority countries for the Global Plan

1. Angola

2. Botswana

3. Burundi

4. Cameroon

5. Chad

6. Côte d’Ivoire

7. DR Congo

8. Ethiopia

9. Ghana

10. India

11. Kenya

FRAME IT

12. Lesotho

13. Malawi

14. Mozambique

15. Namibia

16. Nigeria

17. South Africa

18. Swaziland

19. Tanzania

20. Uganda

21. Zambia

22. Zimbabwe

89%of all HIV-positive pregnant women in low- and middle-income countries in 2011

These countries accounted for

The gap in treatment and prophylaxis coverage is uneven among low- and middle-income countries

Source: UNAIDS 2012

Nigeria29%

Mozambique, 7%

Uganda, 8%

India, 6%Ethiopia, 5%

Dem. Rep. of Congo, 5%

Zimbabwe, 5%

Malawi, 5%

Kenya, 5%

Tanzania, 4%

Cameroon, 2%Chad, 2%

Zambia, 2%

Lesotho, Côte d'Ivoire, Angola, Chad, Botswana,

Swaziland, Ghana, Rwanda, Namibia,

Brazil, South Sudan, South Africa, 3%

Other low- and middle-income countries, 13%

The share of each low- and middle-income country in the total shortfall in providing antiretroviral medication to HIV-positive pregnant women to prevent new HIV infections among children.

FRAME IT

Reduce the number of new HIV infections among children by 90% from a baseline of 2009

2- Specific targets for 2015

maternaldeaths

50%reduction inAIDS-related90

%

A four-pronged approach is requiredto prevent new HIV infections among children and keep mothers alive

1. Prevent HIV among womenof reproductive age

2. Prevent unintended pregnancies among women living with HIV

3. Prevent HIV transmission through antiretroviral treatment during pregnancy and breastfeeding

4. Treatment, care and support for mothers living with HIV, their children, partners and families

DO IT

Progress Toward Global Plan Targets

Source: Towards Universal Access, 2011; Global Report, UNAIDS, 2012

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline

28%

34%

16%

1%

Baseline

26%21%

61%

48%

21%

28%

90%

5%

90% 90%

50%

100%

2009 Baseline

2011

2015 Target

Number of new child infections, 21 priority countries

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

0

100,000

200,000

300,000

400,000

500,000

600,000

Source: UNAIDS Estimates 2012

New HIV infections among children, 2009–2011

Note: The baseline year for the Global Plan is 2009. Some countries had already made important progress in reducing the number of new HIV infections among children in the years before 2009, notablyBotswana which by 2009 already had 92% coverage of antiretroviral regimens among pregnant women and a transmission rate of 5% (see table pp122–123). In countries with high coverage, furtherdeclines are much harder to achieve.

Will reach the target if the2009–2011 decline of more than30% continues through 2015.

Can reach the target if thedecline in 2009–2011 of20–30% is accelerated.

In danger of not reaching thetarget, with a decline in 2009–2011 of less than 20%.

Source: UNAIDS Estimates 2012

Slight decline in new HIV infections among women 15-49, 21 priority countries

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

200000

400000

600000

800000

1000000

1200000

Source: UNAIDS Estimates 2012

Reduction in unmet need for family planning is slow, countries with available data

Zimbab

we 2005-10

Nigeria

2003-08

Namibia

2000-06

Leso

tho 2004-09

Tanzan

ia 2004-10

Kenya

2003-08

Malawi 2

005-2010

Ethiopia

2005-11

Zambia

2002-07

Uganda 2

006-11

Ghana 2

003-080

5

10

15

20

25

30

35

40

Survey 1Survey 2

Perc

ent

Source: Demographic and Health Surveys 2000-2011

… As a results the number of women in need of PMTCT services remains flat

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

Source: UNAIDS Estimates 2012

New child HIV infections and PMTCT coverage, 21 priority countries

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 -

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

-

10

20

30

40

50

60

70

80

90

100

14 23

33 43 48 50

61

470,000 450,000

420,000 400,000

370,000

320,000

280,000

37,000

Num

ber o

f new

chi

ld in

fecti

ons

Cove

rage

Percent of HIV+ pregnant women receiving any ARV medicines (including SdNVP)

Percent of HIV+ pregnant women receiving effective ARV medicines (excluding SdNVP)

Before the Global Plan

Source: UNAIDS Estimates 2012

PMTCT coverage, 21 priority countries

High coverage66+ %

BotswanaCôte d’IvoireGhanaKenya NamibiaSwazilandSouth AfricaTanzania Zambia

Medium coverage 33-65%

BurundiCameroonLesothoMalawiMozambiqueUgandaZimbabwe

Low coverage <33%

AngolaChadDR CongoEthiopiaNigeria

Source: UNAIDS Estimates 2012

Prophylaxis coverage: the other half of the picture

During pregnancy During breastfeeding0

200000

400000

600000

800000

1000000

1200000

1400000

Nonesd NVPDualOption A/BART

Number of women/infant pairs receiving prophylaxis, 2011, 21 priority countries

Source: UNAIDS Estimates 2012

As a result … MTCT transmission rates are still high

BotswanaNamibiaZambia

SwazilandSouth Africa

KenyaUganda

ZimbabweUnited Republic of Tanzania

BurundiLesotho

CameroonMalawiGhana

Cote dIvoireMozambique

EthiopiaNigeria

ChadAngola

Dem Rep of Congo

0% 5% 10% 15% 20% 25% 30% 35% 40%

MTCT rate (percent)

Source: UNAIDS Estimates 2012

Looking to the (near) Future: B+Evidence Needs for WHO 2013 GuidelinesEvidence and Lessons for Other Countries

• Acceptability to women• Adherence and retention• Linkages with ART• Implementability• Impact --

– Mother’s health– Vertical transmission– Prevention of sexual transmission

Prong 4: Care and treatment for the family

Early Infant diagnosis is still unacceptably low: 35% in 21 countries

High coverage66+ %

KenyaLesothoSouth Africa

Medium coverage 33-65%

Botswana Côte d'IvoireNamibiaSwaziland

Low coverage <33%

Angola BurundiDR CongoEthiopiaGhanaMozambiqueNigeriaTanzaniaUgandaZambiaZimbabwe

Source: Global AIDS Progress Reporting 2012

Maternal survival is important for child growth and development.

Increasing ART results in substantial declines in pregnancy-related deaths

IndiaChad

DR Congo

Ethiopia

Angola

Burundi

Ghana

Nigeria

Camero

on

Côte d'Ivoire

Tanzan

iaKenya

Uganda

Mozam

bique

Mala

wi

Zambia

Zimbab

we

Leso

tho

Botswan

a

Namibia

South

Africa

Swazi

land

01020304050607080

Percent change in pregnancy-related deaths to women living with HIV between 2005 and 2010

Source: WHO, 2012. Trends in Maternal Mortality 1990-2010

TOGETHER WE WILL END AIDS

Actions needed to reach zero

• Strengthen efforts to reduce unmet need for family planning

• Limited data on unmet need among women living with HIV

• Increase coverage of prophylaxis during breastfeeding

• Ensure eligible children receive ART• Increasing early infant diagnosis from 35% to

higher levels will improve ART uptake

• Integrating PMTCT into maternal and child health services.

Thank you