PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV

WHAT’S NEWPrepared by Dr. Debbie Carrington

National HIV/AIDS Prevention & Control ProgrammeMinistry of Health, Jamaica

November 2007

• Population of Jamaica 2.6 M• Sero-prevalence among adults 1.5%• Estimated No. with HIV/AIDS 25,000• Est. No. unaware of HIV status 15,000• No. of persons in need of ARV 6,000• No. of persons currently on ARV 3,651

HIV/AIDS IN JAMAICA

0

200

400

600

800

1000

1200

1400

1600

Nu

mb

er o

f C

ases Cases

Deaths

Cases 1 1 0 3 7 35 36 65 70 143 135 219 335 511 491 609 643 892 903 939 989 1070 1112 1344 1186

Deaths 0 1 1 0 9 18 21 40 37 105 108 146 200 269 243 393 375 549 617 588 692 650 665 514 432

82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005 2006

AIDS Cases & Deaths

Reported Annually in Jamaica (1982 to 2006)

Annual AIDS Case Rates by Sex Reported

in Jamaica: 1982 - 2005

0

10

20

30

40

50

60

Rat

e pe

r 100

,000

pop

.

MaleFemale

Male 0.09 0.09 0 0.26 0.6 1.69 2.2 3.85 3.8 6.39 7.7 11.01 16.13 25.69 24.23 29.06 31.87 41.68 41.74 39.55 44.5 46.93 46.32 53.25

Female 0 0 0 0 0 1.28 0.85 1.6 1.99 5.35 3.26 6.62 10.95 15.16 14.6 18.61 18.21 27.45 31.63 32.97 31.32 34.26 37.99 48.22

82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005

0

200

400

600

800

1000

1200

1400

Age Group

Rat

e p

er 1

00,0

00 p

op.

MaleFemale

Male 273.8 100.4 16.4 453.7 1192.1 1077 854.6 277.2

Female 248.1 98.6 45.6 517.9 806.9 573.4 403.9 146.3

0 - 4 5 - 9 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 +

AIDS Case Rates in Jamaica by Age and Sex (per 100,000 population) 1982 - 2006

AIDS definition includes advanced HIV disease in 2005 and 2006

0

5

10

15

20

25

Year

Rat

e pe

r 1,

000

Antenatal 1.41 1.04 2.8 4.38 1.39 6.33 5.41 19.67 9.77 15.43 16.1 12.21 12.24 14.33 16.65 12.5 15.1

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

HIV Seroprevalence AmongAntenatal Clinic Attendees in Jamaica: 1989 -

2005

0

10

20

30

40

50

60

70

80

90

Num

ber

of C

ases

CasesDeaths

Cases 1 1 4 10 7 9 12 12 30 27 49 44 55 70 83 66 81 67 61 78 73

Deaths 1 0 1 7 6 7 7 5 23 21 17 25 35 36 34 27 45 29 34 19 13

86 87 88 89 90 91 92 93 94 95 96 97 98 992000

2001

2002

2003

2004

2005

2006

Paediatric AIDS Cases & Deaths

(1986 - 2006)

Reference: Ministry of Health, National HIV/STI Prevention and Control Program,Facts and Figures, HIV/ AIDS Epidemic Update, January to December 2006

Website www.jamaica-nap.org

Paediatric AIDS Cases per 100,000 population (1986 – 2006)

292.4112.3

119.6

123.0

275.4127.1

PMTCT in Jamaica

Protocol• Routine HIV and Syphilis Screening of all

pregnant women.• CD4 tests for all HIV positive women.• Mothers: CD4<250: AZT+3TC plus NVP CD4 >250: AZT + 3TC plus LPV/r• Infants: Single dose NVP plus AZT for four

weeks.• Replacement formula provided for at least

the first six months of life. 

Percentage of ANC clients tested for HIV 2003 - 2006ANC 2003

(1st Year)

2004 2005 2006

No. of HIV tests

11,898 28,113 28,651 28,446

No. of 1st time visits

30,524 28,750 29,741 29,943

Percentage

38.9 97.7 96.3 95.0

pMTCT indicators 2003 to 2007

0

20

40

60

80

100

120

2003 2004 2005 2006 2007

Year

Perc

ent

% of ANC clients thattest for HIV

% of HIV-infectedwomen receiving pMTCT

% HIV exposed infantsreceivimg ARVs

Prevention of MTCT 2005 and 2006

2005 2006

No. ANC attendees tested 28,651 28,446

No. ANC attendees HIV +ve 326 470

No. of HIV +ve women given ARV 300 371

No. of HIV +ve women delivered 401 442

Percentage of women getting pMTCT 74% 84%

No. of HIV exposed infants 407 433

No. HIV exposed infants getting ARV 353 (87%) 403(93%)

Percentage of HIV infected infants born to HIV infected women

8-10%

(estimated)

?

PMTCT in JamaicaGoal: To reduce perinatal transmission of HIV to

below 5% through provision of universal access to quality PMTCT care and support services.

Objectives:• To test 100% of all antenatal clients for HIV• To ensure that all HIV positive pregnant women

receive antiretroviral therapy to reduce the risk of HIV transmission to their unborn child.

• To ensure that all infants born to HIV positive women receive a prophylactic course of antiretroviral medication.

• To ensure the availability of formula feed for all HIV-exposed infants for at least the first six months of life.

Benefits of Early Diagnosis of Infants by PCR Testing

• Efficiently monitor PMTCT program

• Facilitates medical Rx, improve outcome

• PCP prophylaxis

• ARV

• Mental benefit (especially for uninfected results)

• Family can make proper plan for the child and caretakers

PMTCT in Jamaica

Threats to the programme:• Prevalence of stigma and discrimination leading

to reluctance among HIV+ women to disclose their status at the point of delivery and limiting the ability of health care workers to administer appropriate prophylaxis to prevent MTCT.

• Cultural practices eg. Early first sex, young girls and older men, low condom use, perpetuation of myths

• Gender inequity• Social vulnerability.

PMTCT in Jamaica

Lessons Learned.• Universal HIV testing of antenatal mothers is a

must. Innovative ways of ensuring this must be found in resource limited settings, for example mobile phlebotomy teams where there are no lab services.

• Decentralization of services and increased accessibility greatly increases adherence to care.

• Centres that had dedicated staff had better client follow-up and outcomes.

• Clients require continued support especially in adherence to selected infant feeding method.

• Buy-in of implementers essential to success of the programme.