CD4 assessment among newly diagnosed HIV-infected pregnant women in India’s National Prevention of Parent to Child Transmission Programme (PPTCT)

Implications for a ‘Test and Treat’ Approach

1Reproductive and Child Health Division, Ministry of Health and Family Welfare, New Delhi, India

2National AIDS Control Organisation, Ministry of Health and Family Welfare, New Delhi, India

3HIV/AIDS Division, San Francisco General Hospital, UCSF, San Francisco, USA

1. S. K. Mohammed1

2. R.S. Gupta2

3. R. Rao2

4. V. Joseph2

5. P. Srikantiah3

Importance of CD4 assessment in HIV-infected pregnant women

WHO 2010 Guidelines

Strongly recommend initiation of lifelong ART for all HIV+ pregnant women with CD4 ≤350 cells/mm3

Highlight importance of prompt CD4 assessment and linkage to

treatment for HIV-infected pregnant women

Globally, estimated that 20-60% of HIV+

pregnant women require lifelong ART

Data from large national programme settings in low and middle income

countries are limited

HIV among pregnant women in India

Estimated 2.4 million people live with HIV in India • ANC prevalence 0.42%

India ranks as one of the 10 “highest burden” countries for MTCT • 27 million pregnancies/year• Estimated 43,000 HIV+ pregnant

women per year• MTCT accounts for 5.2% of new HIV

infections

PPTCT Programme in India

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

Year

Pregnant Women Who Receive Antenatal HIV Testing, 2001-2011

Num

ber P

regn

ant W

omen

Test

ed

PPTCT Guidelines - India, 2010

CD4 < 350 CD4 > 350

Specimen transport for

those who cannot travel

HIV+ pregnant woman detected

Referred for HIV clinical assessment and CD4 testing at

nearest ART centre

Lifelong ART sd-NVP

Objectives of the Study

Evaluate CD4 testing practices and results among newly diagnosed HIV+ pregnant women identified through the national programme in 2009 and 2010

Examine strength of linkages between PPTCT and HIV treatment services

Use data to guide programme policy regarding the selection of a revised national PPTCT ARV regimen in India

Methods

Antenatal HIV testing data were routinely collected from HIV Integrated Counselling and Testing Centres (ICTCs)

ICTC and ART centre records abstracted to evaluate: • Proportion of HIV-infected pregnant women who received CD4

testing• Proportion with CD4 count <350 cells/mm3,• Number of women initiated on lifelong ART

ResultsIndicator 2009 2010Number of HIV testing sites 6,297 7,548

Pregnant women screened for HIV 5,807,778 6,877,617

HIV+ pregnant women detected (%) 18,692 (0.32%) 16,024 (0.24%)

Pregnant HIV+ women received CD4 assessment (%)

10,192 (54.5%) 9,917 (61.2%)

HIV+ pregnant women with CD4 < 350 cells/mm3 ( %)

3,082 (30.2%) 3,934 (39.7%)

Number HIV+ pregnant women started lifelong ART

2,154 2,292

Conclusions

Among those tested, close to 40% of pregnant women diagnosed HIV+ve require ART for their own health

This underscores importance of ANC settings as key entry point for HIV care/treatment for women

Highlights importance of pursuing universal antenatal HIV testing even in concentrated epidemic setting

Universal testing is officially endorsed by Indian National Programme since August 2010

Conclusions & Policy Implications

Almost 40% of detected HIV+ pregnant women did not receive CD4 assessment or linkage to treatment

In light of this data, the national programme selected a single maternal triple ARV prophylaxis regimen (Option B) :

• To be used in all detected HIV+ pregnant women, irrespective of CD4 count

• Can be started before CD4 results known• A “Test and Treat” Approach• Prevent delays in ART initiation• Help reduce loss to follow up

Conclusions & Policy Implications

Continued expansion of prompt CD4 assessment still remains a priority• CD4 results will be used to decide

duration of triple ARVs (lifetime vs. through breastfeeding period)

India has committed to working towards elimination of new pediatric HIV infections • Implementation of universal

antenatal HIV screening that is integrated with MCH services

• Strengthening CD4 assessment and linkages between ANC and ART services

Thank You