Roll - out of AZT and Nevirapine in Operational Programs

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Roll - out of AZT and Nevirapine in
Operational Programs
Siripon Kanshana M.D.,M.P.H.
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The Treat 3 Million by 2005 Initiative
Goal
To make the greatest possible contribution to
prolonging the survival and restoring the quality
of life of individuals with HIVAIDS Access to
antiretroviral therapy for those in need of care
, as a human right and within the context of a
comprehensive response to HIVAIDS
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UNGASS Target (1)

• Reduce proportion of infants
• infected with HIV
• - 2005 by 20
• - 2010 by 50

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UNGASS Target (2)

• By
• ensuring that 80 of pregnant women
• accessing antenatal care have information
• counseling and HIV prevention services
  available
• increasing the availability of and by
  providing access
• for HIV-infected women and babies to
• - effective treatment to reduce MTCT
• - effective interventions include
• - VCT
• - ARV
  
• - breast milk substitute
• - provision of continuum
  care

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Strategies for prevention of MTCT
All women
Prevent HIV infection
Prevent unintended pregnancy
HIV infected women

Prevent HIV transmission to infants
HIV infected pregnant women
HIV infected pregnant women and family
Treatment and care
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Prevention of MTCT of HIV
HIV Infected pregnant women
Children
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The risks of transmission in infants at 6-8
weeks in several trials conducted in Africa
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AZT Trial
S-S
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PHPT 2
Mother Infant
NVP-NVP NVP-Plac. Plac.-Plac.
ZDV
2.0
2.8
ZDV
ZDV
6.3
NVP dosing Mother 200 mg po at onset of
labor Infant 6 mg po 48-72 hrs after
birth ZDV regimen Pregnancy 300mg bid from
28 wks gestation or as soon as possible
thereafter Labor 300mg po every 3 hours
Infant 2mg/kg for 1 wk(6 wks if lt4 wks in
mother)
No breastfeeding
Perinatal HIV Prevention Trial, Thailand
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How will countries meet the UNGASS and
WHO goal - in prevention of MTCT of HIV
- Continuous Care and Treatment of HIV Mother
and Family
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PMTCT Thailand Experience
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Selected Health Indicators, Thailand

• Maternal mortality ratio 35/100,000 live birth
• infant mortality rate 21 / 1,000 live
  births
• Access to safe water
• - urban 89
• - rural 77
• Adult literacy 94
• 4 ANC visit 83
• Initiating breastfeeding 87

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Nationally-Supported Mother-Child HIV Prevention
Program, Thailand, 2004

• VCT for all pregnant women
• AZT will be given to HIV infected pregnant women
  at 28 wks until delivery
• Single dose of Neverapine will be given for HIV
  infected pregnant women during lobor and to
  newborns after birth
• Infant formula for 12 mos to replace
  breastfeeding
• HIV test for infant at 12 mos. re-test at 18
  mos.
• Continuous care and ARV treatment after
  delivery for HIV infected mothers , partners
  and children

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Thailands National PMTCT Program2001-2003
Number of women who gave birth 1,744,095 --
with ANC 1,691,919 ( 97 ) -- with HIV
test result 1,669,273 (95.7 ) -- HIV
positive 19,234 (1.2) -- took AZT
14,599 (75.9)
Ministry of Public Health, Thailand
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Thailands National PMTCT Program2001-2003

Number of LBs born to HIV 18,888
-- took AZT syrup 17,904
(94.8) -- took formula at birth 15,765
(83.5)
Ministry of Public Health, Thailand
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Thailands National PMTCT ProgramNumber of
Infections Prevented,2001-2003

• Number of births to HIV-infected women
  18,888
• Number of infants infected
• With no intervention TR 30 5,666
• With MOPH program TR 8,75.9 HIV women
  participate 1,147

Estimated Infections Being Prevented 4,519
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National Sentinel Surveillance Pregnant Women at
First Antenatal Care, Thailand
HIV Prevalence ()
Year
Division of Epidemiology, MOPH
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Number of AIDS Cases of Children 0 - 4 years
from Vertical Transmission
Epidemiology Division, Oct 2003.
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Care for HIV infected mothers family
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6 weeks post partum
ve Husband
ve women
Test for CD 4 Count
CD4gt200 - ongoing counseling
(HP FP) - Prevention and Care
(National Guideline)
- Recheck CD4 every 6
months
CD4lt200 - Provide ARV - ongoing
counseling - Prevention and
Care (National Guidline)
- Recheck CD4
every 6 months
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Target provinces (pilot Project)

1. Ubonrajathani 2. Udonthani
3. Lampang 4. Yala
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Implementation of CARE Program in pilot
provinces

No. HIV infected women 454 joint in the
program 80 CD4 lt 200 or develop symptom
34 ARV treatment 88

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Implementation of CARE Program in pilot
provinces

No. HIV infected husband 191 joint in the
program 78 CD4 lt 200 or develop symptom
28 ARV treatment 92

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Implementation of CARE Program in pilot
provinces

No. Child born to HIV infected 18 joint in
the program 83 CD4 lt 20 or develop
symptom 47 ARV treatment 71

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Lesson Learned

• Policy
• Training
• Provision of Test Kit ARV and formula
• Monitoring supervision

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Conclusion
1. Proven ARV Regimens to Prevention of MTCT
are available 2. Continuation From Prevention of
MTCT to Treatment and Care is possible 3.
Implementation varies from country to country 4.
How will Country achieved their goals Targets
for both PMTCT and 3 X 5 ??
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