6th Annual Emergency Plan for AIDS Relief Track 1.0 ART Program Meeting

August 11–12, 2008; Washington D.C.

Christian Pitter, MD MPHDirector, Global Technical Policy

PMTCT Scale-upElizabeth Glaser Pediatric AIDS Foundation

Rwanda

Uganda

Kenya

Thailand

Angola

Malawi

Tanzania

Zambia

Zimbabwe

Russia

Swaziland

Dominican Republic

Cameroon

India

Georgia

Honduras

Mozambique

China

Cote d’Ivoire

Lesotho

D.R. Congo

SouthAfrica

Project initiated with EGPAF funds & successfully transitioned to other support

EGPAF Country Programs: 8 sites in 6 countries in 20003,000 sites as of March 31, 2008, with a presence in 18 countries

EGPAF PMTCT CascadeTotals 2000-2008

EGPAF PMTCT CascadeTotals 2000-2008

EGPAF PMTCT

• Accelerating outputs– Approximately 2 million women tested since

2006 out of 5 million cumulative

• Improving Performance– Counseling, Testing & Results– Maternal and Infant ARV uptake

EGPAF PMTCT CascadePercents 2000-07 vs. 2007-08

EGPAF PMTCT CascadeImproved Performance

• Experience at facility level

• Making it simpler for women– Rapid Testing– Opt-out HIV Testing– SD-NVP Dosing at Diagnosis

EGPAF PMTCT CascadePrevalence, maternal and infant

ARV uptake 2000-07

New Challenges in PMTCT 1

• Combination Prophylaxis– More efficacious than SD-NVP– Numerous implementation challenges (supply

chain, training, support)– 28% of EGPAF PMTCT sites using

combination prophylaxis; increasing capacity

• Integration/Linkage with Reproductive Health, HIV C&T, Child Health

New Challenges in PMTCT 2

• Achieving universal access– “Low-hanging fruit”– Working at all levels of

the health system– Sustainability

WHO, 2008

PMTCT District Approach

• Zimbabwe, Tanzania, Zambia, Uganda, Côte d’Ivoire, others

• Working with/in/through district administrative structure– Subgrant mechanisms with accountability– TA for planning, targets, infrastructure– TA for clinical and program services– Ongoing support and mentorship