Achieving Optimal Treatment for Pregnant Women Living with HIV
Addressing the challenges and successes in providing comprehensive treatment for pregnant women living with HIV, the presentation by Agnes Mahomva at the International AIDS Conference explores the Option B+ model and its impact on reducing vertical transmission. The programmatic challenges, successes, and lessons learned highlight the importance of rapid ART initiation, harmonized regimens, and high acceptability among pregnant women. Zimbabwe's progress in increasing ART initiating sites underscores the positive outcomes of implementing Option B+ policy on a national scale.
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Presentation Transcript
Treatment for all pregnant women: Lessons learned and an overview of programmatic challenges Presented by: Agnes Mahomva, MBChB, MPH Country Director , EGPAF Zimbabwe International AIDS Conference, Durban, South Africa July 18, 2016
Outline Introduction and Background Option B+ Successes Programmatic Challenges Lessons Learnt and Conclusion
PMTCT Drug Options HIV-positive Pregnant Women HIV-exposed Infant CD4 < 350 CD4 >350 PMTCT Option Preg Labor/ delivery Post- partum Dail y Drug Duration ART for life AZT AZT/3T C +sdNVP AZT/3TC for 7 d NVP Until stop breastfeeding (min 4-6 wk) A from wk 14 ART for life ART from HIV dx ART ART until stop BF NVP or AZT Birth to age 4-6 weeks B NVP or AZT Birth to age 4-6 weeks B+ ART for life Source: WHO, 2013
Background Option B+ is a model of treatment for all in a specific population All pregnant and breast feeding women living with HIV Rapid shift to initiate ART for all pregnant and breast feeding women living with HIV since 2013* Since end of Oct 2015 all 22 Global Plan priority countries (except Nigeria) officially endorsed Option B+ National Option B+ policy implemented at >90% of all sites in 14/22 *Source: IATT Update, October 2015
ART Sites in Zimbabwe, 2004-June 2015 Rapid increase of ART initiating sites in 2014/15 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 non ART sites Static ART Sites Outreach follow up sites ART Initiating Sites Source: Zimbabwe MOHCC national data
Option B+ Successes Vertical transmission benefit Increased coverage of ART among pregnant women Ease of implementation/rapid roll out Harmonized regimens High acceptability by pregnant women Adoption of differentiated care models Some HSS as part of roll out
Option B+ Successes: ART coverage as percent of all infected adults or children (Increased coverage of ART among pregnant women) Adults (Age 15+) Children (Age 0-14) Pregnant women 100% 80% 60% 40% 20% 0% 2009 2010 2011 2012 2013 2014 Source: UNAIDS data AIDS info (Nov 2015)
Option B+ Successes Acceptability:Pregnant women s responses to B+ Easy to accept lifelong therapy because it was similar to taking medication for diabetics or birth control Accepted lifelong therapy for the sake of their babies Seeing other people looking healthy on ART in their communities facilitated ART acceptance Low pill burden: one pill a day was much easier to manage Source: IAS 2016 Poster WEPEE514; Acceptability of Option B+ in Zimbabwe
Option B+ Successes Adoption of differentiated care models Decentralization of ART from OI/ART sites to all MNCH facilities OI/ART sites decongested Nurses capacitated to initiate ART Task shifting Pregnant women able to access ART nearer home Introduction of same day ART initiation supported by strengthened adherence counselling at every ANC follow up visit
Option B+ Programmatic Challenges Limited investment in all HSS pillars Leadership to see through an efficient decentralization Financing for additional decentralized program needs Drugs and commodities simplified regimen yes BUT procurement and supply chain management remained a challenge Implementation at site level not always well coordinated Delays in revision of M&E systems and limited program impact evaluations Loss to Follow up Poor retention in care
EGPAF Tanzania: Early retention (2+ visits) in HIV care among non-pregnant vs. pregnant women, by year of enrollment not pregnant pregnant 100 91 88 86 85 85 85 85 85 85 90 78 80 72 65 70 58 57 55 55 54 60 Percent 53 52 52 50 40 30 20 10 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Source: EGPAF Tanzania data
Lessons Learnt Health system strengthening for all six pillars with a focus on the following was key to a smooth roll out: District and site leadership for efficient decentralization Drug forecast and supply chain management Life long ART was acceptable by those not yet ill Retention in care remained a big challenge Loss to Follow up
Lessons Learnt Introduction of innovative care models important for rapid rollout of life long ART and for follow up : Decentralization of ART to all MNCH sites Same day ART initiation with strengthened adherence counselling at follow up visits Support groups to strengthen follow up and adherence after deliver and during breast feeding (eg CATS* for adolescent mothers) *Community Adolescent Treatment Supporters (eMTCT Champions)
Thank you! Tatenda
