# Presentation: 668015

## PERINATAL HIV PREVENTION:  US AND INTERNATIONAL CHALLENGES Dr. Catherine WilfertElizabeth Glaser Pediatric AIDS Foundation 

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- PERINATAL HIV PREVENTION:  US AND INTERNATIONAL CHALLENGES Dr. Catherine Wilfert*Elizabeth Glaser Pediatric AIDS Foundation*

## Slide 2

## PERCENTAGE OF PREGNANCIES SCREENED FOR HIV

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| County | Before | During/After | Change |
| --- | --- | --- | --- |
| Durham |         3                       |         70 |     +67 |
| Cumberland |         1 |         97                 |     +96 |
| Franklin |        50 |         68 |     +18 |
| Granville |          2 |         87 |     +85 |
| Person |        31 |       100 |     +69 |
| Vance |         3 |         81 |     +78 |
| Warren |         6 |         79 |     +73 |

## Prenatal Testing by Health DeptNov 29, 1993-May 31, 1994Walter  PIDJ 1995;14:376-81

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- Prenatal Testing by Health DeptNov 29, 1993-May 31, 1994Walter  PIDJ 1995;14:376-81

| County |   No.Screened |    Percent |
| --- | --- | --- |
| Durham |         148 |       73.6 |
| Franklin |           76 |       73.7 |
| Granville |           27 |       88.9 |
| Person |           44 |       93.2 |
| Vance |           23 |       60.9 |
| Warren |           21 |       85.7 |

## Prenatal Testing by SiteWalter  PIDJ  1995;14:376-81

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- Prenatal Testing by SiteWalter  PIDJ  1995;14:376-81

|  |    DUKE |   LCHC |     HD |
| --- | --- | --- | --- |
| Screened (n)        |     380 |      148 |     178 |
| Offered (%) |     85.8 |      91.2 |     93.2 |
| Accepted (%) |     58.3 |      78.5 |     87.3 |
| Tested (%) |     52.1 |      73.6 |     82 |

## Maternal factors Associated With Not Being HIV TestedWalter PIDJ 1995;14: 376-381

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- Maternal factors Associated With Not Being HIV TestedWalter PIDJ 1995;14: 376-381

- Race              White    OR = 2.22(1.49,3.31)
- Age (years) 	≥ 30     OR = 2.11(1.43,3.11)
- Education 	≥ 12     OR = 2.24(1.37,3.69)

## NC Provider Survey 1995-96(Walter)

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- NC Provider Survey 1995-96(Walter)

- HIV Testing primarily based upon patient request (8%), offered to all patients (82%), or risk assessment (10%).
- Would recommend HIV Testing to prenatal patients without identified risks:
-     Tertiary centers   62%
-      Health dept         69%
-      Private practice   52%

## NC 1993-94  Urban Rural ZDV USE (%)

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- 0
- 7
- 6

## New Mothers and Perinatal HIV Walter, Ob & Gyn 2001;97:70-6

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- New Mothers and Perinatal HIV Walter, Ob & Gyn 2001;97:70-6

- 1997 multicenter, cross sectional survey of 1362 women from 7 hospitals in 4 states NC, NY,Florida, Connecticut)
- 89% received information & offered testing
- 69% overall tested; 75% tested of those offered
- 84% thought all pregnant women should be tested
- 60% thought it should be a law

## New Mothers and Perinatal HIVWalter, Ob & Gyn 2001;97:70-6

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- New Mothers and Perinatal HIVWalter, Ob & Gyn 2001;97:70-6

- 95% women knew HIV transmissible to baby
- 74% knew if baby tested positive, mother was HIV +
- 70% knew transmission was not 100%
- 60% knew HIV transmitted by breast feeding
- 51% knew a medicine could decrease HIV transmission

## Barriers to Universal HIV Testing 1997Royce AJPH 2001; 91:727-733

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- Barriers to Universal HIV Testing 1997Royce AJPH 2001; 91:727-733

- 69% tested:  56% 1st trimester, 33% 2nd trimester, 11% 3rd trimester.
-  30% did not know their status at delivery
- Women with private insurance 3 times more likely not to be tested
- 55% (of those not tested) did not perceive a need for the test
- 39% (of those not tested) were tested prior to this pregnancy

## ART of HIV Exposed Infants NC 1993-99Fiscus:  In Press

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- ART of HIV Exposed Infants NC 1993-99Fiscus:  In Press

## Infection Status & ART of 978 HIV Exposed Infants NC 1993-1999 (Fiscus, In Press)

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- Infection Status & ART of 978 HIV Exposed Infants NC 1993-1999 (Fiscus, In Press)

## 1995-97 NC VCT and Transmission (Fiscus, 98)

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- 1995-97 NC VCT and Transmission (Fiscus, 98)

- 407 TOTAL MOTHERS
- 2% no prenatal care
- 93% counseled
- 5% not counseled
- 2% refused testing
- 2% seroconverted during pregnancy
-  35 INFECTED INFANTS
- 46% not counseled
- 63% No ART

## <footer>

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## UN-sponsored Africa MTCT Programme 

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**UN-sponsored Africa MTCT Programme**

- ANC

- Counseled (65%)

- HIV Tested (67%)

- HIV+ (19%)

- Mothers on AZT/NVP (39%)

- 0

- 20000

- 40000

- 60000

- 80000

- 100000

**Number of Pregnant Women**

## ELIZABETH GLASER PEDIATRIC AIDS FOUNDATIONIN PARTNERSHIP WITH FHICALL TO ACTION PROJECTREDUCING MOTHER-TO-CHILD HIV TRANSMISSION IN THE DEVELOPING WORLD

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**ELIZABETH GLASER PEDIATRIC AIDS FOUNDATION****IN PARTNERSHIP WITH FHI****CALL TO ACTION PROJECT****REDUCING MOTHER-TO-CHILD HIV TRANSMISSION ****IN THE DEVELOPING WORLD**

**THE PROJECT SITES LISTED BELOW REPRESENT ACTIVE PROGRAMS IN OVER 90 LOCATIONS THROUGHOUT 13 COUNTRIES IN THE DEVELOPING WORLD, AND WILL BRING HIV TESTING AND MOTHER-TO-CHILD TRANSMISSION INTERVENTION SERVICES TO MORE THAN 250,000 WOMEN IN THE NEXT TWO YEARS.**

## Call To ActionPreliminary Data

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- Call To Action*Preliminary Data*

- N
- o
- of
- women

**6/1/01**

**12/1/01**

**Cumulative**

## Percentage of Women Counseled AcceptingTestingPreliminary Data

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- Percentage of Women Counseled AcceptingTesting*Preliminary Data*

**PERCENTAGE**

## EGPAF PMTCT ProgramPreliminary Data

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- EGPAF PMTCT Program*Preliminary Data*

**54,852**

**49,714**

**33,433**

**6244**

**3266**

**1958**

**38,958**

**Notes:**
ANC = 54,852,  VC = 49,714, Tested = 38,958, Results =33,433, HIV + = 6244, Mom \NVP = 3266, Baby NVP = 1958

## NW Province Cameroon Preliminary Data

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- NW Province Cameroon *Preliminary Data*

- 2/1/00 Cameroon Baptist Convention Health Board
- 12/01/00 Etoug
- 2/01/01 Banso
- 6/01/01Belo;Nkwen;Ashong;Bangolan;
-     Mbingo;
- 6/20/01 Ndu;Jikijem;
- 7/12/01 Ndop
- 8/1/01 Nkambe district; Bamenda PMI;Batibo
- 9/15/01 Bamenda Provincial

## NW Province Cameroon Preliminary Data

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- NW Province Cameroon *Preliminary Data*

- Percentage

**   ****459**

**     ****114**

**282**

**227**

**1603**

**985**

**2509**

**Notes:**
CBHB ANC = 2509, Bamenda ANC = 459, Mbingo ANC = 114,Belo AC = 282, Jikijem ANC = 227, Banso ANC = 1603, Etoug ANC = 985

## Observations pMTCT Africa Preliminary Data 

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- Observations pMTCT Africa *Preliminary Data*

- Access to ANC and maternity variable.
- Estimated 40% hospital care is private not for profit rather than public
- Delivery at home with TBA
- Facilities:  No private space
- Counseling:  opt-in/opt out
- Is testing a barrier to intervention?
- Intervention only to HIV +, those who refuse testing?, all women in high seroprevalence areas?

## KIJABE

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**KIJABE**

**FEB-JUNE 2001 84% WOMEN IN ANC ACCEPTED HIV TESTING AND PREVALENCE WAS 3.8%**
**AN ANONYMOUS SEROPREVALENCE STUDY OF WOMEN IN ANTENATAL CLINIC WAS CONDUCTED**
**  ****182 WOMEN TESTED **
**   ****22 HIV + (12.1%)**
**HIV TESTING WITH CONSENT MISSED 74% OF HIV POSITIVE WOMEN**
**56% OF THOSE WOMEN REFUSING TESTING WERE HIV +**

## Uptake of HIV testing: from pilot projects to implementation Preliminary Data

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- Uptake of HIV testing: from pilot projects to implementation *Preliminary Data*

**%**

**Source: Ministry of Public Health, Thailand**

**Region 10**
**7/97-12/00**

**Region 7**
**7/98-6/00**

**Country **
**2000**

**Country **
**1/01-7/01**

**Notes:**
The uptake of HIV testing was 97% in Region 10 and 70% in Region 7. After initiating nationwide expansion, the PMTCT programme achieved 84% uptake of HIV testing during the first year and 93% during the first seven months of the second year. 

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