Global Plan towards the elimination of new
HIV infections among children by 2015 and
keeping their mothers alive
DR. Nicholas Muraguri
OGW, MD,MPH, MBA, PhD (c)
Director,
Global Plan Secretariat
www.zero-hiv.org
The Creation of the Global Plan



Global Plan launched at UN High Level Meeting on
AIDS in July 2011 as part of Political Declaration on
AIDS
Global Task Team co-chaired by Michel Sidibé and
Ambassador Eric Goosby
Membership of 40 countries, 30 civil society and
private sector organizations, and 15 international and
regional bodies/organizations
FRAME IT
There are 22 priority countries for the Global Plan
1.
Angola
12.
Lesotho
2.
Botswana
13.
Malawi
3.
Burundi
14.
Mozambique
4.
Cameroon
15.
Namibia
5.
Chad
16.
Nigeria
6.
Côte d’Ivoire
17.
South Africa
7.
DR Congo
18.
Swaziland
8.
Ethiopia
19.
Tanzania
9.
Ghana
20.
Uganda
10.
India
21.
Zambia
11.
Kenya
22.
Zimbabwe
These countries
accounted for
89%
of all HIV-positive
pregnant women
in low- and middleincome countries
in 2011
FRAME IT
The gap in treatment and prophylaxis coverage
is uneven among low- and middle-income countries
The share of each
low- and middleincome country in
the total shortfall
in providing
antiretroviral
medication to HIVpositive pregnant
women to prevent
new HIV infections
among children.
Lesotho, Côte
d'Ivoire, Angola,
Chad, Botswana,
Swaziland, Ghana,
Rwanda, Namibia,
Brazil, South
Sudan, South
Africa, 3%
Other low- and
middle-income
countries, 13%
Nigeria
29%
Chad, 2%
Cameroon, 2%
Zambia, 2%
Tanzania, 4%
Kenya, 5%
Malawi, 5%
Uganda, 8%
Zimbabwe, 5%
Dem. Rep. of
Congo, 5%
Mozambique, 7%
Ethiopia, 5%
India, 6%
Source: UNAIDS 2012
2- Specific targets for 2015
90%
Reduce the number of new
HIV infections among children
by 90% from a baseline of 2009
50%
reduction in
AIDS-related
maternal
deaths
DO IT
A four-pronged approach is required
to prevent new HIV infections among children and keep mothers alive
1. Prevent HIV among women
of reproductive age
2. Prevent unintended pregnancies
among women living with HIV
3. Prevent HIV transmission through
antiretroviral treatment during pregnancy
and breastfeeding
4. Treatment, care and support for mothers
living with HIV, their children, partners and
families
Progress Toward Global Plan Targets
100%
100%
90%
90%
90%
90%
2009 Baseline
80%
2011
70%
2015 Target
61%
60%
40%
30%
50%
48%
50%
34%
26%
28%
28%
21%
21%
20%
16%
10%
Baseline
5%
Baseline
0.5%
0%
Reduce new cases of
pediatric HIV infection
MTCT rate
Maternal ARV
coverage
ART coverage for
mothers
Reduction in maternal
AIDS deaths
Source: Towards Universal Access, 2011; Global Report, UNAIDS, 2012
ART coverage for
children
Number of new child infections,
21 priority countries
600,000
500,000
400,000
300,000
200,000
100,000
0
Source: UNAIDS Estimates 2012
New HIV infections among children, 2009–2011
Will reach the target if the
2009–2011 decline of more than
30% continues through 2015.
Can reach the target if the
decline in 2009–2011 of
20–30% is accelerated.
In danger of not reaching the
target, with a decline in 2009–
2011 of less than 20%.
Note: The baseline year for the Global Plan is 2009. Some countries had already made important progress in reducing the number of new HIV infections among children in the years before 2009, notably
Botswana which by 2009 already had 92% coverage of antiretroviral regimens among pregnant women and a transmission rate of 5% (see table pp122–123). In countries with high coverage, further
declines are much harder to achieve.
Source: UNAIDS Estimates 2012
Slight decline in new HIV infections among
women 15-49, 21 priority countries
1200000
1000000
800000
600000
400000
200000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: UNAIDS Estimates 2012
Reduction in unmet need for family planning
is slow, countries with available data
40
35
Percent
30
25
20
15
10
5
0
Source: Demographic and Health Surveys 2000-2011
Survey 1
Survey 2
… As a results the number of women in
need of PMTCT services remains flat
1,800,000
1,600,000
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: UNAIDS Estimates 2012
New child HIV infections and PMTCT coverage,
21 priority countries
450,000
400,000
100
470,000
450,000
420,000
400,000
370,000
Before the
Global Plan
350,000
300,000
90
80
70
320,000
280,000
60
250,000
50
200,000
40
150,000
100,000
50,000
14
23
33
43
48
50
30
61
20
37,000
-
10
-
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Percent of HIV+ pregnant women receiving any ARV medicines (including SdNVP)
Percent of HIV+ pregnant women receiving effective ARV medicines (excluding SdNVP)
Source: UNAIDS Estimates 2012
Coverage
Number of new child infections
500,000
PMTCT coverage, 21 priority countries
High coverage
66+ %
Medium coverage
33-65%
Low coverage
<33%
Botswana
Côte d’Ivoire
Ghana
Kenya
Namibia
Swaziland
South Africa
Tanzania
Zambia
Burundi
Cameroon
Lesotho
Malawi
Mozambique
Uganda
Zimbabwe
Angola
Chad
DR Congo
Ethiopia
Nigeria
Source: UNAIDS Estimates 2012
Prophylaxis coverage: the other
half of the picture
Number of women/infant pairs receiving prophylaxis, 2011, 21 priority countries
1400000
1200000
1000000
None
800000
sd NVP
600000
Dual
Option A/B
400000
ART
200000
0
During pregnancy
Source: UNAIDS Estimates 2012
During breastfeeding
As a result … MTCT transmission rates
are still high
MTCT rate (percent)
Dem Rep of Congo
Angola
Chad
Nigeria
Ethiopia
Mozambique
Cote dIvoire
Ghana
Malawi
Cameroon
Lesotho
Burundi
United Republic of Tanzania
Zimbabwe
Uganda
Kenya
South Africa
Swaziland
Zambia
Namibia
Botswana
0%
Source: UNAIDS Estimates 2012
5%
10%
15%
20%
25%
30%
35%
40%
Looking to the (near) Future: B+
Evidence Needs for WHO 2013 Guidelines
Evidence and Lessons for Other Countries
•
•
•
•
•
Acceptability to women
Adherence and retention
Linkages with ART
Implementability
Impact -– Mother’s health
– Vertical transmission
– Prevention of sexual transmission
Prong 4: Care and treatment for the family
Early Infant diagnosis is still unacceptably low:
35% in 21 countries
High coverage
66+ %
Medium coverage
33-65%
Low coverage
<33%
Kenya
Lesotho
South Africa
Botswana
Côte d'Ivoire
Namibia
Swaziland
Angola
Burundi
DR Congo
Ethiopia
Ghana
Mozambique
Nigeria
Tanzania
Uganda
Zambia
Zimbabwe
Source: Global AIDS Progress Reporting 2012
Maternal survival is important for
child growth and development.
Increasing ART results in substantial declines in
pregnancy-related deaths
Percent change in pregnancy-related deaths to women
living with HIV between 2005 and 2010
Source: WHO, 2012. Trends in Maternal Mortality 1990-2010
Swaziland
South Africa
Namibia
Botswana
Lesotho
Zimbabwe
Zambia
Malawi
Mozambique
Uganda
Kenya
Tanzania
Côte d'Ivoire
Cameroon
Nigeria
Ghana
Burundi
Angola
Ethiopia
DR Congo
Chad
India
80
70
60
50
40
30
20
10
0
TOGETHER
WE WILL
END AIDS
Actions needed to reach zero
• Strengthen efforts to reduce unmet need for family
planning
• Limited data on unmet need among women
living with HIV
• Increase coverage of prophylaxis during
breastfeeding
• Ensure eligible children receive ART
• Increasing early infant diagnosis from 35% to
higher levels will improve ART uptake
•
Integrating PMTCT into maternal and child health
services.
Thank you