GETTING READY FOR DUAL EMTCT
VALIDATION IN THE AMERICAS
Adele Schwartz Benzaken
OUTLINE
1. BACKGROUND OF EMTCT IN THE AMERICAS
2. DEVELOPMENT OF REGIONAL VALIDATION
METHODOLOGY AND STRUCTURE
3. CONCLUSIONS
EMTCT HISTORY IN THE AMERICAS
• 1994: The 24th Pan American
Sanitary Conference called for
the elimination of congenital
syphilis as a public health
problem.
• 1995: Development of the Plan
of Action for elimination of
congenital syphilis.
• 2005: Regional HIV/STI Strategy
for the Health Sector with
ambitious HIV/STI PMTCT goals,
including congenital syphilis
elimination.
• 2008: PAHO and UNICEF host
Caribbean side event at IAC to
explore elimination of MTCT of
HIV
• 2008- 2009: Sub-regional
technical consultations &
development of dual EMTCT
implementation strategy
• November 2009: official launch
of Regional Dual EMTCT
Initiative
• September 2010: PAHO Member
States adopt the regional EMTCT
Strategy and Plan of Action by
Resolution
REGIONAL DUAL EMTCT STRATEGY
Pillars:
• Strengthening and integration of HIV/STI, SRH, MCH, newborn care
and family and community health services
• Strengthening the capacity of MCH, newborn, child health and
other services for early detection, care and treatment of HIV and
syphilis in pregnant women, their children, and their partners
• Intensify surveillance of HIV and syphilis in MCH services
Regional implementation:
• Development of tools, including a conceptual document, Regional
Monitoring Strategy, Costing tool, Field Guide
• Direct support to countries
• Regional monitoring and reports
Pregnant women tested for syphilis at antenatal care in Latin America and the
Caribbean (2012-2013)
Reported congenital syphilis rates in selected
countries in the Americas, 2009-2013
New HIV infections in children in Latin America
and the Caribbean 2001-2013
ARV coverage among pregnant women for
prevention of mother to child transmission of HIV
Pregnant women tested for HIV in Latin
America and the Caribbean, 2005-2013
DEVELOPMENT OF THE REGIONAL EMTCT
VALIDATION STRUCTURE
• Considering that several countries appeared to be
close to achieving the EMTCT targets, PAHO, in
collaboration with UNICEF and other partners,
initiated development of a validation methodology in
2011:
– Drafting of a methodology
– Pilot implementation in two countries (St. Lucia &
Chile)
– Merging of efforts with WHO HQ in 2012
– Establishment of regional mechanisms in 20132014
VALIDATION METHODOLOGY
1. Verification of achievement of the elimination targets:
– Verification of the quality of the reported data
– Assessment of the underlying data collection and reporting systems
2. Verification of the existence of an adequate laboratory network
that:
– provides the services needed to achieve, maintain and measure the
elimination targets
– Generates reliable results
3. Verification of the existence of an adequate network of services
that:
– Provides all needed services, accessible to all in need
– Provides quality services
Country pilots
• Full assessments, which included interviews and
site visits with:
– All national programs (MCH, HIV, STI, etc)
– Sample of first, second and tertiary level service
delivery sites in the capital and districts with the
highest burdens of disease (HIV or syphilis or both)
– Feedback and discussion sessions with stakeholders
(Minister of Health , managers and service delivery)
– Final report produced by the external team with
recommendations and final conclusions
PILOT IMPLEMENTATION
• In two countries (St. Lucia & Chile)
• External team of experts (6-10) in the areas of
MCH, HIV, STI, laboratory, epidemiology,
health systems.
• One week of field work: 1) interviews with
policy makers, program managers, service
providers, civil society, clients;2) field visits to
service delivery sites: 3) verification and
recalculation of data on local and national
level.
LESSONS LEARNED
• Pilots indicated validity of the methodology to
understand the national program, verify the
data, and identify (potential) issues and
challenges.
• Estimated cost of country validation: $ 15,000$ 20,000 (depending on size).
• Considering the required investment and
formal commitment for dual EMTCT, only
country requests for validation of EMTCT of
both HIV and syphilis will be considered.
Data gaps
• PAHO emphasizes reporting on elimination impact and
coverage targets based on “real” data.
• Some countries might have gaps, in particular in
coverage data due to various reasons, including
significant private sector.
• Acceptable modalities to assess these data gaps:
– Special studies
– Sufficient private sector representation in assessment
samples?
– Others
The Regional Validation Committee
• Established as a high level Committee convened by the
PAHO Director (May 2014).
• Membership: 13-15 regional experts: independent
experts, representatives from UN partners,
representatives from regional technical organizations
• Main role is to provide regional oversight of the
validation process, coordinate country evaluation
exercises, and determine whether a candidate country
can be recommended for validation.
CURRENT STATUS
• Ongoing refining of the methodology and
tools, including development of approaches
for small population sizes.
• Ongoing application of the tools for program
assessments upon request of countries in
2013 and 2014.
• Preparations for first round of formal country
validations (Cuba, Bahamas and others)
CONCLUSIONS
• Region of the Americas has longstanding and
formal commitments for elimination of
congenital syphilis and vertical transmission of
HIV.
• Dual EMTCT is imminent for some countries in
the region.
• Validation requires establishment of formal and
credible regional structures and processes
aligned with global.
ACKNOWLEDGEMENTS
– Dr. Massimo Ghidinelli (PAHO/WDC)
– Dr. Sonja Caffe (PAHO/WDC)
– HAYASHI, Chika (WHO/HIV Department)
– Regional Committee for Validation of Elimination
of Mother-to-Child Transmission of HIV and
Congenital Syphilis (RVC)Members