What Will It Take To End Pediatric AIDS What Will It Take To End Pediatric AIDS? Lessons from the Emergency Plan Dr. Nadia A. Sam-Agudu Senior Technical Advisor, Pediatric and Adolescent HIV Institute of Human Virology Nigeria, Abuja. Assistant Professor of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore.

Conflict of Interest I have no conflicts of interest to declare.

Presentation Outline “State of the PMTCT” The PMTCT Toolkit for Success The Global Plan: Successes and Challenges Next Steps Towards Ending Pediatric AIDS

1. Lifelong ART for HIV-infected women in need of treatment 2. Short-term maternal ARV prophylaxis to prevent MTCT during pregnancy Maternal postpartum ART Infant postpartum ARVs Nathan Shaffer, WHO; Lynne Mofenson, EGPAF Kesho Bora Study Group, Lancet 2011. “Triple antiretroviral prophylaxis during pregnancy and breastfeeding is safe and reduces the risk of HIV transmission to infants.”

Access to PMTCT antiretroviral drugs (ARVs) among pregnant women has increased globally Percentage of pregnant women living with HIV receiving most effective antiretroviral medicines for PMTCT https://data.unicef.org/topic/hivaids/emtct/#

21 sub-Saharan African Global Plan countries, 2000-2015 Percentage of pregnant women living with HIV receiving most effective antiretroviral medicines for PMTCT New HIV infections among children (0-14y) Global Plan 2011-2015 https://data.unicef.org/topic/hivaids/emtct/#

Key Toolkit Items for PMTCT Policy: Expanded ART eligibility and duration Drugs: Supply of, and access to potent regimens Testing: Increased access, coverage for rapid tests HRH, Service delivery: decentralized delivery of services and consistent access to interventions Enhanced Monitoring and Evaluation systems: track progress and quality Community Engagement: maximize advocacy and participation IATT, UNICEF, WHO Toolkit, March 2013

The Global Plan: 2011-2015 The Global Plan Towards the Elimination of New HIV Infections among Children and Keeping Their Mothers Alive Prioritized 22 countries for eMTCT Main objectives: Reduce new child HIV infections by 90% ART to ≥90% of pregnant women living with HIV Reduce mother-to-child HIV transmission rate <5% among breastfeeding infants <2% among non-breastfeeding infants UNAIDS 2011, 2016

Global Plan Priority Countries: Successes and Challenges UNAIDS 2016

Virtual eMTCT and syphilis: Validated Successes Belarus Moldova Armenia Cuba Thailand

What is the “Secret”? Strong policy backed by sustained political will Strong/strengthened health systems Functional Monitoring and Evaluation Operational research Adequate and sustained financing Advocacy & community participation

Global Plan Country Challenges: Pediatric AIDS “Hotspots” UNAIDS 2016

Global Plan Country Challenges: Pediatric AIDS “Hotspots” Inequitable funding for the HIV response Weaker health systems Conflict, instability, competing interests Relatively lower HIV prevalence More resources needed to find, test, treat ? Sense of urgency

Points to Consider “Hardware” “Software”: behavioral drivers Drug regimens, test kits, funding, staff “Software”: behavioral drivers Issues 1: stigma, discrimination, denial, lack of education Issues 2: HCWs, policy-makers, MOH Impactful behavioral interventions Sustained uptake and desired outcomes In combination with hardware

Malawi, Option B+ 21 sites, 1,269 women SOC v Facility v Community PS 24 month retention: 66 v 80 v 83% Nigeria, Option B 20 sites, 497 women Unstructured v structured PS 6 month retention: 25 v 62% Zimbabwe, Option B+ 30 sites, 350 women SOC v Facility-based mother support groups 12 month retention: Regular vs non-regular attendance 3x higher JAIDS 2017; 75 INSPIRE Supplement

Next Steps: Post-Global Plan is Acceleration Plan Politicians to champion political will Increase allocation from domestic funding Mobilize PLHIV in acceleration plan Community education Optimize software strategies Target interventions to right places Multicomponent interventions Subnational level Cohort-based data

https://data.unicef.org/topic/hivaids/emtct/

Acknowledgements International AIDS Society UNICEF- Geneva and Nigeria Prof. Linda-Gail Bekker & Prof. Landon Myer UNICEF- Geneva and Nigeria Dr. Dorothy Mbori-Ngacha UNAIDS, WHO Geneva & WHO AFRO Dr. George Siberry, Office of the US Global AIDS Coordinator IHV-Nigeria, Abuja and IHV Maryland, USA PLHIV in Nigeria