Characterizing viral load burden among HIV-positive women around time of delivery: Findings from four tertiary obstetric units in Gauteng, South Africa.

Slides:



Advertisements
Similar presentations
Scaling up HIV services for women and children achievements and challenges e-lluminate session e-lluminate session Yves Souteyrand 2 March 2010.
Advertisements

Scaling up Early Infant HIV Diagnosis (EID) in Karamoja Health Nutrition HIV coordination meeting 9 th December 2009.
Towards Universal Access Recommendations for a Public Health Approach BASED ON WHO GUIDELINES Antiretroviral Drugs for Treating Pregnant Women and Preventing.
Draft Generic Protocol: Measuring Impact and Effectiveness of National Programs for Prevention of Mother-To-Child HIV Transmission at Population-Level.
EMTCT Tanzania Experience 6 th Joint Biennial HIV & AIDS Sector Review Dr MD Kajoka PMTCT Coordinator.
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,
PMTCT FAILURE: THE ROLE OF MATERNAL AND FACILITY –RELATED FACTORS ICASA Presentation 8 th to 12 th Dec 2013 Onono Maricianah 1, Elizabeth A. Bukusi 1,
Enhanced Perinatal Surveillance, Georgia
Scaling up Prevention of Mother to Child Transmission of HIV (PMTCT): What Will it Take to Eliminate MTCT? Jessica Rodrigues Presentation for UNICEF Written.
Prevention of Mother-to-Child Transmission of HIV in Ghana
1 Towards getting more HIV- positive infants on lifesaving treatment: assessing turn- around times for early infant diagnosis in Lesotho M Gill, HJ Hoffman,
Feedback from Pregnancy research group UK CHIC / UK HIV Drug Resistance Database Meeting, 2 July 2010 Pregnancy Group: Jane Anderson, Loveleen Bansi, Susie.
Pediatric HIV Care & Treatment in Uganda A Five-Day Training Course For Health Professionals.
Preliminary findings of a routine PMTCT Option B+ programme in a rural district in Malawi Rebecca M. Coulborn 1, Laura Triviño Duran 1, Carol Metcalf 2,
Presenter : Dr T. G. Nematadzira on behalf of The IMPAACT PROMISE 1077BF/1077FF Team Efficacy and Safety of Two Strategies to Prevent Perinatal HIV Transmission.
PMTCT at Different Levels of Care: The Uganda Experience Dr. Saul Onyango National PMTCT Coordinator Ministry of Health 1 1.
LIMPOPO PROVINCIAL MEN’S SECTORS/BROTHERS FOR LIFE PRESENTED BY: RAPAKWANA JOHANNAH MANAGER:GAAP in HIV & AIDS & STIs Directorate DEPT OF HEALTH AND SOCIAL.
The Rationale for Option B+ in Malawi
Models of Care for Paediatric HIV Miriam Chipimo MD MPH Reproductive Health & HIV&AIDS Manager, UNICEF, Malawi.
Generic protocol for national population-based impact evaluation of national programs for PMTCT at 6 weeks post-partum Thu-Ha Dinh, MD., MS., US CDC/GAP.
Washington D.C., USA, July 2012www.aids2012.org Preventing Mother to Child HIV Transmission through Community Based Approach in Nepal Nafisa Binte.
8èmes Rencontres Nord-Sud Avelin Aghokeng IRD-UMI233 & University of Montpellier I Yaoundé-Cameroon Avelin Aghokeng IRD-UMI233 & University of Montpellier.
Charles S. Kiptemas, MBChB, MPH Director South Rift Valley HIV Care & Treatment Program Kenya Medical Research Institute/Walter Reed Project Track 1 Partners.
Provider initiated testing in Kenya Ruth Nduati Associate Prof Paediatrics University of Nairobi.
Impact and Effectiveness of South Africa’s PMTCT Programs on Perinatal HIV Transmission, : Using data to improve program implementation, and policy.
Overcoming sample transportation challenges: Using FedEx to transport HIV early infant diagnosis (DBS) samples from hard to reach areas to a central lab.
EMTCT in Europe. MTCT rates, UK and Ireland, CROI 2007 Poster 761, Townsend et al diagnosed women, Low rates of MTCT from diagnosed.
Human Immune Deficiency Virus Infection Dr Huda Taha Sep 2015.
HIV Prevention in Mothers and Infants DR KANUPRIYA CHATURVEDI.
A Call to Action Children – The missing face of AIDS.
MATERNAL ANTIRETROVIRAL THERAPY AND INFANT OUTCOMES THROUGHOUT THE FIRST YEAR OF LIFE: results from the DREAM study in Dschang, Cameroon Taafo F, Doro.
INVESTING IN COMMUNITY SYSTEMS TO SUPPORT LIFELONG ART INITIATED IN MATERNAL & CHILD HEALTH SETTINGS Dr. Chewe Luo MD, PhD, FRCP UNICEF PROGRAM DIVISION.
Adults living with HIV (15+) (thousands) [5] Children living with HIV (0-14) (thousands) [5] Pregnant.
BARRIERS TO AND FACILITATORS FOR RETENTION OF MOTHER BABY-PAIRS IN CARE IN ELIMINATION OF MOTHER TO CHILD TRANSMISSION OF HIV IN EASTERN UGANDA Gerald.
Global Monitoring Framework for Elimination of New HIV Infections among Children Priscilla Akwara, PhD Senior Adviser, Statistics & Monitoring UNICEF,
Gayle Sherman Associate Professor, Department of Paediatrics and Child Health, University of the Witwatersrand, Centre for HIV & STI, National Institute.
A snapshot of the situation of children in SA Sonja Giese Yezingane Network Summit 2009.
How did we miss them? High HIV prevalence among Women testing for the First Time in Labour and Delivery in Zimbabwe Page-Mtongwiza S, Webb, K., Chiguvare,
Recalibrating the EID Cascade in Zimbabwe True outcomes among a sample of HIV-exposed infants with no documented EID Karen Webb 1, Vivian Chitiyo 1, Theresa.
HIV-RH INTEGRATION IN TANZANIA
HIV Point of Care tests in Babies Study (BABY) Operational evaluation of HIV Point of Care tests for very early infant HIV diagnostics in infants born.
Ute Feucht Paediatrician, Tshwane District Clinical Specialist Team
Post natal integrated clubs as a way to improve retention in care of mother infant pairs in a primary care setting, Khayelitsha, South Africa. Aurélie.
Patient and financial impact of implementing WHO recommendations for EID testing – expanding entry point testing and introduction of POC Jenna Mezhrahid.
Trends in maternal deaths in HIV-infected women, on a background of changing HIV management guidelines in South Africa: 1997 to ,2,3CN Mnyani, 1EJ.
Pregnancy and living with HIV
Module 4 (e) Pregnancy and Breast Feeding
Earlier treatment and lower mortality in infants Initiating ART at
Interface of Maternal–Child Health & HIV care in South Africa
Abstract THDB1016 Treatment cascade of HIV-infected infants in the Thailand National Program: How close are we to the target?   1 Thanyawee.
Breastfeeding : Challenges and Opportunities
Abstract 791 Impact of Birth PCR on Retention in Care of HIV Exposed Infants in Primary Care Aurelie Nelson1, Laura Trivino Duran1, Tali Cassidy1, Gilles.
“Treatment for all pregnant women:
DEPARTMENT OF PAEDIATRICS, THE QUEEN ELIZABETH HOSPITAL,
National Agency for the Control of AIDS, Nigeria
2017 Key Considerations for adolescents and children & Key populations
Pediatrics HIV/AIDS and PMTCT research in Barbados: lessons learned for monitoring the epidemic and evaluating the interventions.   ALOK KUMAR, MD. Lecturer.
Obstetric and paediatric HIV surveillance data from the UK and Ireland
Obstetric and paediatric HIV surveillance data from the UK and Ireland
The Last Mile to EMTCT: Are we there yet?
Claire Gamble Friday 30th June 2017
January 2014 Update Obstetric and paediatric HIV surveillance data from the UK and Ireland.
Antiretroviral therapy coverage in sub-Saharan Africa,
Dorina Onoya1, Tembeka Sineke1, Alana Brennan1,2, Matt Fox1,2
Cepheid Symposium, IAS 23rd July 2018
Fatima Oliveira Tsiouris Deputy Director, Clinical & Training Unit
Multi-disease diagnostic integration
Cost effective implementation of POC molecular testing and the impact on a priority population: EID and beyond.
HUMAN IMMUNODEFICIENCY VIRUS (HIV) PREVENTION & CARE
Presentation transcript:

Characterizing viral load burden among HIV-positive women around time of delivery: Findings from four tertiary obstetric units in Gauteng, South Africa Faith Moyo

Conflict of Interest No disclosure

Acknowledgements Paediatric HIV Surveillance group NICD: Prof Gayle Sherman, Dr Ahmad Haeri Mazandarani, Dr Tendesayi Kufa, Sr Moipone Piliso, Ms Aurélie Mukendi, Dr Tanya Murray, NHLS: Prof Sergio Carmona Charlotte Maxeke Johannesburg Academic Hospital Sr Lerato Mthombeni, Sr Beverley Letsoalo, Dr Coceka Mnyani, Dr Natalie Odell, Prof Mphele Mulaudzi Chris Hani Baragwanath Academic Hospital Sr Ntaoleng Moreko, Rebecca Kgame, Prof Yasmin Adam, Dr Vuyelwa Baba, Dr Firdose Nakwa, Dr Alison van Kwawegen Kalafong Provincial Tertiary Hospital Sr Nkele Selepe, Sr Khensani Phelane, Dr Felicia Molokoane, Dr Valerie Vannevel, Dr Khomotso Masemola, Dr Derisha Pillay, Dr Marike Boersema, Prof Nicolette du Plessis, Dr Khosi Ngobese Rahima Moosa Mother and Child Hospital Prof Karl-Günter Technau, Sonjiha Khan, Lebo Phakathi Funding: -This project is made possible thanks to Unitaid’s support through a grant to CHAI/UNICEF. Unitaid accelerates access to innovation so that critical health products can reach the people who most need them.

Background: PMTCT in South Africa 1 in 3 pregnant women in South Africa is HIV-positive Antiretroviral therapy (ART) initiation rate amongst antenatal clinic clients is >95% in the public health sector VL suppression rates in HIV-positive, pregnant and post partum women are not well documented Maternal VL suppression critical to: ◦ Maternal & neonatal health ◦ MTCT of HIV ◦ Maternal & neonatal death

Monitoring Early Infant Diagnosis in SA 6 week MTCT rate Birth (<7 days) MTCT rate Graphs: Sherman G et al; http://www.samj.org.za/index.php/samj/article/view/7598/5852

Road to eMTCT in South Africa Number of women conceiving on ART increasing -universal test & treat strategy IU transmission rate <1.0% Equates to 247 cases/100 000 live births (WHO eMTCT target = <50 cases/100 000 live births or <5% in breastfeeding populations) eMTCT efforts challenged by: Poor VL monitoring in pregnancy & postpartum -limited information on VL suppression rates among pregnant and breastfeeding HIV-positive women High rates of seroconversion in pregnancy & during breastfeeding Road to eMTCT in South Africa Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive.

Potential eMTCT Game Changers: Point of Care HIV VL & EID testing Centralized routine laboratory HIV VL & EID testing remains standard of care in South Africa Point of care (PoC) HIV VL (for mothers) & EID (for infants) testing have potential to: ↓ result turn-around times & ↑ result return-rate ↑ interventions to improve viral suppression and early ART initiation/initiate high risk infant prophylaxis

Study Objective To describe maternal VL burden and intra-uterine transmission rates among HIV-positive pregnant women and their HIV-exposed neonates using PoC testing around time of delivery at four tertiary obstetric units in Gauteng, South Africa

Methodology Study sites: 4 tertiary obstetric units in Gauteng province (3 Johannesburg sub-districts and 1 in Tshwane Metro) Study period: June 2018-Mar 2019 Specimen handling: Specimen collection performed by doctors & nurses as part of routine care Testing conducted by PoC operators (mostly nurses) on weekdays, between 08h00-16h00

Methodology: Procedures All HIV-positive mothers admitted to labour/ postnatal wards Infants Offered PoC EID PCR Positive Confirmatory tests done on same sample + 2nd sample Referred for care PCR Negative Reassured and counselled to return for testing at 10wks Mothers Offered PoC VL VL ≥1 000 copies/mL Adherence counselling for mother High risk prophylaxis for infant VL <1 000 copies/mL Mother reassured about VL suppression Low risk prophylaxis for infant Slide: Dr T Kufa, Centre for HIV & Sexually Transmitted Infections, NICD

Site of Tertiary Obstetric Unit Findings Table 1. Maternal Viral Load and Early Infant Diagnosis PCR testing around time of delivery: Results from a point-of-care study at four tertiary obstetric units in Gauteng, South Africa. N, number; VL, viral load; EID, early infant diagnosis; cps/ml, copies per millilitre; PCR, polymerase chain reaction; IU, intra-uterine; PoC, Point-of-care; JHB, Johannesburg; *Median VL= 24 600 copies/mL (IQR: 6 380–82 100)   Maternal PoC VL Neonatal PoC EID Routine Setting Site of Tertiary Obstetric Unit Live births to HIV-positive woman Valid VL result N (%) Median VL cps/ml (IQR) VL ≥50 cps/ml VL ≥400 cps/ml VL ≥1 000* cps/ml Valid EID result PCR positive % IU transmission per Unit JHB B 2 103 1 230 (58.5%) <40 (0–287) 415 (33.7%) 284 (23.1%) 254 (20.7%) 1 292 (61.4%) 19 (1.5%) 1.6 JHB D 3 324 693 (20.8%) (0–387) 248 (35.8%) 169 (24.4%) 156 (22.5%) 1 305 (39.3%) 14 (1.1%) 1.5 JHB F 1 543 309 (20.0%) (0–186) 102 (33.0%) 67 (21.7%) 58 (18.8%) 823 (53.3%) 7 (0.9%) 1.2 Tshwane Metro 1 177 537 (45.6%) (0–2450) 242 (45.1%) 170 (31.7%) 153 (28.5%) 913 (77.6%) 25 (2.7%) 3.0 Total 8 147 2 769 (34.0%) (0–398) 1 007 (36.4%) 690 (24.9%) 621 (22.4%) 4 333 (53.2%) 65 1.7

Discussion ≈20% of women delivering across the four obstetric units had a VL ≥1 000 cps/mL; 36% had a VL ≥50 cps/mL eMTCT requires VL suppression throughout pregnancy, postpartum and during breastfeeding in HIV-positive women Tshwane site had higher proportions of viraemic women at delivery compared to Johannesburg sites (p=0.001). A similar trend was observed for % neonatal positivity Suggesting the Tshwane site had a higher MTCT-risk maternal population % IU transmission rates ≈ programmatic IU transmission rates, overall and by site Suggesting representativity of study population despite low coverage

Concluding Remarks High maternal VL burden around time of delivery across multi-site tertiary obstetric units in Gauteng province, South Africa Scale-up of VL monitoring and improving quality of ante- and postnatal care is urgently required for VL suppression around time of delivery and postpartum in breastfeeding populations for eMTCT