1. Outcome of a Prevention of mother to child transmission (PMTCT ) programme following Implementation of prophylaxis for HIV infected pregnant women in Barbados: a decade later. M. Anne St John. Consultant Paediatrican Queen Elizabeth Hospital, Barbados.

2. UNAIDS-WHO report for C’bean End 2005 330,000 people living with HIV/AIDS National prevalence 1.5% 51% of total - adult females 22, 000 children aged < 15 years (UN AIDS fact sheet)

3. Global situation Highest prevalence of HIV/AIDS in Sub- Saharan African population Caribbean- 2nd highest prevalence

4. UNAIDS/WHO global view of HIV infection >40 million individuals living with HIV Cumulative infection: >60 million Courtesy of UNAIDS. Sourced from http://www.phrusa.org/campaigns/aids/maps.html ID: E1 1300% 160% 100% 60% 40% 30% 20% Increases in HIV infection 1300%

5. UNAIDS/ WHO epi. data End of 2006 37.2 Million infected adults 2.3 Million children living with HIV/AIDS

6. Prevention of Pediatric HIV Infection

7. Epidemiology of Perinatal HIV Infection

8. Paediatric HIV infection from Mother to child transmission > 90% cases Exposure to infected body fluids e.g blood transfusions < 5% Sexual abuse < 1%

9. Mother to child transmission In utero- pregnancy Intrapartum - time of birth Post partum (breast feeding - 10-20%)

10. Why of PMTCT ? -Without treatment 15-40% (mean 35%) -Significantly reduced with preventive treatment - antiretroviral drug therapy (ART)

12. New Eng. Journal -in 1994 Large research study Collaborative Pediatric AIDS Clinical Trials Group ( 1994) multi- centre trial reduction in mother to child transmission from 25.5% to 8.3% ( 67.5% RR) of HIV

13. In Barbados PMTCT programme initiated in 1995 after a decision by government anti-retroviral therapy free of charge to ALL diagnosed HIV infected pregnant women through the Barbados Drug Service for prevention of mother to child transmission of HIV.

14. Subsequent years: treatment provided to pregnant women and infant after birth: 1995- 1999 Zidovudine/ AZT long course 2000-2001 Nevirapine short course 2002 - Highly Active Anti- Retroviral Therapy ( HAART)- mother ZDV infant

15. Prospective research study: Outcome of a PMTCT programme following Implementation of prophylaxis for HIV infected pregnant women in Barbados: a decade later. At the Queen Elizabeth Hospital, Barbados.

16. Ongoing research…1996 Objective: To review the impact of a national PMTCT programme in Barbados after the first decade of PMTCT prophylaxis

17. Design and Methods Using a specific database commencing in 1996, surveillance of all HIV infected pregnant women seen at government Polyclinics and private practicioners was performed. A national PMTCT programme was simultaneously initiated.

18. 3 successive time periods, HIV infected pregnant women and respective infants received ART according to three protocols: long course zidovudine short course nevirapine Highly Active Antiretroviral Therapy (HAART) CHART guidelines- senario D2)

19. None of the infants were breast fed Mothers and respective infants were followed –up after discharge with ongoing counselling at clinic visits and defaulting patients were tracked by a dedicated senior public health nurse to ensure follow–up.

20. At 2 successive follow-up visits after discharge, infants received: - clinical examinations - testing by RNA PCR testing- viral loads - ELISA serological testing at 18 months to determine whether they were infected.

21. HIV exposed live births by year 1996-2006 9697989900010203040506 1925 3421302420191639

22. Live births delivered- 1996-2006

23. Mother to child transmission of HIV 1996 -2006 Prophylaxis# live births# children infected % transmission Long course ZDV (1996- 2000) 94 5 5. 5 Short course NVP ( 2000- 2001) 37 3 8. 5 HAART (2002-2006) 118 4 3. 3

24. Overall experience : 1996-2006 Overall transmission rate - 4.4% * Last 5 years trans. rate - 3.3%

25. Conclusion: Barbadian experience PMTCT During the first decade the PMTCT programme in Barbados utilising ART has been extremely successful, with a significant decrease in transmission of the HIV, moreso during the past 5 years.

26. Thank you for sharing in this presentation.