1. Washington D.C., USA, 22-27 July 2012www.aids2012.org Preventing Mother to Child HIV Transmission through Community Based Approach in Nepal Nafisa Binte Shafique Chief, HIV and AIDS Section UNICEF Nepal

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org About Nepal Total Population – 28,810,000 Estimated annual births – 780,000 Maternal mortality ratio – 380 per 100,000 live births Contraceptive prevalence rate – 48% Unmet need for family planning – 24.6% ANC coverage (at least 1 visit) - 87% ANC coverage (4 or more visits) – 50%

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org About Nepal Skilled attendant at delivery – 29% Institutional delivery – 28% Exclusive breastfeeding for infant <6 months – 53% Infant mortality rate (per 1,000 live births) - 39 Under 5 mortality rate (per 1,000 live births) - 48

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org HIV situation in Nepal – a brief overview 1988 First HIV case reported in 1988 Evolved from low prevalence to ‘concentrated epidemic’ among the most at risk population IDU, FSW, MSM and TG, Labour migrant 55,626 Estimated HIV infections – 55,626 18,396 Identified cases – 18,396 0.33% Adult (15 – 49) HIV prevalence – 0.33% (one of the highest in South Asian Region) 28% Proportion of women 15 – 49 living with HIV – 28% 6.2% Proportion of young girls(15 – 24) living with HIV – 6.2% 6 Average number of new infections per day – 6 460 Average number of new infections amongst children (0 – 14) per year – 460 284 Average number of average deaths among children (0 – 14) per year – 284 24,000+ Estimated number of children affected by AIDS - 24,000+

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org PMTCT Situation Government of Nepal initiated PMTCT services in 2005 however, only at district level hospitals Accessibility by most disadvantaged pregnant women living in remote areas remained as a challenge In 2009, GoN with UNICEF’s support and in collaboration with CBOs introduced a community based PMTCT service integrated with MNCH, in one of the highest HIV burden districts of Nepal.

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org Method Where The CB-PMTCT model uses the government’s existing MNCH structures Who Trained Volunteers provide HIV information to pregnant women and refer them for ANC services When During ANC visits pregnant women are encouraged to take HTC services What If positive, the pregnant woman is referred for further treatment and support How During the pregnancy she is provided with counseling on delivery preparedness and treatment adherence. HIV-positive women are encouraged for institutional delivery

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org Results

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org Conclusions Utilization of PMTCT by pregnant women dramatically increased by taking services at the community level The volunteers and WLHIV created demand for PMTCT services and care practices The integration of PMTCT in MNCH services is an efficient, cost effective and sustainable approach

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org Conclusions Because of the proven efficacy of the intervention Government is keen to scale up the model in 7 districts with GFATM funding In order to improve the service utilization, HTC services should be decentralized up to the community level It is also imperative to address stigma and discrimination and change social norms to ensure equitable access to services by KAP

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org Thank you Any Question?