1. 6 th Annual Emergency Plan for AIDS Relief Track 1.0 ART Program Meeting August 11–12, 2008; Washington D.C. Christian Pitter, MD MPH Director, Global Technical Policy PMTCT Scale-up Elizabeth Glaser Pediatric AIDS Foundation

2. Rwanda Uganda Kenya Thailand Angola Malawi Tanzania Zambia Zimbabwe Russia Swaziland Dominican Republic Cameroon India Georgia Honduras Mozambique China Cote d’Ivoire Lesotho D.R. Congo South Africa Project initiated with EGPAF funds & successfully transitioned to other support EGPAF Country Programs: 8 sites in 6 countries in 2000 3,000 sites as of March 31, 2008, with a presence in 18 countries

3. EGPAF PMTCT Cascade Totals 2000-2008

5. EGPAF PMTCT Accelerating outputs –Approximately 2 million women tested since 2006 out of 5 million cumulative Improving Performance –Counseling, Testing & Results –Maternal and Infant ARV uptake

6. EGPAF PMTCT Cascade Percents 2000-07 vs. 2007-08

7. EGPAF PMTCT Cascade Improved Performance Experience at facility level Making it simpler for women –Rapid Testing –Opt-out HIV Testing –SD-NVP Dosing at Diagnosis

8. EGPAF PMTCT Cascade Prevalence, maternal and infant ARV uptake 2000-07

9. New Challenges in PMTCT 1 Combination Prophylaxis –More efficacious than SD-NVP –Numerous implementation challenges (supply chain, training, support) –28% of EGPAF PMTCT sites using combination prophylaxis; increasing capacity Integration/Linkage with Reproductive Health, HIV C&T, Child Health

10. New Challenges in PMTCT 2 Achieving universal access –“Low-hanging fruit” –Working at all levels of the health system –Sustainability WHO, 2008

11. PMTCT District Approach Zimbabwe, Tanzania, Zambia, Uganda, Côte d’Ivoire, others Working with/in/through district administrative structure –Subgrant mechanisms with accountability –TA for planning, targets, infrastructure –TA for clinical and program services –Ongoing support and mentorship