1. EMTCT in Europe

2. MTCT rates, UK and Ireland, 1990-2011 CROI 2007 Poster 761, Townsend et al 2 3703 diagnosed women, 1990-2004 Low rates of MTCT from diagnosed women 2000-2006 Townsend et al. AIDS 2008; 22:973-81 Overall MTCT 1.2% (61/5151, CI 0.9-1.5%) 0.8% among 4864 women who received >14 days ART Only 3 transmissions (0.1%) among 2117 women delivering with undetectable viral load Current MTCT rate 2007-11 <1% All available at www.nshpc.ucl.ac.uk

3. MTCT rates based on ELISA testing at 18 months, Ukraine, 2001-2009,

4. Level of Validation Validation criteria to be met among: General population Key populations – additional studies and indicators to assess service coverage and impact

5. MTCT rates among IDU in ECS cohort study, Ukraine, 2000-09

6. 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 - Partner HIV testing - CD4 post partum and linkage to HIV care for mother and family -Short course zidovudine (AZT) - CD4 antepartum and every 6 month - HAART for mother CD4 200 cell/mm3 - tail regimen (AZT+3TC) couples HIV counseling and testing HAART for all Measuring impact of Thai National EMTCT programs,2000-2012 -Voluntary counseling and testing (VCT) for all pregnant women -Formula feeding -HIV antibody testing for HIV-exposed infants at 12, 18 months - AZT + single dose nevi rapine (NVP) PHIMS version 1-2 ….........................................V 3 PHIMS version 3.1 PHOMS “Perinatal HIV outcome monitoring system” (4 provinces (2001), 14 provinces (2004) NAP,NHSO EID CD4 > 350 stop ARV Develop by Sarawut boonsuk,DOH,MOPH,Thailand 2012

7. PHIMS v3.1(update) Web-based,Online system Community Hospital Provincial Health Office DOH -server/ analysis Provincial Hospital Regional Hospital System development & maintenance Country data analysis BMA - DMS Data entry /Utilization RHPC Data utilization/analysis supervision

8. PMTCT menu National Electronic Data base National AIDS Program, Outcome and impact monitoring Developed by National Health Security Office with technical support for PMTCT outcome report by GAP Thailand – U.S.CDC Since 2007

9. Malawi (1) 1.N/A 2.Challenges in measuring PMTCT impact: – How to gain an accurate reflection of the national program impact while intervening to track “lost” patients and get them back into care – Estimating loss-to-follow-up across the cascade: Appropriate tools to track women from ANC to L&E to follow-up ART; – Tracking infants from delivery (live discharge) to follow-up care and final diagnosis 3.Study information for program improvement: – Identifying “holes” in the program: Where are we losing most ground in our EMTCT effort?

10. Malawi (2) 4.Key gaps in current evaluation approach: – Connecting expanded VL and DNA-PCR services for the study to the broader National Lab strategy – EFV toxicity monitoring; separate study being considered 5.Future impact evaluation approaches: – WHO/CIDA funded evaluations starting soon Impact of service delivery models on uptake, retention and adherence (ie. ART provided in ANC or ART clinic?) Other evaluations planned but not yet underway by partners: UNC, Dignitas International