m2m Budget

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					  (In)Equity in HIV Care
               …or…
         Mind The Gap
        Mitchell J. Besser, MD
     Founder and Medical Director
           mothers2mothers
Department of Obstetrics and Gynecology
       University of Cape Town
           28 October 2009
             Global HIV infections: 2007


                                               33 million in world


                                               22 million in SSA


                                               5.7 million in SA

 South Africa has less than 1% of world’s population but 17% of
                          HIV infections
SA is one of the 12 countries which account for 3/4 of world’s HIV
                     positive pregnant women
                                                            UNAIDS 2008
                      Grim Inequities
Prevalence in Pregnancy             Adult Prevalence
• Nigeria – 2.4-4.0%                • Nigeria – 3%
• Mozambique –15-21%                • Mozambique – 13%
• South Africa – 29%                • South Africa – 18%
• US and UK – 0.6%                  • US and UK - 0.3-0.6%




Coverage – PMTCT ARVs               ARV Coverage – children
• Nigeria – 10%                     • Nigeria – 12%
• Mozambique – 42%                  • Mozambique – 21%
• South Africa – 73%                • South Africa – 61%
• US and UK > 95%                   • US and UK > 95%
                                        Towards Universal Access, WHO, 2009
                  Grim Reality

FACTS:
– 2.5 million new infections (2007)
– 2.1 million adults and children died of HIV/AIDS (2007)
– 1.0 million people started on treatment in 2008



      ►Twice as many people become
         infected with HIV as start on
         treatment each year;




                                                       UNAIDS: 2007, 2009
      ► Twice as many die of AIDS
         as start on treatment.
                           Population HIV Prevalence

Southern Africa East Africa               West Africa                    Asia   LAC

                           Zimbabwe
 Botswana


            South Africa




                                                        Senegal

                                                                  Mali
Changes in life expectancy in countries with
high and low HIV prevalence: 1950-2005
                           65

                           60                                                                              with high HIV prevalence:
                                                                                                            Zimbabwe
                           55
 Life expectancy (years)




                                                                                                            South Africa
                                                                                                            Botswana
                           50

                           45
                                                                                                           with low HIV prevalence:
                           40                                                                               Madagascar
                                                                                                            Senegal
                           35                                                                                Mali

                           30
                                1950–1955- 1960- 1965- 1970- 1975- 1980- 1985- 1990- 1995- 2000-
                                1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005



                                   Source: UN Department of Economic and Social Affairs (2001) World Population Prospects, the 2000 Revision.
PACTG 076
 USPHS AZT
 Recommendations



          80%
        decline
   Decrease in pediatric HIV infections after
implementation of PMTCT programs in Thailand,
                  1994-2004




                                                 80%
                                                decline




                                 Siripon Kanshana, 2007
Mother-to-Child Transmission (MTCT) of HIV
Estimated Children Newly Infected in World

 700,000

 600,000

 500,000

 400,000

 300,000

 200,000

 100,000

      0
       1979   1982   1985   1988   1991   1994    1997    2000     2003   2006


                                                 UNAIDS estimates 2008
      Reality Check: a question of lives



• 1,200 new infections in children
  each day
• Approximately:
    • < 1 per day in the U.S.
    • 1 per day in Europe
    • 100 per day in Asia and Pacific
    • 1,100 per day in Africa




                            UNAIDS 2007
     Reality Check: a question of scale

Annual pregnancies in HIV-positive women:

       United States             < 7,000
       Rwanda                      8,600
       Soweto                      9,000


       Thailand                   10,000
       Europe                     15,000

       Kenya                     100,000
       South Africa              300,000
 PMTCT services – what’s not working
• 21% of pregnant women
  received an HIV test during
  pregnancy in 2008

• 45% of pregnant women with
  HIV received anti-retroviral
  drugs

• 15% of infants born to
  mothers with HIV were tested
  in the first two-months of life   WHO, 2009
Prevalence of HIV Pregnant Women at
       Antenatal Clinics in SA
 35
                                                          29%
 30

 25

 20

 15

 10

 5

 0
      1990 1992 1994 1996 1998 2000 2002 2004 2006 2008
                                           Dept. of Health, 2009
Challenges and Responses




 Missed Opportunities
Missed PMTCT Opportunities: The Cascade
                                        Routine offer of HIV testing


  100

   90

   80

   70

   60

   50

   40

   30

   20

   10

    0



    ANC clinic visits   Accepting VCT    Receive results   HIV-positive   NVP Mom   NVP baby
                                                                                                    Average no of women/infants reached per
                                                                                                                    month




                                                                                                                      200
                                                                                                                      400
                                                                                                                      600
                                                                                                                      800
                                                                                                                     1000
                                                                                                                     1200




                                                                                                                        0
                                                                                     AN
                                                                                        C
                                                                                             fi rs
                                                                                                       tv
                                                                                                            is i
                                                                         W                                      ts
                                                                          om
                                                                            en
                                                                                                                                                1020


                                                                               tes
                                                                                   tin
                                                                                      g
                                                                W                                      for
                                                                 om                                        H   IV
                                                                   en
                                                                      tes
                                                                                                                                              894




                                                                          tin
                                                                                                                                                    88%




                                                                             g
                                                                                           HI
                                                            CD                                V
                                                                 4t                                 po
                                                                   es                                 s it
                                                                      tin                                 i ve
                                                                         g
                                                                                                                                396




                                                                               of
                                                                                                                                        44%




                                                                                  po
                                                                                    s it
                                                            Ne                          i ve
                                                              v ir                                  wo
                                                                     ap                               me
                                                                       in e                              n
                                                                              do
                                                                                                                      146




                                                                                se
                                                                                                                                  37%




                                                                                   s      to
                                                                                             H    IV
                                                              Li v
                                                                  e   bi r
                                                                                                       po
                                                                                                         s i.
                                                                           ths                               ..
                                                                               to
                                                                                                                          212
                                                                                                                                  54%




                                                                                    HI
                                                                                       V
                                                                                           po
                                                             Ne                              s it
                               PMTCT programme components
                                                                                                                                                                      Amajuba PMTCT Cascade




                                                               v ir                              i ve
                                                                      ap                             ...
                                                                        in e
                                                                                                                     73




                                                                               do
                                                                                                                                18%




                                                                                 se
                                                                                    s      to
                                                            PC                                i   nfa
                                                               R                                     nts
                                                                     tes                                 ..
                                                                         ts
                                                                              of
                                                                                                                     62




                                                                                 H
                                                                                                                            16%




                                                                                     IV
                                                                                          ex
Chopra et al MRC Report 2007




                                                                                             po
                                                                                               se
                                                                                                 db
                                                                                                   ...
                                                                                                                     85
                                                                                                                                21%
                                                                                                                                                          Amajuba District – KZN: PMTCT Cascade - 2007
    HIVNET 012 – Nevirapine Study

          Nevirapine (sdNVP) Oral AZT
Mother    200mg in labor     300mg q3° in
  labor
Infant    One dose            AZT x 7 days
Feeding   Breast              Breast

            Transmission at 6 Weeks:
              Nevirapine       8%
              AZT              16%
Timing of HIV Transmission
  (non Breast-Feeding cohort)




                      sdNVP




                          Am J Epidem 1995
Thailand: Dual Therapy – AZT+sdNVP

• AZT 300 mg twice daily from 28 weeks
• AZT 300 mg every 3 hours in labour
• AZT syrup to infant for 7 days

• sdNVP at onset of labor to mother
• sdNVP syrup to infant at delivery

• Infants formula fed.

                         (Lallemant et al; NEJM July 15, 2004)
   Efficacy of AZT+sdNVP in Thailand

• 3 groups by NVP treatment:
     Mother             Baby                     TR
  1) NVP                NVP                      1.9%*
  2) NVP                Placebo                  2.8%*
  3) Placebo            Placebo                  6.3%**

  * No difference between arms (1) and (2)
  ** Arm (3) discontinued




                                 (Lallemant et al; NEJM July 15, 2004)
 WITS Study – Vertical Transmission
 Prospective Cohort Study 1990-1999

Therapy       TR      Viral Load   TR
Untreated     20.7%   <400          .9%
ZDV<’94       19.4%   400-3K       6.4%
ZDV>’94       7.7%    3K-40K       11.3%
Combo/no PI   3.9%    40K-100K     21.1%
HAART         1.1%    >100K        30.1%
Timing of HIV Transmission
  (non Breast-Feeding cohort)




                        sdNVP




              Dual Rx/HAART




                              Am J Epidem 1995
                                                                                                    Average no of women/infants reached per
                                                                                                                    month




                                                                                                                      200
                                                                                                                      400
                                                                                                                      600
                                                                                                                      800
                                                                                                                     1000
                                                                                                                     1200




                                                                                                                        0
                                                                                     AN
                                                                                        C
                                                                                             fi rs
                                                                                                       tv
                                                                                                            is i
                                                                         W                                      ts
                                                                          om
                                                                            en
                                                                                                                                                1020


                                                                               tes
                                                                                   tin
                                                                                      g
                                                                W                                      for
                                                                 om                                        H   IV
                                                                   en
                                                                      tes
                                                                                                                                              894




                                                                          tin
                                                                                                                                                    88%




                                                                             g
                                                                                           HI
                                                            CD                                V
                                                                 4t                                 po
                                                                   es                                 s it
                                                                      tin                                 i ve
                                                                         g
                                                                                                                                396




                                                                               of
                                                                                                                                        44%




                                                                                  po
                                                                                    s it
                                                            Ne                          i ve
                                                              v ir                                  wo
                                                                     ap                               me
                                                                       in e                              n
                                                                              do
                                                                                                                      146




                                                                                se
                                                                                                                                  37%




                                                                                   s      to
                                                                                             H    IV
                                                              Li v
                                                                  e   bi r
                                                                                                       po
                                                                                                         s i.
                                                                           ths                               ..
                                                                               to
                                                                                                                          212
                                                                                                                                  54%




                                                                                    HI
                                                                                       V
                                                                                           po
                                                             Ne                              s it
                               PMTCT programme components
                                                                                                                                                                      Amajuba PMTCT Cascade




                                                               v ir                              i ve
                                                                      ap                             ...
                                                                        in e
                                                                                                                     73




                                                                               do
                                                                                                                                18%




                                                                                 se
                                                                                    s      to
                                                            PC                                i   nfa
                                                               R                                     nts
                                                                     tes                                 ..
                                                                         ts
                                                                              of
                                                                                                                     62




                                                                                 H
                                                                                                                            16%




                                                                                     IV
                                                                                          ex
Chopra et al MRC Report 2007




                                                                                             po
                                                                                               se
                                                                                                 db
                                                                                                   ...
                                                                                                                     85
                                                                                                                                21%
                                                                                                                                                          Amajuba District – KZN: PMTCT Cascade - 2007
 Estimates of PMTCT cascade: “typical” sites
1000 positive mothers                Enter into                    Missed -
                                      program                     no PMTCT


Attend ANC: 90%                           900                          100
                                                                                    685 No ARV
Counseled and tested                                                                (25% MTCT):
                                          630                          270
for HIV, CD4: 70%
                                                                                    172 infected
Get ARVs (pre- and
                                          315                          315
perinatal) 50%

Transmission rates:                                              Overall Program Efficacy:
• sdNVP (8% MTCT):     25 infected                               • sdNVP:       19.7%
• AZT/sdNVP (3% MTCT): 9 infected                                • AZT/ sdNVP: 18.1%
• HAART (2% MTCT):     6 infected                                • HAART :      17.6%
            Adapted from P. Barker, IHI, WHO PMTCT Mtg Nov 2008, L Mofenson, 2009
                             Myth of the 80’s
1000 positive mothers                Enter into                    Missed -
                                      program                     no PMTCT


Attend ANC: 80%                           800                          200
                                                                                    488 No ARV
Counseled and tested                                                                (25% MTCT):
                                          640                          160
for HIV, CD4: 80%
                                                                                    122 infected
Get ARVs (pre- and
                                          512                          128
perinatal) 80%

Transmission rates:                                              Overall Program Efficacy:
• sdNVP (8% MTCT):     41 infected                               • sdNVP:       16.3%
• AZT/sdNVP (3% MTCT): 15 infected                               • AZT/ sdNVP: 13.7%
• HAART (2% MTCT):     10 infected                               • HAART :      13.2%
            Adapted from P. Barker, IHI, WHO PMTCT Mtg Nov 2008, L Mofenson, 2009
     Estimates of PMTCT cascade: ―excellent site‖
                                                                                 Soweto PMTCT
1000 HIV +ve                     Enter into               Missed -               program 2008
mothers                           program                no PMTCT


Attend ANC: 96%                       960                      40
                                                                            69 No ARV
Counseled and tested                                                        (25% MTCT):
                                      950                      10
for HIV, CD4: 99%
                                                                            17 infected
Get ARVs (pre- and
                                      931                      19
perinatal) 98%

Transmission rates:                                      Overall Program Efficacy:
• sdNVP (8% MTCT):     74 infected                       • sdNVP:       9.1%
• AZT/sdNVP (3% MTCT): 28 infected                       • AZT/ sdNVP: 4.5%
• HAART (2% MTCT):     19 infected                       • HAART :      3.6%
             Adapted from P. Barker, IHI, WHO PMTCT Mtg Nov 2008, L Mofenson, 2009
           Missed Treatment Opportunities



                     73%
Patients




                                 50%
                                       Mahdi, Abs. 437, HIV
                           25%         Implementers, 2007
Challenges and Responses




     Incident HIV
 Couples Status - Discordance Predominates
Couples Status - Discordance Predominates
                                          Data Source
     Country       Ratio     Prevalence

                                             DHS-05
    Ethiopia        6:1      1.8%/0.3%

                                            AIS 03/04
    Tanzania        3:1      7.9%/2.6%

                                             DHS-03
    Kenya           ~2:1     7.4%/3.7%

                                             DHS-05
    Rwanda          ~2:1     3.1%/1.7%

                                             AIS-04/5
    Uganda         1.6:1     4.6%/3.4%


               (Discordant/concordant)
Couples Status - Discordance Predominates


       If Man HIV+ and in a couple…
                               Data Source
    Country    % HIV+ Woman
                                  DHS-05
    Ethiopia        27%
                                 AIS 03/04
    Tanzania        37%
                                  AIS-04/5
    Uganda          55%
                                  DHS-05
    Rwanda          55%
                                  DHS-03
    Kenya           57%
         HIV Incidence in Pregnancy

      Where effective interventions have reduced
   transmission in identified women, new infections
  during pregnancy may be a major source of MTCT.

•Incident HIV in pregnancy = new infections in women
 with a documented negative test in that pregnancy

•MTCT rates:

  • 70% during pregnancy and childbirth

  • 36% during breastfeeding
  Impact of incident HIV infection in pregnancy
• A Botswana study showed:
   • Among women testing negative in early pregnancy:
      • 1.3% were infected in 17 weeks before delivery, plus
      • 1.8% were infected in the first postpartum year.
• Extrapolating this to the national Botswana figures:
   • Estimate 950 women acquired HIV during pregnancy or first
     postpartum year, and infected 470 infants.
• Botswana National PMTCT program transmission data show
   • 13,900 women infected an estimated 620 infants (4.7%).
   Incident HIV thus estimated to to account for 470/1090
 Incident HIV is is thus estimatedaccount for 470/1090 (43%)
              (43%) in 2007
 of infant infectionsof all infant infections in 2007
                                          T Creek, personal communication 2008
Challenges and Responses




  Magical Thinking
World Population
Doctors Working in the World
HIV Prevalence
       Challenges and Responses




Sub-Saharan Africa – 24% of world disease burden
           Magical Thinking workforce
                – 3% of healthcare
                Staffing Ratios

   Selected categories of health care workers per
             100,000 population (2007)
Region/Country     Physicians           Nurses
United States          256                          937
South Africa            77                          408
Botswana                40                          265
Zambia                  12                          174
Zimbabwe                16                           72
Lesotho                 5                            62
Mozambique              3                            21
                                http://www.hst.org.za/uploads/files/cahp9_07.pdf
South African Population (2007):                 47 849 800
population dependent      health professionals    vacant posts
on public health sector     in public sector        in public
                                                  health sector



             85%            Nurses
                                     44%                 36%
       of Total




              93%              Doctors
                                         10%             34%
      of Black
      Africans
                           South Africa Situation
                  Clinical Load at Primary Health Center Level
                            Doctor:                       Nurse:
                   30 patients per day               40 patients per day
             = one every 16 mins                   = one every 12 mins




http://www.hst.org.za/uploads/files/cahp9_07.pdf
Transmission Rates:
     14-16%
                      Counsel for HIV test
                      Perform HIV test,
                                   explain results
 PMTCT Program        Dispense single dose nevirapine

  Interventions:                   explain how to take
                      Discuss infant feeding options

  In 2001…            Reinforce exclusive infant feeding
                      Perform infant HIV test at 12-months
                                   explain results




                       Nurse: 12
                      minutes per
                        patient
Transmission Rates:
      2-5%
                      Counsel for HIV test
                      Perform HIV test,
    PMTCT                          explain results
                      Perform CD4 test,
   Program                         get and explain results
                      Dispense cotrimoxazole
Interventions:        Discuss infant feeding options
                      Dispense AZT (from 28 weeks), explain how to take

In 2008…              Dispense HAART (if eligible), explain how to take
                      Counsel on adherence to HAART
                                   Screen for HAART related toxicity
                                          Reinforce exclusive infant feeding
                                                Where ARVS for breast feeding are
                                                         available, explain how to use
                                                       Perform infant HIV test at 6
                                                             weeks, explain results
                       Nurse: 12                            Refer mother to follow-up care,
                                                                encourage her to attend
                      minutes per
                        patient
            Task Shifting
            Task Shifting:
Global Recommendations and Guidelines
             (WHO - 2008)

  “…we must seek innovative ways of
    harnessing and focusing both the
 financial and the human resources that
             already exist…”
mothers2mothers
        PMTCT Isn’t Working…


• Poor uptake of HIV testing
• Poor uptake of AZT/NVP by mother and baby
• Uncertainties regarding infant feeding:
   – Choice
   – Adherence
   – Weaning
• Poor follow-up for infant testing
• Poor transition of mothers to ARV programs
  and Wellness Care during and after pregnancy
• Poor transition of babies to baby clinics and
  HIV/AIDS care
                   Causes
• Institutional
     too few nurses and midwives
     poor links between PMTCT and on-going HIV
      care
     poor links between health care facility and
      community
• Societal
     disempowered women
     Stigma
• Same issues across Africa
                  mothers2mothers
       Vision                      Goal 1: PMTCT
m2m envisions a world       To prevent babies from contracting
 where babies are not           HIV through mother-to-child
 born with HIV, where       transmission and promote HIV-free
HIV+ mothers are alive                   survival.
and healthy to care for      Goal 2: Healthy mothers
  their families and
                                   and infants
  where HIV-positive
                            To keep HIV-positive mothers and
women are empowered
                             their infants alive and healthy by
   to live positively
                            increasing their access to health-
                                  sustaining medical care

                               Goal 3: Empowerment
                              To empower mothers living with
                             HIV/AIDS, enabling them to fight
                            stigma in their communities and to
                             live positive and productive lives
                Primary Objectives
• Increase HIV and CD4 testing during pregnancy
• Enhance uptake of antiretroviral medications:
     PMTCT during pregnancy
     ARVs during and after pregnancy
• Choice of and adherence to method of exclusive infant
  feeding
• Appropriate weaning and introduction of complementary
  foods
• Infant testing
• Referral of mother and infant
  to follow-up care
• Disclosure
• Reducing stigma
• Partner involvement
• Empowerment – ―living positively‖
           Secondary Benefits

Promote health systems and 4-prong approach to
   PMTCT:
• Attendance at antenatal and postnatal clinics
• Safe motherhood initiatives - deliveries in
   health care facilities
• Family planning – reduce the number of
   unwanted pregnancies
• Couples testing for primary prevention of HIV
   infection in discordant couples
     Simple, Scale-able Model of Care

Mothers are a community’s single greatest resource

Mothers living with HIV (Mentor Mothers) educate and
support HIV-positive pregnant women and new
mothers in health facilities
                          • Individual and group
                            engagement
                          • Daily presence for
                            education and support
                          • Mentor Mothers:
                            professional members of
                            health care team—paid
                            for service
   Site Coordinators and Mentor Mothers


• Recruited locally
• Selection criteria
     Mothers
     HIV-positive
     Attended PMTCT
     Disclosed
• Basic numeracy & literacy skills
• Mentors engaged for up to two years
• Site Coordinators manage services and relieve facility
  staff of management concerns
          Training

Training cascade:
National Trainer SC/MM     Patients

            • Curriculum based education
            • 2 weeks - Mentor Mothers
            • 3 weeks - Site Coordinators
               – Mentor Mother training
               – Management training
            • Periodic top-up training
             Points of Service



•   Antenatal clinics
•   Post-delivery wards
    before discharge
•   Postnatal programs
•   Targeted community
    outreach
    m2m Does Not:

• Counsel for or perform HIV testing
• Provide medication
• Distribute formula


    m2m Does:
 • Support medical
   services that do
                Site Management Plan

           Regional or District Program Manager



     SC                    SC


                                           Site Systems
     MM
           MM              MM
MM
     MM


Tertiary                 Primary
 Care                    Health
Hospital                 Center
Site System

              Community Outreach




                      Satellite Health Centres



                             Hospital
                             or Major
                             HC




              Community
                Outreach
                                   Community Outreach
     Program Implementation
Buy-in from:
• National government health services
• District health services
• Facility managers and staff
• CBOs and civil society
Community involvement
• Facility staff and CBOs assist with staff
  recruitment
       promotes integration of m2m into
          healthcare facilities and communities
       links PMTCT care with other community
          services
Population Council - Horizons Study:
        Research Questions


            Does mothers2mothers:
              – Increase HIV-positive women’s
                utilization of key PMTCT
                services?
              – Improve PMTCT outcomes and
                psychosocial well-being?
 Population Council - Horizons Study (2007)
• PMTCT
   – 95% of mothers received nevirapine
   – 88% of babies received nevirapine
• Care
   – 79% had CD4 counts
   – 88% knew CD4 count results
• Infant Feeding
   – 89% chose exclusive infant feeding method
• Family Planning
   – 70% using contraception
• Disclosure
   – 97% disclosed (4.4x non-participants)
   Program Participants Report Better
        Psychosocial Well-being
• Pregnant participants were significantly more
  likely to feel they could:
   – Do things to help themselves
   – Cope with taking care of baby
   – Live positively
• Postpartum participants were significantly more
  likely to feel less:
   – Alone in the world
   – Overwhelmed by problems
   – Hopeless about future
          Early Baby Testing Study

• Background:
      • Poor uptake of early infant HIV testing across Africa.
      • Importance of early infant diagnosis for short-term
        and long-term health of babies.
• Objective: To assess feasibility and effectiveness of
  interventions to promote early infant HIV testing
• Eligibility criteria:
      • m2m HIV+ clients
      • > 32 weeks attending one of 10 IC sites for antenatal
        care
      • Access to cell phone
• Sample size: N = 435 clients enrolled
      • 211 in Standard sites and 224 in Enhanced sites.
          Early Baby Testing Study

• “Standard” intervention:
  – Clinic based care only
     • Improved education on importance of early infant HIV testing
     • Use of m2m wheel to estimate date of return visit
     • Client information sheet – date and location of baby HIV test
• “Enhanced” intervention:
  – Clinic based care PLUS active client follow-up
     • 8 week telephone call
     • 10 week call + home visit if needed
• Key outcomes (HIV test and test result):
     • m2m clinic based records
     • 16 week phone call if no clinic based record
 Resources developed for study


                   Baby HIV Test Card




m2m Wheel
       Early Baby Testing Study

• “Standard” intervention:
  – Clinic based care only
     • Improved education on importance of early infant HIV testing
     • Use of m2m wheel to estimate date of return visit
     • Client information sheet – date and location of baby HIV test
• “Enhanced” intervention:
  – Clinic based care PLUS active client follow-up
     • 8 week telephone call
     • 10 week call + home visit if needed
• Key outcomes (HIV test and test result):
     • m2m clinic based records
     • 16 week phone call if no clinic based record
       Early Baby Testing Study
           Interim Results (n = 130)
“Standard Sites”            “Enhanced Sites”
     n = 74                      n=56

                           Eligible 8 week call
     Lots of                 Y=43 (77%), N=13 (23%)

      calls               Eligible 10 week call
                                & home visit
                            Y=12 (21%), N=44 (79%)


                           10 week home visit
                          Y=2 (4%) Excluded/too far = 4
                                   Not found = 6
       Early Baby Testing Study
           Interim Results (n = 130)
“Standard Sites”            “Enhanced Sites”
     n = 74                      n=56

                           Eligible 8 week call
                             Y=43 (77%), N=13 (23%)


                          Eligible 10 week call
                                & home visit
                            Y=12 (21%), N=44 (79%)
    Very few
     home                  10 week home visit
                          Y=2 (4%) Excluded/too far = 4
     visits                        Not found = 6
               Early Baby Testing Study
                                        Key Infant HIV Study
                                  Key Findings Findings

    100%

      90%
              Data from                                                                         95%
              other m2m                                    90%                            91%
      80%                                                               87%
                 sites                   84%                                  83%
      70%
              (logbooks)
                                                     74%
      60%

      50%
                                   53%
      40%

      30%        28%       46%
      20%
                         7%
      10%

       0%
            Los t to Fol l ow up Infa nts tes ted of Infa nts wi th    Mothers wi th Tes ted Nega tive
                                      mothers        recorded bi rth res ul ts of i nfa nts (n=33,39)
Standa rd                             enrol l ed     da tes tes ted* tes ted (n= 39, 47)
Enhanced                              (n=74,56)         (n=53,52)
M2M2B – 2001




               South Africa
          m2m – 2009/10
                      “Ethiopia”
                      Uganda
                      Kenya
                      Rwanda
                      Zambia
                      Tanzania
                      Malawi
                      “Botswana”
                      Mozambique
                      Swaziland
                      Lesotho
Namibia               South Africa
m2m Today




            70
             m2m – Activities 2009

 Timing     Sites     Field   Patient encounters    New HIV-
                      Staff       per month         positive
                                                   women per
                                                     month
September   581       1645         208,907           24,165
  2009

                    Total HIV-positive pregnant
                          women reached:

               20% of the global disease
                        burden
                   Gratitudes



• James McIntyre
• James McIntyre
• Monica Nolan
• Monica
          Nolan
• Mickey Chopra
• David Wilson
• Tanya Doherty
• UNICEF
• Wenli Cai
   Zapiro
• …and to all of the
• …and to all of the
   mothers…
mothers…

				
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