6th International AIDS Society Conference

Better Diagnostics Are Needed to Achieve an AIDS-Free Generation

UNITAID Satellite Event18 July 2011

Jimmy KolkerChief, HIV/AIDS Section UNICEF Programme DivisionNew York

Percentage of pregnant women living with HIV receiving ARVs for PMTCT 2005, 2008 and 2009

Distribution of antiretroviral regimens provided to pregnant women, in 2007 (59 countries) and 2009 (86 countries)

Paediatric HIV Treatment

In 2009, about 356,400 children under 15 received antiretroviral treatment, an increase from only 75,000 in 2005.

However, this is only 28% of the 1.27 million children in need of ART under the new guidelines are receiving it.

• The key entry point is widespread testing of HIV-exposed newborns.

• Ideally, this would be done as soon after delivery as possible.

• Developing a test that would do this is one of UNICEF and partners’ top goals.

• EID can also be routine during 6-week immunization visits, hospital admissions or as part of family-based care for parents and older children.

Point of Care Diagnostics in PMTCT and Paediatric Care and Treatment• POC assays hold promise to help expand ART

to lower-level clinics and reach the unreached– This is especially important for access to HAART

for pregnant women (CD4) and infants (EID)• POC assays are not a solution alone to the

poor follow-up of mothers and infants– The goal is to strengthen access to and quality of

the needed continuum of care

• Compelling argument for investing low cost technologies to bring CD4 screening in less capacitated ANC facilities to treat more pregnant mothers with ART.

• Zimbabwe is working on a national approach to scale up point of care CD4 machines.

Expanding CD4 Testing in low-level facilities

Low utilization EID testing at lower-level clinics:15% of EID sites in Namibia collected >93% of all samples

8

0

20

40

60

80

100

120

140

Receive Results

HIV+ infants

Enrolled in counseling &

treatment

Infants still active after

1 year

76%

48% of HIV+ infants never received results. Several died prior to receiving results. Not

all infants were on CTX.

Of those who enroll in HIV services, almost

1/3 are no longer tracked at the site.

Without investment through the entire follow-

up continuum, the maximum impact of Early Infant Diagnosis (EID) will

not be realized.

Maximizing Impact of Early Infant Diagnosis

Follow up of infants testing HIV+ Jinia Regional Hospital, Zambia Jan 1, 2008 – December 1, 2009

BOTTLENECK: Less than 1/3 of infants tested for HIV at birth receiving treatment after one year

48%

68

34%

29%45

32

131

10

Benefits

• Speed – Wait time for results is cut in half

• Cost – No SMS cost for clinic staff

• Scale – Easier scalability using clinic staff’s own phones

• Reporting – Web portal provides national view of clinic’s DBS usage

RESULT: increased # of children correctly identified and enrolled to receive treatment

Aggregated Web Reports

Investing in diagnostics in eMTCT and Paediatric care

• Assess where there is the greatest unmet need

• Involve providers and clients to assess key bottlenecks

• Identify evidence-informed solutions and investments

• Scale-up priority intervention as component of MNCH services– HIV testing and counseling– CD4 and ARVS including ART for HIV positive pregnant wowen– Early Infant Diagnostic technologies and supportive system responses such as SMS