Mother to child transmission of HIV Sri Lankan experience
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Mother to child transmission of HIV
Sri Lankan experience
Mile stones
2002 Pilot project
PMTCT of HIV programmeAZT at 28/52 of POA
single dose NVP Baby syp AZT
2012 ART for all pregnant
women
2014 Baby syp NVP
Universal screening 6 provinces
05/02/2023 Lil/EMTCT/2015
Scaling up of EMTCT programme
HIV testing coverage among pregnant women from 2012-2015
2012 2013 2014 20150.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
HIV testing coverage
HIV testing coverage
Outcome of pregnancies (n=67)
Negative children50-75%
Positive children7-10%
Miscarriage8 -12%
Maternal death1-2%
Defaulter1-1%
Exposed children who became positive
yearDiagnosed POA wks
PMTCT started POA
PMTCT ARV
CD4 count
mode of delivery
ARV for baby weeks feeding HIV status Outcome
2001 33 36AZT 1366NVD AZT 6 BF Posdied at 3 years
2007ND 28AZT 609LSCS FF PosDied 21 days
2007 27 29AZT 430LSCS AZT 1 FF Pos
Died in 20 days VSD, Pneumonia
2009 25 27AZT+ SD NVP 830LSCS AZT/1W FF Pos
can not trace
2009Known
PLHIV36AZT+ SD NVP 67LSCS AZT/4W FF Pos on ART
*2009 20 28AZT + SD NVP 574LSCS AZT/6W FF Pos on ART
2010 40 40 745LSCSAZT+3TC+ NVP/6W FF Pos on ART
2001 2004 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150
2
4
6
8
10
12
14
16
1 1 1
2
8
5
6
7
5
6
9
16
pregnant women with HIV
pregnant women with HIV
Early ART3 drugs
AZT at 28/52
HIV positive babies born to mothers who received PMTCT services - 7
2001 2004 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150
2
4
6
8
10
12
14
16
18
Chart Title
pregnant women with HIV Baby positive
Outcome of pregnancies of mothers who received PMTCT services
2001 2004 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
02468
10121416
0 1 10 5 1
3 5 5 6 7
16
Chart Title
Baby positive Negative babies miscarriage
Miscarriage
serial No year POA wksPMTCT started POA PMTCT/ ARV CD4 count Remarks
1*2008 24w NA NA 383miscarriage. Died in 2009
2 20099wmiscarriage before ART ND 46
miscarriage 12 wks. Died in 2012
3*2010 NA NA NA 398miscarriage
4 201012 weeks AZT+3TC+NVP 366miscarriage 21w
5 20116 Weeks Already on ART AZT+3TC+NVP 499Miscarriage 8 wks
6 201112 weeks Already on ART AZT+3TC+EFV 479Miscarriage 12 w
7 20147w Already on ARTon ART & defaulted
Miscarriage/10w
8 20145w Already on ART AZT+3TC+EFV 397Miscarriage/10w
Pregnant woman with HIV
ChildrenPartner
HIV Infection among partners (n=39)
2001 2004 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150
2
4
6
8
10
12
14
1 1 12
3 3
6
32
3
5
9
Chart Title
partner+ Partner -
Infection among other children in the family (n=11)
2001 2004 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150
5
10
15
20
25
30
Other children -Other children +
Children with HIV by end December 2015
Mother to child transmission
Estimate children living with HIV Year 2015 - 100
Reported from 1994 – 78
(16 reported dead-72 records)
>15 years – 9
<= 15 years - 46
New cases reported in 2015 – 7
14
Estimated number of children (0-14 years) living with HIV, 2007-2015
15
2007 2008 2009 2010 2011 2012 2013 2014 20150
10
20
30
40
50
60
70
80
90
FemaleMale
Num
ber
Source: National STD/AIDS Control Programme_Report on HIV Estimates and Projections 2009
19941995
19961997
19981999
20002001
20022003
20042005
20062007
20082009
20102011
20122013
20142015
0
2
4
6
8
10
12
14
0
0 0 10 0
1
0
0
0
1
4
0
1
1
6
2
22
8
0
4
Annual Reported children with HIV
Male Female
Social aspect of paediatric HIV
Child Father
Siblings
Mother
Among children 67.4% had both parents having HIV. One child was an orphan and was not having any information regarding parents.Source – Dr. A Azran
both parents positive Only mother positive No data0
5
10
15
20
25
30
35
31
14
1
Figure 1.4 : HIV serostatus of their parents
Both parents alive Only mother alive Only father alive Both parents died No data0
5
10
15
20
25
30
29
11
3 2 1
Figure 1.5 : Status of the parents; live or not
Source – Dr. A Azran
Burden to the family
3 positive children
2 positive children
one positive child
0 5 10 15 20 25 30
2
6
28
Source – Dr. A Azran
Paediatric HIV cases - 2015 Age Sex District Dead/Alive Stage/Presenting
symptomsRemarks
4 yrs M Gampaha Alive
Stage 3 Both parents and sister HIV positive, Father died of AIDS
9 Yrs F
Gampaha Alive Stage 2 Both parents and brother HIV positive, Father died of AIDS
5Yrs F Polonnaruwa Alive Stage3,Fever,Bronchopneumonia
Both parents are HIV positive
3 1/2 Months F Anuradhapura died Stage 4 Mother and brother HIV positive,Father
HIV negative
3 ½ Yrs M Anuradhapura Alive Asymptomatic Mother and sister HIV positive,sister
died of AIDSFather HIV negative
3 Months F Kegalle died LRTI with febrile illness
Both parents are HIV positive
4 Years M Anuradhapura Alive Asymptomatic Both parents HIV positive,Father died
of AIDS,Other siblings HIV negative
Source – epidemiology unit, NSACP
• Isn’t it an immense injustice, that children are born with HIV still,When treatment exists,When no baby needs to be born with HIV?
Carla Bruni-SarkozyFirst Lady FranceGlobal Fund Ambassador for the Protection of Mothers and Children against HIV
EMTCT/Lil
Early Diagnosis andEarly EMTCT services
will eliminate the risk of
mother to child transmission
Of HIV.
05/02/2023 Lil/EMTCT/2015
Sri Lanka aims to achieve Elimination of Mother to Child Transmission of HIV
by end 2017
Acknowledgements
• Dr. K A M Ariyaratne• Dr. S. Beneragama• Dr. A. Azran• Dr. Iruka Rajapaksa• Dr. Chrishanthi• Staff HIV clinic
Thank You
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