Washington D.C., USA, 22-27 July 2012 www.aids2012.org Preventing Mother to Child HIV Transmission through Community Based Approach in Nepal Nafisa Binte Shafique Chief, HIV and AIDS Section UNICEF Nepal
Jan 15, 2016
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Preventing Mother to Child HIV Transmission through Community Based
Approach in Nepal
Nafisa Binte Shafique
Chief, HIV and AIDS Section
UNICEF Nepal
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Washington D.C., USA, 22-27 July 2012www.aids2012.org
About Nepal• Total Population – 28,810,000• Estimated annual births – 780,000• Maternal mortality ratio – 380 per 100,000
live births• Contraceptive prevalence rate – 48%• Unmet need for family planning – 24.6%• ANC coverage (at least 1 visit) - 87%• ANC coverage (4 or more visits) – 50%
Washington D.C., USA, 22-27 July 2012www.aids2012.org
About Nepal
• Skilled attendant at delivery – 29%• Institutional delivery – 28%• Exclusive breastfeeding for infant <6
months – 53%• Infant mortality rate (per 1,000 live births) -
39• Under 5 mortality rate (per 1,000 live
births) - 48
Washington D.C., USA, 22-27 July 2012www.aids2012.org
HIV situation in Nepal – a brief overview• First HIV case reported in 1988• Evolved from low prevalence to ‘concentrated epidemic’ among the most at
risk population IDU, FSW, MSM and TG, Labour migrant • Estimated HIV infections – 55,626• Identified cases – 18,396• Adult (15 – 49) HIV prevalence – 0.33%(one of the highest in South Asian
Region)• Proportion of women 15 – 49 living with HIV – 28%• Proportion of young girls(15 – 24) living with HIV – 6.2%• Average number of new infections per day – 6• Average number of new infections amongst children (0 – 14) per year – 460• Average number of average deaths among children (0 – 14) per year – 284• Estimated number of children affected by AIDS - 24,000+
Washington D.C., USA, 22-27 July 2012www.aids2012.org
PMTCT Situation
• Government of Nepal initiated PMTCT services in 2005 however, only at district level hospitals
• Accessibility by most disadvantaged pregnant women living in remote areas remained as a challenge
• In 2009, GoN with UNICEF’s support and in collaboration with CBOs introduced a community based PMTCT service integrated with MNCH, in one of the highest HIV burden districts of Nepal.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
MethodWhere
• The CB-PMTCT model uses the government’s existing MNCH structures
Who
• Trained Volunteers provide HIV information to pregnant women and refer them for ANC services
When
• During ANC visits pregnant women are encouraged to take HTC services
What
• If positive, the pregnant woman is referred for further treatment and support
How
• During the pregnancy she is provided with counseling on delivery preparedness and treatment adherence. HIV-positive women are encouraged for institutional delivery
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Results
ANC Coverag
e
HTC uptak
e
ARV rece
ived by +
ve preg
nant w
omen
Infant A
RV cove
rage
Institutional
delive
ry
.000%10.000%20.000%30.000%40.000%50.000%60.000%70.000%80.000%90.000%
2008 - 2009
2011
2008 - 20092011
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusions
• Utilization of PMTCT by pregnant women dramatically increased by taking services at the community level
• The volunteers and WLHIV created demand for PMTCT services and care practices
• The integration of PMTCT in MNCH services is an efficient, cost effective and sustainable approach
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusions
• Because of the proven efficacy of the intervention Government is keen to scale up the model in 7 districts with GFATM funding
• In order to improve the service utilization, HTC services should be decentralized up to the community level
• It is also imperative to address stigma and discrimination and change social norms to ensure equitable access to services by KAP
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Thank youAny Question?