1_SAMU_summaries_PMTCT_05_08_2017.ppt - PMTCT SAMU SUMMARIES AUGUST 2017 samumsf.org Objectives of this Presentation • To describe the global response

1_SAMU_summaries_PMTCT_05_08_2017.ppt - PMTCT SAMU...

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PMTCT SAMU SUMMARIES AUGUST 2017 samumsf.org
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Objectives of this Presentation To describe the global response to PMTCT To implement the essential programmatic components of PMTCT The four pillars of PMTCT The elements of the PMTCT cascade PMTCT /SRH integration To implement evidence based solutions to address the challenge of retention in PMTCT programmes
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Souce WHO Global Health Sector Response to HIV 2000-2015 Global PMTCT Coverage 77% coverage of ART in PMTCT 29% Nigeria 95% South Africa
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Global Targets : UNAIDS Reach and sustain 95% of pregnant women living with HIV with lifelong HIV treatment by 2018
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WHO Dual EMTCT Validation Guide International standard to allow validation to be carried out using a credible, systematic approach Monitoring of EMTCT achievement globally Recognition of countries that have successfully eliminated (and sustained elimination) of MTCT of HIV and/or syphilis
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1 Primary prevention 2. Family Planning 3. Testing and ARV Intervention for mum and baby 4. Keeping mum , dad and any positive baby alive ad well The four pillars of PMTCT ?
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Pillar 1 : Primary prevention of HIV 8 elements of prevention in antenatal and postnatal care ( WHO 2017) HIV testing HTS for all sexual and drug injecting partners Partner referral for ART if HIV positive Male partner referral for VMMC STI screening and management Condom promotion Risk reduction counselling Offer, start or continue PreP
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Pillar 1: Primary prevention in pregnancy in context of PreP WHO 2017 released guidance on role of PreP in pregnancy and breastfeeding Support the safety of PreP during pregnancy and breastfeeding
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Who to prioritise for PreP Assessment of ongoing risk ( risk scores may be used) Unknown partner status in high prevalence settings HIV positive partner not on ART or with unknown viral load Current STI including syphilis High risk exposures ( female sex work ; injecting drug use )
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Pillar 2: Family Planning All HIV positive women should have access to family planning and should be given a choice of methods FP services should be integrated into ART clinics and provided as a one stop service For stable HIV clients receiving a differentiated model of ART refill, provision for FP must be made – ideally through use of a long lasting method or community delivery of FP Women should also be encouraged to “ plan their families” – aiming to conceive when they are well and their viral load is suppressed
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Pillar 2: Family Planning Longs acting methods are preferred IUDs and IUS devices can be safely used by HIV positive women Progestogen injections can be safely used – refer to local guidelines for frequency of use Oral combined contraceptives should not be used in combination with NNRTIs There is some evidence that the effectiveness of implants may be reduced when used in combination with EFV based regimens. However where supply of other forms of contraception may be limited
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