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?