Transcript PMTCT Impact Short Guide

International Guidance on
Methods to Measure
PMTCT Impact
Chika Hayashi
Strategic Information, HIV Department
WHO
E-MTCT Targets
Towards the Elimination of New Paediatric HIV Infection
among Children by 2015 and Keeping Their Mothers
Alive, Global Plan 2011-2015
Launched June 2011
2015 Targets in the Global Plan:
 90% reduction in new child HIV infections
 50% reduction in HIV-related maternal deaths
 <5% MTCT (final transmission)
 Other targets for all 4 prongs of PMTCT
Where are we with MTCT?
Estimated M TCT Rate and Target among low and middle income countries,
2000 to 2015
0.40
Modelled
33%
0.35
27%
0.30
2005
0.25
0.20
UNGASS
2010
0.15
0.10
0.05
2015: MTCT<5%
0.00
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
How should we measure progress in
achieving E-MTCT ?
~Global and National Level~
Outcomes of Interest and Definition
Methods
Baseline and Measurement Frequency
Plan from now to 2015
Goal is to Assess Population-Level Outcome
PMTCT Cascade
Final Outcome Assesed
Early infant diagnosis
ARVs: postnatal transmission
ARVs: perinatal transmission
Identified HIV+ pregnant women
Estimated HIV+ pregmant women
 Outcomes of interest: MTCT at different timepoints, new child HIVinfection, HIV-free survival, survival
 Directly ascertain outcome. Some loss-to-follow-up is inevitable and
thus need to couple with assumptions on outcomes in population not
captured.
Short Guide: Methods to Measure PMTCT Impact
For each approach (3-5pages):
 Modelling (and better data for it)
1. Brief description of method
 Immunization Clinic Survey and
Follow-Up
2. Questions it can answer
 Population-based surveys
 Cohort/Follow-up Data
 Analysis of EID Data
3. Suitable setting
4. Pros and cons
5. Steps and Tips
6. Budgeting for It
Generic Protocol for Each Approach outlines what needs to
be done step-by-step, with key country decision options
for steps that should be adapted to the country context.
Summary of Methods
Method
Description
Modelling ●Estimation of population MTCT
and new paediatric HIV infections,
based on PMTCT ARV coverage
and transmission assumptions.
Other outcomes (e.g. deaths) can
be modelled too.
●Transmission rates for Option A/B
updated in 2011 Spectrum.
Pros & Cons
Pros:Easy to implement
Cons: Quality of input data
and asumptions.
ARV data input not
necessarily accurate
reflection of adherence.
Transmission assumptions
based on clinical trials.
Immuniza ●Cross-sectional facility-based
Pros: Captures infants
-tion survey testing for HIV exposure and with unknown HIV
infection in infants attending DPT1 exposure status.
Clinic visit around 6 weeks. PMTCT
Survey intervention uptake history linked Cons: Bias from
immunization seeking
with transmission outcome.
behaviour. Survival bias.
●Can be an entry point to FU study
of identified HIV-exposed child for
later/final outcomes.
Method
Description
Pros & Cons
Pros:Ideal to get full
Cohort/ ●Intensive cohort follow-up;
picture.
Follow-Up retrospective data linking,
extraction and tracing.
Cons: Loss to follow-up is
Data
●Significant attrition is the reality inevitable.
in many settings so need to make Hawthorne effect.
assumptions for those not
Resource intensive.
captured in data.
Population- ●Population-based household
Pros: Captures child
that includes HIV testing in deaths.
based survey
children (and mothers). Provides
surveys survival
Triangulate
multiple
methods
for validation
and HIV
status among
all Nationally
representative.
children born in a defined time
Cons: Large sample size
period.
required and only practical
●Can collect intervention uptake in very high prevalence
and other data at the same time. countries. Expensive.
Analysis of ●Analyze routinely collected EID Pros: EID lab database
usually exists.
EID and data for positivity rate.
Cons: Unless PITC in all
to be coupled with
Testing ●Need
estimating number/% of children children, EID data is not
representative. Bias from
Data
with no HIV test and their
health seeking behaviour.
outcomes, to get a national
Survival bias.
estimate.
EID alone does not
address final transmission.
Next Steps
 One national M&E system
 M&E Working Group of IATT PMTCT and
other experts.
PMTCT Impact
Assessment
Guide
 Short guide finalized over the next month
to be available for COP and GF-R11.
We welcome your input!
 Generic protocols underway, finalize with
experts and field-experience
 Field-test multiple methods in a few
countries
 Collective effort to scale-up PMTCT
impact evaluations