«II. About the Global Plan The Global Plan aims to eliminate new HIV infections among children by 2015 and keep their mothers alive. There are now ...»
There are fewer options of age-appropriate antiretroviral drugs available for use by children and the cost of treatment for children is higher. Treatment can only be successful if children receive WHO recommended regimens and are assisted in adhering to their medication, a challenge in many settings. There is also an urgent need for paediatric antiretroviral formulations that are heat stable, palatable and easy for parents to administer. Medication supply issues further hinder paediatric treatment. Complex formulations and regimens complicate pricing and ordering decisions are contrary to a public health approach that focuses on the uptake of a limited number of optimized regimens. The 2013 WHO guidelines have recommended a more simplified approach to paediatric antiretroviral therapy, and work is ongoing to further simplify and harmonize paediatric regimens.
IV. Update on implementation during 2014 The bulk of effort during 2014 was devoted to technical assistance to countries. Technical assistance to countries is implemented and coordinated by the Inter-agency Task Team for the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers and Children (referred to here at the IATT).
The IATT is co-chaired by WHO and UNICEF, and is housed at UNICEF New York. It comprises of 33member organization and has the following mandate within the Global Plan:
To coordinate and track the provision of technical assistance To monitor and track progress of country-led implementation of the Global Plan; and To develop, update and disseminate operational and normative tools and guidance The IATT supports countries to ensure that the needed building blocks for the elimination of motherto-child transmission of HIV (eMTCT) are in place, and aims for more effective, coordinated national planning for service delivery with PEFPAR, Global Fund and other multilateral and bilateral support.
It has representatives in each of the 22 priority countries and provides day-to-day technical support at country level. It also implements global activities and missions, and below is a sampling of those
implemented during 2014:
Nigeria country mission PMTCT coverage remains low in Nigeria. Low numbers and capacity of health cadres trained in essential ARVs for eMTCT has been identified as a critical issue, which can be mitigated in part through a task shifting policy. The IATT Secretariat and the Human Resources for Health (HRH) Working group (represented by EGPAF, Intrahealth and WHO) conducted a joint mission to Nigeria to hold consultations with the Federal Ministry of Health (FMoH), National AIDS Control Programme (NASCOP), partners and professional organizations in May 2014 to assess key bottlenecks to task shifting and advocate for policy change. The task shifting policy has since been revised and adopted by the FMoH.
The Finance and Economic Working Group (FEWG) members provided in-country support to cost Options A, B, and B+ with MoH staff from 12+1 States with a high burden of HIV in pregnant women (Abia, Akwa Ibom, Anambra, Bayelsa, Benue, Cross River, Federal Capital Territory, Kaduna, Lagos, Nasarawa, Plateau, Rivers). This consisted of an initial meeting to outline the process and collect data and a second capacity building workshop to apply the costing models and train PMTCT and M&E staff from the States to conduct the costing exercise. These cost projections have been used to inform programmatic decision-making to adopt new PMTCT guidelines and development of state implementation plans.
Democratic Republic of Congo country mission UNICEF/WHO provided technical assistance to help revise the Global Fund concept note to better articulate TB/HIV integration. UNICEF supported the Katanga Department of Health to review 6 months of data on Option B+ implementation and provided recommendations on M&E systems strengthening through the process. As a result of this work, UNICEF will support the Katanga Department of Health to undertake an assessment in 6 zones looking at health systems constraints, models of care, patient support services and demand creation activities as part of UNICEF’s Optimizing HIV Treatment Access (OHTA) for pregnant women project.
Mozambique country mission The IATT secretariat supported revision of national M&E registers to introduce cohort reporting and monitor implementation of Option B+.
Tanzania country mission The IATT Secretariat M&E Specialist, in collaboration with Centers for Disease Control (CDC) Atlanta, supported protocol development and data analysis for evaluation of the early experiences in the Option B+ rollout, including retention of mothers in antenatal care. The Secretariat also participated in the dissemination of the results in Tanzania and supported editing of the final report that was released by the Ministry of Health in May 2014.
Cote D’Ivoire country mission At the request of the MoH, a joint mission by the UN regional and headquarters’ technical advisers was conducted to review the PMTCT/paediatric HIV programme in light of the slow progress towards achieving eMTCT goals, and to advocate for adoption of Option B+. The transition from Option B to B+ has not yet started but following the joint mission, a taskshifting policy has been approved, to be piloted in 2015.
Zimbabwe country mission UNICEF/WHO and IATT partners supported many facets of the strategic dialogue and national evaluation of Option B+ roll out and paediatric ART services. As a result of this effort, Zimbabwe rapidly moved from pilot and planning of Option B+ to full national implementation and monitoring in 2014. Discussions of paediatric ART scale up are still ongoing.
South Africa UNICEF and WHO supported midterm review of the National RMNCH Strategic Plan in June 2014.
Global The IATT also provided multi-country support for the development of Global Fund concept notes. This consisted of supporting the development of tools and guidance on how to integrate MNCH and PMTCT into concept notes. This was facilitated at a regional meeting held in Johannesburg in July 2014 in collaboration with the Global Fund, UNICEF, WHO and UNFPA and 10 country teams. Of the 22 Global Plan countries, 12 had submitted concept notes by December 2014, while 8 planned to submit in the early part of 2015.
2014 Meeting of Global Plan Partnership In November 2014, the Global Plan partnership held its annual consultations to take stock of country progress, and to plan for 2015. There were two adjacent meetings, which brought together national country Focal Points, IATT delegates, implementing partners, networks of women living with HIV, and Global Plan core partners and management. These consultations examined the technical, programmatic and political barriers to greater progress, and how to
address them. Delegates prioritized the following actions:
1. Strategic high- level advocacy missions to countries for sustained commitment to eMTCT and resource mobilization especially for domestic resources, including public-private partnerships
2. Strengthening PMTCT leadership at national level, including leadership by networks of women living with HIV.
3. Political support for civil society organizations and persons living with HIV in planning, implementation and monitoring of performance
4. Documentation of the promising experiences, particularly on expansion of post-natal mother-baby pair cohort follow up, optimal use of viral load monitoring and related clinical practices
5. Advocacy to strengthen human resources including better remuneration, in order to enable improved staff retention
6. Prioritize actions to increase pediatric diagnosis and treatment
7. Promote adoption of normative guidance, develop “how-to” guidance and tools to operationalize WHO normative guidance and roll-out of Option B/B+
8. Provide operational guidance: Support country implementation on re-testing of pregnant women, birth testing of children, and confirmatory maternal HIV testing before ART initiation.
9. Effective integration and provider-initiated testing and counselling at child health entry points to optimize yield of positive children
10. Support community engagement activities to improve access and retention V. A word about women and communities At the core of the Global Plan has always been the role of communities and networks of women living with HIV, in both the design, implementation and assessment of this initiative. The Global Plan embodies the principle that the rights of women living with HIV are respected, and that women, their families and communities are empowered to fully engage in ensuring their own health and especially the health of their children. Therefore, since inception, national plans for eliminating new HIV infections among children and keeping their mothers alive were firmly grounded in the best interests of the mother and child, and a growing recognition of the role of communities in supporting them. Countries have been encouraged to ensure meaningful participation of communities and women living with HIV in the process of developing and implementing programmes, as true partners in providing care. The Global Plan also strives to ensure that women living with HIV have access to family planning services and commodities, in order to prevent unintended pregnancies. These aims have remained part of the Global Plan and will continue to guide its activities in 2015 and beyond.