Presentation for the 8 th Task Force Meeting : Lao People’s Republic 23-25 th November 2010

1. Prevention of Mother-to-Child Transmission of HIV infection in Sri Lanka Presentation for the 8th Task Force Meeting : Lao People’s Republic 23-25th November 2010 Dr Sujatha Samarakoon Consultant Venereologist / Focal Point ECS & PMTCT – National STD/AIDS Control Programme, Ministry of Health

3. HIV/AIDS situation in Sri Lanka Adult HIV prevalence rate <0.1% - Sri Lanka has a low level HIV epidemic Number reported as at end September 2010 = 1285 ( females=518) Male :female ratio = 1.5:1 Cumulative AIDS deaths =212 Estimated PLHIV by 2009 = 3000 Estimated of number of Pregnant women with HIV (2010) = 50 Estimated number of pregnant women in need of ART (2010)=42 Number of reported cases of Vertical Transmission =44

4. The PMTCT Strategy… Prevention of unintended pregnancies in HIV + women Prevention of transmission of HIV in young people & women of childbearing age Care and support for the mother & her family Prevention of transmission from an HIV positive woman to her infant

5. PMTCT activities - • Girl child – PMTCT included in the school education programme of SP • Women in child bearing age – Preconception package of Family Health Bureau (FHB) included PMTCT & ECS, Work plan of women’s health of FHB • Antenatal mothers • Antenatal care package of FHB includes PMTCT& ECS • PHC staff training includes PMTCT & ECS ( PHNS, PHI, PHM, Labour room staff) should be now included in the curriculum • Male partner – Parent craft classes • Sensitization meeting for VOG/SR/SHO - 4 meetings • NSACP member of the Perinatal Mortality Review Committee of DMH

6. PMTCT target for SL 70% of pregnant mothers accepting VCT, 60% of HIV 70%infected mothers detected, and 80% of infants born to HIV infected mothers free from HIV Antenatal syphilis screening for all pregnant women attending antenatal services

7. PMTCT activities • In three selected areas, pilot programs are being carried out • One of the leading Maternity Hospitals is offering routine HIV testing as Standard of Care • One hospital offering – Opt out • One MOH area offering Opt out (62,000 samples tested 2004-2009 and only 6 were positive giving a rate of 0.02%)

9. Antenatal HIV testing profile(2000-2009) HIV prevalence among AN mothers very low

10. HIV + women - Goals of Prenatal care • Optimize HIV positive woman’s physical and psychological well being • Prevent vertical transmission of HIV • Minimize maternal risks • Optimize neonatal well being • Prepare for or prevent next pregnancy

11. PMTCT services • Routine obstetric care – PHC/ VOG/Hospital staff • Clinical and immunological assessment of HIV infection – Venereologist/MO-STD • Provision of ART – Venereologist/MO-STD/VOG • Provision of safe delivery practices – VOG/ anesthetist • Provision of safe feeding practices- paediatrician/VOG/MO-STD

12. ARV in Pregnancy For her own health or as prophylaxis as per new WHO guidelines Prophylaxis – Option A or B ?

13. ARV for infant As per new WHO guidelines

14. Breast feeding / Replacement feeding Replacement feeding – If no AFASS then exclusive breastfeeding for 6 months

15. Guidelines for Management of HIV Infection in Pregnancy Preparation in progress

16. Thank you