Prévention de la transmission mère-enfant du VIH
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Prévention de la transmission mère-enfant du VIH L’apport des recherches en sciences sociales dans les pays du Sud Paris, 14 janvier 2011. Prévention de la transmission mère-enfant du VIH L’apport des recherches en sciences sociales dans les pays du Sud … et si on partait quand même

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Prévention de la transmission mère-enfant du VIH

L’apport des recherches en sciences sociales dans les pays du Sud

Paris, 14 janvier 2011


Prévention de la transmission mère-enfant du VIH

L’apport des recherches en sciences sociales dans les pays du Sud

… et si on partait quand même

de l’approche biomédicale ?

François Dabis

Avec le concours de Renaud Becquet et Didier Ekouevi

INSERM U 897, ISPED, Bordeaux


Percentage of pregnant women who received an HIV test in low- and middle-income countries by region2005, 2008 and 2009


Estimated number of women living with HIV needing low- and middle-income countries by regionand receiving antiretrovirals for PMTCTin low- and middle-income countries, 2009


Percentage of pregnant women living with HIV receiving antiretrovirals to prevent mother-to-child transmission of HIV in 25 countries with the highest HIV burden, 2009


Percentage distribution of various antiretroviral regimens provided to pregnant women in low- and middle-income countries in 2007 (59 countries) and 2009 (86 countries)


New HIV recommendations to improve health, reduce infections and save lives

2009 - 2010

  • Antiretroviral therapy for HIV infection in adults and adolescents

  • Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants

  • WHO principles and recommendations on infant feeding in the context of HIV

  • Antiretroviral therapy for HIV infection in children

2009 PMTCT ARV Guidelines



2010 pmtct guiding principles

Women (including pregnant women) in need of ARV for their own health should get life-long ART

Antenatal CD4 is critical for decision-making about ART eligibility

Interventions should aim to maximize reduction of vertical transmission, minimize side effects for mothers and infants, and preserve future HIV treatment options

Effective postpartum ARV-based interventions for all women will allow safer breastfeeding practices

Simple, unifying principles needed for different country settings

ART and ARV prophylaxis

2010 PMTCT guiding principles


Antiretroviral therapy art

Women with CD4 own health should get life-long ART<350 regardless of clinical stage

Women with clinical stage 3 or 4 (symptomatic) regardless of CD4

Start ART as soon as feasible regardless of gestational age and continue for life

Strong recommendation

Antiretroviral therapy (ART)

2010 PMTCT ART / ARV Guidelines


Art for eligible mothers and prophylaxis for exposed infants
ART for eligible mothers own health should get life-long ARTand prophylaxis for exposed infants

  • Strong recommendation

20010 PMTCT ART/ARV Guidelines


Arv prophylaxis to prevent mtct

For women not eligible for ART or unknown eligibility own health should get life-long ART

Beginning as early as 14 weeks of gestation (2nd trimester) or as soon as possible thereafter

Strong recommendation

ARV prophylaxis to prevent MTCT

2010 PMTCT ART / ARV guidelines


What arv prophylaxis to give to non eligible pregnant women
What own health should get life-long ARTARV prophylaxis to giveto non-eligible pregnant women?

2 possible options:

  • Maternal AZT mono-prophylaxis

  • Maternal triple ARV prophylaxis

    (NVP-based regimens are not recommended)

    Strong recommendation

2009 PMTCT ARV Guidelines


Arv prophylaxis options for women and infants
ARV Prophylaxis options for women and infants own health should get life-long ART

*sd-NVP and AZT+3TC can be omitted if mother receives > 4 wks AZT antepartum

2009 PMTCT ARV Guidelines


New 2009 key recommendation
New 2009 key recommendation own health should get life-long ART

2009 PMTCT ARV Guidelines


Le d fi du passage large chelle des interventions de ptme
Le défi du passage à large échelle des interventions de PTME

Femmes en âge

de procréer

Prévention primaire

Seules 35% des femmes enceintes ont été testées pour le VIH en Afrique en 2009

Femmes infectées

par le VIH

Accès au dépistage et

aux interventions de PTME

La couverture des interventions de PTME déjà existantes reste faible en Afrique (54% en 2009)

Taux de PTME : 40%

Taux de PTME : 5% à 12%

11


Projet pearl c te d ivoire 570 femmes vih 9650 cordon ombilical
Projet PEARL, Côte d’Ivoire PTME570 femmes VIH+ (9650 cordon ombilical)

98%

59%

52%

40%

Centre PTME : 40% des femmes VIH connaissent leur statut


Prise effective de nevirapine PTME

Etude menée chez 29,103 couples mère-enfant VIH+

dans 4 pays

51%

75% Cam

59% Zam

54% SA

16% CI


Two dimensions needed to improve pmtct courtesy of a ciaranello and k freedberg
Two Dimensions Needed to Improve PMTCT PTME(courtesy of A. Ciaranello and K. Freedberg)

No PMTCT

sdNVP

Option A

Option B

“Option B+”

Improve PMTCT Uptake (95%?)

Improve along both axes


  • Prévention de la transmission mère-enfant du VIH PTME

  • L’apport des recherches en sciences sociales dans les pays du Sud

  • - Comment dépister toutes les femmes enceintes et qui accouchent ?

  • - Comment révéler leur statut VIH à toutes les femmes dépistées ?

  • - Comment lier services de SMI, interventions ARV de PTME, promotion de l’allaitement maternel et services de prise en charge VIH adultes et enfants ?

  • Comment porter un diagnostic d’infection pédiatrique à temps pour tous les enfants à risque ?