Global Plan to Eliminate New HIV Infections

spheric Plan to Eliminate New human immunodeficiency virus InfectionsAbstractThe count prizeed the progress of 20 priority sub-Saharan African countries in the attainment of the physical objects outlined in the orbicular Plan for the emptying of New human immunodeficiency virus Infections among Children by 2015 and Keeping their M others subsisting.The 2012 progress reports of the countries were extracted from the UN support online database. The world(a) and Prong 1, 3, and 4 targets were analysed with respect to the May 2013 targets and milest whizs. The 2009 to 2012 and the 2005 to 2010 mid point estimates were analysed respectively for international target 1 Reduce shape of virgin infections among children by 90% and global target 2- Reduce AIDS-related deaths during gestation or within 42 old age of the end of pregnancy by 50%. Estimates were calculated utilise Spectrum version 4.6 and Wilcoxon class-conscious test was used for data analysis.Between 2009 and 2012, there was 38% total reduction in global target 1 slice between2005 to 2012 there was 25% total reduction in global target 2 for the 20 priority countries. Ghana and South Africa put down the intimately significant reduction for global target 1 with 72% and 63% respectively while Nigeria, Chad, congou representative country and Lesotho natureed slight than 20% reduction. Only Botswana and Ethiopia enter over 50% reduction in global target 2. There has been significant progress however the global milestones vex non been attained. more effort is indispensablenessed in Nigeria, Congo popular Republic and Angola and sustained momentum in other priority countries to achieve the global Plan goals and milestones.human immunodeficiency virus infection remains one of the major cause of death in children and their mothers in Sub Saharan African (SSA) countries 1,2,3. Transmission of human immunodeficiency virus infection from mothers to their unborn children and infants is mostly during pregnancy, weary and post nat everyy during breastfeeding period. 4,5. There has been gradual reduction in brand- in the altogether-fashioned human immunodeficiency virus infections among children of human immunodeficiency virus infected mothers since the commencement of continueion of mother to child transmitting programme (PMTCT) entirely as at 2009, a staggering 370,000 children were recorded to capture became newly infected with human immunodeficiency virus worldwide and an estimated 42,000 60,000 meaning(a) women excessively died due to human immunodeficiency virus infection and its complications. 6,7.Over 90% of the countries responsible for this high essence of human immunodeficiency virus infection and high mother to child transmission (MTCT) browse are located in SSA. India, which is located in Asia is another clownish which too contri thoe importantly to this burden. These countries narrative for the bulk of the human immunodeficiency virus infected women requiring antiretroviral therapy (ART) in order to prevent MTCT. They in any case account for over 90% of the paediatric human immunodeficiency virus infected children who withdraw ART 7.The case of MTCT presents a big disparity globally with high income countries recording almost postal code new human immunodeficiency virus infections among children and maternal(p) and infant mortalities due to HIV infection. nevertheless most of the low and middle countries especially those located in SSA record new infections because the military issue of women get ating HIV prevention and discussion services is substantially very low. The same situation applies to their children and this exposes them to new infections and death 7.The success recorded in reducing MTCT to almost zero and keeping their mothers alive is mathematical globally. However, this can tho be a reality if all winding will ensure that all enceinte women living with HIV and their children have easy access to antiretroviral drugs and other necessary care as indicated during pregnancy, lecture and breastfeeding. These measures will go a long way in preventing new infections among the children and take care of the health of the mothers as well. Provision and appropriate use of goods and services of ARVs as prophylaxis has been proven to reduce HIV MTCT to less than 5% 9. different measures that targets HIV infection prevention among women at increased risk of HIV and the unmet family planning needs of women living with HIV will contribute significantly to reduction for subsequent antiretroviral prophylaxis and treatment need 12.In May 2009, the Joint joined Nations Programme on HIV/AIDS (UNAIDS) made a cancel for the virtual excretion of MTCT globally. This call was supported by many other multilateral and bilateral mount upncies, regional coordinating bodies, national governments and their HIV/AIDS control agencies . In furtherance of this noble course, the World Health system of r ules (WHO) in 2010 published new guidelines which include the best available scientific and programmatic tools to accele localise the reduction of MTCT and achieve the virtual elimination of MTCT. These guidelines overly included advice for safer infant feeding. 6,7The call for the virtual elimination of new paediatric HIV infection led to the launching of an initiative known as world-wide Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive in July 2011 at the United Nations General Assembly High train Meeting on AIDS. The Global Plan was developed through a consultative process by a Global Task team convened by UNAIDS. The Global Task Team included experts and policy makers from 25 countries and 30 civil society organisations, private sector, ne cardinalrks of people living with HIV and international organisations. This plan was designed to provide the foundation for country-led movement towards the elimination of new HIV in fections among children and keeping their mothers alive.The Global Plan covers all low- and middle-income countries, but with a particular focus on the 22 countries with the highest estimated quashs of enceinte women living with HIV. These countries are Angola, Botswana, Burundi, Cameroon, Chad, Cte dIvoire, Democratic Republic of the Congo, Ethiopia, Ghana, India, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia and Zimbabwe. These countries were selected based on the fact that they account for nearly 90% of pregnant women living with HIV in need of services. These countries also need exceptional efforts to achieve this goal. The Global Plan also supports and reinforces the development of country-driven HIV national plans 7.The Global Plan focuses on arrival pregnant women living with HIV and their children prior to pregnancy, through the time of pregnancy until stoppage of breastfeeding. The HIV preventio n and treatment needs of mothers and children will be met within the existing comprehensive HIV care programmes.The implementation theoretical account for the Global Plan is based on two global targets and broader four-pronged strategy. The strategy provides the foundation for national plans development and implementation. It encompasses ranges of HIV prevention and treatment indicators for mothers and their children, inseparable maternal, newborn and child health services and family planning, and as a life-and-death cyclorama of efforts to achieve Millennium Development Goals 4, 5 and 6 10,11.Global identify 1 Reduce the number of new HIV infections among children by 90% .Global tail 2 Reduce the number of AIDS-related maternal deaths by 50%.Prong 1 Prevention of HIV among women of reproductive age within services related to reproductive health such as an ecstasyatal care, postpartum and postnatal care and other health and HIV service delivery points. prey Reduce HIV inciden ce in women 15-49 by 50%.Prong 2 Providing appropriate counselling and support, and contraceptives, to women living with HIV to meet their unmet needs for family planning and spacing of births, and to optimize health outcomes for these women and their children.Target Reduce unmet need for family planning to zero (Millennium Development Goal).Prong 3 For pregnant women living with HIV, ensure HIV testing and counselling and access to the antiretroviral drugs needful to prevent HIV infection from being passed on to their babies during pregnancy, delivery and breastfeeding 9.Target Reduce mother-to-child transmission of HIV to 5%.90% of mothers receive perinatal antiretroviral therapy or prophylaxis.90% of breastfeeding infant-mother pairs receive antiretroviral therapy or prophylaxis.Prong 4 HIV care, treatment and support for women, children living with HIV and their families.Target Provide 90% of pregnant women in need of antiretroviral therapy for their own health with life-long antiretroviral therapy.By the end of 2015, the estimated number of new HIV infections in children is expect to have been cut down by at least 85% in each of the 22 priority countries, the estimated number of HIV-associated pregnancy-related deaths reduced by 50% and all countries will have met the targets for elimination of new HIV infections among children and keeping their mothers alive. There is however need to measure the progress made by these countries and to address gaps and repugns identified.This study aimed to assess the progress made by twenty of the priority countries involved in the Global Plan in sub Saharan Africa. This is coming two years after the formal launching of the Global Plan with the countries reservation commitment towards the elimination of new HIV infections in children and keeping their mothers alive.This study looked at the progress made so out-of-the-way(prenominal) in opposition some of the targets and milestones set to be met by May 2013.We sear ched the UNAIDS online database of the 2012 progress reports submitted by the priority countries. The 2009 2012 mid point estimates were analysed for 20 of the sub- Saharan African Global Plan priority countries. The estimates were calculated development Spectrum version 4.6. The Spectrum files were developed by country teams and compiled by UNAIDS in 2013. However, the estimates from AIDS related deaths during pregnancy or within 42 days of the end of pregnancy was from 2005 to 2010 8.Only 20 of the Global Plan priority countries data were analysed due to non availability of country particular(prenominal) data for Uganda and India. .In order assess the progress made, the global targets and Prong 1, 3, and 4 targets were quantitatively analysed with respect to the May 2013 targets and milestones.Some of the global and country targets and milestones assessed were The estimated number of new HIV infections in children is reduced by 50% from 2010 levels in at least 10 high-burden countries. (Country target and milestone).The estimated number of new HIV infections in children is reduced by 50%. (Global target and milestone).The data was analysed using statistical package Stata version 12.1.Overall TargetsBetween 2009 and 2012, the number of new infections among children in the 20 Global Plan priority countries in sub-Saharan Africa countries with country-specific data was estimated to have reduced from 315570 to 197170. ( Wilcoxon ranked test P = 0.0001 shelve 1 and 5). The total reduction in the estimated number of new HIV infections among children was 38% from 2009 levels in the high-burden countries.AIDS-related deaths during pregnancy or within 42 days of the end of pregnancy among the 20 Global Plan priority countries in sub-Saharan Africa countries with country-specific data reduced from 36000 in 2005 to 29030 in 2010.Prong 1 TargetThe new HIV infections among women 1549 years old among the 20 Global Plan priority countries in sub-Saharan Africa countr ies with country-specific data reduced from 687900 in 2009 to 606000 in 2012 (Wilcoxon ranked test P = 0.0001 hedge 2 and 5 ).Prong 3 TargetsThe last-place Mother to Child Transmission rate (%) among the 20 priority countries with country-specific data reduced from 27% in 2009 to 19% in 2012 (Wilcoxon ranked test P = 0.0001 Table 3 and 5 ).The percent of women receiving antiretroviral medicines (excluding single-dose nevirapine) to prevent MTCT increased from 34% in 2009 to 63% in 2012 (Wilcoxon ranked test P = 0.0001 Table 3 and 5).The percentage of women or infants receiving antiretroviral medicines during breastfeeding to prevent MTCT increased from 11% in 2009 to 43% in 2012 (Wilcoxon ranked test P = 0.0001 Table 3 and 5).Prong 4 TargetsThe percentage of antiretroviral therapy reporting among children 014 years old increased appreciably from 22% to 35% in all the Global Plan priority countriesIn SSA,the percentage of pregnant women living with HIV receiving antiretroviral th erapy for their own health increased from 23% in 2009 to 57% in 2012 (Wilcoxon ranked test P = 0.0001 Table 4 and 5).Two countries namely Ghana and South Africa have through tremendously well in achieving the highest reduction in the numbers of new HIV infections among children from 2009 to 2012 with 72% and 63% reduction respectively 8. Others deal Botswana, Malawi, Ethiopia, Zambia and Namibia had also achieved remarkable reduction with Zimbabwe, Kenya, Mozambique and Tanzania almost reaching the 50% reduction.Angola, Nigeria, Chad, Congo Democratic Republic and Lesotho are still lagging behind in the aspect of reduction of new infection in children. The case of Nigeria is really a concern considering the fact that she has the highest number and about one third of all new paediatric infection in sub Saharan Africa. Angola is also a case for concern, there has been increase in new infections or else than reduction since 2009.Furthermore , there has been reduction in the AIDS-rela ted deaths during pregnancy or within 42 days of the end of pregnancy from 2005 to 2010, although with some exceptions like Mozambique and South Africa. There has been some reduction in new HIV infections among women 1549 years old in the priority countries but with some exceptions such as Angola, Cameroun, Chad, Cote DIvoire, Mozambique, Namibia and Zimbabwe.There was reduction in the final Mother to Child Transmission rate with Botswana and South Africa lead story the pack. These two countries have already reached the 5% target for the reduction in transmission rate 8. More women are now able to access antiretroviral medicines and thereby reducing the risk of new HIV transmission to their children compared to 2009. intravenous feeding countries had already surpassed the 90% target for the increase in percentage of women receiving antiretroviral medicines (excluding single-dose nevirapine) to prevent MTCT, however, Angola, Chad, Nigeria and Congo DR did poorly in this area of mat ernal antiretroviral reporting. The increase in the percentage of women or infants receiving antiretroviral medicines during breastfeeding to prevent MTCT among the priority countries is a commendable tonus because some of the countries do not have this programme in place as of 2009. There was a significant increase in antiretroviral therapy coverage for pregnant women living with HIV in the priority countries. Botwsana and Namibia had achieved above 90% antiretroviral therapy coverage for pregnant women living with HIV . These increased coverage levels of antiretroviral medicines is expected to translate into lower mother-to-child transmission rates.Over the years, there has been an increase in the number of children who are on antiretroviral therapy but this increase is still not the desired expectation with two third of eligible children been denied the needed medical specialty in most of the priority countries. It is noteworthy that Botswana was already having above 95% paed iatric antiretroviral coverage as at 2009.A major boundary of this study is the non availability of Uganda and India country specific data . Another challenge was in measuring the progress of the initiative because most of the priority countries do not have a direct measurement of the number of new HIV infections among children 8.There has been a significant progress among most of the sub Saharan African priority countries in the bid to eliminate new HIV infections in children as seen by the reduction in the percentage of final mother to child transmission of HIV.The success story so far include reduced number of children newly acquiring HIV infection, ameliorate and increased access to HIV treatment for eligible women and their children, increased coverage of antiretroviral medicines for pregnant women living with HIV to prevent mother-to-child transmission from and reduction in AIDS-related deaths during pregnancy or within 42 days of the end of pregnancy.However, only seven co untries has been able to achieve the 50% reduction in estimated number of new HIV infections among children thereby falling short of the expected ten countries target by May 2012 7. Also the number of new HIV infections in the countries declined by only 38% against the target of 50%. More effort is needed in certain countries like Nigeria, Congo Democratic Republic and Angola and sustained momentum in other priority countries in order to achieve the Global Plan goals.