Barn och hiv i ett globalt perspektiv 29 september 2016 Tobias Alfvén, MD, PhD Sachsska Barnsjukhuset & Global Health, Department of Public Health Sciences Karolinska Institutet Tobias Alfvén 1
Unites the world against AIDS Globalt Riktlinjer och policies Påverkansarbete Fakta om HIV-epidemin På landsnivå Att tillsammans med FNs andra organisationer och andra aktörer samordna arbetet med att stoppa hiv-epidemin
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Millennniemålen 2000-2015 MDG 6a: Stoppa spridningen av hiv och aids Have halted by 2015 and begun to reverse the spread of HIV/AIDS Dokumentansvarig, Personalavdelningen 5
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Millennniemålen 2000-2015 35% minskning av antalet nya HIV infektioner 70% minskning av antalet nya HIV infektioner hos barn (<15 år) MDG 6a: Stoppa spridningen av hiv och aids Have halted by 2015 and begun to reverse the spread of HIV/AIDS 42% minskning av antalet dödsfall relaterade till aids (från peaken 2004) 60% minskning av antalet dödsfall relaterade till aids hos barn (<15 år) (från peaken 2004) Tobias Alfvén 8
Millennniemålen 2000-2015 MDG 6a: Stoppa spridningen av hiv och aids Have halted by 2015 and begun to reverse the spread of HIV/AIDS Hållbarhetsmålen Agenda 2030 Tobias Alfvén 9
Hållbarhetsmålen Agenda 2030 Sustainable Development Goals Tobias Alfvén 10
Barn och vuxna som lever med HIV 2015 Tobias Alfvén 11
Nya HIV-infektioner - barn och vuxna 2015 Tobias Alfvén 12
Dödsfall AIDS - barn och vuxna 2015 Tobias Alfvén 13
Barn (<15 år) som lever med HIV 2015 Tobias Alfvén 14
Nya HIV-infektioner - barn (<15 år) 2015 Tobias Alfvén 15
Dödsfall AIDS - barn (<15 år) 2015 Tobias Alfvén 16
Global plan to towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive Global Target 1: Reduce the number of new childhood HIV infections by 90%. Reduce AIDS related infant deaths by > 50% Provide ART to all children Global Target 2: Reduce the number of HIVrelated maternal deaths by 50%. The Global Plan focused on the 22 countries with the highest estimated numbers of pregnant women living with HIV. 17
Global plan, fortsättning The Four Prongs of EMTCT Prong 1: Primary prevention of HIV among women of reproductive age Prong 2: Providing appropriate counselling and support to women living with HIV to enable them make an informed decision about their future reproductive life, with special attention to preventing unintended pregnancies. Prong 3: For pregnant women living with HIV, ensure HIV testing and access to the antiretroviral drugs that will help mothers own health and prevent infection being passed on to their babies during pregnancy, delivery and breastfeeding. Prong 4: Better integration of HIV care, treatment and support for women found to be positive and their families. 18
Prevention av mor-barn-smitta olika alternativ Single-dose Nevirapine (NVP) Option A AZT (eller annan NRTI) under graviditet och NVP under förlossning Option B Trippel-behandling under graviditet (ex. TDF+3TC+EFV) Option B Livslång behandling med ARTs (ex. TDF+3TC+EFV) 19
Prevention av mor-barn-smitta Option B+ 20
Prevention av mor-barn-smitta 2000-2015 Distribution of the number of pregnant women living with HIV receiving most effective antiretroviral medicines for PMTCT, by regimen, 21 sub-saharan Global Plan countries, 2000-2015 1 250 000 Option B+ (ART) Option A Single-dose nevirapine Option B (triple prophylaxis) Dual ARVs Pregnant women not receiving ARVs for PMTCT 1 000 000 750 000 500 000 250 000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 21
PMTCT och barn som smittas med HIV 500 000 Percentage of pregnant women living with HIV receiving most effective antiretroviral medicines for PMTCT and new HIV infections among children (aged 0-14), 21 sub-saharan African Global Plan countries, 2000-2015 PMTCT coverage (Most Effective Regimens) 100% 90% 400 000 77% 80% 80% 73% 70% 69% 300 000 61% 60% 52% 50% 200 000 40% 36% 30% 100 000 21% 20% 13% 10% 0 3% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Dokumentansvarig, 2014 2015 Personalavdelningen 0% 22
Prevention av mor-barn-smitta 2000-2015 Percentage of pregnant women living with HIV receiving most effective ARVs for PMTCT, Eastern and Southern Africa, 2015 South Africa Uganda Namibia Mozambique Swaziland Rwanda Botswana Burundi Zambia United Republic of Tanzania Zimbabwe Malawi Kenya Lesotho Eritrea South Sudan Angola Somalia Madagascar 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 23
Minskning mor-barn smitta 2009-2015 Dokumentansvarig, Personalavdelningen 24
Andel av barn till mödrar som lever med HIV som smittas med HIV 2000-2015 Estimated percentage of infants born to pregnant women living with HIV who become vertically infected with HIV (mother-to-child transmission rate), sub-saharan Africa, 2000-2015 Final mother-to-child transmission rate Perinatal mother-to-child transmission rate (within 6 weeks of birth) 35% 30% 25% 32% 32% 32% 31% 31% 30% 29% 27% 26% 23% 20% 20% 15% 10% 5% 17% 17% 17% 17% 17% 16% 15% 14% 12% 11% 9% 18% 8% 16% 7% 13% 6% 11% 9% 5% 4% 0% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Dokumentansvarig, 2013 2014 2015 25 Personalavdelningen
Nysmittade barn (0-14 år) och ungdomar (15-19 år) New HIV infections among children aged 0 14 and adolescents aged 15 19, Global, 2000 2015 500 000 Paediatric HIV infections Adolescent HIV infections 400 000 300 000 200 000 100 000 0 2000 2003 2006 2009 2012 2015 26
Nya infektioner, ART och dödsfall i AIDS, barn (<15) 2000-2015 600 000 Trends in coverage of ART, number of new infections, and number of AIDS-related deaths among children (aged 0-14), all low- and middleincome countries, 2000-2015 Paediatric ART coverage Paediatric AIDS deaths New HIV infections among children 100% 500 000 90% 80% 400 000 70% 60% 300 000 49% 50% 200 000 100 000 0 43% 37% 31% 26% 21% 16% 12% 9% 4% 6% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Dokumentansvarig, 2014 2015 Personalavdelningen 40% 30% 20% 10% 0% 27
People livinh with HIV receiving antiretroviral therapy Barn sämre möjligheter att få behandling än sina mammor Percentage of pregnant women and children (0-14 years) living with HIV receiving antiretroviral therapy, 2009-2015 80 74 70 60 Only half the children living with HIV are receiving treatment 56 50 51 45 40 38 30 20 20 26 21 31 27 Preganant women receiving antiretroviral therapy 15 15 children receiving antiretroviral therapy 10 10 0 2009 2010 2011 2012 2013 2014 2015
Vad händer nu? Enormous gains, Persistent Challenges (UNAIDS Global report 2016) Dokumentansvarig, Personalavdelningen 29
Vad händer nu? 60 (a): Commit to 90-90-90 treatment targets, and to ensuring that 30 million people living with HIV access treatment by 2020 with special emphasis on providing 1.6 million children (0-14 years of age) with antiretroviral therapy by 2018 and that children, adolescents and adults living with HIV know their status and are immediately offered and sustained on affordable and accessible quality treatment to ensure viral load suppression and underscore in this regard the urgency of closing the testing gap; Dokumentansvarig, Personalavdelningen 30
Vad händer nu? 31
Utmaningar Kunskap om hiv, MTCT, PMTCT Kännedom om HIV+/HIV- Stigma och diskriminering 32
Utmaningar, fortsättning Engagemang från män/partners Oklarheter kring amning/ersättning Svårigheter med B+ 33
Utmaningar, fortsättning Svaga hälsosystem Finansiering Ledarskap 34
Focus on location and population Nya infektioner hiv i Kenya (2014) Nairobi Source: UNAIDS estimates; Kenya Ministry of Health.
Nya infektioner i Kenya, olika Scenarier 2015-2030 Source: Kenya HIV Prevention Revolution road map: count down to 2030. Nairobi: Kenya Ministry of Health; 2014.
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Dödorsaker barn <5 år globalt (2013) Tobias Alfvén 38
WWW.KAHOOT.IT 39
Veta mer? 40
Tack till kollegorna vid UNAIDS, UNICEF och WHO för data och input till presentationen! 41
Tack! Tobias Alfvén 42