Transcript Экспресс-оценка ситуации по вертикальной передаче ВИЧ

Situation analisys on HIV
vertical transmission
Dr Zhanna Trumova
Republican HIV/AIDS center
The Republic of Kazakhstan
Number of HIV-infected people
detected in
Kazakhstan (per year)
1175
1200
1000
number of HIV infected
735
800
531
600
437
347
299
400
185
200
4
0
3
4
4
2
5
6
2
5
48
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 8 ???
2003
Spread of HIV/AIDS in Kazakstan (as of
01.09.03)
59 сл.
58 сл.
196 сл.
705 сл.
56сл.
137 cл.
110 сл.
12 сл.
73 сл.
1210 сл.
38 сл.
19 сл.
7 сл.
62 сл.
368 сл.
3788 HIV-cases are registered in Kazakhstan
185сл.
Ways and factors of HIV transmission
heterosexual
not identified
in hospital
through drugs
hemotransmission
0,40%
homo- and bisexual
intrauterus
83,2%
0,1%
7,1%
0,32%
8,9%
0,12%
0,1%
Prevalence of HIV - infected women by
age groups
113
120
100
80
98
99
2000
2001
2002
78
60
37
40
30
14
13
20
0 1 0 1 0
2
< 15 years
15-19
45
41
32
19
28
14 12
12
0
20-29
30-39 years
Growth rates of HIV-positive
women
women
3788
total of HIV infected
3257
2522
1347
817
1000
516
78
13
1996
100
1997
168
1998
207
1999
289
2000
520
2001
700
2002
812
8 ??? 2003
Number of pregnant women tested
for HIV (per year)
150000
126942
110027
100000
47064
82466
38874
46020
50000
20847
30832
0
1996
1997
1998
1999
2000
2001
2002
2003
Number of detected HIV-infected pregnant
women
80
75
76
70
60
Pregnancies
50
Deliveries
40
34
30
20
20
10
0
0
1996
5
8
5
86
1997
1998
1999
14
7
2000
17
4
2001
2002
8 ???
2003
Prevalence of HIV-infected pregnant women
by region
Мангист.обл.; 1
Жамбыл.обл.; 1
Акмол.обл.; 3
СКО; 2
Актюб.обл.; 3
Астана;
3
Total - 205
Алмат.обл.; 1
ВКО; 5
Костан.обл.; 12
Караганд.обл.; 96
ЮКО; 11
ЗКО; 8
Алматы; 13
Павлодар.обл.; 46
Risk factors for HIV-infected pregnant
women
76,0%
75,40%
75,0%
74%
74,0%
73,0%
intravenous drug usage
frequent intercourses )
Co-factors for HIV-infected pregnant
women
60%
syphilis
50%
40%
30%
54,60%
15,40%
20%
35%
10%
13,10%
0%
virus hepatits B,
C
STIs, including
syphilis
Chronic
concommitant
diseases
Pregnancy outcomes
3
ated abroad
11
nder control
13
Miscarriage
s caused by
ocial status
99
6
re deliveries
73
ng deliveries
0
10
20
30
40
50
60
70
80
90
100
1
3
Ю
КО
ан
гы
ш
л.
об
л.
4
С
КО
1
1
ЗК
О
4
М
ат
ы
бы
л.
об
л.
А
кт
ю
б.
об
л.
ам
лм
1
Ж
г.А
ан
а
1
ст
5
г.А
15
КО
50
В
ан
д.
П
об
ав
л.
ло
да
р.
об
л.
Ко
ст
ан
.о
бл
А
км
ол
.о
бл
.
Ка
ра
г
Spread of children by region
n=75
48
45
40
35
30
25
20
11
10
1
4
0
1
Health status of children born to HIV-infected
mothers
39
Constant perinatal care
hypox.-eschemic
encephalopatia
28
14
Hypotrophical
8
Intrauterus Hypotrophy
Respiratory diseases
(pneumonia)
7
HIV infection
7
0
5
10
15
20
25
30
35
40
45
Antiretroviral therapy of newborn, begun in
2002
50
47
45
40
35
28
30
25
20
15
10
5
0
???????? ?????
Feeding of newborn , n=81
artificial
78
3
breasfeeding
0
10
20
30
40
50
60
70
80
Proposed preventive treatment schemes

Scheme 1 – ZDV (Protocol 076: from 14th week of pregnancy to
delivery (II and III trimesters of pregnancy) 600 mg/pd; from the
beginning of labour to delivery 2 mg/kg, then 1 mg/kg
intravenous per hour; to the child – suspension ZDV 2 mg/kg
every 6 hours in the course of 6 weeks)

Scheme 2 – short-term treatment ZDV from 36th week

Scheme 3 –Nevirapin: the pregnant – 200 mg once in delivery,
the child – nevirapin suspension 2 mg/kg once within 72 hours
(HIVNET 012, Uganda)
Current activities
• A Government Dicree # 1207 «Programme on AIDS prevention in
Kazakhstan from 2001 till 2005» dated from 14 september 2001 was
developed and aproved in Kazakhstan.
• Preventive Programmes aare being intriduced with the assistance of
international organizations.
• Access to counselling and HIV voluntary testing
• Pregnant women and children are provided with antiviral medicine
and child nutrition free of charge from public funds
• Quality medical care and preventive interventions are provided to
HIV- infected women during pregnancy and deliveries
Challenges




Lack of information and educational materials on «HIV and
pregnancy»
Difficulties related to timely detection, registration, examination of
people from risk-groups (drug addicts, RKS, etc) including pregnant
women
Weak VCT services network in health care, including PHC, obs genecologi , in particular lack of professional training for health
workers in HIV/AIDS consultation
Lack of financing for equipment, test-systems, antiviral medications
Possible solutions






Primary prevention among pregnant women, access to HIV/AIDS
info, promotion of safe sex, prevetion of unwanted pregnancy,
availability of contraceptives, STIs treatment
Introduction of voluntary consultation and testing for target-groups
(IDU, CSW, married couples, youth) as a supplement to ongoing
prevention programmes
Prevention of mother-to-child HIV transmisstion in antenatal,
intranatal and postnatal periods
Access to antiretroviral medications
Artificial feeding
Care and support of HIV-infected women, their children and family
members