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)

4 3 4 4 2 5 6 2 548

437299

185

347

1175

735

531

0

200

400

600

800

1000

1200

1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 8 ???2003

number of HIV infected

137 cл. 56сл.

58 сл.

73 сл.

38 сл.

185сл.

12 сл.

110 сл.

62 сл.

1210 сл.

705 сл.196 сл.

7 сл. 19 сл.

368 сл.

59 сл.

3788 HIV-cases are registered in Kazakhstan

Spread of HIV/AIDS in Kazakstan (as of 01.09.03)

Ways and factors of HIV transmission

0,40%

0,32%8,9%

7,1%

0,1%

0,1%

0,12%

83,2%

heterosexual through drugs homo- and bisexualnot identified hemotransmission intrauterusin hospital

Prevalence of HIV - infected women by Prevalence of HIV - infected women by age groupsage groups

0 1 0 1 0

13

2

14

30

19

3732

41

113

78

14 1212

45

28

0

20

40

60

80

100

120

< 15 years 15-19 20-29 30-39 years

9899200020012002

Growth rates of HIV-positive women

13 100 168 207 289520

700 812

78

516817

10001347

2522

3257

3788

1996 1997 1998 1999 2000 2001 2002 8 ??? 2003

women total of HIV infected

Number of pregnant women tested for HIV (per year)

126942

82466

110027

30832

4706438874 46020

20847

0

50000

100000

150000

1996 1997 1998 1999 2000 2001 2002 2003

Number of detected HIV-infected pregnant women

05

8 814

20

75 76

5 5 6 74

17

34

0

10

20

30

40

50

60

70

80

1996 1997 1998 1999 2000 2001 2002 8 ???2003

Pregnancies Deliveries

Prevalence of HIV-infected pregnant women by region

Актюб.обл.; 3

ЮКО; 11

Костан.обл.; 12

ЗКО; 8

Павлодар.обл.; 46

Алматы; 13

Акмол.обл.; 3

ВКО; 5

СКО; 2

Жамбыл.обл.; 1

Астана; 3

Мангист.обл.; 1

Алмат.обл.; 1

Караганд.обл.; 96

Total - 205

Risk factors for HIV-infected pregnant women

75,40%

74%

73,0%

74,0%

75,0%

76,0%

intravenous drug usage frequent intercourses )

Co-factors for HIV-infected pregnant women

54,60%

13,10%

15,40%35%

0%

10%

20%

30%

40%

50%

60%

virus hepatits B,C

STIs, includingsyphilis

Chronicconcommitant

diseases

syphilis

-

Pregnancy outcomes

73

6

99

13

11

3

0 10 20 30 40 50 60 70 80 90 100

Undalying deliveries

Immature deliveries

Abortions caused byhealth/social status

Miscarriage

Under control

migrated abroad

Spread of children by regionn=75

48

11

41 1

1

41 1

3 14

1

0

5

10

15

20

25

30

35

40

45

50

Health status of children born to HIV-infected mothers

7

7

8

14

28

39

0 5 10 15 20 25 30 35 40 45

HIV infection

Respiratory diseases(pneumonia)

Intrauterus Hypotrophy

Hypotrophical

hypox.-eschemicencephalopatia

Constant perinatal care

Antiretroviral therapy of newborn, begun in 2002

47

28

0

5

10

15

20

25

30

35

40

45

50

???????? ?????

Feeding of newborn , n=81

3

78

0 10 20 30 40 50 60 70 80

breasfeeding

artificial

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