getting ready for dual emtct validation in the americas
DESCRIPTION
GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS. Adele Schwartz Benzaken. OUTLINE . BACKGROUND OF EMTCT IN THE AMERICAS 2. DEVELOPMENT OF REGIONAL VALIDATION METHODOLOGY AND STRUCTURE 3. CONCLUSIONS. EMTCT HISTORY IN THE AMERICAS. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/1.jpg)
GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS
Adele Schwartz Benzaken
![Page 2: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/2.jpg)
OUTLINE
1. BACKGROUND OF EMTCT IN THE AMERICAS
2. DEVELOPMENT OF REGIONAL VALIDATION METHODOLOGY AND STRUCTURE
3. CONCLUSIONS
![Page 3: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/3.jpg)
EMTCT HISTORY IN THE AMERICAS• 1994: The 24th Pan American
Sanitary Conference called for the elimination of congenital syphilis as a public health problem.
• 1995: Development of the Plan of Action for elimination of congenital syphilis.
• 2005: Regional HIV/STI Strategy for the Health Sector with ambitious HIV/STI PMTCT goals, including congenital syphilis elimination.
• 2008: PAHO and UNICEF host Caribbean side event at IAC to explore elimination of MTCT of HIV
• 2008- 2009: Sub-regional technical consultations & development of dual EMTCT implementation strategy
• November 2009: official launch of Regional Dual EMTCT Initiative
• September 2010: PAHO Member States adopt the regional EMTCT Strategy and Plan of Action by Resolution
![Page 4: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/4.jpg)
REGIONAL DUAL EMTCT STRATEGY
Pillars: • Strengthening and integration of HIV/STI, SRH, MCH, newborn care
and family and community health services• Strengthening the capacity of MCH, newborn, child health and
other services for early detection, care and treatment of HIV and syphilis in pregnant women, their children, and their partners
• Intensify surveillance of HIV and syphilis in MCH services
Regional implementation:• Development of tools, including a conceptual document, Regional
Monitoring Strategy, Costing tool, Field Guide• Direct support to countries• Regional monitoring and reports
![Page 5: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/5.jpg)
Pregnant women tested for syphilis at antenatal care in Latin America and the Caribbean (2012-2013)
![Page 6: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/6.jpg)
Reported congenital syphilis rates in selected countries in the Americas, 2009-2013
![Page 7: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/7.jpg)
ARV coverage among pregnant women for prevention of mother to child transmission of HIV
New HIV infections in children in Latin America and the Caribbean 2001-2013
![Page 8: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/8.jpg)
Pregnant women tested for HIV in Latin America and the Caribbean, 2005-2013
![Page 9: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/9.jpg)
DEVELOPMENT OF THE REGIONAL EMTCT
VALIDATION STRUCTURE• Considering that several countries appeared to be
close to achieving the EMTCT targets, PAHO, in collaboration with UNICEF and other partners, initiated development of a validation methodology in 2011:– Drafting of a methodology– Pilot implementation in two countries (St. Lucia &
Chile)– Merging of efforts with WHO HQ in 2012– Establishment of regional mechanisms in 2013-2014
![Page 10: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/10.jpg)
VALIDATION METHODOLOGY
1. Verification of achievement of the elimination targets:– Verification of the quality of the reported data– Assessment of the underlying data collection and reporting systems
2. Verification of the existence of an adequate laboratory network that:– provides the services needed to achieve, maintain and measure the elimination
targets– Generates reliable results
3. Verification of the existence of an adequate network of services that:– Provides all needed services, accessible to all in need– Provides quality services
![Page 11: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/11.jpg)
• Full assessments, which included interviews and site visits with:– All national programs (MCH, HIV, STI, etc)– Sample of first, second and tertiary level service
delivery sites in the capital and districts with the highest burdens of disease (HIV or syphilis or both)
– Feedback and discussion sessions with stakeholders (Minister of Health , managers and service delivery)
– Final report produced by the external team with recommendations and final conclusions
Country pilots
![Page 12: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/12.jpg)
PILOT IMPLEMENTATION • In two countries (St. Lucia & Chile)• External team of experts (6-10) in the areas of
MCH, HIV, STI, laboratory, epidemiology, health systems.
• One week of field work: 1) interviews with policy makers, program managers, service providers, civil society, clients;2) field visits to service delivery sites: 3) verification and recalculation of data on local and national level.
![Page 13: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/13.jpg)
LESSONS LEARNED
• Pilots indicated validity of the methodology to understand the national program, verify the data, and identify (potential) issues and challenges.
• Estimated cost of country validation: $ 15,000-$ 20,000 (depending on size).
• Considering the required investment and formal commitment for dual EMTCT, only country requests for validation of EMTCT of both HIV and syphilis will be considered.
![Page 14: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/14.jpg)
• PAHO emphasizes reporting on elimination impact and coverage targets based on “real” data.
• Some countries might have gaps, in particular in coverage data due to various reasons, including significant private sector.
• Acceptable modalities to assess these data gaps:– Special studies– Sufficient private sector representation in assessment samples?– Others
Data gaps
![Page 15: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/15.jpg)
The Regional Validation Committee• Established as a high level Committee convened by the
PAHO Director (May 2014).
• Membership: 13-15 regional experts: independent experts, representatives from UN partners, representatives from regional technical organizations
• Main role is to provide regional oversight of the validation process, coordinate country evaluation exercises, and determine whether a candidate country can be recommended for validation.
![Page 16: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/16.jpg)
CURRENT STATUS
• Ongoing refining of the methodology and tools, including development of approaches for small population sizes.
• Ongoing application of the tools for program assessments upon request of countries in 2013 and 2014.
• Preparations for first round of formal country validations (Cuba, Bahamas and others)
![Page 17: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/17.jpg)
CONCLUSIONS
• Region of the Americas has longstanding and formal commitments for elimination of congenital syphilis and vertical transmission of HIV.
• Dual EMTCT is imminent for some countries in the region.
• Validation requires establishment of formal and credible regional structures and processes aligned with global.
![Page 18: GETTING READY FOR DUAL EMTCT VALIDATION IN THE AMERICAS](https://reader036.vdocuments.us/reader036/viewer/2022062501/56815f05550346895dcdc545/html5/thumbnails/18.jpg)
ACKNOWLEDGEMENTS
– Dr. Massimo Ghidinelli (PAHO/WDC)– Dr. Sonja Caffe (PAHO/WDC)– HAYASHI, Chika (WHO/HIV Department)– Regional Committee for Validation of Elimination
of Mother-to-Child Transmission of HIV and Congenital Syphilis (RVC)Members