Mother to child transmission of HIV is the primary route of transmission for HIV among children. This transmission is known to occur during pregnancy, delivery and breast-feeding period with equal frequency. It is estimated that without any intervention the risk of transmission of HIV from infected mother to her child is between 20 to 45%. But with effective use of Anti-retroviral (ARV) drugs, this risk reduces significantly. Therefore to address burden of HIV among children, the National AIDS Control Programme (NACP) launched Prevention of Parent to Child (HIV) Transmission (PPTCT) of HIV services in the year 2002. This provided access to HIV testing services to all pregnant women enrolled into Ante Natal Care (ANC) along with provision of ARV prophylaxis with single dose of Nevirapine (SD-NVP) at the time of delivery to mother and baby.
These services were rapidly scaled-up across India during the NACP-III (2007-2012). Although implemented effectively in the high HIV prevalence states reach of PPTCT services to all pregnant women in the country remains limited. In line with WHO recommendation, India has successfully launched (September 2012) the more efficacious PPTCT Option B regimen in the three States of Andhra Pradesh, Karnataka initially and later in Tamilnadu.
Globally evidence suggest that although ARV prophylaxis using SD-NVP is highly effective in reducing risk of transmission from about 45% to less than 10%, the 10% uncovered risk is unacceptably high since paediatric HIV can be eliminated if currently available drugs are used effectively. The World Health Organization (WHO) therefore recommends use of more efficacious ARV regimens, using multiple drugs for PPTCT. These regimens can reduce transmission to less than 5% if started early in pregnancy and continued throughout period of delivery and breasts feeding.
WHO has moved away from the previous terms “Options A, B and B+”. Instead, the WHO new guidelines (June 2013) recommend two options:
Karnataka’s Annual Pregnancy estimation was 12.53 lakh for 2014-’15. Out of which 12.32
lakh ANCs have been counseled and tested from April 2014 - Mar 2015 thus achieving 98.4% testing of annual estimated pregnancies .
WHO new guidelines (Option B) on Prevention to Parent to Child transmission of HIV was implemented in Karnataka from September 2012, with a goal to reduce mother to child transmission to less than 5%. The state responded to the challenge of roll out of multi drug regimen from August to December 2012. A total of 3800 field workers were trained to augment successful implementation. Multiple levels of the capacity building was done. A resource pool at the district level was also created. Subsequently in December 2013 training of 1000 Government health functionaries & others were conducted which led to the promising result of achieving less than 5% HIV transmission from mother to child.
New Guidelines for Lifelong ART for all Pregnant Women Living with HIV for Prevention of Parent-to-Child Transmission (PPTCT) of HIV is implemented from January 2014 across the country.
|Annual number of pregnancies in a year
|No. pregnant women counseled and tested||569474||796721||784794||1014012||759366||1136056||12.32|
|No. of pregnant women detected positive||3257||3544||2536||2333||1397||1446||1295|
|HIV Positive ANCs (%)||0.57||0.44||0.32||0.23||0.23||0.13||0.11|
|MB pairs coverage for NVP (%)||50||60||85||98||91||95||95|
Institutional deliveries in Karnataka is approx. 95%. Out of which, 75% is in the public sector and 25% is in the private sector. Under the Karnataka Private Medical Establishment Act (KPME), 2007, the District Health & Family Welfare Officers issue licences to the private hospitals, clinics and laboratories which then gives them the authority to also seek information on the number of ANCs who have been counseled and tested for HIV in their institutions. DAPCU Officers have been collecting this information from the District Health & Family Welfare Officers which not only gives information on number of ANCs who have been counseled and tested for HIV in the private sector but also gives them an opportunity to forge partnership with the private sector for establishing ICTCs in them (PPP ICTCs).
HIV counseling and testing services in Karnataka has been brought almost to the door step of the ANCs through the variety of ICTC facilities they can choose to access viz., Stand-alone ICTCs (SA ICTCs); Facility Integrated ICTCs (F ICTCs); PPP ICTCs; Mobile ICTCs; Mobile Medical Units (MMUs – NRHM and Karnataka Health Systems Project) as well as Whole Blood Finger Prick Testing done for screening by ANMs in Bijapur, Belgaum and Bagalkot (3’B’ districts) where the HIV epidemic is at its peak.