While the overall coverage of ARVs for PMTCT for low- and middle-income countries reached 62 per cent in 2012, there was considerable variation across regions (see Figure 1.3). In Eastern and Southern Africa, where the HIV burden is greatest, three quarters of pregnant women have access (66–85 per cent). In Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS), coverage is reported as very high (greater than 95 per cent), as it is in Latin America and the Caribbean (88 per cent; 58–95 per cent). All other regions have estimated coverage below half.21 One of the core targets of the Global Plan is to provide ARVs to 90 per cent of the world’s pregnant women living with HIV by the end of 2015. This is now within reach. In the 22 Global Plan priority countries, 62 per cent of pregnant women living with HIV received ARV prophylaxis in 2012, compared with 57 per cent in 2011 and 49 per cent in 2010.22
Since 2009, most countries have shifted their policies away from the use of single-dose nevirapine to more effective regimens for PMTCT. Four priority countries of the Global Plan – Botswana, Ghana, Namibia and Zambia – have already met the 90 per cent target, while Mozambique, South Africa, Swaziland and Zimbabwe are close to it. However, five countries – Kenya, Lesotho, Nigeria, South Africa and Swaziland – have experienced declines in PMTCT coverage in the last year, and four countries – Angola, Chad, the Democratic Republic of the Congo and Nigeria – had national ARV coverage for PMTCT of less than 20 per cent in 2012.23 The 2013 World Health Organization (WHO) guidelines on ART recommend universal HIV testing for all pregnant women as part of the basic package of services for antenatal care in all settings. In some countries with concentrated or low-prevalence
TOWARDS AN AIDS-FREE GENERATION – Children and AIDS: Sixth Stocktaking Report, 2013
FIGURE 1.3 Estimated percentage of pregnant women living with HIV receiving the most effective antiretroviral medicines for PMTCT, in UNICEF regions, all low- and middle-income countries and the 22 Global Plan priority countries, 2005–2012 2005*
2010
2011
2012
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
Eastern and Southern Africa
West and Central Africa
Middle East and North Africa
East Asia and the Pacific
South Asia
Latin America and the Caribbean
CEE/CIS
All low- and middle-income countries
22 Global Plan priority countries
Note: The vertical lines indicate the uncertainty ranges around the estimates. Coverage values for 2005–2009 are not comparable with those for 2010–2012 because they are based on previous WHO treatment guidelines and include single-dose nevirapine. Source: UNAIDS, UNICEF and WHO, 2013 Global AIDS Response Progress Reporting, and UNAIDS 2012 HIV and AIDS estimates.
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