HIV and Infant feedingHIV and Infant feedingReport of 5 Country Rapid Report of 5 Country Rapid

AssessmentAssessment

Dr. Arun Gupta, MD, FIAP Dr. Arun Gupta, MD, FIAP Coordinator Coordinator Dr J.P. Dadhich, MD Dr J.P. Dadhich, MD Co -coordinatorCo -coordinator

IBFAN Asia Pacific Working Group on IBFAN Asia Pacific Working Group on HIV-Infant feeding HIV-Infant feeding

Outline Outline

Need and RelevanceNeed and Relevance ProcessProcess

♠ ♠ CountriesCountries

♠♠ QuestionnaireQuestionnaire

♠♠ National ConsultationNational Consultation OutcomeOutcome ChallengesChallenges

Need and RelevanceNeed and Relevance

To facilitate discussion and find out To facilitate discussion and find out how HIV and infant feeding is being how HIV and infant feeding is being addressed in the PMTCT addressed in the PMTCT programmes as part of HIV AIDS programmes as part of HIV AIDS Programmes, specifically to list the Programmes, specifically to list the processes being followed by a processes being followed by a countrycountry

Need and RelevanceNeed and Relevance

To raise awareness of the issues To raise awareness of the issues and particularly, the latest material and particularly, the latest material on HIV/IF, especially UN materials on HIV/IF, especially UN materials

To create a solidarity/trusting To create a solidarity/trusting relationship around each other's relationship around each other's concernsconcerns

To network for cooperation to To network for cooperation to initiate some joint actionsinitiate some joint actions

ProcessProcess

Initiated a dialogue with IBFAN Focal Initiated a dialogue with IBFAN Focal points/Contacts in 6 countries,5 points/Contacts in 6 countries,5 responded responded – AfghanistanAfghanistan– BangladeshBangladesh– IndonesiaIndonesia– MalaysiaMalaysia– NepalNepal

QuestionnaireQuestionnaire

Shared a common framework of Shared a common framework of questions for rapid country assessmentquestions for rapid country assessment

Issues covered in the framework Issues covered in the framework includedincluded– Policy and Guidelines at national levelPolicy and Guidelines at national level– PMTCT Strategies in voguePMTCT Strategies in vogue– Utilization of UN GuidelinesUtilization of UN Guidelines– National Capacity, Training curriculum National Capacity, Training curriculum – Skills of CounselorsSkills of Counselors

ProcessProcess

Country Specific Consultations Country Specific Consultations involving stakeholders were held in 5 involving stakeholders were held in 5 countries and reports receivedcountries and reports received

MalaysiaMalaysia 25 participants, both breastfeeding groups and HIV 25 participants, both breastfeeding groups and HIV

community as well as Govt. UNICEF, WHO, medical community as well as Govt. UNICEF, WHO, medical association, consumer’s groups.association, consumer’s groups.

National MTCT program in placeNational MTCT program in place Govt. policy is to practice replacement feeding for Govt. policy is to practice replacement feeding for

all HIV positive mothersall HIV positive mothers The mother is provided with free alternative feeding The mother is provided with free alternative feeding

(formula) (formula) Govt. assumes AFASS criteria are fulfilled by the Govt. assumes AFASS criteria are fulfilled by the

countrycountry A joint task force is proposedA joint task force is proposed Joint statement to be issuedJoint statement to be issued Several issues were raised including organizing a Several issues were raised including organizing a

3-4 day meeting to think forward.3-4 day meeting to think forward.

Nepal Nepal 25 Participants, included govt. and non govt. 25 Participants, included govt. and non govt.

organizations working in the field of child health organizations working in the field of child health and HIV, UNFPA, PSI, Save the children, and HIV, UNFPA, PSI, Save the children, breastfeeding group NEBPROF, health breastfeeding group NEBPROF, health professionalsprofessionals

Lack of program for PPTCT at national levelLack of program for PPTCT at national level Lack of national policy on HIV and Infant feedingLack of national policy on HIV and Infant feeding Capacity building of the health workers is Capacity building of the health workers is

requiredrequired Plan of action was developed at the meeting; Plan of action was developed at the meeting;

addressing training, of health workers, addressing training, of health workers, establishing standards/guidelines, Code establishing standards/guidelines, Code implementation, strengthening partnership implementation, strengthening partnership

IndonesiaIndonesia 31 Participants,included breastfeeding groups, govt. 31 Participants,included breastfeeding groups, govt.

agencies, UNICEF, WHO, National AIDS Commission, agencies, UNICEF, WHO, National AIDS Commission, health professional organizations, Save the Children, health professional organizations, Save the Children, John Hopkins.John Hopkins.

National program on HIV/AIDS in placeNational program on HIV/AIDS in place Nodal agency on HIV presentNodal agency on HIV present Draft policy on PPTCT under consideration(VCT,ARV Draft policy on PPTCT under consideration(VCT,ARV

and Infant feeding counseling)and Infant feeding counseling) Recommended first choice is Infant formulaRecommended first choice is Infant formula FU Actions :Capacity building of health workers is FU Actions :Capacity building of health workers is

being planned using WHO 2000 HIV Infant feeding being planned using WHO 2000 HIV Infant feeding module ; strengthening coordination, awareness module ; strengthening coordination, awareness programmesprogrammes

BangladeshBangladesh Participation in consultation widely Participation in consultation widely

representative, 23 participants Govt., UNICEF, representative, 23 participants Govt., UNICEF, WHO, Research instt. , Nutrition instt.WHO, Research instt. , Nutrition instt.

National AIDS/STD Program (NASP) supervises National AIDS/STD Program (NASP) supervises AIDS/HIV at national levelAIDS/HIV at national level

No national policy of HIV and Infant feedingNo national policy of HIV and Infant feeding Utilize UN documentsUtilize UN documents infant feeding and HIV not in curriculuminfant feeding and HIV not in curriculum Capacity building of health workers is a major Capacity building of health workers is a major

gapgap National policy to promote exclusive National policy to promote exclusive

breastfeeding for all babiesbreastfeeding for all babies

AfghanistanAfghanistan

20 participants, included Govt. UNCEF, UNDP, 20 participants, included Govt. UNCEF, UNDP, WHO, National Aids Cell, TDh, Pediatrics body. WHO, National Aids Cell, TDh, Pediatrics body.

Issue of HIV as such is not a priority area for Issue of HIV as such is not a priority area for the govt. agenciesthe govt. agencies

No national policy on HIV/MTCT/HIV and Infant No national policy on HIV/MTCT/HIV and Infant feedingfeeding

No educational program or curriculum to train No educational program or curriculum to train and orient health workers.and orient health workers.

Formation of a working group at the aim to Formation of a working group at the aim to look after different aspects of the program look after different aspects of the program

India : Some fresh news!India : Some fresh news!

We have finished combining BF, CF and HIV We have finished combining BF, CF and HIV courses courses

Launched in 3 states with UNICEF and State Launched in 3 states with UNICEF and State governmentsgovernments

NACO asked BPNI to integrated its NACO asked BPNI to integrated its PMTCT/PPTCT module with IYCF , PMTCT/PPTCT module with IYCF , accomplishedaccomplished

Future training will be based on this Future training will be based on this module.module.

October a TOT is planned in IndiaOctober a TOT is planned in India

ChallengesChallenges Lack of national policy, guidelines and Lack of national policy, guidelines and

initiatives for PPTCT in preventing infant HIVinitiatives for PPTCT in preventing infant HIV Lack of educational program or curriculum to Lack of educational program or curriculum to

train and orient health workers/counselorstrain and orient health workers/counselors Lack of national policy on HIV and Infant Lack of national policy on HIV and Infant

feedingfeeding Lack of understanding of AFASS; being used Lack of understanding of AFASS; being used

to formulate blanket policiesto formulate blanket policies

Lessons LearntLessons Learnt

Feasible activity in a short timeFeasible activity in a short time Not very expensive.Not very expensive. Opportunity for various stakeholders Opportunity for various stakeholders

to come together to discuss locally to come together to discuss locally relevant action planrelevant action plan

Two sides (BF and HIV) can sit Two sides (BF and HIV) can sit together at national level.together at national level.

RecommendationsRecommendations

Rapid assessment process may be Rapid assessment process may be expanded.expanded.

Organize National colloquium on Organize National colloquium on Infant Feeding and HIV to better Infant Feeding and HIV to better understand guidelines and prepare a understand guidelines and prepare a road map for implementation; road map for implementation; UNICEF WHO could step up efforts UNICEF WHO could step up efforts

Revisit AFASS, UN Guidelines and UN Revisit AFASS, UN Guidelines and UN Framework ensure clarity.Framework ensure clarity.