Reaching the Goal of Elimination of Mother-to-Child Transmission of HIV by 2015

Photo of two women
James Pursey/EGPAF

INTRODUCTION

A heartrending consequence of HIV infection in women is the possibility of transmitting the virus to an infant in pregnancy, during delivery or through breastfeeding. The overall cumulative risk of transmission, with no drug interventions, stands as high as 40 to 45 percent, and over 90 percent of all childhood HIV cases are acquired in this fashion. In 2011, it was estimated that about 330,000 children acquired HIV.

We have learned that using antiretroviral medications in pregnancy can decrease the rate of HIV transmission to less than 2 percent. Between 2009 and 2011, antiretroviral prophylaxis prevented 409,000 children from acquiring HIV infection – a great success. However, the percentage of pregnant and breastfeeding women receiving optimal antiretroviral therapy only stands at 57 percent, so more work is needed.

In 2011, the Global Task Team developed the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive [PDF, 785KB]. With the Global Plan in mind, the U.S. Agency for International Development (USAID) increased its energies in prevention of mother-to-child-transmission of HIV (PMTCT) by supporting countries’ expansion of access to treatment and protection of pregnant women and their infants through pregnancy and beyond.

A NEW PARADIGM IN PREVENTION OF MOTHER-TO-CHILD TRANSMISSION – OPTION B+

A mother breastfeeding her infant at a Nigerian clinic.
A mother breastfeeding her infant at a Nigerian clinic.
Anouk Amzel

Most recently, in response to the Global Plan, Malawi’s Ministry of Health developed a new strategy to simplify PMTCT called Option B+. This strategy adopts a public health approach for the PMTCT program by making all HIV-infected pregnant women eligible for lifelong antiretroviral therapy. USAID worked with the Ministry of Health in Malawi on the development and implementation of its PMTCT program. The implications of the new program paradigm have been far reaching and have resulted in a shift in PMTCT program implementation.

As a result of the incredible success of this new PMTCT strategy, a number of other countries are now planning to implement the Option B+ strategy, and USAID is working closely with these countries’ ministries to help in the transition.

CURRENT PROGRAMMATIC HIGHLIGHTS

Situkulwane Lesiphephile (Safe Generations) in Swaziland

The transition from one PMTCT strategy to another is a challenge for the many countries looking to change from their current program to a new one – Swaziland is no exception. With Situkulwane Lesiphephile, the International Center for AIDS Care and Treatment Programs will be testing whether the Option B+ approach to PMTCT will reduce the rates of HIV transmission and improve retention of mother-infant pairs in the PMTCT cascade from antenatal care through cessation of breastfeeding. The Swazi Government, in turn, will be looking to the study results to inform its future policies in preventing mother-to-child transmissions.

Case Studies in PMTCT

Lay counselor with clients at the Nakambala Urban Health Centre in Zambia.
Lay counselor with clients at the Nakambala Urban Health Centre in Zambia.
Lewis Holmes

Through the AIDSTAR-One mechanism, John Snow, Inc. has reviewed a number of promising PMTCT practices worldwide and publicized the locally developed successes on its website. One of the case studies was done on the Boston University Prevention of Mother-to-Child Transmission Integration Project (BUPIP) initiative called the Community PMTCT Follow-Up Register Project or Community Register. The project was developed to improve uptake of and retention in PMTCT services – all with the goal of reduced transmission of HIV from mother to infant. With a simple tracking system and extensive follow-up by lay counselors, the program has had significant success – outlined in the case study done by John Snow, Inc.

PMTCT Costing Website

In this time of transition, Futures Institute, through the USAID Health Policy Initiative Costing Task Order, has developed a website that allows policymakers and program managers to estimate the cost and impact of scaling up country PMTCT programs.  This website is a user-friendly alternative to more detailed – but more data- and time-intensive – options such as Spectrum’s AIDS Impact Module. It incorporates information on cost, coverage and effectiveness of different PMTCT regimens to generate estimates of new infections, infections averted, the average cost and costs averted by the program.

Partnership for HIV-Free Survival

4 steps of mother-infant care.

The Partnership for HIV-Free Survival is a six-country initiative (Tanzania, Kenya, Uganda, Mozambique, Lesotho and South Africa) designed to assist the countries with their current national efforts to improve postnatal HIV, maternal and infant care and nutrition support through effective implementation of the 2010 World Health Organization (WHO) Guidelines on HIV and Infant Feeding.

WHO released guidelines in 2010 on prevention of mother-to-child transmission of HIV and infant feeding in the context of HIV. They provide guidance on how all of the different HIV care and treatment programming can be strengthened and improved for HIV-infected mothers and their infants. Many countries, however, are still discovering how to effectively and extensively implement these guidelines. Using quality improvement methods, the Partnership for HIV-Free Survival will support existing country-specific protocols and the ongoing Nutrition Assessment, Counseling and Support activities to achieve four essential steps of postnatal mother-infant care (see graphic on right). Its goal is to provide excellent nutritional and HIV care for both the HIV-exposed and non-exposed infants over the first 24 months of life. A step-by-step guide has been developed to help countries and their partners set up the quality improvement learning systems in each country to implement the Partnership for HIV-Free Survival.

Last updated: October 09, 2013

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