A mother and her child wait outside a USAID-supported clinic in Zambia.
Photo credit: John Healy/USAID
According to recent global estimates by UNAIDS, women carry the burden of HIV, and AIDS is still the leading cause of death for women of reproductive age. Pregnant women living with HIV are at a greater risk of experiencing pregnancy complications compared to women who are HIV-negative. Pregnant women living with HIV are also at increased risk of life-threatening infections such as sepsis and opportunistic infections, including TB, pneumonia, and meningitis.
The vast majority of maternal deaths are preventable when women have access to quality antenatal and postnatal care, and safe delivery attended by skilled personnel that is backed by emergency obstetric care. While the death of a mother is a tragedy in itself, it also has devastating effects on the survival of her children, the economic stability of the family, and the productivity of the community.
Providing care and support for women living with HIV during pregnancy, delivery, and the postpartum period presents unique challenges not only for the prevention of mother to child transmission (PMTCT), also known as vertical transmission, but also for the woman’s own health and survival. According to recent global estimates by UNAIDS, 85% of pregnant women living with HIV were receiving antiretroviral therapy (ART) to prevent vertical transmission of HIV through PMTCT programs, preventing up to 220,000 new infant infections. Despite these efforts, global estimates indicate that 11% of infants born to women living with HIV acquired HIV during pregnancy or the postpartum period.
Considerations for HIV testing and linking to treatment for infants are crucial in eliminating vertical transmission. Globally, 60% of infants born to pregnant women living with HIV received a virologic test within the first two months of birth. The fast rate of HIV progression and the high morbidity and mortality among infants and children with perinatally-acquired HIV means that early infant diagnosis and rapid enrollment of infants living with HIV in care and treatment programs should be a priority. Several countries have achieved elimination of vertical transmission, but none of these countries are in sub-Saharan Africa, a region that accounts for 90% of the global burden of vertical HIV transmission.
USAID builds on decades of successes in improving maternal health and HIV prevention, care, and treatment to move towards elimination of vertical transmission, critical to stemming the rise in new HIV diagnoses and achieving control of the HIV epidemic. As an implementing agency of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID supports PEPFAR to implement HIV services for women, infants, and children. USAID also has the goal of ending preventable child and maternal deaths by providing comprehensive maternal and infant health HIV prevention, care, and treatment services to mothers living with HIV and their infants. Since 2015, USAID support has enabled 2.6 million babies to be born HIV-free to mothers living with HIV.
We make a difference by focusing our work in developing countries with the most need – those that have high rates of both HIV and maternal mortality – with a particular focus on sub-Saharan African countries. USAID engages with communities and health facilities to provide patient-centered services that span the continuum of HIV care for mothers and infants, including:
- Preventing incident HIV acquisitions in women through comprehensive prevention approaches, including pre-exposure prophylaxis (PrEP).
- Providing access to voluntary family planning (FP) services for women living with HIV to prevent unintended pregnancies, including FP services that promote healthy timing and spacing of pregnancies to reduce the risk of adverse pregnancy outcomes such as low birth weight, preterm birth, and infant mortality.
- Providing HIV testing services to pregnant and breastfeeding women living with HIV as early as possible, including women who may acquire HIV later in pregnancy or during breastfeeding, and providing safe and ethical index testing to reach their sexual partners and biological children.
- Linking pregnant and breastfeeding women living with HIV to optimized ART regimens to promote viral suppression, including dolutegravir-based treatment regimens.
- Identifying infants living with HIV early and facilitating rapid linkage to optimized treatment and clinical follow-up, and support through pediatric HIV services.
- Supporting expansion of HIV testing devices used at health facilities (“point-of-care”), which allow same-day results for viral load testing for pregnant and breastfeeding women, infant HIV diagnosis, and rapid linkage to ART.
- Improving health of mothers and infants through the use of infant prophylaxis to prevent HIV until the end of the breastfeeding period, and lifelong maternal treatment.
- Analyzing and addressing barriers to the continuity of care for the mother and infant through patient-centered and family-based innovations in PMTCT service delivery, including differentiated service delivery, multi-month dispensing (MMD) and telehealth models.
USAID also works to provide PMTCT services to certain priority populations who are at higher risk of HIV and who have poorer maternal and infant health outcomes, including adolescent girls and young women and key populations. USAID’s PMTCT programs collaborate with orphans and vulnerable children (OVC) programs, strengthening bi-directional referrals between the health facility and community, in order to increase enrollment of mother-baby pairs at risk of interruption in treatment (e.g., adolescent mothers and their HIV-exposed infants). OVC programs provide family-based case management, comprehensive services, and routine tracking of mother-baby pairs to help improve their health, including access to timely diagnostic testing, and ascertainment of the infant’s HIV status after breastfeeding ends.
USAID leverages deep technical expertise to work in partnership with host country governments, multilateral organizations, the private sector, service providers, and local stakeholders to integrate evidence-based maternal health and HIV and AIDS information and services to reduce maternal mortality and save lives.
In Fiscal Year 2021, USAID:
- Tested 3,924,247 pregnant women at their first antenatal care visit;
- Newly identified 70,202 pregnant women living with HIV, and enrolled over 73,000 women on life-saving ART;
- Supported viral load suppression among pregnant women (92%) and breastfeeding women (93%) living with HIV;
- Tested 227,650 infants of pregnant women living with HIV by two months of age, and an additional 137,338 infants between two and 12 months of age;
- Newly identified 4,752 infants living with HIV and linked 3,975 infants to ART; and,
- Ensured that 99% of infants born to women living with HIV had a known outcome documented at the end of the breastfeeding period.
Additional highlights include:
- Increased client-centered programming by expanding access to multi-month dispensing (MMD) of ART for 1.88 million women of reproductive age living with HIV.
- Developed standard dried blood spot (DBS) commodity packages and job aids to increase access to point-of-care/near point-of-care virological testing for priority populations living with HIV, including infants, children, and pregnant and breastfeeding women.
- Prevailing Against Pandemics by Putting People at the Centre: UNAIDS 2020 Report
- Start Free, Stay Free, AIDS Free: UNAIDS 2020 Report
- Community Focal Mothers: Improving mother-baby pair retention in integrated maternal and child health and HIV services in Eswatini
- Increasing Access and Coverage of HIV-1 Early Infant Diagnosis through Use of Point of Care Testing in Mozambique
- We’ve Got the Power: Women, Adolescent Girls and the HIV Response