Results for "Prevention of Mother to Child Transmission"
This technical brief summarizes the latest evidence on PMTCT of HIV in the Southern African region. It presents the current WHO guidance on antiretroviral use in pregnant HIV-positive women: Options A, B and B+. Option B+ is a new development, emerging from experiences in Malawi, which was the focus of much attention at the recent International AIDS Conference. It describes regional guidance from the Southern African Development Community, and highlights recommendations and promising practices in the region.
In Ethiopia, male-dominated gender dynamics and health care provider attitudes lead many women to avoid or not fully utilize antenatal care (ANC) and prevention of mother-to-child transmission (PMTCT) services, creating barriers to women’s access to care and to interrupting vertical transmission of HIV.
Following the World Health Organization’s 2013 guidelines endorsing antiretroviral therapy for all HIV-infected pregnant women, Ethiopia adopted Option B+ (initiation of triple regimen antiretroviral therapy (ART) for the duration of breastfeeding or for life regardless of a pregnant woman’s CD4 count) as the national standard for prevention of mother-to-child transmission (PMTCT) of HIV in 2012.
I’d like to call attention to an important set of articles in the recent HIV/AIDS themed issue of The Lancet.
UNAIDS estimates that about 2.6 million children (aged 0-14) were living with HIV/AIDS in sub-Saharan Africa at the end of the year 2001, and most of these HIV infections were a result of mother-to-child transmission (MTCT) of HIV. In the same year, about 11 million children aged 0-14 were orphans as a result of their parent or parents' AIDSrelated death.
Background: HIV prevalence among pregnant women in Malawi is 12.6%, and mother-to-child transmission is a major route of transmission. As PMTCT services have expanded in Malawi in recent years, we sought to determine uptake of services, HIV-relevant infant feeding practices and mother-child health outcomes. Methods: A matched-cohort study of HIV-infected and HIV-uninfected mothers and their infants at 18-20 months post-partum in Zomba District, Malawi. 360 HIV-infected and 360 HIV-uninfected mothers were identified through registers. 387 mother-child pairs were included in the study.
We conducted a cross-sectional analysis of 33,744 mother–infant pairs to estimate the use and outcomes of the Malawian programme for the prevention of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV). Most women used the Malawian programme for the prevention of MTCT. The risk of MTCT increased if any of the four main steps in the programme were missed.
In 2011, the Malawi Ministry of Health (MOH) implemented an innovative approach (called "Option B+"), in which all HIV-infected pregnant and breastfeeding women are eligible for lifelong antiretroviral therapy (ART) regardless of CD4 count. Since that time, several countries have adopted the Option B+ policy. Using data collected through routine program supervision, this report is the first to summarize Malawi's experience implementing Option B+ under the direction of the MOH and supported by the Office of the Global AIDS Coordinator through the President's Emergency Plan for AIDS Relief (PEPFAR). In Malawi, the number of pregnant and breastfeeding women started on ART per quarter increased by 748%, from 1,257 in the second quarter of 2011 (before Option B+ implementation) to 10,663 in the third quarter of 2012 (1 year after implementation). Of the 2,949 women who started ART under Option B+ in the third quarter of 2011 and did not transfer care, 2,267 (77%) continue to receive ART at 12 months; this retention rate is similar to the rate for all adults in the national program. Option B+ is an important innovation that could accelerate progress in Malawi and other countries toward the goal of eliminating mother-to-child transmission of HIV worldwide.
Prevention of mother-to-child transmission of HIV (PMTCT) programs can greatly reduce the vertical transmission rate (VTR) of HIV, and Malawi is expanding PMTCT access by offering HIV-infected pregnant women life-long antiretroviral therapy (Option B+). There is currently no empirical data on the effectiveness of Malawian PMTCT programs. This study describes a surveillance approach to obtain population-based estimates of the VTR of infants
A new and more expansive agenda must be articulated to ensure that those infants and children who will never feel the impact of the current elimination agenda are reached and linked to appropriate care and treatment. This agenda must addresses challenges around both reducing vertical transmission through PMTCT and ensuring access to appropriate HIV testing, care, and treatment for all affected children who were never able to access PMTCT programming. Option B+, or universal test and treat for HIV-infected pregnant women, is an excellent start, but it may be time to rethink our current approaches to delivering PMTCT services. New strategies will reduce vertical transmission to less than 1% for those mother-infant pairs who can access them allowing for the contemplation of not just PMTCT, but actual elimination of MTCT. But expanded thinking is needed to ensure elimination of pediatric HIV.