Preventing Mother-to-Child Transmission

Thanks to a desire on the part of governments and partners, progress is being made in the delivery of prevention of mother-to-child transmission (PMTCT) of HIV services for women.

The urgency is clear. An estimated 370,000 children were newly infected with HIV in 2007, mainly through mother-to-child transmission. Without treatment, one out of two infected infants will die before age 2.

Knowledge applied in high-income countries has already resulted in a steep drop in the rate of transmission – down to about 2 per cent. Reductions occur through such essential actions as identifying HIV-infected pregnant women through the routine offer of testing, enrolling them in PMTCT programmes, ensuring that health systems are fully able to deliver effective antiretroviral (ARV) regimens, and supporting women in providing optimal and safe infant feeding.

Situation and trends

One in ten young pregnant women living in the capital cities of sub-Saharan Africa is HIV-infected and about one in three children born to HIV-infected pregnant women will contract the virus. Infection rates are highest in Gaborone, Botswana and Mbabane, Swaziland, where one in three young pregnant women is infected, and in Maseru, Lesotho and Pretoria, South Africa, where one in four is infected.

An estimated 33 per cent of pregnant women with HIV in low- and middle-income countries were receiving ARV prophylaxis for preventing transmission to their children in 2007.

Only seven countries, Jamaica, Argentina, Ukraine, Russian Federation, Botswana, Thailand and Brazil, provided ARV prophylaxis to more than 40 per cent of HIV-infected pregnant women in 2005. Except for Botswana, all of these countries lie outside sub-Saharan Africa, the most affected region. Yet in some high-prevalence countries in Eastern and Southern Africa (Namibia, Rwanda, South Africa and Swaziland), ARV access for PMTCT is increasing dramatically.

Progress can be attributed partly to a decentralized approach in which local structures – such as district, regional and provincial health management teams – are responsible for the planning, implementation and monitoring of PMTCT services, including the training of service providers, and demonstrated political commitment. To date, more than 100 countries surveyed by UNICEF have established national PMTCT programmes.

In some countries, programmes are moving from care for the infected individual to care for the whole family. The MTCT-Plus Model of Care – a package of HIV prevention, care, support and treatment for mothers, children and their families, using PMTCT as an entry point – has been adopted in several countries, including nine countries supported by the Columbia University Mailman School of Public Health, which pioneered this approach.

In August 2006, the World Health Organization (WHO) issued revised guidelines on preventing HIV infection in children that include more effective ARV regimens and maternal HIV care and treatment. In November 2006, WHO and UNAIDS released draft guidelines on provider-initiated routine offer of HIV testing and counselling that derived from an ongoing consultative process.

Towards eliminating HIV in children

Emanating from the Global Partners Forum on preventing mother-to-child transmission of HIV Abuja, Nigeria in December 2005, was a call to action for national governments and partners to support measures needed to eliminate HIV in infants and young children.

The Abuja call has been a real catalyst, and regional follow-up meetings on PMTCT held in 2006 in Kampala, Uganda and Nairobi, Kenya, reflected a new momentum in partnership-building around the issue. The Kampala meeting was a follow-up to a resolution by health ministers of the East, Central and South African Health Community Secretariat on strengthening PMTCT programmes in the region. It identified key programme areas and technical support needs for accelerating scale-up. The Nairobi meeting sought to build the capacity of a core group of regional experts to support countries in adapting and implementing a standard PMTCT training package.