Improving Child survival through enhancing Prevention of Mother to Child Transmission of HIV

Abstract

Background: Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. Effective strategies are needed for the Prevention of Mother-To-Child Transmission of HIV (PMTCT). The complete PMTCT package includes comprehensive antenatal (ANC) care, modified obstetric practices, antiretroviral therapy and infant feeding counseling and support.

Aim: This article presents syntheses of evidence on the cost-effectiveness of HIV MTCT strategies for LMICs, investigates whether a maternal triple-antiretroviral regimen that was designed to maximally suppress viral load in late pregnancy and the first 6 months of lactation was safe and well-tolerated, investigates acceptability of the PMTCT programme components, and identifies structural and cultural challenges to male involvement in the reduction of MTCT.

Methods: I identified articles on the use of ARVs to prevent MTCT of HIV through a comprehensive database search including PubMed and Embase. I screened the titles and abstracts from the individual database search results from year 2002-2011, pooled the potentially eligible studies, retrieved full-text articles, and then assessed whether they met the inclusion criteria. I extracted the data based on publication date, demographic characteristics and HIV transmission rates to babies.

Results: The articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMICs. HIV-transmission rates among subgroups defined by maternal risk factors, including baseline CD4 cell count and viral load was 15% after 24 months, while transmission rates for those who have received ARVs was 7% for the same period. This reveals that triple-antiretroviral regimen for pregnant-women was safe and feasible. Routine testing for HIV of women at the antenatal clinic was found to be highly acceptable and appreciated by men, while other programme components, notably partner testing, condom use and the infant feeding recommendations, were met with continued resistance. The vision, goal, objectives and targets noted by Global Partners Forum will serve as a framework for WHO to support countries to focus on and prioritize the accelerated scale-up of effective and comprehensive PMTCT services.

Conclusion and recommendations: Interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Deep-seated ideas about gender roles and hierarchy are major obstacles to male participation in the PMTCT programme. Empowering men to participate by creating a space within the PMTCT programme that is male friendly should be feasible and should be highly prioritized for the PMTCT programme to achieve its potential. Increased community sensitization, counseling and testing, treatment and support of women identified as HIV infected should improve acceptance of PMTCT services in Africa and subsequently reduce paediatric HIV.

Correspondence: Mkoma George F., e-mail: georgemkoma@yahoo.com