A Framework for Elimination of Perinatal Transmission of HIV in the United States

Abstract

The availability of effective interventions to prevent mother-to-child HIV transmission and the significant reduction in the number of HIV-infected infants in the United States have led to the concept that elimination of mother-to-child HIV transmission (EMCT) is possible. Goals for elimination are presented. We also present a framework by which elimination efforts can be coordinated, beginning with comprehensive reproductive health care (including HIV testing) and real-time case-finding of pregnancies in HIV-infected women, and conducted through the following: facilitation of comprehensive clinical care and social services for women and infants; case review and community action; allowing continuous quality research in prevention and long-term follow-up of HIV-exposed infants; and thorough data reporting for HIV surveillance and EMCT evaluation. It is emphasized that EMCT will not be a one-time accomplishment but, rather, will require sustained effort as long as there are new HIV infections in women of childbearing age.

Ending Sexual HIV Transmission: Lessons Learned from Perinatal HIV

“…As knowledge evolved, the cascade was updated, integrating new technologies and interventions, providing a context for targeted efforts at national and local levels. In 2012, the Centers for Disease Control and Prevention (CDC) proposed a framework for the elimination of perinatal HIV transmission in the United States (Nesheim et al, 2012).…”

“…Widely heralded as one of the greatest public health successes in the United States, perinatal HIV transmissions declined from 1650 in 1991 to 151 by 2009, a greater than 90% reduction (Nesheim et al, 2012). Several interventions led to this success: (a) routine prenatal HIV screening, (b) rapid HIV testing during labor and delivery, (c) maternal ART and infant ART prophylaxis, and (d) infant replacement feeding.…”

Elimination of perinatal HIV infection in the USA and other high-income countries

“…Indeed, in this era of low MCT rates, as each transmission's specific characteristics take on heightened importance, it remains important to review cases, with the goal of changing the local system in ways that may prevent further transmissions and improve the care of HIV-infected women to optimize their health prior to—and between—pregnancies, as well as to prevent unwanted pregnancies. The Framework for EMCT [1] incorporates Case Review and Community Action as one of its key components, as the Fetal-Infant Mortality Review—HIV (FIMR-HIV) Prevention Program. The US Centers for Disease Control and Prevention includes FIMR-HIV among activities encouraged by its prevention grantees.…”

“…Elimination of mother-to-child HIV transmission (EMCT) has been adopted as a goal in high-income countries such as the United States (US) [1] and the countries of Europe [2], and also in less-resourced countries [3]with much higher incidences of mother-to-child transmission (MTCT) of HIV. In the US, the achievements of the past two decades leading to this goal are the result of the following:1) early and ongoing clinical research, 2) proactive public health policies and recommendations, 3) dedicated funding for clinical care (including laboratory monitoring, antiretrovirals [ARV] for prophylaxis and treatment, and alterations in obstetric practice), 4) case management services through Medicaid and the federal Ryan White Program and, 5) federal and state public health support for surveillance for MTCT, HIV testing, and public education.…”

Contemporary Management of Human Immunodeficiency Virus in Pregnancy

“…1 Now, more than 3 decades later, perinatal transmission in resource-rich settings has become uncommon and the goal of elimination of perinatal HIV transmission may be possible in the foreseeable future. [2][3][4] This review covers key concepts in the pathophysiology of HIV, with emphasis on perinatal transmission, and reviews appropriate screening and diagnostic testing for HIV during pregnancy. Current recommendations for medical, pharmacologic, and obstetric management of women newly diagnosed with HIV during pregnancy and women with preexisting infection, with an emphasis on the resource-rich setting, are also discussed.…”