Overcoming Health System Challenges for Women and Children Living With HIV Through the Global Plan

Abstract

To meet the ambitious targets set by the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), the initial 22 priority countries quickly developed innovative approaches for overcoming long-standing health systems challenges and providing HIV testing and treatment to pregnant and breastfeeding women and their infants. The Global Plan spurred programs for prevention of mother-to-child HIV transmission to integrate HIV-related care and treatment into broader maternal, newborn, and child health services; expand the effectiveness of the health workforce through task sharing; extend health services into communities; strengthen supply chain and commodity management systems; reduce diagnostic and laboratory hurdles; and strengthen strategic supervision and mentorship. The article reviews the ongoing challenges for prevention of mother-to-child HIV transmission programs as they continue to strive for elimination of vertical transmission of HIV infection in the post-Global Plan era. Although progress has been rapid, health systems still face important challenges, particularly follow-up and diagnosis of HIV-exposed infants, continuity of care, and the promotion of services that are respectful and client centered.

Implementing prevention policies for mother-to-child transmission of HIV in rural Malawi, South Africa and United Republic of Tanzania, 2013–2016

“…32 The overall reduction in maternal and infant ARV drug stock-outs between survey rounds, as well as in the median duration of the longest stock-out in the past 12 months, may indicate the success of Option B+ in simplifying drug forecasting, procurement and stock monitoring. 33 These findings also suggest that concerns that Option B+ may over-burden health systems through increased client numbers have not been realized with regards to drug supply chains. 34 Nevertheless, further evidence is needed to understand the impacts of Option B+ on other aspects of health systems including on the workforce and service delivery mechanisms such as integration.…”

“They haven’t asked me. I haven’t told them either”: fertility plan discussions between women living with HIV and healthcare providers in western Ethiopia

“…If WLHIV receive quality reproductive information, they might make better-informed decisions and feel more in control of their fertility plan decisions [ 29 ]. Improving both number and quality of trained human resources to avoid rushing and effective service integration is therefore very helpful in improving the quality of fertility plan discussions [ 38 ]. Involving women in their preconception planning through discussions and non-judgemental care is also very important.…”

Associations between health systems capacity and mother-to-child HIV prevention program outcomes in Zambia

“…Each facility domain may contribute differently to the equitable delivery of evidence-based interventions and towards impact along the PMTCT cascade[ 38 , 39 ]. Overall facility capacity—and systems strengthening interventions—may lead to varied effects on health outcomes depending on underlying facility and patient characteristics.…”