Prevention of mother-to-child HIV transmission within the continuum of maternal, newborn, and child health services

Abstract

Purpose of review To reach virtual elimination of pediatric HIV, programs for the prevention of mother-to-child HIV transmission (PMTCT) must expand coverage and achieve long-term retention of mothers and infants. While PMTCT have been traditionally aligned with maternal, newborn, and child health (MNCH) services, novel approaches are needed to address the increasing demands of evolving global PMTCT policies. Recent findings PMTCT-MNCH integration has improved the uptake and timely initiation of antiretroviral therapy (ART) among treatment-eligible pregnant women in public health settings. Postpartum engagement of HIV-infected mothers and HIV-exposed infants has been insufficient, although alignment of visits to the childhood immunization schedule and establishment of integrated mother-infant clinics may increase retention. Evidence also suggests that the integration of maternal HIV testing into childhood immunization clinics can significantly increase the identification of at-risk HIV-exposed infants previously missed by traditional PMTCT models. Summary Targeted service integration models can improve PMTCT uptake. However, as global PMTCT policy shifts to universal provision of maternal ART during pregnancy (i.e., Option B/B+), these findings must be reexamined in the context of increased service demand and systems burden. Intensive evaluation is needed to ensure quality clinical care is maintained both for PMTCT and for underpinning MNCH services.

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities

“…Recent assessments of HIV counseling and testing, and ART services in Zambia have concluded that provider practices are inconsistent and often do not follow the national guidelines [4,5]. Evidence also suggests that the quality of services for prevention of mother-to-child transmission (PMTCT) of HIV is under strain in Zambia, as in other countries, following the adoption of option Bþ, which calls for lifetime ART for all pregnant women with HIV [6].…”

Implementation and Operational Research

“…36, 37 However, decentralization to primary care settings alone may not be enough to maximize coverage of services. In rural settings, new models may be needed to extend the existing health system.…”

HIV-1 Proteins, Tat and gp120, Target the Developing Dopamine System

“…Of the total estimate of 35 million people living with HIV, 3.2 million are children [<15 years of age, 2.9–3.5 million] and 4 million are young people (15–24 years of age, 3.6–4.6 million], 29% of whom are adolescents (15–19 years of age). Providing antiretroviral therapies for pregnant women living with HIV has significantly lowered the number of children newly infected with HIV [8–10]. Nevertheless, 18 years after starting the use of combined antiretroviral therapy (cART), 240,000 new pediatric HIV infections still occurred worldwide in 2013; i.e., thus another infant is infected approximately every two minutes.…”