Progress, Challenges, and New Opportunities for the Prevention of Mother-to-Child Transmission of HIV Under the US President's Emergency Plan for AIDS Relief

Abstract

In June 2011, the Joint United Nations Programme on HIV/AIDS, the US President's Emergency Plan for AIDS Relief (PEPFAR), and other collaborators outlined a transformative plan to virtually eliminate pediatric AIDS worldwide. The ambitious targets of this initiative included a 90% reduction in new pediatric HIV infections and a 50% reduction in HIV-related maternal mortality--all by 2015. PEPFAR has made an unprecedented commitment to the expansion and improvement of prevention of mother-to-child HIV transmission (PMTCT) services globally and is expected to play a critical role in reaching the virtual elimination target. To date, PEPFAR has been instrumental in the success of many national programs, including expanded coverage of PMTCT services, an enhanced continuum of care between PMTCT and HIV care and treatment, provision of more efficacious regimens for antiretroviral prophylaxis, design of innovative but simplified PMTCT approaches, and development of new strategies to evaluate program effectiveness. These accomplishments have been made through collaborative efforts with host governments, United Nations agencies, other donors (eg, the Global Fund for AIDS, Tuberculosis, and Malaria), nongovernmental organizations, and private sector partners. To successfully meet the ambitious global targets to prevent new infant HIV infections, PEPFAR must continue to leverage the existing PMTCT platform, while developing innovative approaches to rapidly expand quality HIV services. PEPFAR must also carefully integrate PMTCT into the broader combination prevention agenda for HIV, so that real progress can be made toward an "AIDS-free generation" worldwide.

Uptake of prevention of mother-to-child-transmission using Option B+ in northern rural Malawi: a retrospective cohort study

“…Retention on ART depends on good referral systems and linkage between facilities. While dropout was low within the time frame of this study, potential barriers to continuation in care may include transportation costs, distance to clinic and human resource constraints resulting in excessive waiting times and scheduling difficulties 17 18…”

Factors associated with HIV testing and receiving results during antenatal care in Tanzania

“…Global and National responses focused at adoption of comprehensive PMTCT strategies at national level and enhanced capacity of the health care systems to increase coverage in order to achieve the goal that all eligible children will access ART by 2015 (Chi, Adler et al 2012;Paredes, Marconi et al 2013). Tanzania response included adoption of PMTCT guiding goal to eliminate new HIV pediatric infections and keep mothers alive through improved maternal, newborn and child health and survival programs by 2015.…”

Human Immunodeficiency Viruses Types 1 and 2

“…The most recent available UNAIDS report on progress through the Global Plan [ 540 ] is relatively optimistic: new HIV infections have declined by an average of 38 % in 21 target countries with progress accelerating in several vulnerable ones, and new recommendations for women and children should lead to improved delivery of HIV prevention and treatment services, earlier initiation of HIV treatment, and harmonization of eligibility and regimens among various populations. Unfortunately, MTCT may persist in less developed countries at far higher rates than it should at this stage of knowledge and capacity [ 541 ] if access to cART in those places remains in adequate.…”