An estimated 430,00 new human immunodeficiency virus (HIV) infections occurred among children younger than 15 years of age in 2008, most in sub-Saharan Africa and most due to mother-to-child transmission (MTCT). In marked contrast, MTCT of HIV has been virtually eliminated in well-resourced settings through the use of combinations of antiretroviral (ARV) drugs for the mother during pregnancy and labor and for the infant postpartum; cesarean delivery to reduce the infant's exposure to trauma and infection in the birth canal; and formula feeding to protect the infant from transmission from breastfeeding. While effective, these interventions are costly and require strong health-care systems. From 1999 to 2003, Horizons conducted operations research to determine how interventions successful in the clinical trial setting would translate to the real-world environments of maternal and child healthcare delivery in low-resource settings. A second set of Horizons studies (2004–2007) sought to address gaps in adherence to ARV prophylaxis; examine roles of family planning in prevention of MTCT (PMTCT) programs; show the value of psychosocial support for HIV-positive mothers; and identify ways to improve the quality of care and follow-up for women in the postpartum period. This article provides an assessment of the findings of Horizons studies on PMTCT interventions from 1999 to 2007 and identifies needs for follow-on efforts.
References
1.
Joint United Nations Programme on HIV/AIDS. AIDS epidemic update: November 2009. Geneva: UNAIDS; 2009.
2.
FowlerMGLampeMAJamiesonDJKourtisAPRogersMF. Reducing the risk of mother-to-child human immunodeficiency virus transmission: Past successes, current progress and challenges, and future directions. Am J Obstet Gynecol2007;197(3 Suppl):S3–9.
3.
StoverJFahnestockM. Coverage of selected services for HIV/AIDS prevention, care, and treatment in low- and middle-income countries in 2005. Washington: Constella Futures, POLICY Project; 2006.
4.
GuayLAMusokePFlemingTBagendaDAllenMNakabiitoC. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet1999;354:795–802.
5.
RutenbergNBaekCKalibalaSRosenJ. Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. New York: UNICEF and Population Council; 2003.
6.
KankasaC. Provision of VCT and ARVS: Achievements and challenges. Presented at the Horizons PMTCT Symposium; 2003 Dec 10; Washington.
7.
World Health Organization. HIV and infant feeding: New evidence and programmatic experience: Report of a technical consultation held on behalf of the Inter-agency Task Team (IATT) on prevention of HIV infections in pregnant women, mothers and their infants. Geneva: WHO; 2007.
8.
KaaiSBaekCGeibelSOmondiPUloBMuthumbiG. Community-based approaches to prevention of mother-to-child transmission of HIV: Findings from a low-income community in Kenya. Horizons Final Report. Nairobi: Population Council; 2007.
9.
BaekCMathamboVMkhizeSFriedmanIApicellaLRutenbergN. Key findings from an evaluation of the mothers2mothers program in KwaZulu-Natal, South Africa. Horizons Final Report. Washington: Population Council; 2007.
10.
MahendraVSMudoiROinamAPakkelaVSarnaAPandaS. Continuum of care for HIV-positive women accessing programs to prevent parent-to-child transmission: Findings from India. Horizons Final Report. Washington: Population Council; 2007.
11.
FowlerMGNewellML. Breastfeeding and HIV-1 transmission in resource-limited settings. J Acquir Immune Defic Syndr2002;30: 230–9.
12.
World Health Organization. New data on the prevention of mother-to-child transmission of HIV and their policy implications: Conclusions and recommendations. Geneva: WHO; 2001.
13.
DohertyTChopraMNkonkiLJacksonDGreinerT. Effect of the HIV epidemic on infant feeding in South Africa: “When they see me coming with the tins they laugh at me.”Bull World Health Organ2006;84:90–6.
14.
Hope Humana, LINKAGES, National Food and Nutrition Commission, Ndola District Health Management Team, Horizons Program, Zambia Integrated Health Project. Empowering communities to respond to HIV/AIDS. Ndola demonstration project on maternal and child health: Operations research final report. Horizons Final Report. Washington: Population Council; 2003.
15.
WarrenCShongweRWaligoAMahdiMMaziaGNarayananI. Repositioning postnatal care in a high HIV environment: Swaziland. Horizons Final Report. Washington: Population Council; 2008.
16.
World Health Organization. Guidance on global scale-up of the prevention of mother-to-child transmission of HIV: Towards universal access for women, infants and young children and eliminating HIV and AIDS among children. Geneva; WHO; 2007.
17.
RutenbergNBaekC. Field experiences integrating family planning into programs to prevent mother-to-child transmission of HIV. Stud Fam Plann2005;36:235–45.
18.
BaekCKaaiSGeibelSMcOdidaPUloBRutenbergN. Assessing HIV-positive women's fertility desires and demand for family planning in prevention of mother-to-child transmission of HIV (PMTCT) programs in Nairobi, Kenya. Presented at the American Public Health Association 133rd Annual Meeting and Exposition; 2005 Dec 10–14; Philadelphia.
19.
BaekCCreekTJonesLApicellaLRednerJRutenbergN. Evaluation of HIV counseling and testing in ANC settings and adherence to short course antiretroviral prophylaxis for PMTCT in Francistown, Botswana. Horizons Final Report. Washington: Population Council; 2009.
20.
World Health Organization. The right to know: New approaches to HIV testing and counselling. Geneva: WHO; 2003.
21.
Joint United Nations Programme on HIV/AIDS, World Health Organization; Global Reference Group on HIV/AIDS and Human Rights. UNAIDS/WHO policy statement on HIV testing. Geneva: UNAIDS and WHO; 2004.
22.
BoluOOAllreadVCreekTStringerEFornaFBulterysM. Approaches for scaling up human immunodeficiency virus testing and counseling in prevention of mother-to-child human immunodeficiency virus transmission settings in resource-limited countries. Am J Obstet Gynecol2007;197(3 Suppl):S83–9.
23.
World Health Organization, United Nations Children's Fund, United States Agency for International Development, Joint United Nations Programme on HIV/AIDS, the Policy Project. Coverage of selected services for HIV/AIDS prevention, care and support in low and middle income countries in 2003. Geneva: WHO; 2004.
24.
MedleyAGarcia-MorenoCMcGillSMamanS. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: Implications for prevention of mother-to-child transmission programmes. Bull World Health Organ2004;82:299–307.
25.
SripipatanaTSpensleyAMillerAMcIntyreJSangiwaGSaweF. Site-specific interventions to improve prevention of mother-to-child transmission of human immunodeficiency virus programs in less developed settings. Am J Obstet Gynecol2007;197(3 Suppl): S107–12.
26.
GrayRHLiXKigoziGSerwaddaDBrahmbhattHWabwire-MangenF. Increased risk of incident HIV during pregnancy in Rakai, Uganda: A prospective study. Lancet2005;366:1182–8.
27.
DruceNNolanA. Seizing the big missed opportunity: Linking HIV and maternity care services in sub-Saharan Africa. Reprod Health Matters2007;15:190–201.
