Yesterday the Foundation for AIDS Research, or amfAR, hosted a briefing on Capitol Hill on the successes and challenges in the global response to mother-to-child transmission of HIV/AIDS. A panel of experts representing programs funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) discussed their respective organizations’ prevention of mother-to-child transmission (PMTCT) activities and made clear how PEPFAR dollars are greatly contributing to achieving an AIDS free generation.
Without PMTCT, 25-40 percent of pregnant women living with HIV will transmit the virus to their infants. With PMTCT, that number drops to below five percent. With women of reproductive age making up the majority of people living with HIV in sub-Saharan Africa, scaling up PMTCT services is imperative to reducing the prevalence of the deadly disease.
Dr. Charles Holmes, Chief Medical Officer with the Office of the U.S. Global AIDS Coordinator (OGAC), explained that PMTCT is not only one of the highest priorities of the PEPFAR program but also one of the central challenges. It remains extremely difficult to reach women in some African countries where most women deliver their babies at home. A transition is also under way to move the standard of care for pregnant women from a single drug to full antiretroviral therapy (ART) throughout pregnancy and the breastfeeding period. In addition to providing women with better treatment, Holmes explained that PMTCT programs must operate at all levels of health care and beyond, from educating mothers and families, to creative community demand for testing, services, and peer support, to scaling up services at antenatal clinics and labs.
PEPFAR dollars helped test and counsel 8 million women last year, and of the more than 3 million people receiving HIV treatment with PEPFAR dollars, 60 percent are women. PEPFAR funded programs prevented 114,000 infant infections in 2010, and there has been an overall reduction in HIV prevalence of 40 percent among children. Nevertheless, 260,000 children died from HIV infection in 2009. PEPFAR’s latest five-year plans include aggressive PMTCT scale-up plans, which include 85 percent ART coverage among HIV-infected pregnant women. PEPFAR has also offered selected six countries with low PMTCT coverage to submit “PEPFAR PMTCT Acceleration Plans.” He cited Nigeria as one of the target countries with low uptake of PMTCT and noted that Nigerian women aged 15-24 are twice as likely as their young male counterparts to acquire HIV infection. These six priority nations will receive additional funding. PEPFAR will target an additional $100 million in funding to these countries in 2011.
Laura Guay, MD, vice president of research at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), explained that thanks to funding from PEPFAR and other donors, EGPAF went from sponsoring eight sites in six countries in 2000, to sponsoring 5,100 sites in 17 countries 10 years later. She reminded the audience of Hill staff and nongovernmental organization representatives that the PEPFAR program actually began with initiatives to prevention vertical transmission of HIV infection. Guay explained that in addition to more funding, creative strategies are needed in PMTCT delivery to make additional progress. To highlight this point she explained that if a woman in rural Africa is able to buy a bottle of Coke, she should be able to access PMTCT services as well.
Elaine Abrams, MD, senior research director at the International Center for AIDS Care and Treatment (ICAP), stressed that people’s thinking on PMTCT needs to shift from regarding PMTCT as life-saving therapy for a child, to life-saving therapy for two people. She characterized PMTCT as “a program of care and treatment for women, children and families.”
Mitchell Besser, MD, founder and medical director of mothers2mothers, echoed Abrams by stressing that PMTCT services are an entry point to holistic care and can be used as a platform to address other key health issues for women and children. Besser described the “mother2mother” model that uses HIV-infected mothers to support pregnant, HIV-infected women to stay in care and adhere to drug treatment regimens for themselves and their infants. The mothers, who receive special training, are paid as professional members of the health care team.
Areana Quiñones, director of grants acquisition and management for the Catholic Medical Mission Board, explained that her organization is working to increase male partner involvement in PMTCT, which will result in an uptake in woman seeking PMTCT services.
To learn more about mother-to-child transmission of HIV, PMTCT, and the importance of continued support for PMTCT, click here to view a new fact sheet developed by the Center for Global Health Policy.