AIDS-Free Generation may remain elusive goal

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Dr. Dorothy Mbori-Ngacha from UNICEF presented a sobering picture of the potential to eliminate 90 percent of HIV infections among children by 2015—the goal established by UNAIDS and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program in June of 2011.  She outlined the four pillars of the achieving that goal at the 19th Conference on Retroviruses and Opportunistic Infections Wednesday — preventing HIV in women, preventing unintended pregnancies, prevention of transmission, and support for HIV-infected mothers and their families.

The challenges are numerous. Mbori-Ngacha presented data about rates of unintended pregnancies among HIV-infected women – for example, an astonishing 93 percent of HIV-infected Ugandan women in care. She noted that family planning programs in the context of prevention of mother-to-child transmission (PMTCT) programs must be strengthened.

“It is clear it will take more than provision of antiretroviral (ARV) drugs to drive down mother-to-child transmission rates,” Mbori-Ngacha said.

Mbori-Ngacha also spoke about missed opportunities with pregnant women who test negative in PMTCT programs but remain at extremely high risk for HIV infection during their pregnancies. If infected, they are even more likely to transmit the infection to their infants in pregnancy or lactation than those with chronic infection, as acute HIV infection has been shown to increase transmission risk 2.3 fold. She called for the prioritization of pregnant women for access to pre-exposure prophylaxis (PrEP) or microbicides.

Mbori-Ngacha discussed the challenges and critical importance of strengthening the PMTCT continuum.  Pregnant women are at extremely high risk of loss to follow-up, particularly those who are young and poor. She noted that as many as 30 percent of pregnant women presenting for services at PMTCT clinics in sub-Saharan Africa may be adolescents, and special strategies may be needed to engage and retain them in care.  Intervening early in pregnancy is also really important.  For instance, each additional week of antiretroviral therapy (ART) during pregnancy reduces the risk of transmission by seven percent. She flagged a study from Mozambique that showed that the availability of point-of-care CD4 testing at HIV testing sites was associated with earlier access to ART for eligible pregnant women and better retention in care.

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