How can efforts to prevent mother-to-child HIV transmission work better to save the lives of women who need treatment for their own health? How can programs to prevent mother-to-child transmission reach more mothers, and reach their partners with testing and information as well? How cost-effective are faith-based programs compared to clinic-based programs?
These are some of the questions the office of the U.S. Global AIDS Coordinator and the National Institutes of Health are seeking to answer with grants totaling up to $7.5 million over the next two years. The grants will support implementation science projects exploring how to achieve the goal of eliminating new pediatric HIV infections while keeping mothers alive. PEPFAR’s implementation science program seeks to apply scientific evidence to guide program planning and policies by examining programs’ effectiveness in light of their efficiency, impacts, costs and intentions.
The announcement of the latest grants to improve prevention of mother-to-child transmission efforts came on the eve of the release last week of the PEPFAR Blueprint to create an AIDS-free generation. The plan heartened advocates of expanded treatment and prevention efforts with its emphasis on strengthening efforts to reach women, on addressing critical reproductive health needs, and its recognition of UNAIDS four-pronged approach to preventing mother to child HIV transmission — an approach that includes working to prevent HIV infections from occurring, and to help HIV-positive women avoid unintended pregnancies. At the same time, the plan does not address a restriction in existing guidelines that prevents PEPFAR-funded programs from making contraceptives available to women, leaving a critical gap, global health advocates say, in efforts to protect women. Efforts to help women control their reproductive lives are considered vital to reducing their risks of being exposed to HIV, and women are more vulnerable to HIV infection when pregnant.
Heather Boonstra, senior public policy associate at the Guttmacher Institute, who wrote a post for Science Speaks Blueprint series calling for contraceptive availability, says the latest grants represent the opportunity for progress.
“This is very exciting to see that the administration is directing its dollars to implementation science,” she said. Implementation science studies have been important to programs on the ground, that welcome the opportunity to examine ways to maximize their effectiveness, she added.
The question she has heard the most from those working in programs to prevent mother to child HIV transmission, she said, is how to reach women sooner, and better improve their odds, when too often they first see women shortly before delivery.
“That’s not the most effective time to talk to women about family planning. Post-delivery is a good time, but then you have loss to follow up,” Boonstra said. “When should we be talking to women about how to plan their families? That’s a PMTCT (prevention of mother to child transmission) program question.”
The grants provide an opportunity for progress in prevention efforts, she said, offering answers to questions on the ground, including “what are the range of options programmers should be thinking about as they about how to help women achieve their fertility goals?”
PEPFAR has awarded 74 implementation science grants so far.