Research identifies barriers, answers to reaching families with proven measures for preventing mother to child HIV transmission

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Journal supplement examines effectiveness of efforts to protect infants from infection

PMTCTImpSci

An expectant mother in Nigeria is tested for HIV while attending a “baby shower,” at a church, where free HIV tests and prenatal care are offered.Photo by Dina Patel/HealthySunrise Foundation

A church-sponsored baby shower draws more mothers to HIV testing and treatment than a clinic offering the same services . . . Home visits with information on family planning double chances that a man in the house will get tested for HIV . . . Offering cash for clinic visits helps keep women in care, but doesn’t add an incentive to taking medicine for HIV . . .

These are some of the ideas and impacts examined by researchers awarded grants through a U.S. National Institutes of Health/Office of the Global AIDS Coordinator initiative to find ways to ease access to HIV testing, treatment, and other measures to prevent HIV transmission from parents to children. Findings from their studies are collected in a supplement edition of the Journal of Acquired Immune Deficiency Syndromes on Advancing PMTCT Implementation Through Scientific Research.

The science of what needs to be done to prevent HIV transmission from parents to children is already known, and has yielded tremendous benefits, the authors of the supplement note. But how to do it remains a question in places where limited health and financial resources prevent people who need services the most from accessing them. That’s why, the introduction notes, even as 21 countries in sub-Saharan Africa have seen a 60 percent drop in pediatric HIV incidence over the last seven years, still 150,000 children in low and middle-income countries become infected with the virus every year, while 42,000 women die of complications from pregnancy and HIV. That’s where implementation science, the study of barriers — first identifying them, and then identifying how to overcome them —  enters the picture.

The approaches described in the supplement include ones informed by on-the-ground experience, as in the church-based Healthy Beginning Initiative in Nigeria, a country that in 2014 was home  to a full third of HIV infections among children in the highest priority countries. There, an intervention that began in a familiar and nonclinical setting led to lower rates of transmission, and higher rates of diagnosis among the children who were infected. They also include solutions with known value that all the same must be demonstrated before they are put into action — as in Zambia, where a study has set out to prove that access to virologic testing for infants will improve the outcomes of those living with HIV. And some offer an answer to one need — in this case, support for breast-feeding mothers with HIV through volunteer “feeding buddies” — while potentially introducing a new need — how do you keep getting impoverished women to “volunteer” without the compensation most of us expect for providing needed functions?

The outcomes of the studies will continue to manifest over time, with researchers collaborating to share insights, methods and lessons along the way according to the supplement. The ultimate outcome will ensure access to what science has promised, and with that, an AIDS-free generation.

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