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The road to elimination of new pediatric HIV infections: FHI 360’s contribution

November 27, 2012

This piece originally appeared on FHI 360's Degrees Blog. For the complete text, please visit: http://degrees.fhi360.org/the-road-to-elimination-of-new-pediatric-hiv-infections-fhi-360s-contribution/.

By Justin Mandala, MD, MPH, FHI 360 Technical Advisor, and Kwasi Torpey, MD, PhD, MPH, Director of Technical Support in FHI 360′s Zambia Prevention Care and Treatment Partnership

We’ve been at this challenge of preventing mother-to-child transmission of HIV for more than a decade, and the international community is looking for ways to measure the effectiveness of everyone’s efforts. We need to look not only at process goals — such as the number of pregnant women with HIV who received antiretrovirals (ARVs) — but also at impact benchmarks.

The most desirable impact measurement is HIV-free survival (HFS), which is the proportion of children who are alive and HIV free even though the mothers have HIV at the time of their births. This proportion is often challenging to measure, though, and the alternative is to calculate the mother-to-child transmission rate — the proportion of children who are not infected with HIV despite birth by HIV-positive mothers. In rural Malawi, FHI 360 supported primary health centers and observed an 82 percent HFS at 24 months of age when both the HIV-positive mothers and their infants received ARVs. The HFS rate was 61 percent when only the mother received ARVs. The rate is known to be 55 percent with no intervention.

In Zambia, an analysis was done of early-infant HIV diagnosis results for 28,320 children born to HIV-positive mothers in provinces where FHI 360 works. Results indicated that six weeks after birth, the mother-to-child transmission rate was 7.3 percent in January 2009, and had dropped to 5.9 percent in July 2010. When there was no intervention, the rate was 21.8 percent. This encouraging trend was attributed to an increasingly higher proportion of mother-infant pairs receiving ARVs and of mothers receiving more efficacious regimens of two or more ARVs. This effort should be maintained and even accelerated for the elimination goal — 2 percent transmission rate at six weeks — to be reached by 2015.

Efforts to prevent mother-to-child transmission improve HIV-free survival and make the goal of eliminating transmission (defined as reducing the rate to less than 5 percent at 12 months of age) an achievable dream. To reach this goal by 2015, virtually all pregnant women with HIV should receive both the most efficacious ARV combinations and access to family planning methods. The momentum is here; the main challenge remains the inadequacy between the needs and available resources to provide accessible and efficacious intervention to all women in need of them.