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Review
. 2012 Aug 15;60 Suppl 3(Suppl 3):S78-87.
doi: 10.1097/QAI.0b013e31825f3284.

Progress, challenges, and new opportunities for the prevention of mother-to-child transmission of HIV under the US President's Emergency Plan for AIDS Relief

Benjamin H Chi  1 , Michelle R Adler, Omotayo Bolu, Dorothy Mbori-Ngacha, Didier K Ekouevi, Anna Gieselman, Tsungai Chipato, Chewe Luo, B Ryan Phelps, Craig McClure, Lynne M Mofenson, Jeffrey S A Stringer
Affiliations
Review

Progress, challenges, and new opportunities for the prevention of mother-to-child transmission of HIV under the US President's Emergency Plan for AIDS Relief

Benjamin H Chi et al. J Acquir Immune Defic Syndr. .

Abstract

In June 2011, the Joint United Nations Programme on HIV/AIDS, the US President's Emergency Plan for AIDS Relief (PEPFAR), and other collaborators outlined a transformative plan to virtually eliminate pediatric AIDS worldwide. The ambitious targets of this initiative included a 90% reduction in new pediatric HIV infections and a 50% reduction in HIV-related maternal mortality--all by 2015. PEPFAR has made an unprecedented commitment to the expansion and improvement of prevention of mother-to-child HIV transmission (PMTCT) services globally and is expected to play a critical role in reaching the virtual elimination target. To date, PEPFAR has been instrumental in the success of many national programs, including expanded coverage of PMTCT services, an enhanced continuum of care between PMTCT and HIV care and treatment, provision of more efficacious regimens for antiretroviral prophylaxis, design of innovative but simplified PMTCT approaches, and development of new strategies to evaluate program effectiveness. These accomplishments have been made through collaborative efforts with host governments, United Nations agencies, other donors (eg, the Global Fund for AIDS, Tuberculosis, and Malaria), nongovernmental organizations, and private sector partners. To successfully meet the ambitious global targets to prevent new infant HIV infections, PEPFAR must continue to leverage the existing PMTCT platform, while developing innovative approaches to rapidly expand quality HIV services. PEPFAR must also carefully integrate PMTCT into the broader combination prevention agenda for HIV, so that real progress can be made toward an "AIDS-free generation" worldwide.

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Conflict of interest statement

The authors have no other funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Important policy and program milestones in the PMTCT, 1999–2012. PMTCT, prevention of mother-to-child transmission of HIV.
FIGURE 2.
FIGURE 2.
National coverage of HIV testing among all pregnant women and antiretroviral provision among HIV-infected pregnant women in 22 high priority countries for EMTCT in 2010. *Indicates that national coverage estimates not yet available. Adapted from the Joint United Nations Programme on HIV/AIDS (UNAIDS), Global HIV/AIDS update: epidemic update and health sector progress towards universal access, progress report 2011. EMTCT, eliminating mother-to-child HIV transmission.
FIGURE 3.
FIGURE 3.
Modeled estimates of infant HIV infections averted through PEPFAR-supported programs, 2004–2011. Between 2004 and 2010 (shaded grey), modeling was based on the effectiveness of single-dose nevirapine regimen only because disaggregated data regarding prescribed regimens were not routinely collected. Starting in 2011, detailed data about prescribed regimens were collected across all supported countries. The estimate from 2011 (shaded black) takes into account the decreased risk of transmission with more efficacious regimens.
FIGURE 4.
FIGURE 4.
Number of pregnant women placed on antiretroviral prophylaxis or treatment and the corresponding annual program funding across 22 high priority countries for EMTCT, 2004–2011. EMTCT, eliminating mother-to-child HIV transmission.
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References

    1. Joint United Nations Programme on HIV/AIDS. Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, 2011–2015. Available at: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspubl.... Accessed April 2, 2012.
    1. World Health Organization. Strategic approaches to the prevention of HIV infection in infants: reporting a WHO meeting, Morges, Switzerland, March 20–22, 2002. Available at: http://www.who.int/hiv/pub/mtct/en/StrategicApproachesE.pdf. Accessed April 6, 2012.
    1. US President’s Emergency Plan for AIDS Relief. Partnership frameworks. Available at: http://www.pepfar.gov/frameworks/index.htm. Accessed April 7, 2012.
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    1. Unicef. Statistics and monitoring: country statistics. Available at: http://www.unicef.org/statistics/index_countrystats.html. Accessed April 6, 2012.

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