Eliminating HIV Infections in Children and Keeping their Mothers Alive

Key interventions can reduce mother-to-child HIV transmission from 35% to <5%

• Routine HIV testing and counseling of all pregnant women.
• Provision of antiretroviral drugs (ARVs) to all HIV-positive women during pregnancy, birth, and after delivery.
• Preventive therapy with ARVs for infants born to HIV-positive mothers.
• Safe infant feeding to minimize transmission.

The transmission of HIV from mothers to their infants contributes substantially to global morbidity and mortality for children under-5 years of age. Approximately 1000 HIV-infected infants are born every day, mostly in sub-Saharan Africa, amounting to nearly 370,000 new pediatric infections annually (UNAIDS, 2010). Without treatment, over half of these children will die before the age of two (WHO, 2006). Fortunately, prevention of mother-to-child HIV transmission (PMTCT) can be accomplished by effective, accessible, and scalable interventions within existing maternal and child health services.

Preventing mother-to-child transmission of HIV

Without diagnosis and treatment, about 35% of HIV-infected pregnant women will transmit HIV to their infants. Key interventions, including those listed in the right column, have reduced mother-to-child transmission in the United States to <1% (CDC, 2007), in Botswana to 3.6% (Tlale J, 2008), and in South Africa to 3.5% (MRC South Africa, 2011) in infants 4-8 weeks of age.

A global call to action

In an effort to achieve the Millennium Development Goal 4 (MDG4) to reduce mortality of children under five years of age, the World Health Organization (WHO), UNAIDS, UNICEF and other international health partners, have called for elimination of mother-to-child transmission of HIV by 2015.

CDC’s role in preventing infant HIV infections

The US government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), has been supporting the global strategy by providing technical and financial assistance to countries with a high burden of HIV infection. As the U.S. science-based public health and disease prevention agency, the Centers for Disease Control and Prevention (CDC) plays a unique and essential role in PEPFAR. CDC leverages its technical expertise in public health science and long-standing relationships with Ministries of Health to work side-by-side with countries to build strong programs and sustainable public health systems that respond effectively to the global HIV/AIDS epidemic.
Since 2004, CDC, through PEPFAR, has contributed to significant progress in implementing two essential components of comprehensive PMTCT programs, namely HIV testing and counseling of pregnant women and initiating HIV-infected pregnant women on ARVs. In high burden countries in 2010, with direct PEPFAR-support, 34% of pregnant women were tested, and 56% of those who tested HIV-positive received ARVs for PMTCT (PEPFAR, 2004-2010). These interventions have contributed to nearly 386,000 infants being born without HIV.
CDC uses a variety of approaches to support resource-constrained, high burden countries in combating mother-to-child transmission of HIV.

• Providing technical assistance and support CDC provides technical assistance to in-country US Government teams, Ministries of Health, and nongovernmental (NGO) partners to implement international recommendations and best practices.
• Translating research into practice CDC conducts program evaluations to identify bottlenecks, contributes to the development of evidence-based tools, and recommends implementation strategies to enhance scale up and improve quality of PMTCT programs.
• Contributing scientific expertise CDC collaborates with WHO and other international health partners to develop global PMTCT policies and practice guidelines.

On the path to an AIDS-free generation

On World AIDS Day 2011, President Barack Obama announced a new PMTCT goal, in addition to other HIV prevention goals: By the end of 2013, PEPFAR will reach more than 1.5 million more HIV-positive pregnant women with antiretroviral drugs to prevent them from passing the virus to their children. To achieve this goal, CDC, through PEPFAR, is supporting the rapid scale-up of high quality PMTCT services. An AIDS-free generation means that virtually no children are born infected with the HIV virus, as they become adults they are at far lower risk of becoming infected than they would be today, and if they do acquire the virus, they have access to treatment that helps prevent them from developing AIDS and passing the virus to others.

Broader benefits of PMTCT

In addition to ending HIV infections in children, PMTCT programs provide other significant benefits: they also offer an opportunity to save the lives of mothers by improving the coverage of HIV-positive women on antiretroviral drugs, and significantly decrease their risk of transmitting the virus to uninfected partners.

Citations

South Africa Medical Research Council (MRC). SA PMTCT Evaluation shows that virtual elimination of paediatric HIV is possible with intensified effort. Accessed at http://www.mrc.ac.za/pressreleases/2011/10press2011.htm (2011).
Tlale J et al. Mother to child HIV transmission in Botswana – analysis of dried blood spot (DBS) results from the national PMTCT programme. XVII International Conference on AIDS, Mexico City, Mexico (2008)