Accelerating progress towards the elimination of mother‐to‐child transmission of HIV: a narrative review

Abstract

Introduction Findings from biomedical, behavioural and implementation studies provide a rich foundation to guide programmatic efforts for the prevention of mother‐to‐child HIV transmission (PMTCT). Methods We summarized the current evidence base to support policy makers, programme managers, funding agencies and other stakeholders in designing and optimizing PMTCT programmes. We searched the scientific literature for PMTCT interventions in the era of universal antiretroviral therapy for pregnant and breastfeeding women (i.e. 2013 onward). Where evidence was sparse, relevant studies from the general HIV treatment literature or from prior eras of PMTCT programme implementation were also considered. Studies were organized into six categories: HIV prevention services for women, timely access to HIV testing, timely access to ART, programme retention and adherence support, timely engagement in antenatal care and services for infants at highest risk of HIV acquisition. These were mapped to specific missed opportunities identified by the UNAIDS Spectrum model and embedded in UNICEF operational guidance to optimize PMTCT services. Results and discussion From May to November 2019, we identified numerous promising, evidence‐based strategies that, properly tailored and adopted, could contribute to population reductions in vertical HIV transmission. These spanned the HIV and maternal and child health literature, emphasizing the importance of continued alignment and integration of services. We observed overlap between several intervention domains, suggesting potential for synergies and increased downstream impact. Common themes included integration of facility‐based healthcare; decentralization of health services from facilities to communities; and engagement of partners, peers and lay workers for social support. Approaches to ensure early HIV diagnosis and treatment prior to pregnancy would strengthen care across the maternal lifespan and should be promoted in the context of PMTCT. Conclusions A wide range of effective strategies exist to improve PMTCT access, uptake and retention. Programmes should carefully consider, prioritize and plan those that are most appropriate for the local setting and best address existing gaps in PMTCT health services.

Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study

“…This gap demonstrates the critical need for further research to improve rates of HIV testing for exposed infants at 6 weeks, 6 months and 12 months post-delivery as the most challenging component of implementation of Option B+ guidelines. Some strategies that have shown promise for improved EID activities include pairing mothers with HIV positive peer mentors 24 and increasing men's involvement in maternal and child health activities 25 , 26 .…”

Uninterrupted HIV treatment for women: Policies and practices for care transitions during pregnancy and breastfeeding in Côte d’Ivoire, Lesotho and Malawi

“…These findings provide important insights into improving transition practices and overcoming challenges for policymakers and program implementers. They are also a call to action, in line with priorities to improve maternal retention in HIV care and accelerate progress towards elimination of mother-to-child transmission of HIV [3,41]. While transition of care for continued ART along the PMTCT cascade is a neglected area, important opportunities exist to develop guidance for these transitions, define indicators to measure transition success, and implement systems to improve monitoring of transitions along the PMTCT cascade.…”

A hybrid of long short-term memory neural network and autoregressive integrated moving average model in forecasting HIV incidence and morality of post-neonatal population in East Asia: global burden of diseases 2000–2019

“…Human immunodeficiency virus (HIV) is a tremendous challenge to the society with 37.7 million people living with HIV, 1.5 million new HIV infections and 680,000 deaths from AIDS-related causes that occurred in 2020 all over the world [ 1 , 2 ]. HIV has many routes of transmission including mother-to-child transmission (MTCT) [ 3 ]. Women with HIV infection at childbearing age are associated with a risk of MTCT during pregnancy and breastfeeding [ 4 ].…”