An End to Perinatal HIV: Success in the US Requires Ongoing and Innovative Efforts that Should Expand Globally

Abstract

The dramatic reduction of perinatally transmitted HIV in the United States has been a striking success story in the HIV epidemic. Routine HIV screening during pregnancy followed by appropriate therapy has been extremely effective. This paper puts forth three strategies needed to maintain these gains and reach the goal of eliminating perinatal HIV: standardize medical interventions and policy changes that support perinatal HIV reduction; institute HIV screening in routine preconception care to identify HIV infection in women before pregnancy; and critically focus attention and resources on primary prevention of HIV infection in women. Healthcare providers should incorporate HIV prevention education and routine screening into women's primary health care. Public health leaders should support and fund prevention strategies directed at young women. Successful approaches that have nearly eliminated perinatal HIV transmission in the United States offer valuable lessons that should be applied to primary HIV prevention for women in the United States and globally.

Triple-Antiretroviral Prophylaxis to Prevent Mother-To-Child HIV Transmission through Breastfeeding—The Kisumu Breastfeeding Study, Kenya: A Clinical Trial

“…Kesho Bora [22] reported 42.6% of the participants receiving <6 wk of triple ARVs antepartum and a transmission rate of 3.3%. Given these findings and the transmission rates below 2% in countries where triple-ARV prophylaxis is initiated during the second trimester and where breastfeeding is avoided [25], it is likely that initiating ARVs earlier during pregnancy in this study would have further reduced in utero and intrapartum transmission However, timely initiation of ARVs may be a challenge in areas where many women present late for antenatal care. A 2002 study of recently delivered women in rural western Kenya showed that 64% first visited the antenatal clinic in the third trimester [26].…”

HIV Prevalence and Associated Risk Factors among Rural Pregnant Women in North Central Nigeria

“…Over 90% of these infections occur through mother-to-child transmission (MTCT) 4 . It is pertinent to note that without interventions, the rate of HIV MTCT ranges from 25% to 40%, however with effective interventions, HIV MTCT rates have been reduced below 2% 4 and virtually eliminated in most developed countries, while many developing countries including Nigeria, still record high pediatrics HIV transmission rates [5][6][7] .…”

HIV-TB co-infection in children: associated factors and access to HIV services in Lagos, Nigeria

“…23 HIV MTCT is high in sub-Saharan Africa, with rates as high as 25-40% without intervention. 23 The rate of MTCT has been reduced significantly in industrialised countries due to the implementation of prevention strategies, 24 and such strategies need to be vigorously pursued in Nigeria and other African countries to reduce the burden of HIV among children, and particularly infants.…”