The Promise of Eliminating HIV Infections in Children and Keeping Mothers Healthy

Janet Fleischman
Senior Associate, Global Health Policy Center

This is an exciting and promising moment in the global effort to eliminate new HIV infections among children; we can finally see the possibility of eliminating mother-to-child transmission of HIV. To address the current status of these efforts and the way forward, the heads of WHO, UNICEF, and PEPFAR joined with ministers of health from Africa, representatives from the Global Fund, UNAIDS, UNITAID, the private sector, and women living with HIV at CSIS on July 22. You can find full video of the event here.

In two engaging and interactive panel discussions, participants emphasized the extraordinary progress that has been made in PMTCT. The panelists agreed that the science on PMTCT is certain, the benefits are clear, and if successful, we will be closer to creating an AIDS-free generation. But while the path is clear, it will not be easy to achieve.

In the first panel, the participants described the benefits and challenges of “test and treat”, a program developed in Malawi in which all HIV-infected pregnant women tested at antenatal clinics would be immediately put on anti-retroviral treatment (ART) for life. This ambitious approach aims to prevent mother-to-child-transmission as well as providing essential treatment for the mother, and contrasts with approaches that prevent transmission to the baby but don’t treat the mother. It is known as “Option B+” to the WHO guidelines, which call for beginning ARVs when the patient’s CD4 count falls below 350. In countries with weak health systems, such as Malawi, waiting until CD4 testing is widely available throughout the country results in delays in initiating treatment to the detriment of the mother’s health, as well as that of her partner and future children. While the programmatic simplification of B+ offers obvious benefits and future cost savings, arguments against it involve concerns about short-term costs and long-term sustainability.

Despite these concerns, the panelists agreed that it will be more expensive not to act, and that it is essential to find ways to support countries if they decide to pursue option B+. A key part of this involves giving women the information they need to decide when -- and if -- they want to start treatment, as well as implementing all four “prongs” of PMTCT, which includes preventing unintended pregnancy in HIV+ women. The panelists agreed that not every obstacle to implementing B+ be solved before you start, and that we’ll have to “mend the holes as we sail along.” Women should not be seen simply as vessels for babies, and there’s a danger that PMTCT programs continue to see them that way.

The second panel focused on innovations to eliminate HIV infections among children. Jackline Odongo, an HIV+ mother from Kenya who works with mothers2mothers, described her own harrowing experience of being diagnosed with HIV during pregnancy, and subsequently being beaten and thrown out by her husband. She later became a “mentor mother” and now helps other pregnant women who test positive for HIV to help ensure their babies stay HIV free. Lillian Mworeko, from the International Committee of Women living with HIV, underscored the importance of putting women at the center of programing, implementing, and monitoring. Dr. Max Bweupe discussed the use of mobile phone technology for PMTCT and women’s health.

The session participants came from many different countries and brought many different perspectives, but they all agreed on a central premise: that every woman wants her child to be healthy and thrive, and that every woman wants to live, and can’t be denied that right. The science and prospects for eliminating mother to child transmission and keeping mothers healthy are very compelling; much of the progress, however, is likely to come down to the economic implications of moving forward.

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