Prevention of mother-to-child transmission (MTCT) of HIV in Africa : practical guidance for programs

The bulk of the paper describes the core interventions to combat MTCT that are now available through existing programs: comprehensive maternal child health (MCH) (antenatal, postnatal, and child health) services; voluntary, confidential counseling and testing (VCT) services; counseling and support for safe infant feeding practices; optimal obstetrical practices; short-course antiretroviral (ARV) therapy for HIV-infected pregnant women; and family planning counseling and services that are linked to VCT. These core interventions, which vary in their cost, potential impact, and ease of delivery, are most effective when delivered in combination; no single intervention is 100% effective in preventing MTCT. Further, MTCT prevention is most effective when undertaken as part of a continuum of HIV/AIDS interventions that range from primary prevention to care and support for people living with HIV and AIDS. The care and support of women is of particular relevance to MTCT prevention, and specific issues and activities that link the health and well-being of women to MTCT are described in the paper. All MTCT prevention packages require policy analysis, consideration of ethical issues and human rights, training and supervision, commodity procurement and logistics support, behavior change communication, social mobilization, community participation, operations research, and monitoring and evaluation. Because of these demands, interventions may need to be phased in over time. Because of the impact that MTCT is having on infant and child morbidity and mortality in Africa, government, nongovernmental, and international organizations urgently need to step up support for MTCT prevention programs to slow the alarming increase in pediatric AIDS in Africa. Actions recommended to meet this challenge are detailed. Includes references, statistics on the effect of AIDS on infant and child mortality in sub-Saharan Africa, and a technical review of ARV drugs for MTCT prevention. (Author abstract, modified)