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Reducing Mother-to-Child Transmission (MTCT) of HIV |
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Mother-to-child transmission (MTCT) of HIV remains a major public health problem worldwide, especially in resource-constrained countries, home to more than 95 percent of all people living with HIV/AIDS (PLHA). Heterosexual intercourse is the most common mode of HIV transmission in resource-constrained countries, which results in large numbers of infected women in these settings who then transmit the virus to their babies. In fact, it is estimated that approximately 600,000 HIV-infected infants are born every year–at least 1,600 every day–in resource-constrained countries. In the absence of any intervention, rates of MTCT are 25 percent to 40 percent higher in resource-constrained countries than in the industrialized world (15 to 25 percent). Transmission occurs during pregnancy, labor and delivery, and breastfeeding. In non-breastfeeding populations it is estimated that 65 percent of perinatal infections occur late in pregnancy and during labor and delivery. The rate of MTCT has been reduced to less than 5 percent among the limited number of HIV-infected women in developed countries. But rates remain high in resource-constrained countries, particularly sub-Saharan African countries, where the vast majority of HIV-infected women of childbearing age reside. These high rates are largely due to the lack of access to existing prevention interventions including HIV voluntary counseling and testing (VCT), replacement feeding, selective caesarean section, and antiretroviral drug therapy. Reducing pediatric HIV infection and disease involves three stages: (1) preventing HIV infection among women of childbearing age; (2) preventing unwanted pregnancy among HIV-positive women; and (3) preventing MTCT during pregnancy, labor and delivery, and breastfeeding. This fact sheet focuses on the last level of intervention. Based on current scientific knowledge and collective international experience, there are several interventions that can be implemented as part of a comprehensive package to reduce MTCT . These include: Improved availability, quality, and use of maternal and child health services: Functioning and adequate maternal and child health (MCH) services are the foundation for any intervention to prevent MTCT. But MCH services in most resource-constrained countries face managerial, financial, and human resources constraints. Even where they are available, these services are not fully used by potential beneficiaries. In many resource-constrained countries, less than half of births occur inside of MCH settings. Effective implementation of MTCT programs requires upgrading the infrastructure and essential obstetrical services of existing MCH services. Efforts are also needed at the community level to improve health-seeking behaviors and increase the use of MCH services. HIV voluntary counseling and testing (VCT): VCT is a critical intervention to help women make decisions about the options available for infant feeding, future pregnancy, and HIV prevention, including MTCT. VCT is an important entry point to prevention and care services, and a critical component of MTCT interventions as women have to know their HIV serostatus to access and benefit from these interventions. In most resource-constrained countries, however, VCT services are still underdeveloped and, when they are available, it is challenging to get pregnant women to use them. Ways to improve acceptability of VCT must be explored. Routinely offering VCT is one way with good potential for success. Antiretroviral therapy: The administration of antiretroviral drugs during pregnancy and the time around delivery has proved to significantly reduce the risk of MTCT, mainly among non-breastfeeding populations:
Infant feeding options: Avoiding breastfeeding has proved to be an effective way to prevent postnatal MTCT. Exclusive breastfeeding is also believed to be associated with lower risk than mixed feeding. But formula feeding and exclusive breastfeeding both continue to present a challenge in resource-constrained countries because while formula feeding is not readily affordable and is associated with the risk of infection and diarrhea, exclusive breastfeeding is not necessarily easy to achieve because of beliefs and practices related to infant feeding in most resource-constrained countries. A recent study further suggests that HIV-infected mothers who breastfeed experience higher mortality compared to those who do not. Although WHO recommends that changes in the current infant feeding guidelines are not warranted by these study results, the results underscore the importance of providing adequate care and support to mothers as part of prevention of MTCT (PMTCT) efforts. Caesarean section: Elective caesarean section has been demonstrated to have a more protective effect against MTCT than vaginal delivery. But caesarean section has limited applications in resource-constrained settings where the procedure is associated with increased rates of maternal morbidity and mortality. Care and support: It is important to organize and provide care and support for mothers to help them maintain their health–both for their own and their children's benefit. Identifying and strengthening referral systems contributes significantly to meeting the long-term prevention, care, and support needs of the HIV-infected mothers and their children. Other interventions: Other MTCT prevention options–including vaginal disinfection, vitamin A supplementation, and passive and active immunization–have been proposed but not yet proven to be effective. Vaginal disinfection was shown to reduce infant morbidity and mortality, and vitamin A supplementation reduces the risk of low birth weight, severe pre-term birth, and small size for gestational age at birth. Resources
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