Preventing mother-to-child transmission (PMTCT) of HIV
In 2009, an estimated 860,000 pregnant women were found to be living with HIV in Eastern and Southern Africa, more than in any other region of the world. The region is also home to 47 percent of the global total of children living with HIV, of which over 90 percent were infected through vertical transmission from the mother to the baby during pregnancy, delivery or breastfeeding.
Without effective treatment, more than half of all babies born with HIV will die before their second birthday. In high-burden countries in Southern Africa, HIV contributes to between 10 and 28 percent of all deaths among children under five years of age.
Moreover, HIV contributes to a high portion of maternal deaths in ESA, especially in Southern Africa where they ranged from 26.8 percent in Mozambique to 67.3 percent in Swaziland in 2010.
The risk of mother-to-child transmission of HIV can be reduced to less than 5 percent through a combination of prevention measures (PMTCT) , including antiretroviral therapy (ART) for the expectant mother and her new-born child, hygienic delivery conditions and safe infant feeding. According to new guidelines issued by the World Health Organization (WHO), a woman with HIV can breastfeed her baby in settings where it is judged to be the safest infant feeding option. She must, however, breastfeed exclusively and she or her newborn need to receive ART at the same time.
The challenges to reach pregnant women in need of PMTCT services are immense in the region. Although many countries have made great efforts to establish PMTCT services, many pregnant women in rural areas do not have the means to reach them. Among those who attended antenatal care in 2010, less than a half received an HIV test.
When tested positive, many women drop out of PMTCT programmes, because they fear discrimination and rejection by their male partners and families. In addition, in countries such as Malawi and Zimbabwe, more than 80 percent of women enrolled in a PMTCT programme still receive single-dose nevirapine rather than another more efficacious ARV regimen.
UNICEF in action
UNICEF’s overall PMTCT strategy is based on a comprehensive four-pronged strategy aimed at integrating key interventions into essential maternal, newborn and child health services:
In 2009, UNICEF endorsed the UNAIDS call for a “virtual elimination of mother-to-child transmission of HIV by 2015”, which aims;
To achieve this goal, UNICEF in ESA agreed to reach two concrete goals in nine priority countries that account for 90 percent of pregnant women living with HIV and for 90 percent of children estimated to be in need of ART, plus Lesotho:
In the three hyper-endemic countries that have already achieved both PMTCT coverage of 80 percent and paediatric ART coverage of 60 percent (Swaziland, Botswana, and Namibia), efforts will focus on strengthening the quality of PMTCT and paediatric AIDS interventions.
Results for children
An increasing proportion of pregnant women are being tested for HIV in Eastern and Southern Africa, rising from 15 percent in 2005 to 47 percent in 2010. Of those who tested positive, 64 percent received ART to prevent the transmission of the virus to their baby, up from only 19 percent in 2005. The regional average, however, masks huge disparities between and within countries. Countries such as Botswana, Lesotho, Namibia, South Africa and Swaziland already achieved coverage rates of more than 80 percent, while in others such as Eritrea have 3 percent of HIV-positive pregnant women were enrolled in PMTCT programmes.
The highest HIV burden among pregnant women in Eastern and Southern Africa in descending order
Botswana leads the way in wide-scale provision of PMTCT services. According to the 2011 Universal Access Progress Report, more than 95 percent of pregnant women were tested for HIV and more than 95 percent received ARVs to prevent vertical transmission. Mother-to-child HIV transmission has been reduced to 4 percent in the country.
The availability of PMTCT in Lesotho has further increased to 94 percent of all health facilities, and the proportion of pregnant women who receive PMTCT services has increased to 89 percent in 2010, from only 16 percent in 2006.
Mozambique has also achieved impressive growth in PMTCT scale up. By the end of 2009, more than 700 health facilities provided PMTCT services, reaching almost 890,000 pregnant women (an increase from 668,000 in 2008). Of the total number of sites, 43 percent are UNICEF-supported.
In several countries, UNICEF and partners supported the adaptation of the new WHO guidelines, as well as reprogramming of existing grants by the Global Fund to fight AIDS, Tuberculosis and Malaria for PMTCT and helping high burden countries apply for new funding rounds.
In Kenya, 60 percent of all health facilities (more than 3,000) are now offering PMTCT services, with 83 percent of all women attending antenatal services being tested in 2010.
Also in Kenya, the Government with support of UNICEF launched the “Maisha” MTCT-free Zone Initiative, an innovative approach to prevent mother-to-child transmission of HIV.
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