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For every child, end AIDS

Mother-Baby Pack update: More efforts needed to prevent mother-to-child transmission of HIV

© UNICEF/NYHQ2010-2262/Nesbitt
Nurse Carolyne Kemunto Gichana speaks with a pregnant woman who has taken an HIV test at the antenatal clinic at Kisumu East District Hospital in Kisumu Township, Nyanza Province, Kenya.

NEW YORK, USA, 25 April 2011 – Every day, more than 1,000 infants worldwide are infected with HIV during their mothers’ pregnancy, labour or delivery, or through breastfeeding. Without medical intervention, nearly half of these babies will die before their second birthday.

Pregnant women and mothers living with HIV, and their infants, need to receive medicines from pregnancy all the way through to the end of breastfeeding in order to stop the transmission of HIV. Barriers to this needed treatment include lack of medication, the high cost of antenatal care and delivery, long waits at clinics, lack of transportation to health centres, and HIV-related stigma and discrimination.

For the last few years, UNICEF has been working with partners on an innovation to address some of these issues – the Mother-Baby Pack.

“The Mother-Baby Pack is one small, innovative part of our overall response to the prevention of mother-to-child transmission [also known as PMTCT],” says UNICEF Director of Programmes Dr. Nicholas Alipui. “Strengthening national health systems is the best way to close the gap in PMTCT. This is in addition to expanding early infant diagnosis, ensuring maternal health and making care and treatment available to hard-to-reach children and young people.”

Ensuring quality and effectiveness

Cameroon, Kenya, Lesotho and Zambia are the countries where this innovation is being developed. At this stage, the distribution of the Mother-Baby Pack has been stopped in all but Lesotho, as a number of issues in implementation have arisen. UNICEF and partners are now reviewing pre-requisites for effective Mother-Baby Pack programmes to ensure quality service delivery.

This review is covering site and community readiness, availability of medicines and supplies at sites, clear instructions for pregnant women, and training of health and community providers. Reporting, monitoring and evaluation systems are also being assessed. Each country is shaping the Mother-Baby Pack to its own conditions and challenges – with a focus on strengthened community-level support for mothers.

Partners in the review process include experts from UNICEF, UNAIDS, the World Health Organization (WHO), UNITAID, the Elizabeth Glaser Pediatric AIDS Foundation, the Clinton Health Access Initiative, the Office of the US Global AIDS Coordinator, USAID, the US Centers for Disease Control and Prevention, and Columbia University.

Distribution of the Mother-Baby Pack will move forward once this review is complete and processes are in place to ensure the highest quality and most effective service delivery possible.

From local to global innovation

The concept of the Mother-Baby Pack originated in Lesotho, where health-care workers began putting medicines in plain brown envelopes for pregnant women living with HIV to take home with their newborn infants. In 2007, the Government of Lesotho included these packs in their national PMTCT strategy.

For Lesotho, the packs were a game changer. They made the government and UNICEF re-think how to better deliver medication through co-packaging.

From this local idea, UNICEF and partners developed the Mother-Baby Pack, which goes beyond the Lesotho pack and contains anti-retrovirals (ARVs) and antibiotics consistent with the latest WHO guidelines. The packs co-package medications for use starting from 14 weeks of pregnancy until six weeks after the birth of the infant. After six weeks, mothers are asked to return to the clinics for regular immunizations, an early infant diagnosis test and further ARVs to stop potential infection during breastfeeding.

Reversing the spread of HIV

The UN Secretary General’s 2011 progress report on HIV and AIDS, released on 31 March, points out that the world is beginning to reverse the spread of HIV. The report notes that in 2009, more than half of all pregnant women and mothers living with HIV received the medications they needed to prevent transmission to their babies. Still, much more needs to be done to achieve the elimination of all new HIV infections in children and to keep mothers alive.

Ensuring that the Mother-Baby Pack can contribute to the goal of elimination is vital, and achieving the highest standards of monitoring and delivery is crucial. UNICEF is committed to this challenge and will continue to report on its findings in the months ahead.



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