Operational Issues and Barriers to Implementation of Prevention of Mother-to-Child Transmission of HIV (PMTCT) Interventions in Sub- Saharan Africa
Jim Aizire, Mary G. Fowler and Hoosen M. Coovadia
Affiliation: Makerere University-Johns Hopkins University Research Collaboration, MU-JHU Research Building, Old Mulago Hill Road, P.O. Box 23491, Kampala, Uganda.
Keywords: Prevention of mother-to-child transmission, human immunodeficiency virus, Sub-Saharan Africa
Over the past 10 years substantial progress has been made in the implementation of prevention of mother-tochild
transmission of HIV (PMTCT) interventions in Sub-Saharan Africa (SSA). In spite of this, new pediatric infections
remain unacceptably high, contributing the majority (>90%) of the estimated 390,000 infections globally in 2010; and yet
prolonged breastfeeding remains the norm and crucial to overall infant survival.
However, there is reason for optimism given the 2010 World Health Organization PMTCT recommendations: to start HIV
infected pregnant women with CD4 cell counts less than 350 cells/mm3 on lifelong antiretroviral therapy (ART); and for
mothers not eligible for ART to provide efficacious maternal and/or infant PMTCT antiretroviral (ARV) regimens to be
taken during pregnancy, labor/delivery and through breastfeeding. Current attention is on whether to extend maternal
ARVs for life once triple ARV PMTCT regimens are started.
To dramatically reduce new pediatric infections, individual countries need to politically commit to rapid scale-up of a
multi-pronged PMTCT effort: including primary prevention to reduce HIV incidence among women of reproductive age;
increased access to family planning services; HIV screening of all pregnant and breastfeeding women followed by ART or
ARVs for PMTCT; and comprehensive care for HIV affected families. Efforts to achieve population-level success in SSA
need to critically address operational issues and challenges to implementation (health system) and utilization (social,
economic and cultural barriers), at the country, health centre and client level that have led to the relatively slow progress
in the scale-up of PMTCT strategies.
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