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MEDIA CENTER Preventing Mother-to-Child HIV Transmission WASHINGTON, DC (16 December 2003) — Comprehensive services for the prevention of mother-to-child HIV transmission (PMTCT) are feasible and effective in resource-poor settings, yet implementation challenges remain, according to recent research by the Horizons Program. Horizons, which conducts operations research to improve HIV/AIDS service delivery in developing countries, is managed by the Population Council and funded by the U.S. Agency for International Development. At a symposium here attended by health care experts and government officials, researchers from Kenya and Zambia reported results from Horizons-sponsored studies. The studies examined the effectiveness of introducing a package of PMTCT services—including voluntary HIV counseling and testing, and a short course of antiretroviral (ARV) drugs and guidance on infant feeding strategies—into existing antenatal, maternal, and child health services. Only a small percentage of women who attend their first antenatal care visit receive the whole package of PMTCT services and less than 20 percent of HIV-positive, pregnant women in the study facilities receive ARVs. “Women drop out of the program for many reasons, including their own fear and denial of HIV, lack of partner support, and insufficient clinic staff to handle demand,” said Dr. Chipepo Kankasa of the MTCT Working Group in Zambia, a study partner. Kankasa noted that the research is helping to pinpoint improvements that will enable more women to make use of PMTCT services. For HIV-positive women who do not drop out, the risk of transmitting the virus to their infants is reduced. Another key finding presented was that the “real world” effectiveness of a short course of the drug AZT given to women in resource-constrained settings cut HIV transmission rates to infants at birth by approximately 50 percent. The studies also found that health workers miss opportunities throughout the PMTCT process to discuss contraception, and that there was little difference in the use of family planning between HIV-positive and HIV-negative women. “The studies highlight the multifaceted role that PMTCT programs can play for HIV-positive women such as helping them avoid unintended pregnancy, thus reducing the number of potential orphans, in addition to decreasing the likelihood of HIV transmission to their infants if they are pregnant,” said Horizon’s Dr. Naomi Rutenberg, a principal investigator. Because HIV is transmitted to a substantial proportion of infants via breastfeeding, PMTCT programs also aim to help women make informed choices about options for reducing this risk. But the studies revealed that infant feeding counseling is of variable quality and that many HIV-positive women continue the practice of mixed feeding (giving breastmilk and other foods to infants) and do not wean early. Both of these practices result in a higher rate of HIV transmission to infants. “Women’s poverty limits their options for infant feeding, and HIV-positive African women are some of the poorest women in some of the poorest nations,” said Dr. Ruth Nduati of the Network of AIDS Researchers in East and Southern Africa (NARESA) and a principal investigator. Nduati called on policymakers to pay more attention to PMTCT, and to focus on providing poor, HIV-positive women with safe, accessible, and affordable infant feeding alternatives. During the symposium, speakers and participants highlighted the importance of operations research in helping policymakers make sound decisions about PMTCT. Both groups also noted the value of the findings for developing programs to expand access to ARVs for treatment of women and their families. Horizons is implemented by the Population Council in collaboration with the International Center for Research on Women, the International HIV/AIDS Alliance, the Program for Appropriate Technology in Health, Tulane University, Johns Hopkins University, and Family Health International.
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