Prevention of mother-to-child transmission
Situation and trends
Nearly all young children newly infected with HIV are infected through mother-to-child transmission (MTCT); about 87.7% of the estimated 220 000 children who newly infected with HIV in 2014 were in the WHO African Region. Overall in the 21 African priority countries, MTCT rates declined from an estimated 28% to 14% in 2009-2014. With provision of antiretroviral (ARV) drugs the mother-to-child transmission can decrease to less than 2% (in the absence of breast feeding) or less than 5% (depending on the duration of breastfeeding among HIV-exposed infants). Globally, there were still more than 1.4 million [1.3 million–1.6 million] pregnant women with HIV in 2014 (all of whom needed interventions for PMTCT of HIV) in low- and middle-income countries, of which an estimated 73% [68–79%] received ARV drugs for preventing mother-to-child transmission (PMTCT) of HIV. This marks an increase in PMTCT ARV coverage from 53% [48–57%] in 2009 and 58% [53–63%] in 2011. As of mid-2015 the majority of low- and middle-income countries are piloting, rolling out or fully implementing Options B+ (lifelong ART treatment, beginning immediately at diagnosis). Based on available data, 81% of pregnant HIV-positive women worldwide live in countries where B+ features in national policies. Globally, coverage of ARVs for pregnant women was highest in the WHO European Region 92% [77->95%], followed by the Region of the Americas 81% [61-92%] and the African Region 75% [69-81%]. The Western Pacific Region made progress, with coverage in 2014 at 58% [41-83%], but coverage was very low at 35% [31-42%] in the South-East Asia Region and only 9% [7-13%] in the Eastern Mediterranean Region. PMTCT programmes averted an estimated 1.4 million HIV infections globally during 2000-2014, over on a million of them during 2010-2014. New infections in children younger 15 years could be cut by 58% in the same period. These successes could be achieved to increased HIV testing, improved access to PMTCT programmes and to antenatal care service. However, PMTCT services lag in several high-burden countries including Angola, Central African Republic, Chad, the Democratic Republic of the Congo, Nigeria and South Sudan.
The number of pregnant women with HIV has remained relatively stable since, but the proportion receiving recommended ARV regimens for PMTCT of HIV has increased steadily, as has the proportion receiving more effective regimens.
Coverage of ARV drugs among pregnant women with HIV varies significantly across regions. In 2014, coverage of ARV drugs remained high in the WHO European Region*, followed by the WHO Region of the Americas (81%, range 61–92%), and the WHO African Region (75%, range 69–81%). All the other regions have also made progress, but overall coverage in 2013 in the WHO Western Pacific Region was still relatively low at 58% [41 –83%]. Coverage was 35% [31 –42%] in the WHO South-East Asia Region as well as 9% [7% –13%] in the WHO Eastern Mediterranean Region. The total number of women receiving ARV drugs for PMTCT of HIV is strongly influenced by developments in the WHO African Region, which is home to about 93% of the pregnant women living with HIV in low- and middle-income countries.
*Coverage estimates for the WHO European Region are not available due to inconsistencies between programme coverage and estimated PMTCT need.
The past 15 years of the HIV response have been pioneering and had a global impact; it showed that the goal of ending the AIDS epidemic is ambitious but feasible. Despite this progress major challenges must be overcome to make the global impact sustainable and to end the AIDS epidemic because HIV meant the sixth leading cause of death worldwide. Especially diagnosis should be improved, so that people are diagnosed much sooner after becoming infected, start earlier ART and stay on treatment. This protects people with HIV from illness and prevents further transmission of HIV. Earlier diagnosis should be combined with improved prevention, treatment and care to make this impact sustainable. People living with HIV should be more involved in the ongoing process to reach also key populations and understand the extent and nature of the HIV epidemic in such groups and to avoid stigma, discrimination and criminalisation. Programme management and decision making is based on detailed data, therefore it is necessary to conduct regular reporting. Planning, implementation, evaluation goes hand in hand with the financing. The most HIV response is funded by a mix of domestic, donor and public private funding, but to expand the response it is necessary to make the money go further. The forthcoming Global Health Sector Strategy for HIV, 2016-2021, aligned with the UNAIDS “Fast-Track” approach, lays out targets for the global health sector response for 2020 and 2030. These targets apply to everyone: children, adolescents and adults, rich and poor, women and men, and all key populations. It includes the following main points:
- Reduce annual new adults HIV infections from 2.1 million in 2010 to 500 000 in 2020 and to 200 000 in 2030
- Reduce the HIV-related deaths from 1 million in 2014 to 500 000 in 2010 and 400 000 in 2030.
- Increase the number of people receiving ART from 15 million in 2014 to 30 million in 2020 and 35 million in 2030.
It should be not forgotten that HIV/AIDS is not just a health problem, because the spread of an infections disease is highly correlated with socioeconomic, environmental and ecological factors such as population growth, environmental and land-use changes, changing human behaviours and political reorganizations.