Prevention of mother-to-child transmission (PMTCT)
Situation and trends
Nearly all young children newly infected with HIV are infected through mother-to-child transmission (MTCT); about 83% of the estimated 150 000 children who newly infected with HIV in 2015 were in the WHO African Region. Overall in the 21 African priority countries, MTCT rates declined from an estimated 22% to 9% in 2009-2015. 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 2015 (all of whom needed interventions for PMTCT of HIV), of which an estimated 77% [69–86%] 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. As of end-2016 almost all 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, >95% of pregnant HIV-positive women worldwide live in countries where B+ features in national policies.
Coverage of ARV drugs among pregnant women with HIV varies significantly across regions. In 2015, coverage of ARV drugs remained high in the WHO European Region*, followed by the WHO Region of the Americas (91%, range 81–>95%), and the WHO African Region (79%, 70–88%). All the other regions have also made progress, but overall coverage in 2015 in the WHO Western Pacific Region was still relatively low at 48% [38–67%]. Coverage was 38% [33–44%] in the WHO South-East Asia Region and 9% [7% –14%] 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 90% of the pregnant women living with HIV globally.
*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 to under 500 000 in 2020 and to under 200 000 in 2030
- Reduce the HIV-related deaths to under 500 000 in 2010 and under 400 000 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.