Mother-to-child transmission of HIV
The transmission of HIV from a HIV-positive mother to her child during pregnancy, labour, delivery or breastfeeding is called mother-to-child transmission. In the absence of any intervention, transmission rates range from 15% to 45%. This rate can be reduced to below 5% with effective interventions during the periods of pregnancy, labour, delivery and breastfeeding.
These interventions primarily involve antiretroviral treatment for the mother and a short course of antiretroviral drugs for the baby. They also include measures to prevent HIV acquisition in the pregnant woman and appropriate breastfeeding practices. The new Sustainable Development Goals place heightened emphasis on prevention of mother-to-child transmission (PMTCT) in the context of better health for mothers and their children.
The World Health Organization (WHO) works together with partners to set global standards for HIV prevention, care and treatment for pregnant women, mothers and their children; and to develop evidence-based strategies and define global targets, baselines and indicators that promote the integration of PMTCT into maternal, newborn and child health services, thus strengthening health systems.
Following the release of new guidelines in 2015, WHO no longer recommends different choices for PMTCT, but instead advises that all pregnant and breastfeeding women should receive ART irrespective of clinical stage of disease or CD4 count. This approach, first pioneered by Malawi, has been subsequently adopted by most countries with a high burden of HIV. As a result, at the end of 2014, over two thirds of pregnant women with HIV in sub-Saharan Africa were on ART. This coverage level exceeds that for non-pregnant adults.
The accelerated roll-out of ART for pregnant women was an important factor in the success of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. Between 2009 and late 2014, many countries saw the number of new infections in children drop by over 60%; these countries are now closer than ever to eliminating mother-to-child transmission as a public health concern.
WHO’s normative work in defining standards and recommendations for PMTCT is complemented by the Inter-Agency Task Team for the Elimination of Mother-to-Child Transmission (IATT). The IATT is co-convened by WHO and the United Nations Children’s Fund, and includes a number of other partners and stakeholders. Members of the IATT work together to generate tools, operational materials and technical documents to support the implementation of normative recommendations and programming of PMTCT and paediatric HIV.