Among key achievements
For 40 years, HRP – The UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction – has been the main instrument within the United Nations system for research in human reproduction, bringing together policy-makers, scientists, health care providers, clinicians, consumers and community representatives to identify and address priorities for research to improve sexual and reproductive health.
Preventing mother-to-child transmission of HIV
An estimated 230 000 babies are infected with HIV each year, almost all of them in resource-limited settings. In many developing countries, mothers living with HIV have a tough choice: either breastfeed their babies and risk transmitting the virus through their milk, or give them formula. The latter deprives infants of the natural immunity passed on through breast milk, which helps protect against diarrhoea, malnutrition and other potentially deadly diseases. Sanitation can also be an issue, with a scarcity of clean water with which to mix the formula. Many families cannot afford infant formula.
The Kesho Bora study – or a ‘Better Future’ in Swahili – aimed to assess whether the risk of passing on HIV during breastfeeding could be reduced. The study, led by HRP, was carried out between 2005 and 2008, involving over 800 women in Burkina Faso, Kenya and South Africa. The study found that giving mothers with HIV a combination of antiretroviral medication (ARVs) during pregnancy, delivery and breastfeeding dramatically cuts HIV infections in infants compared with the standard WHO recommendations at the time of the study.
The very clear results from the Kesho Bora study demonstrated a 43% reduction in transmission risk. Women whose virus was suppressed to undetectable levels by the time of delivery had only a 2.7% chance of transmitting HIV to their babies up to one year of age, even if they breastfed. For the first time, there was enough evidence for WHO to recommend use of ARVs during breastfeeding.
Several countries have already adopted the approach pioneered in Kesho Bora of providing priority access to triple-combination ARVs to pregnant women with HIV infection and continuing the medications after breastfeeding has ceased. This not only substantially reduces the risk of HIV infection in the baby, but also preserves the health of the mother so she is better able to provide for her family.
The efficacy of this new therapy led WHO, UNAIDS, UNICEF and PEPFAR (The United States President’s Emergency Plan for AIDS Relief) to launch an initiative to eliminate mother-to-child transmission of HIV. Offering pregnant women with HIV infection priority access to treatment and the means to go safely through pregnancy and breastfeed their new baby are essential steps in increasing the acceptability of and participation in programmes to prevent mother-to-child transmission of HIV.