Antiretroviral Drugs in the Cupboard are Not Enough: The Impact of Health Systems' Performance on Mother-to-Child Transmission of HIV
Abstract
OBJECTIVE: To model the effect of health systems performance on rates of mother-to-child HIV transmission. METHODS: We modeled the effect of variation in performance of the multiple steps of different prevention of mother-to-child transmission (PMTCT) protocols using hypothetical and reported data. SETTING: Data from a PMTCT program in a large province in South Africa was used to compare model predictions with reported outcomes for mother-to-child HIV transmission. MAIN OUTCOME MEASURE: Perinatal HIV transmission was predicted for infants of 6 weeks of age. RESULTS: HIV-infected pregnant women who fulfill eligibility criteria are initiated on lifelong antiretroviral treatment, whereas noneligible HIV-infected women and their infants receive single-dose nevirapine in a health system functioning at reported performance levels, and the overall vertical transmission rate would be 19.5%. Adding azidothymidine for women not eligible for lifelong treatment would further decrease the overall transmission rates only marginally to 17%. If the same steps were accomplished at 95% reliability, then the overall transmission rates would be 9.4% and 4.1%, respectively. CONCLUSIONS: Introduction of more effective combination antiretroviral interventions will yield only marginal reductions in childhood HIV infections and mortality unless health systems achieve high levels of performance at each step of the PMTCT pathway. Investment in and support for the mechanisms of delivering and sustaining PMTCT interventions at scale are required if gains in maternal and child survival are to be realized in countries highly affected by HIV.
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PMTCT care cascade failures drive pediatric HIV infections in sub-Saharan Africa.
“Gaps in the implementation of prevention of mother-to-child HIV transmission (PMTCT) services drive pediatric HIV infection in sub-Saharan Africa (SSA) [1-3].”
In practice, HIV transmission rates are several times higher than trial rates because of high drop-out rates of HIV-positive women along the PMTCT care cascade.
“the rates are several times higher in practice because of the high drop-out rates of HIV-positive women along the PMTCT care cascade [1-3,6-9].”
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- Authors
- Barker, P. M., Mphatswe, W., & Rollins, N.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of KwaZulu-Natal (ZA)
- World Health Organization (CH)
- Corresponding author
- Barker, Pierre M
- Venue
- JAIDS Journal of Acquired Immune Deficiency Syndromes
- Published
- 2011-02-01
- Volume
- 56
- Issue
- 2
- Pages
- e45-e48
- ISSN
- 1525-4135 (ISSN-L)
- OpenAlex
- W2008756593
- Cited by
- 112
- References
- 6
- Citations by year
- 2024: 1 · 2023: 3 · 2022: 1 · 2021: 5 · 2020: 6 · 2019: 1 · 2018: 3 · 2017: 13 · 2016: 10 · 2015: 14 · 2014: 12 · 2013: 15 · 2012: 20
- FWCI
- 8.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAIDS Journal of Acquired Immune Deficiency Syndromes (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
- Keywords
- mother-to-child HIV transmission, prevention of mother-to-child transmission, health system performance, antiretroviral therapy, nevirapine, zidovudine, vertical transmission, maternal and child health, South Africa
- MeSH terms
- Delivery of Health Care, Female, Humans, Infant, Infant, Newborn, Pregnancy, Quality of Health Care, South Africa, HIV Infections, Incidence, Treatment Outcome, Infectious Disease Transmission, Vertical, Antiretroviral Therapy, Highly Active, Anti-Retroviral Agents
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