PMTCT (Prevention from mother to child transmission of HIV/AIDS)

Despite the availability of proven interventions for the prevention of mother-to-child HIV transmission (PMTCT) and substantial donor investments for implementing them in developing countries, paediatric AIDS remains a largely uncontrolled epidemic. The majority of cases occur in sub-Saharan Africa, where high HIV prevalence among pregnant women combines with an under-resourced health-care infrastructure to produce nearly 90% of the world’s 800 000 children who are believed to be infected each year. Several ambitious goals for paediatric AIDS control have been set by various international bodies, including a 50% reduction in paediatric infections by 2010 (United Nations General Assembly Special Session on HIV/AIDS), reaching at least one million women by 2007 and provision of PMTCT services to 80% of those in need by 2010.

While these goals are clearly appropriate in their scope, the disparity in which outcomes they actually target reveals a lack of clarity and consensus around how to monitor the effectiveness of PMTCT programmes. Without this clarity, it is difficult for policy-makers in developing countries to mount a coordinated response. In this paper, we argue for a validated consensus model for PMTCT effectiveness monitoring. This approach is urgently needed to coordinate the global response to paediatric AIDS prevention and to compare progress across programmes with a range of intervention strategies. We develop the case for using population HIV-free child survival as a gold standard metric and examine potential strategies for its measurement across Africa, including its addition into regular country-wide Demographic and Health Surveys (DHS). The standardized modification of the DHS described in this report could provide a reliable and easily replicable method to assess the impact of services at a population level.

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