Infants

Innovative Approaches for Eliminating Mother-to-Child Transmission of HIV: Experiences from Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda

This report documents several promising practices focused on community engagement for PMTCT implemented under the Optimizing HIV Treatment Access for Pregnant and Breastfeeding Women (OHTA) Initiative. OHTA, a UNICEF-supported initiative with funding from the Governments of Norway and Sweden, aimed to accelerate access to Option B+ for the elimination of mother-to-child transmission in Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda. 

Find out more here. 

Innovative Approaches for Eliminating Mother-to-Child Transmission of HIV: Experiences from Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda

This report documents several promising practices focused on community engagement for PMTCT implemented under the Optimizing HIV Treatment Access for Pregnant and Breastfeeding Women (OHTA) Initiative. OHTA, a UNICEF-supported initiative with funding from the Governments of Norway and Sweden, aimed to accelerate access to Option B+ for the elimination of mother-to-child transmission in Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda. 

Find out more here. 

Experiences from Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda

This report documents several promising practices focused on community engagement for PMTCT implemented under the Optimizing HIV Treatment Access for Pregnant and Breastfeeding Women (OHTA) Initiative. OHTA, a UNICEF-supported initiative with funding from the Governments of Norway and Sweden, aimed to accelerate access to Option B+ for the elimination of mother-to-child transmission in Côte d’Ivoire, the Democratic Republic of the Congo, Malawi, and Uganda.

In an effort to strengthen cross-country learning about effective community engagement activities and inform future PMTCT programming, this report includes implementation details, outcomes, factors for success, and considerations for scale-up and sustainability based on the OHTA Initiative’s experiences. The information and data included in this report were collected by project staff in partnership with the Johns Hopkins Center for Communication Programs (CCP) through a desk review of existing OHTA Initiative documents, including annual reports, partner reports, and presentations. CCP and project staff also made site visits to each country to conduct interviews and focus group discussions with the implementing organisations, programme participants, and Ministries of Health (MOHs).

Five promising practices for the elimination of mother-to-child transmission were identified based on the collective experiences in all four countries: male engagement, community client tracing, Community Mentor Mothers, Health Advisory Committees (HACs), and rationalization of implementing partners and services. This report first provides an overview of the HIV/AIDS epidemic in the four countries supported by the OHTA Initiative and of the five promising practices as implemented under the OHTA Initiative. It then follows with a detailed description of each promising practice, including similarities and differences with implementation in each country, outcomes of the promising practice, factors for success, and essential programme elements. Download the country reports of the promising practices here. 

The WHO 2018 guideline update promotes the use of optimal treatment regimens in all populations. Though new, more effective and better tolerated options with a higher genetic barrier to resistance are now available for adults, optimized treatment options for children lag significantly behind.

This fifth edition of the Optimal Formulary and Limited-use List supports the transition to optimal WHO-recommended regimens for infants and children, while giving due consideration to the rapidly evolving treatment landscape and the risks inherent in the uncertain timelines for paediatric drug development.

Despite remarkable progress in prevention of mother-to-child transmission of HIV (PMTCT), 160,000 children were newly infected with HIV in 2016. Less than half of HIV-exposed infants (HEI) received early infant diagnosis (EID) within 6 weeks of life, a major challenge for early antiretroviral therapy for HIV-positive infants. Although introduction of dried blood spot (DBS) has increased EID access, conventional laboratory networks have relatively long (22-60 days) turnaround time, resulting in low proportions of results returned and missed opportunities for ART initiation. The WHO conditionally recommends introduction of point-of-care (POC)/ near-POC nucleic acid testing (NAT) for EID.

Recent encouraging evidence for POC/ near-POC EID warrants consideration of rapid adoption and strategic scale-up of this solution complementing the existing laboratory network.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more. 

Approximately half of HIV infections among children take place during breastfeeding. While there has been success in retaining pregnant women on antiretroviral therapy (ART) during pregnancy, there has been inadequate focus on retention support to
mother-baby pairs (MBPs) during the breastfeeding period.

Literature shows that the majority of MBPs not retained in prevention of mother-to-child transmission (PMTCT) programs are due to loss to follow-up (LTFU) rather than death. These children are at higher risk of vertical acquisition of HIV compared to breastfeeding infants who remain in care. Current postpartum LTFU rates limit successful implementation of PMTCT programs in sub-Saharan Africa. Cumulative sub-Saharan Africa PMTCT LTFU rates in 2011 were estimated to range from 20-28% during antenatal care, then sharply increase to 70% at four months postpartum and reach approximately 81% six months after birth.

Given these staggering statistics, the quality and effectiveness of PMTCT services should include an assessment of the proportion of MBPs retained in care and early infant diagnosis (EID) rates.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more.

Many millions of people around the world are affected by emergencies, the majority of whom are women and children. Among them are many who are known to be living with HIV and others who may not know their HIV status.

The purpose of this document is to provide operational guidance on HIV and infant feeding in emergencies. It is intended to be used to complement emergency and sectoral guidelines on health, nutrition and HIV, including specifically infant feeding, prevention of mother-to-child transmission of HIV and paediatric antiretroviral treatment.

The envisaged target audience consists of decision makers, policymakers, national and subnational government managers and planners, managers of refugee camps and similar settlements for displaced persons, and managers and planners in United Nations agencies, nongovernmental organizations and other groups responding to humanitarian situations.

This operational guidance is based on a consultation convened by the WHO, UNICEF and the Emergency Nutrition Network in Geneva in September 2016, which brought together a cross-section of senior-level participants from United Nations agencies, government, nongovernmental organizations, academia, and other agencies working in nutrition and HIV in emergencies. This document sets out basic principles related to HIV and infant feeding in emergency settings, and the actions that government and other stakeholders can take to prepare for emergencies.