Infants

This document was created by ICAP’s Clinical and Training Unit with valuable input from our teams in Swaziland, Mozambique, Kenya, and Cote d’Ivoire. It was developed as a template document to be adapted for use in various contexts and is one component of a viral load monitoring tool-kit, to be used in conjunction with ICAP’s Viral Load Monitoring Flipchart and Enhanced Adherence Treatment Plan. This area is evolving rapidly therefore it is expected that this document will require frequent updating over time, as recommendations change, and needs to be adapted according to local guidelines and context.

Humanitarian emergencies in countries with a high HIV disease burden can cause considerable PMTCT antiretroviral treatment (ART) interruption. The risk of drug resistance emerging is increased, efficacy of treatment compromised and the effective scale-up of lifelong ART for pregnant and breastfeeding women living with HIV is impeded. Therefore, strategies to ensure the uninterrupted supply of antiretrovirals for PMTCT during crises are needed. This paper highlights lessons learned from PMTCT implementation in emergencies based on reported literature, key informant interviews, and recommendations made. The review focuses on delivering ART for PMTCT.

A robust monitoring and evaluation (M&E) system is a key component of a strong health system. With the current WHO recommendation of lifelong ART for all pregnant and breastfeeding women living with HIV, outcomes (including maternal survival and final infant HIV status) require monitoring through longitudinal data systems complemented with regular cohort analyses and enhanced monitoring. Additionally, as we move toward the need for more strategic policies and programming to garner system and resource efficiencies, M&E systems need to be designed to be able to inform differences arising from age, sex, and geographic trends as well as identify weaknesses such as sub-optimal commodity supply and testing quality.

Monitoring of individuals on ART is important to ensure treatment efficacy and improved health outcomes. Updated WHO Consolidated ARV Guidelines will be available in December 2015 and include recommendations on routine monitoring and the diagnosis of treatment failure.

The 2016 High-Level Meeting on Ending AIDS will focus the world’s attention on the importance of a Fast-Track approach to the AIDS response over the next five years. The UNAIDS Fast-Track approach aims to achieve ambitious targets by 2020, including:

1. Fewer than 500 000 people newly infected with HIV
2. Fewer than 500,000 people dying from AIDS-related causes
3. Elimination of HIV-related discrimination

The new consolidated guidelines provide standardized, simplified and less toxic drug combinations harmonized for the management of Prevention of Mother to Child Transmission (PMTCT), children, adolescents and adults with HIV/AIDS, TB and other common opportunistic infections. It will provide guidance for clinicians, managers and trainers on the use of available regimens within the context of continuum of HIV comprehensive care for prevention, treatment and support for all age groups in private and public sector to realize our vision of a long and healthy life for all citizens. This approach will also ensure that people living with HIV are started on the right regimen at the right time.

This report discusses how community-facility linkages can be used to support the scale up of lifelong treatment for pregnant and breastfeeding women living with HIV. It offers a conceptual framework and describes eleven promising practices associated with increased service uptake, adherence or retention along the continuum of care.