PMTCT

An opportunity to reshape gender norms on sexual and reproductive health in Rwanda: Learning from a pilot project on male partner self-testing for HIV. Rwanda conducted a research study on using self-testing and other means to improve male partner testing and engagement in PMTCT.

This document outlines the fundamentals of PMTCT impact determination and provides considerations for development of pragmatic, streamlined and resource-efficient systems for MTCT estimate generation in high burden settings. The guidance attempts to acknowledge the current reality of PMTCT programme data and the need for reliable MTCT rates while also encouraging a forward-looking approach towards sustainable PMTCT programme data improvements.

Note that this document is intended for countries in sub-Saharan Africa with a high prevalence of HIV among women of reproductive age. Although many of the underlying principles are relevant to settings with a lower burden of HIV, the guidance is not targeted for those programmes.

The tools in appendix 2 can be accessed here.

The Optimizing HIV Treatment Access (OHTA) Initiative (2012—2017), funded by Sweden and Norway through UNICEF, supported the scale-up of lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women living with HIV. The project focused on four countries with a high HIV burden: Côte d’Ivoire, the Democratic Republic of the Congo, Malawi and Uganda. OHTA aimed to strengthen health systems to deliver lifelong treatment (also known as ‘Option B+’) for pregnant women and breastfeeding mothers living with HIV.

The three objectives of OHTA were:

1. More effective delivery of treatment for pregnant women and mothers living with HIV by strengthening the capacity of the primary health-care system;
2. Increase demand timely utilization and retention rates in prevention of mother-to-child transmission (PMTCT) services;
3. Strengthening monitoring and evaluation (M&E) efforts to improve health service delivery for pregnant and breastfeeding women living with HIV and their children.

PROMISING PRACTICES FROM THE OHTA INITIATIVE

This governance guidance provides clarity, consistency and detail related to the structure, function, composition and operational duties of validation committees at national, regional and global levels as an extension to what is provided in the Global guidance on the criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis. In addition, this publication describes the standardized methods for country programme review and validation of EMTCT of HIV and syphilis and PTE at these levels.

This guidance document provides standardized processes and consensus-developed criteria to validate EMTCT of HIV and syphilis, and to recognize high-HIV burden countries that have made significant progress on the path to elimination. The guidance places strong emphasis on country-led accountability, rigorous analysis, intensive programme assessment and multilevel collaboration, including the involvement of communities of women living with HIV. It provides guidance to evaluate the country’s EMTCT programme, the quality and accuracy of its laboratory and data collection mechanisms, as well as its efforts to uphold human rights and equality of women living with HIV, and their involvement in decision-making processes.

In the global quest to end the AIDS epidemic as a public health threat by 2030, meeting the HIV-related needs of children, adolescents and pregnant and breastfeeding women represents a critical piece of unfinished business. To inject a sense of urgency in to global efforts to end the epidemic among children, adolescents and young women, global partners joined together in 2015 to launch the Start Free, Stay Free, AIDS Free framework. Unveiled as the global community was embracing a series of 2020 targets intended to Fast-Track the HIV response, Start Free, Stay Free, AIDS Free called for a super-Fast-Track approach to end AIDS as a public health threat among children, adolescents and young women by 2020.

Since the deadline for achieving the targets passed in December 2020, this is the final Start Free, Stay Free, AIDS Free progress report. Although the targets were global, partners identified 23 countries for intensified focus under the framework. This report specifically highlights progress against the targets in focus countries. The only focus countries outside sub-Saharan Africa (India and Indonesia) do not report data on Start Free, Stay Free, AIDS Free targets and are not covered in this report.