Children and HIV and AIDS

Preventing Mother-to-Child Transmission (PMTCT) of HIV

© UNICEF/ HQ04-1220/Vitale

A woman who is HIV-positive, lies next to her newborn child in V.V. Hospital, in Bangalore. The HIV status of her newborn is not known.

The facts

Most countries are making remarkable progress towards preventing mother-to-child transmission (PMTCT) of HIV, particularly in sub-Saharan Africa. But Mother-to-child transmission (MTCT) of HIV continues to occur in children during pregnancy, labour and delivery, or breastfeeding, at a time, when there are available effective interventions to curb the infection and better resourced countries have been able to bring the risk of children infected though MTCT to less than 2 per cent. An estimated 420,000 children were newly infected in 2007, over 90 per cent of them in sub-Saharan Africa. Without treatment, an estimated half of these infected children will die before their second birthday.

To combat MTCT, a comprehensive four-pronged strategy to prevent HIV among infants and young children was released in 2003. The approach recommends a set of key interventions to be implemented as an integral component of essential maternal, newborn and child health services.

The first and second prongs emphasize the important role of primary prevention of HIV among women of reproductive age and of preventing unintended pregnancies among women living with HIV.

The first prong promotes the delivery of primary prevention interventions within services related to reproductive health such as antenatal care, postpartum/natal care and other health and HIV service delivery points, including working with community structures.

The second prong underscores the importance of providing appropriate counselling and support to women living with HIV to enable them make an informed decision about their future reproductive life, with special attention to preventing unintended pregnancies.

The third prong of the strategy targets pregnant women already infected and demands that HIV testing be integrated in maternal child health units where ARVs are provided to prevent infection being passed on to their babies and also the woman’ s own health; and adequate counselling is provided on the best feeding option for the baby.

Finally, the fourth prong calls for better integration of HIV care, treatment and support for women found to be positive and their families.

The issues

In 2005, approximately 123 million women were estimated to have given birth globally in low and middle income countries. With 77 per cent of women (70 million) in these countries having access to at least one antenatal care (ANC) visit, this provides the opportunity for all these women to have access to PMTCT services. But this remains a missed opportunity for most women. In 2005, the proportion of women accessing testing is these countries was estimated to be around 10 per cent and of the estimated number of infected pregnant women, only 11 per cent received PMTCT antiretrovirals (ARVs). The near universal acceptance of HIV testing among pregnant women who received counseling for PMTCT illustrates that women desire and need this important bridge to prevention and treatment services.

Taking PMTCT programmes to scale remains a challenge. In 2005, only seven countries: Argentina, Botswana, Brazil, Jamaica, Russian Federation, Thailand and Ukraine, provided ARV prophylaxis to more than 40 per cent of HIV-infected pregnant women. Except for Botswana, all of these countries lie outside sub-Saharan Africa, the most affected region.

UNICEF's role

In line with the UNICEF Medium Term Strategic Framework, UNICEF country regional and global offices provide technical and financial assistance to countries for PMTCT implementation activities, including policy, strategy, guideline and human resource capacity development. In addition, UNICEF works closely with the World Health Organization (WHO) on PMTCT programmes.

In most countries, UNICEF works in partnership with other agencies to build capacity and to expand PMTCT services delivery points; strengthen referral linkages and model integration of PMTCT services within existing services; maternal and child health; and community level structures and activities.

Within the UN Division of Labour, UNICEF has been mandated to co-convene with WHO the provision of technical assistance for PMTCT activities. In this role and in order to harmonise responses, UNICEF and WHO co-lead the operations of the PMTCT Inter-agency Task Team (IATT) currently made up of 20 key PMTCT implementing partners and have recently developed a Guidance document for global scale up of PMTCT programmes current scientific evidence and lessons learnt to date. The document was endorsed by national governments and partners that attended the second High-Level Global Partners Forum in South Africa on 26- 27 November 2007.

In December 2005, UNICEF and WHO convened the first High-Level Global Partners Forum on PMTCT in Abuja, Nigeria that culminated in the ‘call to action’ declaration for an HIV-free generation by eliminating HIV and AIDS in children. 

Between 2005 and November 2007, UNICEF led thirteen of the fourteen IATT joint technical country missions (Botswana, Burkina Faso, Cambodia, Cameroon, Cote d’Ivoire, India, Lesotho, Malawi, Myanmar, Nigeria, Rwanda, Swaziland, the United Republic of Tanzania and Zambia) to review strategies and plans in support of acceleration of national scale up efforts of both PMTCT and Paediatric HIV care, treatment and support services.

UNICEF and WHO are currently co-convening with the IATT several capacity-building workshops for core groups of experts at regional and national levels to ensure quality technical support in development of the scale up plans for PMTCT and Paediatric HIV, implementation in line with the revised WHO normative guidance and the package of services to be integrated into the maternal health and child survival interventions.

Accelerating trends in coverage of PMTCT services evident in Botswana, Namibia, Rwanda, South Africa and Swaziland, are in no small part because of UNICEF and its partners’ commitment to Unite for Children, Unite Against AIDS. UNICEF has played a leading role in building the political will and in-country capacity to address PMTCT in many countries.