Abstract
A recent World Health Organization (WHO) report found a complex array of positive and negative impacts of global health initiatives (GHIs) on existing health systems [1]. The report's examination of published studies and both quantitative and qualitative data collected in 15 countries demonstrated the need for programs proactively designed to have positive effects on “nontargeted” health services. Here, we describe an effort that was designed to improve the quality and extend the impact of prevention of mother-to-child transmission of HIV/AIDS (PMTCT) care in a manner that benefited multiple areas of clinical care. The 2006 WHO treatment guidelines for PMTCT emphasize that efforts to decrease transmission must be based on the delivery of broad maternal and child health services. Such approaches can reduce transmission rates to less than 2% [2]. Studies to improve PMTCT suggest that in order for interventions to be most effective, they should be delivered via decentralized, community-based, longitudinal programs [3],[4]. In recent years, the percentage of HIV-positive pregnant women living in low- and middle-income countries who are receiving antiretroviral medication to prevent transmission to their infants has increased: from 10% in 2004 to 45% in 2008 [5]. However, this statistic includes women who received a single dose of nevirapine at the onset of labor, indicating that coverage rates for women receiving PMTCT care according to WHO treatment guidelines are lower.
Highlights
A recent World Health Organization (WHO) report found a complex array of positive and negative impacts of global health initiatives (GHIs) on existing health systems [1]
The 2006 WHO treatment guidelines for prevention of mother-to-child transmission of HIV/AIDS (PMTCT) emphasize that efforts to decrease transmission must be based on the delivery of broad maternal and child health services
Increasing health center attendance through provision of material incentives, expanding access to services through outreach sites, and strengthening links between patients and health care providers through community health worker (CHW) were among the many ideas health centers explored
Summary
A recent World Health Organization (WHO) report found a complex array of positive and negative impacts of global health initiatives (GHIs) on existing health systems [1]. The 2006 WHO treatment guidelines for PMTCT emphasize that efforts to decrease transmission must be based on the delivery of broad maternal and child health services. Such approaches can reduce transmission rates to less than 2% [2]. The percentage of HIVpositive pregnant women living in lowand middle-income countries who are receiving antiretroviral medication to prevent transmission to their infants has increased: from 10% in 2004 to 45% in 2008 [5]. That coverage rates for women receiving PMTCT care according to WHO treatment guidelines are lower
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