Progress and emerging challenges in preventing mother-to-child transmission

Abstract

There is a widening gulf between the effectiveness of interventions for preventing mother-to-child transmission (PMTCT) of HIV in sub-Saharan Africa and other regions of the world. Compared with long-course, triple antiretroviral regimens used in Brazil, Europe, and the United States, most countries in sub-Saharan Africa use a less effective regimen consisting of single-dose nevirapine (NVP). Furthermore, the documentation of unacceptable levels of resistance following this regimen makes it prudent to review current PMTCT strategies. Not only is it necessary to review the use of single-dose NVP for PMTCT, but efforts to minimize breast milk transmission of HIV should be enhanced. This review summarizes the programmatic and evidence-based reasons for adopting a standardized approach to long-course, triple-drug MTCT prophylaxis in sub-Saharan Africa. Antiretroviral treatment programs in resource-constrained settings have achieved similar levels of effectiveness as high-income countries, despite adopting standardized approaches to antiretroviral treatment. Similarly, in resource-constrained settings with adequate infrastructure and programmatic capacity, use of standardized, long-course, triple-drug regimens for MTCT prevention are likely to achieve levels of effectiveness seen in Brazil, Europe, and the United States.