The prevention of mother-to-child transmission (PMTCT) of HIV is taking center stage this week during USAID’s 5th Birthday campaign — and rightly so.  Preventing mother to child transmission of HIV is one of the most critical, effective tools to helping kids reach their fifth birthdays.

Ambassador Eric Goosby and UNAIDS Executive Director Michel Sidibé have called for the elimination of pediatric HIV by 2015. Touted as one of the HIV prevention interventions with the most “bang for our buck” by the Copenhagen Consensus Center, there is significant momentum behind continuing scale up of mother to child transmission reduction programming towards elimination of mother to child transmission. But, current recommendations requiring a CD4 test before initiating some sort of ARV prophylaxis for HIV-infected pregnant women may not be the most effective way to prevent MTCT, fully treat the mother, and help kids reach their 5th birthdays.

We can move closer to the goal of eliminating pediatric HIV by 2015 by treating the mother, treating the baby, and continuing to treat the mother.

In 2011, only 45 percent of women had access to PMTCT services and many of those that did, couldn’t accurately complete antiretroviral (ARV) prophylaxis.  In the best of circumstances, providing mono or dual therapy (Option A) or triple therapy through breast feeding (Option B) may be equally efficacious in preventing transmission of HIV to the baby.  However, in the majority of countries hardest hit by the epidemic and lacking the necessary infrastructure, this likely is not the case.

Management Sciences for Health (MSH) does not accept that pregnant women with less advanced HIV infection upon diagnosis should be put on antiretroviral prophylaxis only during pregnancy for the sole purpose of preventing HIV transmission to her unborn child. We support Dr. Chewe Luo’s, senior advisor on HIV and AIDS at UNICEF, call at the 16th International Conference on AIDS and STIs in Africa (ICASA) plenary to start discussing MTCT in terms of maternal mortality.

In 2010, MSH helped the country of Malawi develop the B+ option – which calls for initiating triple therapy for life for all HIV infected women– regardless of CD4 count. The WHO recently released preliminary guidance supporting Option B+, but much more needs to be done to build an evidence base around Option B+, ensuring that countries can make accurate decisions about what PMTCT strategy to implement.  Since developing this approach through our work in Malawi, MSH continues to be passionately committed to helping expand these ideas, where they make the most sense.

We are fast approaching the Child Survival Call to Action events, and the 2015 goal of eliminating pediatric HIV. Big goals need game-changing ideas:  it’s time to rethink the way we provide PMTCT services to the millions of women – and their kids — who need them.

Dana Sandstrom Keating, MAIPS, contributed to this post.

Scott Kellerman, MD, MPH, has over 15 years of experience working in national and international public health focusing on HIV/AIDS. As Global Technical Lead for HIV/AIDS at Management Sciences for Health, he provides technical expertise around HIV prevention, care and treatment for MSH’s portfolio of HIV programs.

Related Reading

The Lancet: Prevention of mother-to-child transmission of HIV and the health-related Millennium Development Goals: time for a public health approach

WHO: Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: towards universal access: Recommendations for a public health approach

WHO: PMTCT Strategic Vision 2010-2015 (PDF)