'Moving from Prevention, through Elimination, to Eradication, of new HIV infections in children, and improving survival of their mothers, in poor countries'.

摘要

.The elimination of new HIV infections in infants and children is part of a broader global commitment by the United Nations. Prevention of Mother to Child transmission (PMTCT) programmes have prevented 350 000 new HIV infections with the use of antiretroviral therapy (ARVs) for pregnant women who are HIV infected, and the majority of these gains were in sub-Saharan Africa. Coverage of PMTCT programmes throughout Africa is variable resulting in many women not having access to the appropriate interventions in the antenatal care setting to prevent vertical transmission. The global elimination target requires a 90% reduction of new child infections and to decrease MTCT to <5% which potentially can be achieved utilising the 4 pronged approach proposed by the World Health Organisation. Family planning messages and provision of contraception methods to avoid unplanned pregnancies are shown to be more effective than HIV Counselling and Testing [HCT] and single dose Nevirapine in averting transmission of perinatal HIV infection. Child survival goes beyond HIV-free survival, and safe breastfeeding prevents 13% of deaths under- 5 years of age, rendering it essential to reduce under-5 mortality. Health systems strengthening to deliver more complex regimens either for prevention purposes or the mothers own health, is an important part of a broader continuum of interventions which will depend on the effective delivery of current treatment modalities, development of new prevention interventions including a vaccine, and include prevention of unplanned pregnancies and primary prevention of HIV infections in the mother.