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Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. Overview of findings.
New York, New York, UNICEF, 2003. 47 p. (HIV / AIDS Working Paper)This overview report presents key findings from an evaluation of UN- supported pilot PMTCT projects in eleven countries, including: Botswana, Burundi, Cote d'Ivoire, Honduras, India, Kenya, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Key findings discuss: feasibility and coverage; factors contributing to programme coverage; programme challenges; scaling-up; the special case of low prevalence countries; and recommendations. Recommendations include: To increase coverage and improve infant feeding counseling: supplement clinic staff with lay counselors; introduce rapid HIV tests so women can receive same day counseling, HIV testing, and test results; improve the quality of HIV and infant feeding counseling by providing job aids and active supervision; offer support to PMTCT providers including material support and peer psychosocial support; partner with community groups to offer community education and outreach; and expand the vision of PMTCT to encompass an active role for fathers and male partners. To strengthen postnatal support and follow up of HIV- infected women and their infant to assist them with infant feeding, getting care for themselves and their families, and to evaluate the program: establish national infant feeding guidelines; establish postnatal follow-up protocols; forge partnerships between the PMTCT program and NGO care and support groups; Enhance referral links between PMTCT programs and HIV care; New measurement tools and systems should be developed. To scale up PMTCT programs the findings suggest: expand to new sites but enlarge the scope of activities within existing sites to reach more women; and provide a comprehensive package of HIV prevention and care. The pilot experience has shown that introducing PMTCT programs into antenatal care in a wide variety of settings is feasible and acceptable to a significant proportion of antenatal care clients who have a demand for HIV information, counseling, and testing. As they go to scale, PMTCT programs have much to learn from the pilot phase, during which they successfully reached hundreds of thousands of clients. (author's)
Strategic approaches to the prevention of HIV infection in infants. Report of a WHO meeting. Morges, Switzerland, 20-22 March 2002.
Geneva, Switzerland, WHO, Department of HIV / AIDS, 2003. 22 p.To further guide its contribution to global efforts to reach the UNGASS goal, WHO organized a meeting from 20 to 22 March 2002 with the following specific objectives: to review the likely contribution of current strategic approaches to preventing HIV infection in infants and young children in different epidemiological situations and settings for service delivery; to provide guidance to WHO on priority areas of work for preventing HIV infection in infants within the frame of its mandate, strategic directions and core functions. Annexes 1 and 2 outline the meeting agenda and list of participants. The first day, participants reviewed programme experiences related to preventing HIV infection in infants and young children and discussed how the strategy of the United Nations agencies in this area could be refined and strengthened. Some historical background on the development and implementation of intervention to prevent the mother-to-child transmission of HIV was briefly reviewed. Through plenary presentations, group work and plenary discussions, the elements of a comprehensive strategic approach were defined. During the second day of the meeting, participants focused their attention on the specific role of WHO in global efforts to achieve the UNGASS goal. (excerpt)
Geneva, Switzerland, World Health Organization [WHO], 2003. 13 p. (Perspectives and Practice in Antiretroviral Treatment)The primary objective of the MTCT-Plus Initiative is to provide lifelong care and treatment for HIV/AIDS to families in resource-limited settings. In addition to reducing mortality and morbidity, the Initiative hopes to further reduce the mother-to-child-transmission of HIV; to promote voluntary counselling and testing and other preventive strategies; to strengthen local health care capacity; to decrease stigma among, enhance support for and empower people living with HIV/AIDS; and to develop a model for HIV care in resource-limited settings that can be generalized. An international review committee selected the initial sites after a request for applications was widely distributed in early 2002. Of the 47 eligible applicants – all of whom had ongoing programmes to prevent the mother-to-child-transmission of HIV, HIV prevalence of at least 5% and the ability to enroll at least 250 people per year – the committee selected 12 demonstration sites. An additional 13 sites were given planning grants. (excerpt)
Geneva, Switzerland, WHO, 2003. vi, 30 p.The Executive Board of the World Health Organization, at its 101st session in January 1998, called for a revitalization of the global commitment to appropriate infant and young child nutrition, and in particular breastfeeding and complementary feeding. Subsequently, in close collaboration with the United Nations Children’s Fund, WHO organized a consultation (Geneva, 13–17 March 2000) to assess infant and young child feeding practices, review key interventions, and formulate a comprehensive strategy for the next decade. Following discussions at the Fifty-third World Health Assembly in May 2000 and the 107th session of the Executive Board in January 2001 of the outline and critical issues of the global strategy, the Fifty-fourth World Health Assembly (May 2001) reviewed progress and requested the Director-General to submit the strategy to the Executive Board at its 109th session and to the Fifty-fifth World Health Assembly, respectively in January and May 2002. During their discussion of the draft of the global strategy, members of the Executive Board commended the setting in motion of the consultative, science-based process that had led to its formulation as a guide for developing country-specific approaches to improving feeding practices. They also welcomed the strategy’s integrated and comprehensive approach. Several members made suggestions with regard to the exact wording of the draft strategy. These suggestions were taken carefully into account in preparing the strategy, as were comments from Member States following the Board’s 109th session and observations of other interested parties, including professional associations, nongovernmental organizations and the processed-food industry. Stressing the validity of a well-structured draft, the Executive Board recommended that the Health Assembly endorse the global strategy and that Member States implement it, as appropriate to national circumstances, in order to promote optimal feeding for all infants and young children. (excerpt)
Lancet. 2003 Nov 29; 362(9398):1850-1853.Each year, about 2 million babies are born to HIV-1- infected women. Despite widespread knowledge of proven methods to prevent mother-to-child transmission (MTCT) of the virus, most infants at risk of contracting the infection from their mothers receive no prophylactic intervention. This inaction leads to the infection and ultimate death of about 800 000 children per year. It has been known since 1994 that MTCT is largely preventable, and interventions appropriate for use in the developing world have been available since 1999. Singledose intrapartum and neonatal nevirapine—the simplest and perhaps most effective of the short-course antiretroviral regimens studied—has been available free of charge from the manufacturer since 2000. Nevertheless, few women have access to MTCT-prevention services. In the more than 3 years since its inception, the donation programme has shipped only 189 000 courses of the drug, a tiny fraction (<5%) of the estimate worldwide need. Why this feasible10 and cost-effective intervention has failed to reach so many of the women and infants who need it is a difficult question with no simple answers. Whatever the reasons, we believe that the continued low level of coverage of MTCT-prevention services is no longer acceptable from either a public health or a humanitarian perspective. We argue for a goal-directed approach to scaling-up of such services, in which we first acknowledge that the guiding objective should be to save babies from HIV-1 infection. To meet this objective, it will be necessary in many settings to dissociate the complex business of expanding HIV-1 testing services from the simpler matter of providing nevirapine prophylaxis. (author's)
Geneva, Switzerland, UNAIDS, 2003 Sep. 74 p. (UNAIDS/03.44E)This report provides a snapshot of the action being taken across the African continent in response to the challenge of AIDS. It highlights governments working with all their ministries to deliver a full-scale response. It demonstrates progress in closing the gaps in the provision of HIV prevention and treatment. It shows the value of partnership between government, communities and businesses. It showcases the determination of African women to throw off the disproportionate burden that AIDS represents for them. And it makes manifest the voice of hope, in the many successful responses by young people in fighting the epidemic. (author's)
Lancet. 2003 Aug 16; 362(9383):542.An increasing number of mothers with HIV in Uganda are breastfeeding their babies after UNICEF stopped donating free infant formula. Doctors implementing the prevention of mother-to-child HIV transmission (PMTCT) project said on Aug 7 that most of the women could not afford infant formula. “They have a choice of whether to breastfeed or buy infant formula”, said Saul Onyango, national PMTCT coordinator. (excerpt)