Interventions to Improve Maternal and Child Survival and Prevent Transmission of HIV from Mother-to-Child

Addressing the gaps in HIV service delivery is critical to eliminating mother-to-child transmission of HIV. Even small gains in maternal retention on antiretroviral therapy (ART) can result in large gains in the number of children born HIV-free and significantly improves the health and survival of women and children.

With timely identification of HIV status among pregnant women, timely HIV treatment initiation, and ongoing services for women and infants throughout the breastfeeding period, it’s possible to virtually eliminate mother-to-child transmission of HIV. Yet not all women have access to HIV services during this critical period and not all who start HIV treatment are retained in care and treatment. In addition, not all infants have access to early infant diagnostics and antiretroviral treatment initiation if HIV-positive. Evidence informed interventions that increase access to HIV services for women and their infants living in resource-limited settings are critical to the prevention of mother-to-child transmission of HIV (PMTCT) and keeping HIV-positive women and children alive.

Integrating and Scaling up Pmtct though Implementation Research (INSPIRE), an implementation science research initiative, was launched in 2012 and funded by the World Health Organization through Canada’s Department of Foreign Affairs, Trade and Development (DFATD) to identify and improve access to successful PMTCT interventions. Six implementation studies were funded through the INSPIRE program, two each in Malawi, Nigeria, and Zimbabwe. CHAI was a lead partner in two of the six studies, E4E in Zimbabwe and PRIME in Malawi.

The Promoting Retention among Infants and Mothers Effectively (PRIME) study in Malawi’s main outcome was 12-month maternal and infant postpartum retention. PRIME compared retention among women and their infants receiving one of three models of HIV care. In the first model, integrated HIV and maternal, neonatal and child health services were offered at an integrated mother-infant pair (MIP) clinic. In the second, mothers received integrated health services at MIP clinics; those that missed a visit had text messages sent to community volunteers to actively follow-up and link them back to care. These two models were compared to the standard of care in Malawi. Read about the impact of PRIME and lessons learned about the process of implementing integrated services in rural Malawi.

Evidence for Elimination (E4E) was a 2-arm cluster randomized controlled trial (cRCT) in Zimbabwe. E4E evaluated the impact of point-of-care CD4 count technology followed by CD4 count-specific adherence counseling on 12-month retention in care and ART adherence among pregnant women living with HIV and starting lifelong HIV treatment. Read more about the impact of E4E and what was learned about appointment attendance and adherence.

In order to estimate mother-to-child transmission of HIV for the INSPIRE studies, CHAI analyzed patient-level data from the six INSPIRE studies in the three countries. We found that among the cohort of HIV-positive women from the six studies, almost 80% of all infections could be attributed to the roughly 20% of HIV-positive pregnant and breastfeeding women not initiated or retained on ART. The hard work of retaining mothers and infants needs to be prioritized in order to realize what is possible for their health and survival. Read more in this publication.