Elimination of Mother-to-Child Transmission (EMTCT)

This issue of InFocus zooms in on what the Declaration means for the lives of women and girls in Asia and the Pacific in the context of the challenges they face and policy and programme responses needed to overcome these.

Validation of elimination of mother-to-child transmission, or vertical transmission, of HIV, syphilis and hepatitis B virus (HBV), is an attestation that a country has successfully met standard criteria for elimination, or for being at 1 of the 3 levels of achievement on the ‘Path to Elimination’ while delivering quality services for women, girls and their children, through the life-course, respecting human rights and ensuring gender equality and community engagement. This document, the third version, adds on EMTCT of hepatitis B virus (HBV), bringing together a package of interventions and metrics to support integrated management and monitoring of vertical transmission across a wide range of epidemiological and programmatic contexts.

The HIV epidemic has been spreading slowly in Lao PDR, and the prevalence remains low. Nevertheless there is potential for the epidemic to grow and much need for further prevention efforts and care and support initiatives. The NCCA has established a new Taskforce to address prevention and care in relation to mother to child transmission (MTCT) of HIV. UNICEF Vientiane wishes to assist the Taskforce to develop appropriate national policies and strategies to address the problems raised by parent to child transmission of HIV. 

Mother-to-child transmission is the main way children become infected with human immunodeficiency virus (HIV) worldwide. To date, the primary approach to the prevention of mother-to child transmission (PMTCT) has been to identify HIV-infected pregnant women by voluntary counseling and testing (VCT) for HIV and then provide antiretroviral (ARV) drug prophylaxis to them during delivery and then to their newborn infants. Many HIV-positive births could be prevented, however, by simply preventing unintended pregnancies among infected women. Furthermore, increasing contraceptive use to prevent such pregnancies appears to be at least as cost-effective as providing nevirapine to HIV-infected mothers.

The purpose of this document is to provide guidance to decision-makers in the development of PMTCT interventions in clinical settings, as well as to provide users with the correct technical information on MTCT and PMTCT. 

The ‘Last Mile’ road map draws on the latest scientific research and programmatic evidence to describe and recommend strategies to achieve the elimination of mother-to-child transmission of HIV (EMTCT). It includes a synthesis of evidence and country experiences for reaching EMTCT and recommends clear strategies that can improve the coverage, effectiveness and quality of national programmes for the prevention of mother-to-child transmission (PMTCT). The goal of this document is to provide guidelines for coordinated action so that national programmes address local priority areas to achieve EMTCT in an effective, people-centred, efficient and directed manner.

This guide provides specific information for improving and scaling-up prevention of mother-to-child transmission of HIV (PMTCT) programs, based on what program managers and evaluators identify as successful strategies. The guide is intended for use by national-level PMTCT teams for starting or scaling up PMTCT programs. With appropriate adaptation, national officials can disseminate the guide to district level authorities, site managers, and health workers.

In India, 38.4 percent of the estimated 5.1 million HIV infections are among women (UNAIDS/WHO 2006). Although mother-to-child transmission (MTCT) accounts for a little less than 4 percent of all HIV infections in India, in sheer numbers it is the cause of approximately 56,700 children infected with HIV each year (IAP/NACO 2006, UNICEF 2006). With support from UNICEF, India’s national program for prevention of parent-to-child transmission (PPTCT) of HIV has been underway since 2002.

This Global Plan provides the foundation for country-led movement towards the elimination of new HIV infections among children and keeping their mothers alive.