Guidance on global scale-up of the prevention of mother-to-child transmission of HIV

Towards universal access for women, infants and young children and eliminating HIV and AIDS among children

1 November 2007

AIDS has become a leading cause of illness and death among women of reproductive age in countries with a high burden of HIV infection. Infants born to women living with HIV can become infected during pregnancy, labour and delivery or postpartum through breastfeeding. More than 1400 children under 15 years of age therefore become infected with HIV every day, most through mother-to-child transmission. Children account for more than 10% of all new HIV infections.

In most high-income countries, wide implementation of an evidence-based package of interventions built around the use of antiretroviral drugs, the avoidance of breastfeeding and elective caesarean section has virtually eliminated new HIV infections among children. In contrast, resource-constrained settings have made little progress in scaling up services for the prevention of mother-to-child transmission (PMTCT), and current achievements fall far short of achieving the targets set by the United Nations General Assembly Special Session on HIV/AIDS in 2001. Global coverage of PMTCT services is still low. In 2005, only about 11% of pregnant women living with HIV gained access to HIV testing and counselling and antiretroviral prophylaxis interventions during pregnancy. In addition, most national programmes have paid little attention to primary prevention of HIV in women of childbearing age, preventing unintended pregnancies among women living with HIV and access to antiretroviral therapy for women and children.

The current global guidance has been developed in response to this slow, overall progress to scale up PMTCT in resource-constrained settings. It provides a framework for concerted partnerships and guidance to countries on specific actions to take to accelerate the scale-up of PMTCT. The implementation of actions recommended by this guidance aims to reinforce some recent encouraging trends in the coverage of national programmes. In 2006, at least eight countries exceeded the 40% antiretroviral prophylaxis uptake mark required to achieve the 2005 PMTCT target of the United Nations General Assembly Special Session on HIV/AIDS.