Sexual and reproductive health

Preventing mother-to-child transmission (MTCT) of HIV

A woman in Mozambique who just attended a PMTCT (Prevention of Mother-to-Child Transmission) counseling session during an antenatal visit
© 2004 Arturo Sanabria, Courtesy of Photoshare

Infection of HIV from an HIV-positive mother to her child during pregnancy, labour, delivery of breastfeeding is called mother-to-child transmission (MTCT). An estimated 420 000 children were newly infected with HIV in 2007, the vast majority of them through MTCT.
The rapid expansion of antiretroviral treatment in developing countries provides an opportunity to treat pregnant and breastfeeding women in order to reduce the risk of HIV transmission to their infants.

The Kesho Bora study

In collaboration with research teams from Belgium, France and the USA, the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) is coordinating a study in five sites in Africa to determine the optimum antiretroviral regimen for use in late pregnancy and during the first six months of breastfeeding, with a focus on preserving the health of the mother, keeping side-effects to a minimum, and reducing the risk of MTCT of HIV.

This Kesho-Bora project (“a better future” in Swahili) is a randomized controlled trial among HIV-infected women with intermediate disease (CD4+ count in the range 200–500 cells per mm3). The trial compares a triple-combination antiretroviral regimen, given from the 28th week of pregnancy and continued for a maximum of six months of breastfeeding, with a short-course regimen. All infants receive a single dose of nevirapine within 72 hours of birth. The health status of all women and their children is monitored regularly for one year. The primary end-points of the trial are:

  • HIV-free infant survival at six weeks and 12 months;
  • AIDS-free survival among mothers at 12 months postpartum; and
  • incidence of severe adverse effects in mothers and children.

By the end of 2007, a total of 671 HIV-positive pregnant women had been recruited in five sites: Bobo-Dioulasso (Burkina Faso), Mombasa and Nairobi (Kenya), and Durban and KwaMsane (South Africa). Some 75% of the women declared that they intended to breastfeed. The first cohort of 250 babies born in the study reached their first birthday in 2007. Enrolment was completed in August 2008. The first results are available (See links below).

Related links

PMTCT and HIV Care Monthly Reports

  • See reports
    Monthly Intelligence Reports are compiled from a regular survey of publications related to the prevention of mother to child transmission of HIV. They also cover abstracts presented at international conferences. They include a brief summary and comments prepared by the Bordeaux Working Group.

Guidance for programme managers

Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: towards universal access - Recommendations for a public health approach
The guidelines primarily target national-level programme planners and managers responsible for designing services for PMTCT and provision of ART for women. It should also be a useful resource for health care workers involved in efforts to reduce HIV infection in infants and young children and to provide treatment and care for women living with HIV.

Preventing mother-to-child transmission of HIV during breastfeeding

New evidence published in Lancet Infectious Diseases shows safety and efficacy of combination antiretroviral drugs during pregnancy, delivery and breastfeeding.