Analysis

Monitoring and evaluation of programmes to prevent mother to child transmission of HIV in Africa

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39211.527488.94 (Published 31 May 2007) Cite this as: BMJ 2007;334:1143
  1. Richard Reithinger, epidemiologist1,
  2. Karen Megazzini, project director1,
  3. Stephen J Durako, vice president1,
  4. D Robert Harris, senior epidemiologist1,
  5. Sten H Vermund, director2
  1. 1Clinical Trials Area, Westat, Rockville, Maryland, USA
  2. 2Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  1. Correspondence to: R Reithinger rreithinger{at}yahoo.co.uk
  • Accepted 6 May 2007

Many countries are expanding the coverage of programmes to prevent mother to child transmission of HIV. Although the need is unquestionable, Richard Reithinger and colleagues are concerned that without true measures of effectiveness we may not be making the best use of resources

In 2006, an estimated 2.3 million children under 15 years were living with HIV and about half a million babies became infected with HIV before birth, during delivery, or through breast feeding.1 Prevention of mother to child transmission of HIV is therefore a priority for agencies fighting the global HIV epidemic, but many questions remain about the effectiveness of the current programmes. We use the President's Emergency Plan for AIDS Relief2 as an example to examine how programmes to prevent mother to child transmission are monitored and evaluated and to highlight the problems.

Strategy to prevent transmission

Estimates of the efficacy of antiretroviral prophylaxis3 suggest that at least half of the world's children who are at risk of HIV infection might be protected if a mother receives antenatal care, is offered HIV counselling and testing, and, if infected, she and her baby receive prophylaxis. Prophylaxis is the mainstay of the strategy to prevent mother to child transmission.3 Several antiretroviral regimens are recommended in resource constrained settings, although nevirapine (either alone or with other drugs) is usually favoured because it is cheap, easy to administer, rapidly absorbed, and has a long half life.3 Depending on the regimen and the mother's choice of infant feeding, the risk of HIV transmission can be reduced to <2%.3 Whenever feasible, programmes should strive to provide highly active antiretroviral therapy to pregnant women.

Although formula feeding can reduce HIV infection rates among infants,4 it is often not acceptable, feasible, affordable, sustainable, or safe in resource limited settings.5 6 Programmes …

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