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While mother-to-child transmission (MTCT) of HIV has been reduced to very small numbers in the United States and Europe, more than 1,600 children still become infected with HIV each day, mostly in sub-Saharan Africa, where an estimated 46% of pregnant women are infected with HIV.
Besides free drug programs to prevent MTCT, there have been efforts made by UNAIDS of Geneva, Switzerland, the Elizabeth Glaser Pediatric AIDS Foundation in Washington, DC, and others to combat this problem. Here are brief looks at how some of the programs work:
• Call to Action project: Initiated by the Elizabeth Glaser Pediatric AIDS Foundation in September of 1999 to reduce MTCT of HIV in the developing world, this project allows international health care sites to apply for funding that is used to start MTCT prevention programs. The project supports prevention programs that use proven antiretroviral regimens to reduce MTCT, including zidovudine (AZT) alone, zidovudine and 3TC (Combivir), and nevirapine (Viramune).
As of June 2001, 350 health care workers were trained as part of the Call to Action project, and 18,000 women had been reached with counseling. Of these women, 14,000 agreed to be tested and 2,100 were found to be HIV-positive. A total of 1,248 or 58% received nevirapine to reduce MTCT. The project’s future goals include providing all mothers with access to voluntary counseling and offering access to care to HIV-infected mothers so they may protect their own health, as well as the health of their families.
"Care and support for the HIV-infected mothers and for infants who are infected despite intervention is extremely important," says Dirk Buyse, MD, international program officer for the Elizabeth Glaser Pediatric AIDS Foundation.
"I think, and this is something that we have been advocating, that these MTCT programs might be entry points for more comprehensive care and treatment programs later on," Buyse says. "These are a whole group of people who know their HIV status and will need care and support, and that’s very important when you look at the issue of orphans."
• Accelerating Access Initiative: UNAIDS has encouraged competition between pharmaceutical companies to provide antiretroviral drugs at a reduced cost to poor nations. At present, less than 10% of the HIV-infected people in developing countries have access to antiretroviral therapy. Of the estimated 25 million people infected with HIV in Africa, only 10,000 to 25,000 receive antiretroviral therapy. UNAIDS has been working to change this dire situation through its Accelerating Access Initiative, which has helped bring down some prices.
"The drugs now are very expensive for the majority of people, but they are much cheaper than they used to be," says Connie Osborne, MB.Ch.B, the MTCT voluntary counseling and testing focal point for UNAIDS. "In Africa, they have about 13 countries that are in the Accelerating Access Initiative," Osborne says. "Because the prices are coming down, there are other people who are getting on board with the program."
• MTC Plus: MTC Plus is a new program that UNAIDS would like to begin as a pilot project in 10 low-income countries that have not yet been selected but probably will include nations in Africa, the Caribbean, and Asia. UNAIDS has begun the program as an extension of MTCT prevention therapy. Rather than stopping treatment with the single dose given to mothers during labor, MTCT programs could extend treatment to mothers after they give birth. This continuation of treatment could help prevent MTCT during breast-feeding and keep the mothers alive, Osborne says.