AIDS Alert International: MTCT-Plus initiative now in eight African nations

Women enter program in pregnancy and continue

The Mother-to-Child-Transmission (MTCT)-Plus initiative was developed in response to the expansion of programs for preventing HIV transmission between mothers and children with the added feature of providing ongoing antiretroviral treatment to mothers.

International HIV advocates have long said the success of the inexpensive treatment that prevents women from transmitting HIV to their newborns is far from a long-term solution since those same infants likely will grow up as orphans if their mothers remain untreated after the pregnancy. Already, there are an estimated 10 million orphans in sub-Saharan Africa.

Now, the MTCT-Plus program is working to keep the mothers alive and healthy for the long term. It’s been expanded to 12 programs in eight African countries, and enrollment began in March 2003. Now more than 3,500 people have been enrolled, says Wafaa El-Sadr, MD, MPH, chief of the division of infectious diseases at Harlem Hospital and professor of clinical medicine and epidemiology at Columbia University in New York City.

"The [typical MTCT] programs do not offer the women treatment for their own disease or treatment for their HIV-infected children or partners or household members," she says.

"MTCT-Plus aims to recruit women identified as HIV-infected during pregnancy and offers them a comprehensive package of HIV care including antiretroviral treatment," El-Sadr says. "Women can enroll their partners, household members, and children who are HIV-infected."

Patients receive clinical and psychosocial services through a multidisciplinary team of providers, she explains.

Each site selects its own primary and secondary antiretroviral regimens, based on national guidelines, El-Sadr says.

"We encourage them to enroll women as early as possible during their pregnancies, so they can be engaged in the program," she notes.

"We use the time of pregnancy to enroll them in the program so they can receive psychosocial support, adherence support, and all of that very early in the pregnancy."

Overcoming stigmas 

The programs also help staff support patients in terms of stigma and finding ways to disclose their HIV status to their families, El-Sadr says.

"It’s a testament to the programs that they could enroll this many patients even in settings where we know stigma exists," she continues.

"We provide support group training on exposure and have a peer program where people with HIV, who feel comfortable in disclosing, are able to provide support to other patients as well."

Such programs have shown signs of reducing community stigma and discrimination by opening up communication about HIV, rather than denying the disease exists, El-Sadr notes.

Included in the menu of services provided are tuberculosis management, family planning, supportive interventions, and outreach. However, the chief cost is the antiretroviral drugs, she points out.

"A major cost remains the antiretroviral drugs themselves, even though the cost has come down," El-Sadr explains. "We’re hoping that as antiretroviral prices come down, they can enroll more women into the program."

Funding comes from eight different foundations and USAID, she says.

"These programs are the first of their kind," El-Sadr adds. "For countries with high HIV seroprevalence, these programs are an important site to identify women with HIV and to engage them in an HIV care program early in the course of their disease."