At the recent International AIDS Conference in Washington, DC in late July, there was much optimism: increasing evidence that HIV medications both save lives and prevent transmission to partners and from mom to baby. However, extensive access gaps remain and need to be addressed before an AIDS-free generation can become a reality. Individual donors, big and small, have a critical role to play in supporting access and uptake to evidence-based interventions that work.
Mother-to-child transmission of HIV is almost entirely preventable, yet each day over 1,000 infants are infected with HIV. Mothers are not receiving the cascade of care (prenatal care, HIV counseling and testing, HIV medications, exclusive breastfeeding, and support) needed to prevent HIV in their babies and to ensure their own health. From the conference sessions, here are five of the strategic gaps and most promising philanthropic on-ramps for donors:
1. Treat and prevent now
Increase access to and use of prenatal and HIV services through community-level interventions
As HIV medications become more available, a primary gap is on the demand side. Stigma, geography, and other barriers prevent pregnant women from getting tested for HIV and accessing care. Community frontline health workers anchored in the medical system (and ideally paid) go a long way towards increasing access to and use of existing medications. For example, training and employing mentor mothers (as organizations like mothers2mothers and Intrahealth do) can increase uptake of HIV services, HIV testing in infants, and exclusive breast-feeding (a critical intervention to keep babies healthy given the risk of death from unclean water). Peer support, women’s groups, and home visits by community health workers can help break down the barriers that keep at-risk women from accessing care.
2. Build systems for the long term
Develop capacity in supply chain management, demand forecasting, and processes for continuous quality improvement
Throughout Africa, HIV medications are often out of stock when mothers and babies need them at the clinic. The quality of care delivered is too often sub-optimal — so much so that mothers prefer to go without. Organizations such as Management Sciences for Health are helping local health systems upgrade their management systems to ensure availability of needed medications and improve quality of services so mothers *want* to come for care.
3. Support innovation
Test and scale-up technologies that enable community health workers to track mothers and babies and keep them in care
Too many pregnant women fall out of prenatal care and never receive medications that can ensure their health and the health of their baby. For example, recent data from Zambia showed that more than half of HIV+ pregnant women dropped out of care after HIV testing. Mobile technology initiatives, such as MAMA (Mobile Alliance for Maternal Action) in Bangladesh and South Africa, can increase retention in care by sending text reminders to moms and assisting health workers in tracking moms who miss appointments.
4. Enable policy change
Assist African countries in shifting to better HIV medications for moms and babies (in HIV lingo — change from medication option A to B+ )
Currently, all sub-Saharan African countries except Malawi are still using sub-optimal HIV medication regimens for pregnant women, which is leading to preventable HIV infections in babies and HIV-drug resistance in mothers. Groups such as Management Sciences for Health, UNICEF, Clinton Health Access Initiative (CHAI), and Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) are helping countries develop logistical and implementation plans to switch to better 3-drug regimens which not only improve health but also are likely to be cost-saving in the long run.
5. Address an area of great neglect
Support access to reproductive health services, including contraception for women, and integrate these with HIV services
According to UNAIDS data, women account for the majority of HIV cases worldwide. Also, an estimated 40% of pregnancies are unintended.1 When desired, family planning can have a huge impact on decreasing both HIV infections in children as well as decreasing maternal deaths. Organizations such as Marie Stopes International (MSI) and JHPIEGO are working to train nurses and build health system capacity to reach both HIV+ and HIV- women with a full range of reproductive health services to meet their needs.
Take the next step
Last week, global leaders, community organizations, and funders came together with the goal of creating an AIDS-free generation. Our five takeaways from the International AIDS Conference highlight opportunities for eliminating mother-to-child transmission of HIV — each represents a strategic opportunity for investment from donors. No matter how you decide to invest, you can play a critical role in ensuring an AIDS-free generation.
1 UNAIDS. A progress report on the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. 2012.