Advances in the prevention of mother-to-child transmission of HIV and resulting clinical and programmatic implications

Following scientific advancements in the prevention of mother-to-child transmission (PMTCT) of HIV, a global plan is being implemented to virtually eliminate new pediatric HIV infections. However, despite revisions to guidelines for providing antiretroviral medications, including the availability of more effective drug regimens over the past decade, and the recent rapid scale-up of PMTCT services, sizeable challenges persist in achieving this goal. This paper provides a summary of recent approaches to the provision of antiretroviral medicines to pregnant women and the resulting implications. Emerging programmatic and service delivery considerations, aiming to increase the effectiveness of PMTCT programs to overcome barriers faced by women in accessing PMTCT services are also discussed. Worldwide elimination of pediatric HIV is now a possibility due to the increasing similarity of PMTCT guidelines in developing countries to those in developed countries. However the resulting practical challenges of implementation will require resources and support at local, national, and international levels. As developing countries strive to adopt and implement more efficacious drug regimens, the effectiveness of PMTCT programs will be determined by coverage of services and the recruitment and retention of pregnant women in the cascade. To expand services and provide an effective, comprehensive approach in under resourced settings, harmonized efforts to address barriers whilst considering contextual factors will be needed.