Strategies for prevention of mother-to-child transmission of HIV.

Over 90 per cent of paediatric HIV infections are maternally acquired, most of these in sub-Saharan Africa. Mortality trends underscore the humanitarian and ethical obligation for urgent global action to protect children from HIV. With the adoption of anti-retroviral therapy in pregnancy, mother-to-child transmission rates have declined to 4-6 per cent in the USA and other industrialised countries. In low-resource settings, where most of the children are continuously being exposed to HIV, the cost of anti-retroviral therapy is prohibitive. Very few developing countries apart from Botswana, Thailand and Brazil have national policies for integration of preventive anti-retroviral therapy in antenatal clinics. This paper reviews anti-retroviral and non-anti-retroviral interventions for prevention of mother-to-child transmission of HIV. To support the health of mothers as well, it supports the implementation of a comprehensive package of care in pregnancy and post-partum, such as access to antenatal and delivery services; anti-retroviral preventive therapy; malaria treatment; family planning; multivitamin, iron and folate supplementation; counselling on feeding options; post-natal care for the child and post-partum care for the mother, and calls for a strategy for advocacy, programme communication and community mobilisation.