title: Site-specific interventions to improve prevention of mother-to-child transmission of human immunodeficiency virus programs in less developed settings.
abstract: This article reviews the experiences of programs designed to provide access to prevention of mother-to-child transmission services with the goal of improving services in resource-constrained settings. The article reports new data from the Elizabeth Glaser Pediatric AIDS Foundation's prevention of mother-to-child transmission program in sub-Saharan Africa, which has provided human immunodeficiency virus testing to more than 1,300,000 pregnant women and antiretroviral prophylaxis to 134,000 human immunodeficiency virus-infected pregnant women and more than 78,000 human immunodeficiency virus-exposed infants. Review of qualitative program data highlights the practical innovations that sites are implementing to improve the uptake of prevention of mother-to-child transmission services. Recommendations discussed include opt-out counseling and testing, rapid human immunodeficiency virus testing in antenatal care, counseling and testing in maternity, and provision of antiretroviral prophylaxis for mother and infant at the time of human immunodeficiency virus testing. Successful programmatic innovations need to be disseminated widely as more aggressive prevention strategies must be implemented to increase access to more than 10% of pregnant women worldwide.
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Sripipatana
authors.forename: Allison
authors.initials: A
authors.lastname: Spensley
authors.forename: Anna
authors.initials: A
authors.lastname: Miller
authors.forename: James
authors.initials: J
authors.lastname: McIntyre
authors.forename: Gloria
authors.initials: G
authors.lastname: Sangiwa
authors.forename: Frederick
authors.initials: F
authors.lastname: Sawe
authors.forename: David
authors.initials: D
authors.lastname: Jones
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Wilfert
mesh_terms: D000349:Africa; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001942:Breast Feeding; D003376:Counseling; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy; D011322:Primary Prevention / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods