Elimination of Mother-To-Child Transmission of HIV Infection: The Drug Resource Enhancement against AIDS and Malnutrition Model.
The Drug Resource Enhancement against AIDS and Malnutrition Program (DREAM) gathered professionals in the field of Elimination of HIV-Mother-To-Child Transmission (EMTCT) in Maputo in 2013 to discuss obstacles and solutions for the elimination of HIV vertical transmission in sub-Saharan Africa. During this workshop, the benefits of administrating combined antiretroviral therapy (cART) to HIV positive women from pregnancy throughout breastfeeding were reviewed. cART is capable of reducing vertical transmission to less than 5% at 24 months of age, as well as maternal mortality and infant mortality in both HIV infected and exposed populations to levels similar to those of uninfected individuals. The challenge for programs targeting eMTCT in developing countries is retention in care and treatment adherence. Both are intrinsically related to the model of care. The drop-out from eMTCT programs before cART initiation ranges from 33%-88% while retention rates at 18-24 months are less than 50%. Comprehensive strategies including peer-to-peer education, social support and laboratory monitoring can reduce refusals to less than 5% and attain retention rates approaching 90%. Several components of the model of care for reduction of HIV-1 MTCT are feasible and implementable in scale-up strategies. A review of this model of care for HIV eMTCT is provided.
University of Tor Vergata, 18-00173 Rome, Italy. giuseppeliotta@hotmail.com.
Giuseppe
G
Liotta
LUMSA University, 18-00173 Rome, Italy. mcmarazzi@gmail.com.
Maria Cristina
MC
Marazzi
Health Services Cluster, Cité du Djoué, P.O. Box 06 Brazzaville, South Africa. eula.mothibi@khethimpilo.org.
Khethimipilo E
KE
Mothibi
Community of S.Egidio-DREAM program, Avenida de Julho 7, Maputo, Mozambique. ineszimba@dream.org.mz.
Ines
I
Zimba
Ministère de la Santé et de la lutte contre le SIDA, B.P. 2091, Abidjan, Ivory Coast. evaehua@yahoo.fr.
Evelyne E
EE
Amangoua
Cameroon Baptist Convention Health Services, P.O. Box 1 Bamenda, Cameroon. kunibonje@yahoo.com.
Esther K
EK
Bonje
Programme National Multisectoriel de Lutte contre le Sida, Blvd Triomphal and 24 Novembre Kinshasa, Congo (RDC). bernardbossiky@yahoo.fr.
Bernard N B
BN
Bossiky
National Department of Health, Private Bag X9070, South Africa. robinsonprecious@gmail.com.
Precious A
PA
Robinson
University of Tor Vergata, 18-00173 Rome, Italy. paola.scarcella@gmail.com.
Paola
P
Scarcella
Ministry of Health, Ndeke House, P.O. Box 30205, Lusaka, Zambia.
Kebby
K
Musokotwane
University of Tor Vergata, 18-00173 Rome, Italy. leonardo.palombi@gmail.com.
Leonardo
L
Palombi
INMI L. Spallanzani, 00149 Rome, Italy. paolagermano1@gmail.com.
Paola
P
Germano
INMI L. Spallanzani, 00149 Rome, Italy. pasquale.narciso@inmi.it.
Pasquale
P
Narciso
Division of Infectious Diseases, Department of Medical Biotechnologies, University of Siena, Siena University Hospital, Siena 53100, Italy. andrea.deluca@unisi.it.
Andrea
A
de Luca
Community of S.Egidio-DREAM program, P.O. Box 30355, Blantyre, Malawi. eladarmando@yahoo.com.
Elard
E
Alumando
Community of S.Egidio-DREAM program, P.O. Box 30355, Blantyre, Malawi. drsangarehawa@gmail.com.
Sangare H
SH
Mamary
Community of S.Egidio-DREAM program, Avenida de Julho 7, Maputo, Mozambique. nurjamajid@yahoo.com.
Nurja A
NA
Magid
Community of S.Egidio-DREAM program, Rome 00153, Italy. gianniguidotti1@gmail.com.
Giovanni
G
Guidotti
University of Tor Vergata, 18-00173 Rome, Italy. sandro.mancinelli@gmail.com.
Sandro
S
Mancinelli
Community of S.Egidio-DREAM program, Rome 00153, Italy. stefano.orlando@dreameurope.org.
Stefano
S
Orlando
Community of S.Egidio-DREAM program, Rome 00153, Italy. peronimarco@gmail.com.
Marco
M
Peroni
University of Tor Vergata, 18-00173 Rome, Italy. ersiliabuonomo@gmail.com.
Ersilia
E
Buonomo
David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA. knielsen@mednet.ucla.edu.
Karin
K
Nielsen-Saines
D000163:Acquired Immunodeficiency Syndrome; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D044342:Malnutrition; D008962:Models, Theoretical; D009035:Mothers; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*
D019380:Anti-HIV Agents
DREAM program; elimination of HIV MTCT