title: Using the PMTCT Cascade to Accelerate Achievement of the Global Plan Goals.
abstract: BACKGROUND
  Development of country plans for prevention of mother-to-child HIV transmission (PMTCT), including expansion of comprehensive, integrated services, was key to Global Plan achievements.
  
  
  METHODS
  Use of the PMTCT cascade, an evolving series of sequential steps needed to maximize the health of women and HIV-free survival of infants, was critical for development and implementation of PMTCT plans. Regular review of cascade data at national/subnational levels was a tool for evidence-based decision making, identifying areas of greatest need at each level, and targeting program interventions to address specific gaps. Resulting improvements in PMTCT service delivery contributed to success. Populating the cascade highlighted limitations in data availability and quality that focused attention on improving national health information systems.
  
  
  CONCLUSIONS
  Use of aggregate, cross-sectional data in the PMTCT cascade presents challenges in settings with high mobility and weak systems to track women and children across services. Poor postnatal follow-up and losses at each step of the cascade have limited use of the cascade approach to measure maternal and child health outcomes beyond the early postnatal period.
  
  
  CONCLUSIONS
  A cascade approach was an effective means for countries to measure progress, identify suboptimal performance areas, and be held accountable for progress toward achievement of Global Plan goals. Using the cascade requires investment of time and effort to identify the type, source, and quality of data needed as programs evolve. Ongoing review of cascade data, with interventions to address discontinuities in the continuum of care, can translate across health areas to improve health care quality and outcomes.
authors.affiliation: *Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC; †National Multisectoral Programme for the Fight against HIV/AIDS, Kinshasa, Democratic Republic of Congo; ‡Formerly, Uganda National AIDS Control Program, Kampala, Uganda; §National AIDS Control Program, Kinshasa, Democratic Republic of Congo; ‖South African Medical Research Council, Pretoria, South Africa; ¶Department of Paediatrics, University of Pretoria, Pretoria, South Africa; #Currently, Project Concern International, Washington, DC; **United Nations Children's Fund West and Central Africa Regional Office, Dakar, Senegal; ††National AIDS and STIs Control Programme, Nairobi, Kenya; and ‡‡Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hamilton
authors.forename: Bernard
authors.initials: B
authors.lastname: Bossiky
authors.forename: John
authors.initials: J
authors.lastname: Ditekemena
authors.forename: Godfrey
authors.initials: G
authors.lastname: Esiru
authors.forename: Franck
authors.initials: F
authors.lastname: Fwamba
authors.forename: Ameena E
authors.initials: AE
authors.lastname: Goga
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: Kieffer
authors.forename: Landry D
authors.initials: LD
authors.lastname: Tsague
authors.forename: Roland
authors.initials: R
authors.lastname: van de Ven
authors.forename: Rose
authors.initials: R
authors.lastname: Wafula
authors.forename: Laura
authors.initials: L
authors.lastname: Guay
mesh_terms: D003140:Communicable Disease Control / Q000458:organization & administration*; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014480:United Nations