With the advent of antiretroviral drugs, the rate of mother-to-fetus transmission
of HIV has been greatly reduced. Do you think that these findings justify mandatory
testing and treatment of pregnant women who are at high risk of having HIV/AIDS?
Why or why not?
Answer:
1. A public health approach for increasing access to PMTCT services
The prevention of HIV infection in infants and young children is an evolving area from both a
scientifi c and programmatic standpoint. The public health approach proposed in these guidelines
builds on previous and emerging scientifi c evidence and programmatic experience from low-
as well as middle- and high-income countries. The main purpose of adopting a public health
approach is to ensure access to high-quality services at the population level, while striking a
balance between the best proven standard of care and what is feasible on a large scale in
resource-constrained settings.
PMTCT programmes should aim to deliver ART for pregnant women living with HIV who require
treatment for their own health or, for those who do not yet require such therapy, to provide highly
effective prophylactic treatment to prevent MTCT. To achieve this, recommendations for a public
health approach are provided to assist countries in developing practical standardized protocols
for ensuring the optimal use of scarce human and fi nancial resources, simplifi ed clinical and
laboratory monitoring, sustainable programmes and the highest achievable effectiveness within
existing constraints.
In the public health approach, PMTCT programmes are built around standardized regimens and
simplifi ed approaches suitable for the majority of women. This evidence-based standardization
and simplifi cation facilitates the expansion and management of programmes and training and
the development of skills. Provision is also made for many specifi c circumstances which arise,
for example for women with severe anaemia or co-infection with tuberculosis (TB) and HIV, or
drug toxicity.
2. The WHO comprehensive strategic approach to the prevention of HIV
infection in infants and young children
WHO promotes a comprehensive strategic approach to the prevention of HIV infection in infants
and young children, consisting of four components:
1. primary prevention of HIV infection;
2. prevention of unintended pregnancies among women living with HIV;
3. prevention of HIV transmission from mothers living with HIV to their infants;
4. care, treatment and support for mothers living with HIV, their children and families (12).
All four components must be implemented in order to optimize the effectiveness of programmes
and reach the overall goal of improving maternal and child health (MCH) in the context of HIV.
This comprehensive approach is built around the routine offer of HIV testing and counselling to all pregnant women, ARV prophylaxis for PMTCT and counselling and support for infant feeding,
and is underscored by ART, care and support for women living with HIV, their children and families
. In this strategy, special attention is given to primary prevention services for women
identifi ed as HIV-negative (the majority of women in almost all settings) and strengthening linkages
with other sexual and reproductive health services, particularly family planning. The provision of
family planning counselling and services is especially important during the postpartum period for
women living with HIV who choose not to breastfeed or who stop breastfeeding early as they
have a shorter duration of lactational amenorrhea.
In many resource-constrained settings, PMTCT programmes have not paid adequate attention
to services for women who test HIV-negative. These women require access to essential primary
prevention services, especially during pregnancy and lactation, as both biological and behavioural
factors may increase a woman’s risk of acquiring HIV at this time (21,22). Innovative approaches
should be identifi ed according to local epidemiological and socioeconomic contexts to address
the prevention needs of these women and their partners.