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Beyond prevention of mother-to-child transmission: keeping HIV-exposed and HIV-positive children healthy and alive

Kellerman, Scott E.a; Ahmed, Saeedb; Feeley-Summerl, Theresac; Jay, Jonathanc; Kim, Mariab; Phelps, B. Ryand; Sugandhi, Nanditae; Schouten, Erikf; Tolle, Mikeb; Tsiouris, Fatimag; The Child Survival Working Group of the Interagency Task Team on the Prevention and Treatment of HIV infection in Pregnant Women, Mothers and Children

doi: 10.1097/QAD.0000000000000107
Supplement Articles

In 2011, Joint United Nations Programme on HIV/AIDS announced a plan to eliminate new HIV infections among children by 2015. This increased focus on the elimination of maternal to child transmission (MTCT) is most welcome but is insufficient, as access to prevention of MTCT (PMTCT) programming is neither uniform nor universal. A new and more expansive agenda must be articulated to ensure that those infants and children who will never feel the impact of the current elimination agenda are reached and linked to appropriate care and treatment. This agenda must addresses challenges around both reducing vertical transmission through PMTCT and ensuring access to appropriate HIV testing, care, and treatment for all affected children who were never able to access PMTCT programming. Option B+, or universal test and treat for HIV-infected pregnant women is an excellent start, but it may be time to rethink our current approaches to delivering PMTCT services. New strategies will reduce vertical transmission to less than 1% for those mother-infant pairs who can access them allowing for the contemplation of not just PMTCT, but actual elimination of MTCT. But expanded thinking is needed to ensure elimination of pediatric HIV.

aManagement Sciences for Health, Washington, DC

bBaylor College of Medicine, Texas Childrens Hospital, Houston, Texas

cManagement Sciences for Health, Cambridge, Massachusetts

dOffice of HIV/AIDS, USAID, Washington, DC

eClinton Health Access Initiative, New York City, New York, USA

fManagement Sciences for Health, Lilongwe, Malawi

gICAP - Columbia University, Mailman School of Public Health, New York, New York, USA.

Correspondence to Scott E. Kellerman, MD, MPH, Global Technical Lead, HIV and AIDS, Management Sciences for Health, 4301 N. Fairfax Drive, Suite 400, Arlington, VA 22203, USA. Tel: +1 703 310 3595; e-mail:

Received 07 October, 2013

Revised 07 October, 2013

Accepted 07 October, 2013

© 2013 Lippincott Williams & Wilkins, Inc.