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What is needed to eliminate new pediatric HIV infections: the contribution of model-based analyses

Doherty, Katie; Ciaranello, Andrea

Current Opinion in HIV and AIDS: September 2013 - Volume 8 - Issue 5 - p 457–466
doi: 10.1097/COH.0b013e328362db0d

Purpose of review Computer simulation models can identify key clinical, operational, and economic interventions that will be needed to achieve the elimination of new pediatric HIV infections. In this review, we summarize recent findings from model-based analyses of strategies for prevention of mother-to-child HIV transmission (MTCT).

Recent findings In order to achieve elimination of MTCT (eMTCT), model-based studies suggest that scale-up of services will be needed in several domains: uptake of services and retention in care (the PMTCT ‘cascade’), interventions to prevent HIV infections in women and reduce unintended pregnancies (the ‘four-pronged approach’), efforts to support medication adherence through long periods of pregnancy and breastfeeding, and strategies to make breastfeeding safer and/or shorter. Models also project the economic resources that will be needed to achieve these goals in the most efficient ways to allocate limited resources for eMTCT. Results suggest that currently recommended PMTCT regimens (WHO Option A, Option B, and Option B+) will be cost-effective in most settings.

Summary Model-based results can guide future implementation science, by highlighting areas in which additional data are needed to make informed decisions and by outlining critical interventions that will be necessary in order to eliminate new pediatric HIV infections.

aThe Medical Practice Evaluation Center, Divisions of General Medicine

bInfectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence to Katie Doherty, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, Massachusetts 02114, USA. Tel: +1 617 724 8847; fax: +1 617 726 2691; e-mail:

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