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Advancing PMTCT Implementation Through Scientific Research

A Vital Agenda for Combating the Global AIDS Epidemic in Low- and Middle-Income Countries

Glass, Roger I. MD, PhD*; Birx, Deborah L. MD

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JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1, 2016 - Volume 72 - Issue - p S101
doi: 10.1097/QAI.0000000000001076
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There has been a 60% decline in new HIV infections among children since 2009 in the 21 countries in sub-Saharan Africa that have been most affected by the epidemic. Despite our best efforts, nearly 150,000 children living in low- and middle-income countries are infected with HIV each year.1 And as many as 42,000 women living with HIV die of complications relating to HIV and pregnancy each year. We believe we must do better and to reach the pregnant women remaining we need new approaches.

The NIH and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) have a long-standing commitment to fighting HIV/AIDS in low- and middle- income countries (LMICs). Together, we have invested critical resources, resulting in numerous landmark scientific advances and effective strategies to combat this epidemic. In the context of prevention of mother-to-child transmission (PMTCT) of HIV, research has identified effective and affordable interventions. Last year, PEPFAR tested almost 15 million pregnant women, of which 850,000 were found to be HIV positive and 831,000 started on lifelong antiretroviral treatment to keep them healthy and thriving, and to protect their babies during pregnancy and breastfeeding.

In the absence of any prevention efforts, transmission rates of mother-to-child transmission range from 15% to 45%. However, this rate can be reduced to below 5 percent with effective interventions during the periods of pregnancy, labor, delivery, and breastfeeding.

And indeed, we have the tools at this moment to further decrease incidence of new infections, but we need to apply these tools more effectively to reach the undiagnosed and untreated mothers. We need to collectively address areas where barriers remain, including weak health infrastructure, limited human resources, limited management capacity, lack of access to antiretroviral therapy, and challenges in retention of mother and infant pairs along the PMTCT cascade.

To address the implementation challenges associated with PMTCT interventions and to support progress toward “virtual elimination” of pediatric HIV, we formed the NIH-PEPFAR Implementation Science Alliance. Through the Alliance, NIH and PEPFAR convened implementation scientists, PMTCT implementers (including PEPFAR in-country staff), and in-country policy makers for 4 meetings between 2013 and 2015. The Alliance is grounded in a shared mission to maximize public health outcomes by scaling up interventions in strategic and targeted ways, and provides a unique platform for exchange of ideas and learning to enhance the evidence base for translating effective PMTCT interventions into community- and population-level services and programs.

The articles in this special issue report on the collective learning of the Alliance and important results from implementation science studies—information that will help to move us closer to eliminating mother-to-child transmission of HIV in areas with the highest burden.


1. Joint United Nations Programme on HIV/AIDS. Fact Sheet 2016. Geneva, Switzerland: UNAIDS; 2016. Available at: http:// Accessed June 22, 2016.
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