CSWG Policy Brief: Strategies to improve retention of mother-baby pairs in PMTCT programs

Approximately half of HIV infections among children take place during breastfeeding. While there has been success in retaining pregnant women on antiretroviral therapy (ART) during pregnancy, there has been inadequate focus on retention support to
mother-baby pairs (MBPs) during the breastfeeding period.

Literature shows that the majority of MBPs not retained in prevention of mother-to-child transmission (PMTCT) programs are due to loss to follow-up (LTFU) rather than death. These children are at higher risk of vertical acquisition of HIV compared to breastfeeding infants who remain in care. Current postpartum LTFU rates limit successful implementation of PMTCT programs in sub-Saharan Africa. Cumulative sub-Saharan Africa PMTCT LTFU rates in 2011 were estimated to range from 20-28% during antenatal care, then sharply increase to 70% at four months postpartum and reach approximately 81% six months after birth.

Given these staggering statistics, the quality and effectiveness of PMTCT services should include an assessment of the proportion of MBPs retained in care and early infant diagnosis (EID) rates.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more.

CSWG Policy Brief: Addressing the service delivery needs of children of key populations

Motherhood is common among female sex workers (FSWs) and many have at least one biological child. People who inject drugs (PWID), men who have sex with men (MSM) and transgender people (TG) are also part of families and have at-risk spouses and children in their households. Stigma and discrimination towards key populations (KP) can negatively impact their children’s access to health, education and protection services. Program data from Cameroon, Ethiopia and Tanzania reflect positivity rates of 4-6 per cent when children of FSWs are tested for HIV.  Access to early infant diagnosis (EID), HIV testing and treatment and other critical health, social and economic strengthening interventions for children of KP and their families must be improved as a priority.

This is part of a series of 12 policy briefs by the Child Survival Working Group on scaling up key interventions for children and adolescents living with HIV. Learn more

Social Protection Policy Briefs - UNICEF, RIATT_ESA, the Coalition (2018)

Social Protection and HIV: Research Implications for Policy by UNICEF, the Eastern and Southern Africa Regional Inter-Agency Task Team on Children Affected by AIDS (RIATT-ESA) and the Coalition for Children Affected by AIDS contain the following six briefs:

1: How can Social Protection reduce adolescent HIV-risk?

2: Combination Social Protection improves adolescent ART-adherence

3: Combination Social Protection reduces HIV-risk in adolescents

4: Social Protection: potential for improving HIV outcomes among adolescents

5: Social Protection and the Sustainable Development Goals

6: Combination Social Protection lowers unprotected sex in HIV-positive adolescents

HIV-sensitive Social Protection - ESAR Report (2018)

HIV-sensitive Social Protection: With focus on creating linkages between social cash transfer programmes and HIV services describes an intervention aiming to strengthen the linkages between HIV services and national social protection programmes and provides lessons learned from implementing the intervention in four countries. The focus of the programme is on families with children and adolescents, vulnerable to, or affected by HIV and AIDS. The programme, funded by the Government of the Netherlands, is now being implemented in Malawi, Mozambique, Zambia and Zimbabwe in close collaboration with national, provincial and district level governments.

All In in ESA: Catalysing the HIV Response for Adolescents

Building on the collaborative effort that resulted in tremendous progress in scaling up lifesaving anti-retroviral treatment and preventing mother-to-child transmission of HIV in Eastern and Southern Africa region (ESAR), UNAIDS and UNICEF launched a campaign titled All In to End Adolescent AIDS (All In) in 2015 in Nairobi, Kenya.

This report highlights how All In mobilized partners, engaged adolescents and young people and influenced policies and programmes in the 14 high-burden HIV countries in ESAR. The report documents the progress made in a few short years on adolescent HIV, and offers suggestions and recommendations on how to strengthen strategic information, apply evidence-based programming and mobilize resources for adolescents in the HIV response. 

Eswatini National Strategic Plan for Ending AIDS and Syphilis in Children (2018 – 2022)

The Kingdom of Eswatini (formerly Swaziland) released its National Strategic Plan for Ending AIDS and Syphilis in Children (2018 – 2022). This strategy aligns with the ‘Three Frees’ Framework and aims to make a final push towards the elimination of mother-to-child transmission of HIV and syphilis as well as an end to paediatric AIDS.

This Plan has been designed to ensure that every child is born and remains HIV and syphillis free, and that every pregnant woman or mother living with HIV have access to lifelong HIV treatment. In addition, every child and adolescent living with HIV should be linked to quality HIV treatment, care and support to realize their full potential without stigma and discrimination.

HIV and infant feeding in emergencies: operational guidance (2018)

Many millions of people around the world are affected by emergencies, the majority of whom are women and children. Among them are many who are known to be living with HIV and others who may not know their HIV status.

The purpose of this document is to provide operational guidance on HIV and infant feeding in emergencies. It is intended to be used to complement emergency and sectoral guidelines on health, nutrition and HIV, including specifically infant feeding, prevention of mother-to-child transmission of HIV and paediatric antiretroviral treatment.

The envisaged target audience consists of decision makers, policymakers, national and subnational government managers and planners, managers of refugee camps and similar settlements for displaced persons, and managers and planners in United Nations agencies, nongovernmental organizations and other groups responding to humanitarian situations.

This operational guidance is based on a consultation convened by the WHO, UNICEF and the Emergency Nutrition Network in Geneva in September 2016, which brought together a cross-section of senior-level participants from United Nations agencies, government, nongovernmental organizations, academia, and other agencies working in nutrition and HIV in emergencies. This document sets out basic principles related to HIV and infant feeding in emergency settings, and the actions that government and other stakeholders can take to prepare for emergencies.