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MTCT-Plus Program Has Two Goals: End Maternal HIV Transmission + Treat Mothers

MTCT-Plus Program Has Two Goals: End Maternal HIV Transmission + Treat Mothers When it comes to reducing transmission of HIV to newborns in resource-poor countries, are health care workers throwing the mother out with the bath water? Worldwide more than 1500 children per day become infected with HIV through mother-to-child transmission (MTCT). Low-cost, effective therapies can reduce this grim statistic. But pregnant women with HIV who receive little or no care for their illness may be less likely to seek treatment to avoid infecting their expected children. A new effort, MTCT-Plus, funded by private philanthropic foundations, hopes to change this dynamic. View LargeDownload A girl holds her baby sister at the edge of a sugarcane field near Hlabisa in South Africa's Kwazulu-Natal province, one of the world's worst AIDS hotspots. AIDS has left many children here without parents. (Photo credit: Malcolm Linton/Getty Images) The 5-year demonstration project is intended to show that HIV treatment can be effectively delivered to pregnant women in resource-poor countries—initially those in sub-Saharan Africa. The program, with a $100 million fundraising goal, is a direct response to the Declaration of Commitment on HIV/AIDS by the United Nations General Assembly Special Session held in June 2001. Already committed to the MTCT-Plus project are the foundations of Bill and Melinda Gates, William and Flora Hewlett, Robert Wood Johnson, the Henry J. Kaiser Family, John D. and Catherine T. MacArthur, and David and Lucile Packard, as well as the Rockefeller and United Nations' foundations. MTCT-Plus will work through existing MTCT programs that use well-established treatments, including single doses of nevirapine administered to the pregnant mother and infant. Nevirapine cuts rates of maternal transmission of the virus by almost 50% (Lancet. 1999;354:795-802). What is added? The "Plus" component provides an essential care package with appropriate therapies for mothers. "Plus" therapies include basic care for prevention and/or treatment of HIV-related opportunistic infections and treatment with antiretroviral drugs. In time, MTCT-Plus hopes to include treatment for HIV-infected family members of participating mothers and children. The program does not specifically address the vexing question of transmission of HIV through breastfeeding. MTCT-Plus is based at Columbia University's Mailman School of Public Health in New York City and is coordinated by Allan Rosenfield, MD, the school's dean. "MTCT programs are good low-cost initiatives that are easy to put in place—you give a single pill to the mother and a dose to the baby," Rosenfield said. "But how ethical is it to give a drug to the mother to save the child and then throw the mother aside?" Rosenfield became interested in the maternal component of MTCT 17 years ago when he published, "Maternal Mortality—A neglected tragedy: Where is the M in MCH?" (Lancet. 1985;ii:83-85). How will it work? In the first phase of MTCT-Plus, 10 to 20 existing MTCT programs will serve as demonstration sites. These sites, which are being announced this month, must be in resource-poor areas where HIV prevalence in pregnant women is greater than 5%. They must provide voluntary testing and counseling, standard obstetric, gynecologic, maternal, and pediatric care, and reproductive health and nutritional services. Each site will be given about $200 000 annually for personnel, training, laboratory costs, operational support, and minor infrastructure needs. MTCT-Plus will provide technical assistance, additional staff training if required, oversight, and drugs—including antiretroviral therapy. There are fairly strict requirements to be met by MTCT-Plus program applicants. For example, the program mandates that demonstration sites follow a standardized MTCT-Plus HIV care package protocol and not administer therapies developed locally. Rosenfield said this is important to show that MTCT-Plus works. "We're not testing for drug efficacy," Rosenfield said. "We're looking at operations—how to put a program in place." He added that researchers will perform outcomes evaluations once the program is under way. Establishing a program that maximizes provision of low-cost, effective, HIV/AIDS treatment is critical because the epidemic, especially in resource-poor countries, continues to grow. According to the United Nations Global Programme on AIDS (UNAIDS), in 2001, about 2.6 million pregnant women worldwide were infected with HIV and more than 500 000 transmitted the virus to their infants. UNAIDS reports that several parts of southern Africa have joined Botswana in having HIV prevalence rates among pregnant women that exceed 30%. Many of those women are not seeking treatment that would keep their children from being born infected with HIV. UNAIDS noted a study in Abidjan, Côte d'Ivoire, showing that 80% of pregnant women who agree to having an HIV test performed return to learn their result, but of those who discover they are infected, fewer than 50% return to receive drug treatment for the prevention of mother-to-child-transmission of the virus. MTCT-Plus will not turn the tide in the fight against AIDS by itself. If it reaches its fundraising target (it now has just over $50 million), the program will be able to enroll only 30 000 infected women, children, and other family members. But Rosenfield hopes that MTCT-Plus will serve as a model that can be incorporated into other programs to treat the millions of people infected with HIV. During testimony on April 11 before the US Senate Committee on Health, Education, Labor and Pensions, Rosenfield noted the small impact MTCT-Plus will have on the number of HIV-infected persons and argued that that was a good reason to turn it from a private philanthropic endeavor into a private-public enterprise. "We urge you to join us in a public-private partnership to expand this effort and to make HIV care and treatment available to the women and families who so desperately need our help," Rosenfield said. Such testimony may have gotten the ear of President George W. Bush. The president announced June 19 that the United States would spend $500 million during the next 2 years to prevent MTCT of HIV in 12 African nations and others in the Caribbean. Rosenfield supported the announcement. "It is good that the Bush administration is beginning to focus on MTCT—this is a step in the right direction," Rosenfield said. "We're also hopeful there will be some of the funding directed to mothers for care after they give birth." http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

MTCT-Plus Program Has Two Goals: End Maternal HIV Transmission + Treat Mothers

Mitka, Mike
JAMA , Volume 288 (2) – Jul 10, 2002
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Publisher
American Medical Association
Copyright
Copyright © 2002 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.288.2.153-JMN0710-2-1
Publisher site
See Article on Publisher Site

Abstract

When it comes to reducing transmission of HIV to newborns in resource-poor countries, are health care workers throwing the mother out with the bath water? Worldwide more than 1500 children per day become infected with HIV through mother-to-child transmission (MTCT). Low-cost, effective therapies can reduce this grim statistic. But pregnant women with HIV who receive little or no care for their illness may be less likely to seek treatment to avoid infecting their expected children. A new effort, MTCT-Plus, funded by private philanthropic foundations, hopes to change this dynamic. View LargeDownload A girl holds her baby sister at the edge of a sugarcane field near Hlabisa in South Africa's Kwazulu-Natal province, one of the world's worst AIDS hotspots. AIDS has left many children here without parents. (Photo credit: Malcolm Linton/Getty Images) The 5-year demonstration project is intended to show that HIV treatment can be effectively delivered to pregnant women in resource-poor countries—initially those in sub-Saharan Africa. The program, with a $100 million fundraising goal, is a direct response to the Declaration of Commitment on HIV/AIDS by the United Nations General Assembly Special Session held in June 2001. Already committed to the MTCT-Plus project are the foundations of Bill and Melinda Gates, William and Flora Hewlett, Robert Wood Johnson, the Henry J. Kaiser Family, John D. and Catherine T. MacArthur, and David and Lucile Packard, as well as the Rockefeller and United Nations' foundations. MTCT-Plus will work through existing MTCT programs that use well-established treatments, including single doses of nevirapine administered to the pregnant mother and infant. Nevirapine cuts rates of maternal transmission of the virus by almost 50% (Lancet. 1999;354:795-802). What is added? The "Plus" component provides an essential care package with appropriate therapies for mothers. "Plus" therapies include basic care for prevention and/or treatment of HIV-related opportunistic infections and treatment with antiretroviral drugs. In time, MTCT-Plus hopes to include treatment for HIV-infected family members of participating mothers and children. The program does not specifically address the vexing question of transmission of HIV through breastfeeding. MTCT-Plus is based at Columbia University's Mailman School of Public Health in New York City and is coordinated by Allan Rosenfield, MD, the school's dean. "MTCT programs are good low-cost initiatives that are easy to put in place—you give a single pill to the mother and a dose to the baby," Rosenfield said. "But how ethical is it to give a drug to the mother to save the child and then throw the mother aside?" Rosenfield became interested in the maternal component of MTCT 17 years ago when he published, "Maternal Mortality—A neglected tragedy: Where is the M in MCH?" (Lancet. 1985;ii:83-85). How will it work? In the first phase of MTCT-Plus, 10 to 20 existing MTCT programs will serve as demonstration sites. These sites, which are being announced this month, must be in resource-poor areas where HIV prevalence in pregnant women is greater than 5%. They must provide voluntary testing and counseling, standard obstetric, gynecologic, maternal, and pediatric care, and reproductive health and nutritional services. Each site will be given about $200 000 annually for personnel, training, laboratory costs, operational support, and minor infrastructure needs. MTCT-Plus will provide technical assistance, additional staff training if required, oversight, and drugs—including antiretroviral therapy. There are fairly strict requirements to be met by MTCT-Plus program applicants. For example, the program mandates that demonstration sites follow a standardized MTCT-Plus HIV care package protocol and not administer therapies developed locally. Rosenfield said this is important to show that MTCT-Plus works. "We're not testing for drug efficacy," Rosenfield said. "We're looking at operations—how to put a program in place." He added that researchers will perform outcomes evaluations once the program is under way. Establishing a program that maximizes provision of low-cost, effective, HIV/AIDS treatment is critical because the epidemic, especially in resource-poor countries, continues to grow. According to the United Nations Global Programme on AIDS (UNAIDS), in 2001, about 2.6 million pregnant women worldwide were infected with HIV and more than 500 000 transmitted the virus to their infants. UNAIDS reports that several parts of southern Africa have joined Botswana in having HIV prevalence rates among pregnant women that exceed 30%. Many of those women are not seeking treatment that would keep their children from being born infected with HIV. UNAIDS noted a study in Abidjan, Côte d'Ivoire, showing that 80% of pregnant women who agree to having an HIV test performed return to learn their result, but of those who discover they are infected, fewer than 50% return to receive drug treatment for the prevention of mother-to-child-transmission of the virus. MTCT-Plus will not turn the tide in the fight against AIDS by itself. If it reaches its fundraising target (it now has just over $50 million), the program will be able to enroll only 30 000 infected women, children, and other family members. But Rosenfield hopes that MTCT-Plus will serve as a model that can be incorporated into other programs to treat the millions of people infected with HIV. During testimony on April 11 before the US Senate Committee on Health, Education, Labor and Pensions, Rosenfield noted the small impact MTCT-Plus will have on the number of HIV-infected persons and argued that that was a good reason to turn it from a private philanthropic endeavor into a private-public enterprise. "We urge you to join us in a public-private partnership to expand this effort and to make HIV care and treatment available to the women and families who so desperately need our help," Rosenfield said. Such testimony may have gotten the ear of President George W. Bush. The president announced June 19 that the United States would spend $500 million during the next 2 years to prevent MTCT of HIV in 12 African nations and others in the Caribbean. Rosenfield supported the announcement. "It is good that the Bush administration is beginning to focus on MTCT—this is a step in the right direction," Rosenfield said. "We're also hopeful there will be some of the funding directed to mothers for care after they give birth."

Journal

JAMA – American Medical Association

Published: Jul 10, 2002

Keywords: mothers,hiv transmission

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