Monitoring and evaluation of programmes to prevent mother to child transmission of HIV in Africa

Abstract

Strategy to prevent transmissionEstimates of the efficacy of antiretroviral prophylaxis3 suggest that at least half of the world's children who are at risk of HIV infection might be protected if a mother receives antenatal care, is offered HIV counselling and testing, and, if infected, she and her baby receive prophylaxis. Prophylaxis is the mainstay of the strategy to prevent mother to child transmission.3 Several antiretroviral regimens are recommended in resource constrained settings, although nevirapine (either alone or with other drugs) is usually favoured because it is cheap, easy to administer, rapidly absorbed, and has a long half life.3 Depending on the regimen and the mother's choice of infant feeding, the risk of HIV transmission can be reduced to <2%.3 Whenever feasible, programmes should strive to provide highly active antiretroviral therapy to pregnant women. Although formula feeding can reduce HIV infection rates among infants,4 it is often not acceptable, feasible, affordable, sustainable, or safe in resource limited settings.5 6 Programmes should provide counselling and support on various feeding options (including exclusive breastfeeding), highlighting the potential benefits and risks of each.7 Other activities include promotion of optimal obstetrical practices; improvement of antenatal, postnatal, and child health services; and treatment of maternal diseases. Community based activities are also often implemented to improve community knowledge of HIV and AIDS and counter negative attitudes to people with HIV.8