AIDS-Free Generation: Success Story in the Making

20. November 2014

Key stakeholders from developed and developing countries continue to pursue new strategies to reduce the global disease burden of HIV. One key approach to help reduce HIV prevalence is to advance all aspects surrounding the prevention of mother-to-child transmission.

The World Health Organization (WHO) estimate 2.3 million people worldwide were newly infected with HIV in 2012 – representing a 33% decline since 2001; individuals from sub-Saharan Africa acquire 70% of all new infections. In 2012, 35.3 million people were living with HIV – with 9.7 million people in low- and middle-income countries receiving ART. As governments and other entities strive to improve access to antiretroviral therapy (ART), the number of individuals living with HIV increases, while deaths from AIDS-related causes decreases. One key approach to help reduce HIV prevalence is to advance all aspects surrounding the prevention of mother-to-child transmission (PMTCT).

To ultimately ensure that “no baby is born with HIV is an essential step towards achieving an acquired immune deficiency syndrome (AIDS)-free generation”. The first step in any newborn and child survival is improving maternal health and survival during pregnancy and childbirth. To this end, clinicians and healthcare workers aspire to pursue the elusive goal of sustainable outreach to pregnant females and HIV–positive mothers. These primary care providers support early prevention intervention and treatment optimization, assess the risk of “transmission of HIV from an HIV-positive mother to her child during pregnancy, labor, delivery or breastfeeding”, address health concerns, and ensure the safe and earlier initiation of triple-antiretroviral therapy (ART).

As of 2009, more than half of women (53%) in need had access to PMTCT programs. While control of HIV through the prophylaxis implementation of ART has been lauded as a “defining moment”, barriers persist in basic disease knowledge and testing availability in many countries. “HIV testing is often deferred due to a lack of public awareness, limited access to diagnostic tests, and cultural stigma”, said Elijah Paintsil, MD (Associate Professor of Pediatrics [Infectious Disease], Pharmacology  and Public Health, co-director of the Ghana-Yale Partnership for Global Health [GYPGH]), “Pregnant women with HIV often lack access to antiretrovirals, and existing information technology systems have limited capacity to monitor women and their babies from delivery, through the post-natal period, and beyond.”

Initial trial successes and steady and significant decreases in infections led to the goal of the “elimination of new HIV infections in children” as part of their global health sector strategy on HIV/AIDS. In July 2013, WHO further simplified these guidelines intended for use in low-and middle-income countries or resource-poor settings. The new treatment and infant-feeding guidelines also clarified treatment recommendations and emphasized placing pregnant women with HIV on treatment for life. Dr. Margaret Chan, Director-General WHO, stated that “A key way to accelerate progress is to start treatment earlier, as recommended in the guidelines. As the evidence now shows, earlier treatment brings the dual advantage of keeping people healthier longer and dramatically reducing the risk of virus transmission to others”. The guidelines drew in part from observational data, which indicated that earlier treatment benefited HIV patients by keeping them healthier longer, and two pivotal studies, HPTN 052 and the iPrEx study which showed that HIV-positive people who initiated ART at higher CD4 counts were about 96 percent less likely to transmit the virus. In spite of consolidated guidelines and increased government spending on ART and treatment of opportunistic infections, researchers state that even the best prevention campaigns may be starting HIV-positive mothers on treatment too late.

Taking another bold step forward, WHO recently issued global guidance not simply on prevention, but on criteria and processes for validation for the elimination of mother-to-child transmission (eMTCT) of HIV and syphilis. “Our country, Ghana, is already leading the way in eMTCT – our strategy is to test, treat, and track all HIV positive pregnancies and births in Ghana,” Dr. Paintsil said. “This was inspired by President John Dramani Mahama’s keynote address to the 2012 Summit on Elimination of Mother to Child Transmission (eMTCT) of HIV. We’ve launched an unprecedented public-private partnership aimed at making Ghana the first country in sub-Saharan Africa to eliminate Pediatric HIV.” The strategy is to Test, Treat, and Track all pregnancies in Ghana. [For more information watch this YouTube video from IBM Corporate Service Corps addressing HIV/AIDS in Ghana].

Ghana is among the 22 countries with the highest burden of HIV-infection in pregnant women, yet only possesses a single doctor per 10,000 population. Over the last decade Ghana has lowered the HIV/AIDS cause-specific mortality and morbidity rate by over 50% from 100 per 100 000 population in the year 2000 to 46 per 100,000 population in the year 2012 while also significantly lowering both incidence and prevalence. Researchers have noted that as of 2012, approximately 95 percent of pregnant Ghanaian women with HIV receive antenatal care during pregnancy; however, not all of them receive antiretrovirals to prevent MTCT. The initial objective is to reduce the rate of mother to child transmission of HIV in Ghana from its current level of 15% to less than 5% by 2018, which would meet the WHO criterion for elimination. The ultimate goal is a reduction in the rate of MTCT to less than 1% by 2020.

Ghana is not alone in the pursuit of the elimination of MTCT. They have recognized the need to harness the innovation and efficiency offered by a cross-transfer of public and private sector skills. The international public-private partnership consortium leading the fight on eMTCT of HIV in Ghana draws on the unique expertise, experience, and technical capacity of the Ministry of Health of Ghana, Ghana Health Service, Yale University, IBM, The ONE Campaign and the Institute for Life Sciences Collaboration. In addition to this collaborative effort, several local partners, including the Ghana AIDS Commission, Christian Health Association of Ghana, the National House of Chiefs, and the Rotary Club of Ghana will be playing critical roles at various stages towards the success of the consortium’s objective – which is to establish a robust information technology infrastructure, streamline existing healthcare resource allocations, raise public awareness, and build human capacity to ensure the efficient use of resources to enabling women and children at risk of HIV & AIDS to benefit from state of the art care.

For more information on how to join this effort to eliminate eMTCT of HIV and help create an AIDS-free generation in Ghana through a unique public-private partnership, I invite you to please contact Elijah Paintsil, MD directly and the team at the Institute for Life Sciences Collaboration.

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General medicine, Medicine

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