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Review
. 2015 Oct 21;12(10):13224-39.
doi: 10.3390/ijerph121013224.

Elimination of Mother-To-Child Transmission of HIV Infection: The Drug Resource Enhancement against AIDS and Malnutrition Model

Giuseppe Liotta  1 , Maria Cristina Marazzi  2 , Khethimipilo E Mothibi  3 , Ines Zimba  4 , Evelyne E Amangoua  5 , Esther K Bonje  6 , Bernard N B Bossiky  7 , Precious A Robinson  8 , Paola Scarcella  9 , Kebby Musokotwane  10 , Leonardo Palombi  11 , Paola Germano  12 , Pasquale Narciso  13 , Andrea de Luca  14 , Elard Alumando  15 , Sangare H Mamary  16 , Nurja A Magid  17 , Giovanni Guidotti  18 , Sandro Mancinelli  19 , Stefano Orlando  20 , Marco Peroni  21 , Ersilia Buonomo  22 , Karin Nielsen-Saines  23
Affiliations
Review

Elimination of Mother-To-Child Transmission of HIV Infection: The Drug Resource Enhancement against AIDS and Malnutrition Model

Giuseppe Liotta et al. Int J Environ Res Public Health. .

Abstract

The Drug Resource Enhancement against AIDS and Malnutrition Program (DREAM) gathered professionals in the field of Elimination of HIV-Mother-To-Child Transmission (EMTCT) in Maputo in 2013 to discuss obstacles and solutions for the elimination of HIV vertical transmission in sub-Saharan Africa. During this workshop, the benefits of administrating combined antiretroviral therapy (cART) to HIV positive women from pregnancy throughout breastfeeding were reviewed. cART is capable of reducing vertical transmission to less than 5% at 24 months of age, as well as maternal mortality and infant mortality in both HIV infected and exposed populations to levels similar to those of uninfected individuals. The challenge for programs targeting eMTCT in developing countries is retention in care and treatment adherence. Both are intrinsically related to the model of care. The drop-out from eMTCT programs before cART initiation ranges from 33%-88% while retention rates at 18-24 months are less than 50%. Comprehensive strategies including peer-to-peer education, social support and laboratory monitoring can reduce refusals to less than 5% and attain retention rates approaching 90%. Several components of the model of care for reduction of HIV-1 MTCT are feasible and implementable in scale-up strategies. A review of this model of care for HIV eMTCT is provided.

Keywords: DREAM program; elimination of HIV MTCT.

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Figures

Figure 1
Figure 1
DREAM centers in Sub-Saharan Africa.
Figure 2
Figure 2
Patients receiving care at DREAM centers in Mozambique over the years.
Figure 3
Figure 3
HIV+ pregnancies and HIV-exposed infants followed in DREAM centers in Mozambique over time.
Figure 4
Figure 4
Mean virus load (and 95% CL) of DREAM program pregnant patients at one of our centers over time. CL: Confidence Limits.
Figure 5
Figure 5
Electronic medical records.
See this image and copyright information in PMC

References

    1. Plano Estrategico Nacional de Resposta ao HIV e Sida 2010–2014—Republica de Moçambique. [(acessed on 5 April 2015)]. Available online: http://www.cncs.org.mz/.../PlanoEstrategicoNacional_PENIII_2010junho.pdf.
    1. Joint United Nations Program on HIV and AIDS—UNAIDS UNAIDS Report on the Global AIDS Epidemic 2013. [(accessed on 2 April 2015)]. Available online: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiolo....
    1. UNAIDS World AIDS Day Report 2011. [(accessed on 5 April 2015)]. Available online: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspubl....
    1. WHO—EMTCT Strategic Vision 2010/2015 Preventing Mother-to-Child Transmission of HIV to Reach the UNGASS and Millennium Development Goals, February 2010. [(accessed on 5 April 2015)]. Available online: http://www.who.int/hiv/pub/mtct/strategic_vision/en/index.html.
    1. UNICEF—Mozambique HIV/AIDS in Children. [(accessed on 6 April 2015)]. Available online: http://www.unicef.org/mozambique/hiv_aids_2968.html.

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