In 2009, an estimated 400 000 children were newly infected with HIV, with 90% of infections occurring in children in sub-Saharan Africa through mother-to-child transmission (MTCT). Without any intervention, the risk of MTCT ranges from 20% to 45%; without any treatment, half of the babies will die before their second birthday. About 42 000 to 60 000 of pregnant women die from HIV. In contrast, in high-income countries, the number of new infections among children as well as the number of maternal and child deaths due to HIV are virtually zero.
It is possible to stop new HIV infections among children and keep their mothers alive if pregnant women living with HIV and their children have timely access to quality lifesaving antiretroviral drugs for their own health, as indicated, or as prophylaxis to stop HIV transmission during pregnancy, delivery and breastfeeding. When antiretroviral drugs are available as prophylaxis, mother-to-child transmission of HIV can be reduced to less than 5%. There is an urgent call for action by global and regional bodies as well as governments for the elimination of new HIV infections among children by 2015; this includes keeping mothers alive as well as sustaining children who are living with HIV.
With the vision of a generation alive and free of HIV and syphilis, the goal of this African regional framework is to eliminate new HIV infections among children by 2015 and keep their mothers alive. This framework outlines the aim, objectives, targets and priority actions for eliminating new HIV and syphilis infections in children in the African Region by 2015 and keeping their mothers alive. The framework is designed to provide countries in the Region with a systematic approach to the elimination of mother-to-child transmission of HIV (EMTCT) based on country typology (epidemiology and response) and improvement of maternal and child health and survival in the context of HIV/AIDS. The two targets to be achieved by 2015 are to reduce the number of new HIV infections among children by 90% from the 2009 baseline, and to reduce the number of AIDS-related maternal deaths by 50%.
The proposed priority actions for the EMTCT initiative are based on the following seven building blocks for accelerated actions: (i) ensure leadership and country ownership; (ii) improve coverage, access and utilization of services; (iii) strengthen quality of MNCH services to deliver effective PMTCT interventions; (iv) enhance provision of linked services; (v) strengthen human resource capacity, supply chain management and maintain information systems; (vi) improve measurement of performance and impact; and (vii) develop and engage community systems.
Monitoring and evaluation will be in line with the Global Monitoring and Evaluation Framework and Strategy for the Global Plan Towards the elimination of new HIV Infections by 2015. This Strategic Framework also relies on the global, regional and country milestones of Countdown to Zero: Global Plan towards elimination of new HIV infections among children by 2015 and keeping their mothers alive, 2011–2015. Clear targets, indicators, milestones, roles and responsibilities have been defined with the priority being measurements of progress linked to maternal, newborn and child health.
There is global and regional consensus for elimination of new HIV infections in children and keeping mothers alive, as well as support for linking these efforts with those aimed at eliminating congenital syphilis, given the similar modes of infection transmission and prevention interventions. Countries will require support to implement effective interventions for elimination of MTCT of both HIV and syphilis to ensure universal coverage which is cost-effective and sustainable. It is also vital to have adequate resources, empowerment of communities, and empowerment of women living with HIV to access the HIV prevention, treatment and care that they need for themselves, their children and their families. It is critical to ensure partner involvement while observing and respecting the rights of women living with HIV.
National and global leaders must act in concert to support country-driven efforts, accept joint accountability for delivering results, and ensure integration with other key efforts to improve MNCH services. This framework is a road map for accelerated action to enable each country in this Region, regardless of context or circumstances, to take concrete steps towards eliminating new HIV and syphilis infections among children and keeping their mothers alive.