The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping their Mothers Alive, adopted by the United Nations High Level Meetings on AIDS in 2011, set a goal of reducing the number of new HIV infections among children by 90% and AIDS-related deaths among pregnant women by 50% (UNAIDS, 2011). Although great strides have been made in reaching these goals, vertical HIV transmission to infants remains unacceptably high in many countries, and attrition along the PMTCT cascade remains high.
A number of studies have identified significant barriers to PMTCT, including individual-level factors (e.g. physical and mental health), factors at the family and social level (e.g. stigma and fear of disclosure of HIV status), and structural factors (e.g. socioeconomic factors, barriers associated with healthcare facilities). Families and male partners play a critical role in supporting women in accessing PMTCT and adhering to treatment, and lack of male support has often been noted. Family and partner support will only become more critical as PMTCT programs transition to initiating HIV-positive pregnant women on immediate and lifelong ART under Option B+.
This review focuses on Prong 2 of PMTCT (family planning for HIV-positive women) and especially on community based approaches to Prong 4 (HIV care, treatment, and support for women and children living with HIV and their families). Interventions were reviewed which addressed seven steps in the PMTCT cascade, starting with initiation of ANC care for all pregnant women and ending with ART adherence for HIV-positive mothers and infants. Interventions were identified which addressed each step of the cascade at the community level (and mostly utilizing community health workers), and most interventions addressed multiple steps. The most frequently targeted step in the PMTCT cascade was HIV testing. Community-based, community health worker-led interventions consistently showed impact on PMTCT indicators, suggesting that such approaches have great potential to further increase PMTCT coverage and decrease vertical HIV transmission.