transmission of HIV in low- and middle-income countries was 48% [44–54%] in 2010. In addition, 11% pregnant women, more than 150 000, received single dose nevirapine, a regimen which is no longer recommended by WHO (Fig. 7.7 and table 7.5). The proportion trend analysis is limited as estimated coverage from previous years included single dose nevirapine (14% [13-16%] in 2005; 48% [43–54%] in 2008). Progress on the coverage of antiretroviral medicine for preventing mother-to-child transmission at the national level can mask significant inequality within countries. For example, in Ukraine, the use of antiretroviral medicine for preventing mother-to-child transmission among people who inject drugs and other people, respectively, was: none 12% versus 5%; single-dose nevirapine only 27% versus 9%; zidovudine and singledose nevirapine 45% versus 68%; and antiretroviral therapy 16% versus 18% (52). The 2001 Declaration of Commitment on HIV/AIDS set a target of 80% coverage of antiretroviral medicine
Box 7.12 Antiretroviral regimens Data from the 101 countries reporting disaggregated data show that the proportion of pregnant women living with HIV receiving only single-dose nevirapine decreased substantially between 2007 and 2010 (Fig. 7.8).
Fig 7.8 Percentage distribution of various regimens provided to pregnant women who have received antiretroviral drugs to prevent mother-to-child transmission in low- and middle-income countries, 2007, 2009 and 2010 z Single-dose nevirapine 100 30% 49% 18% z Most effective 90
80
57%
Percentage (%)
70 54%
60 50
33%
40 30 23%
20 10
9% 9%
0 2007
15% 1%
2%
2009
2010
z z
prophylactic regimens Antiretroviral therapy Uncategorized
to reduce mother-to-child transmission by 2010. The target has nearly been achieved in Eastern Europe and Central Asia (with a coverage with the most efficient regimens) of 79%. In Eastern and southern Africa, the sub-region with the highest number of pregnant women living with HIV has achieved 64% coverage (Fig. 7.7 and Table 7.7). But, in addition, 13% of women only received a single dose of nevirapine instead of the most effective regimens recommended by WHO. Coverage remained low in western and central Africa (18%) and North Africa and the Middle East (4%) and in Asia (16%), where most women continue to receive only single-dose nevirapine.
Box 7.13 Monitoring progress on providing antiretroviral medicine to prevent the mother-to-child transmission of HIV Providing antiretroviral medicine to pregnant women living with HIV is a key intervention of programmes for preventing the mother-to-child transmission of HIV. However, at the national and global levels, accurately monitoring the number of women receiving antiretroviral medicine and the type of regimens received is challenging. Women needing lifelong antiretroviral therapy may not access antiretroviral therapy at the same place where antiretroviral prophylaxis is provided, which can result in not including all relevant data on preventing mother-to-child transmission or double-counting when data from different sources are aggregated. When antiretroviral medicine is provided to the same woman or mother–child pair across various service delivery points (for example, at facilities providing antenatal care, labour and delivery services, child health services or HIV care and treatment services), data points may be double counted. Data recording forms may not be able to collect the various types of regimens received, especially when antiretroviral guidelines may have recently been revised or if reporting to the subnational or national levels on the types of regimens delivered is not required, making it impossible to categorize the regimen provided, especially if a mix of regimens is being provided within a country. Thus, some countries may not have monitoring systems that allow the coverage of antiretroviral medicine for preventing mother-to-child transmission to be accurately recorded and reported. In addition to improving existing monitoring mechanisms for adequately monitoring the provision of antiretroviral medicine for preventing mother-to-child transmission, the provision of antiretroviral medicine now needs to be monitored during the breastfeeding period, in accordance with the 2010 guidelines on antiretroviral medicine for preventing mother-to-child transmission (1)). More work is needed at the country level, and as part of global reporting mechanisms, to standardize reporting of the types of regimens received by mother–baby pairs.
Chapter 7 – Scaling up HIV services for women and children: Towards eliminating mother-to-child transmission and improving maternal and child health in the context of HIV
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