INITIATIVES
Lifelong ART for pregnant women: Malawi blazes the trail In 2011, the Government of Malawi pioneered offering lifelong simplified treatment for all pregnant and breastfeeding women (previously known as Option B+) using a provider-initiated (not mandatory) ‘test and treat approach’, regardless of CD4 count or any other preconditions. Children under 5 years of age are also prioritized in this way, without preconditions. For pregnant women living with HIV, simplified treatment, which consists of a fixed-dose, single-pill, triple-drug regimen taken once per day, was made widely available, including through lower-level health-care facilities. The number of pregnant and breastfeeding women living with HIV started on ART had increased from 1,257 in the second quarter of 2011, to 10,663 in the third quarter of 2012.65 By June 2013, 13 of the 22 Global Plan priority countries had adopted the same policy of offering lifelong ART for all pregnant and breastfeeding women living with HIV, and Lesotho and Uganda (besides Malawi) had already started to implement the approach. Further country progress details are available from the website of the Inter-Agency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers and Children: <www.emtct-iatt.org>.
TOWARDS AN AIDS-FREE GENERATION – Children and AIDS: Sixth Stocktaking Report, 2013
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Harmonizing ARV drug regimens for pregnant and breastfeeding women, and other adults and adolescents, living with HIV: Previous WHO guidelines recommended different adult ARV regimens for PMTCT and for treatment. The 2013 WHO guidelines on ARVs recommend the same, fixed-dose, single-pill, triple-drug regimen for all adults and adolescents as first-line therapy. This approach will simplify the delivery of ART for both treatment and prevention and enable pregnant women living with HIV to continue on the same drug regimen for their own health. The experience of Malawi suggests that the simplified regimen is easier to take and that it improves adherence, while also aligning PMTCT and ART services and promoting access to these services in primary-care facilities.66 Expanding ART delivery in antenatal, maternal and child health settings: The 2013 WHO guidelines on ARVs67 include a specific recommendation that, in generalized epidemics, ART should be initiated and maintained in eligible pregnant and post-partum women and infants in maternal and child health-care settings,
with linkage and referral to ongoing HIV care and ART where appropriate. Governments are responding by implementing task-shifting measures to enable midwives and other cadres to initiate and follow up on ART.68
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Making use of new technologies for infant testing: Diagnostic technologies are now advancing rapidly. In the coming years, point-of-care virological tests for early infant diagnosis should become available, which will allow nurses and other non-physician health workers to test infants at lower-level health facilities, without the need to send samples to central laboratories for processing. This important advance should enable more timely identification of HIV-infected infants and promote more rapid linkage to treatment and care.
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Recommending lifelong ART for all children under 5 years of age, regardless of CD4: Infants and children are vulnerable to rapid progression of HIV-related disease. Left untreated, half of children born with HIV will die before their second birthday. In order to facilitate rapid