4. A ccelerate the introduction of new technologies for diagnostics and medicines Implementing the 2013 WHO guidelines on ARVs78 should be a priority for countries in order to streamline PMTCT and ART programming and simplify the provision and procurement of ARVs. Improved ARV formulations for children under the age of 3 years, such as ‘sprinkles’, are likely to be available in the near future and will need to be scaled up to help overcome the current limitations of paediatric HIV treatment. More effort is also needed to develop ART regimens that could be harmonized for use by infants and older children as well as adolescents and adults, such as scored dispersible fixed-dose combinations. Introducing new technologies that enable point-of-care virological testing for early infant diagnosis should also be a high priority. Innovations in the use of mobile phone technology are increasing efficiency by providing appointment reminders and health information and reducing turnaround time for laboratory results.
5. D ecentralize and integrate family-centred HIV services, including task shifting
INITIATIVES
In many countries ART services are provided at locations separate from those where maternal and
child health, family planning and other sexual and reproductive health services are provided. Improved integration of these services, including by decentralizing HIV testing, treatment and care to the primary-care level, is essential to strengthen the continuum of HIV care for women and children. WHO recommends task shifting as a critical tool to allow decentralization of treatment and care, and comparable clinical outcomes can be achieved when appropriate training and supervision are provided to non-physician health-care providers. Task shifting and task sharing are important strategies to optimize human resource capacity in settings with weak health systems.79 In particular, the initiation and maintenance of ARVs in women and children living with HIV in maternal and child health settings should contribute to increased access to treatment at the level of primary care and reduce loss to follow-up of women and children diagnosed with HIV in these settings.80 Integration through non-traditional channels such as the employment sector increasingly offers opportunities to reach more women through their participation in the workforce. With the wider backing of the International Labour Organization’s Convention No. 183 on maternity protection, 57 countries have national HIV workplace policies providing a potential platform to facilitate PMTCT and other HIV-related services.81
Integrating PMTCT with maternal and child health services In Rwanda, the integration of the national PMTCT programme into the country’s existing maternal and child health services has helped ensure that virtually all women receive their test results and doubled the proportion of HIV-exposed infants receiving ARV prophylaxis. Studies in some areas show that this figure increased from 47 per cent in 2007 to 96 per cent in 2011. Male involvement increased as well.82 In South Africa, where HIV testing was linked to an immunization programme, mothers involved in the programme reported feeling comfortable with having their infants tested at immunization clinics, and most would recommend it to others.83
19