Michael Marco

Much success has been made over the years in the prevention of mother to child transmission (PMTCT) in middle- and low-income countries. This session explored a broad range of important factors relating to pregnancy issues for HIV-positive women and outcomes of early infant diagnosis (EID).

A South African study demonstrated the initial success of a “safer conception clinic.” Tailored safer conception care from nurses were offered to serodifferent and seroconcordant couples. While no HIV transmissions were observed, HIV-positive women were less likely to conceive than HIV-negative women and risk of miscarriage was high. A Cameroon study documented that the MTCT rate is inaccurately measured when only focusing on a conventional EID testing point. Over half of infants identified as HIV-positive were tested in non-PMTCT entry points. A large study from Lesotho exploring outcomes of Option B+ documented a 1.3% transmission rate at six weeks with comparable survival between HIV-exposed infants and HIV-unexposed infants. However, prematurity among infants born to HIV-positive mothers was higher. Another Option B+ MTCT study from Malawi found that EID testing within 2 months of birth was associated with higher education, disclosure of mother´s HIV-positive status to family, and cotrimoxazole use.

This session was filled with high quality studies from low- and middle-income countries. There were many lessons learned, namely that Option B+ is extremely effective in a variety of settings. Likewise, safer conceptions clinics should be expanded, and issues surrounding prolonged attempted conception for HIV-positive women highlights the need for approaches to reduce onward transmission risks. As for important EID strategies, it is readily apparent that testing infants at multiple entry points is essential in order to assist in better linkage to care and treatment.