Vertical Transmission Prevention
What is Vertical Transmission for HIV Prevention?
Vertical transmission of HIV (also known as mother to child transmission and abbreviated as ‘MTCT’) has been virtually eliminated in the global North. This is because treatment to prevent HIV infection in newborns has been available for over a decade. The treatment involves is providing a simple, affordable bio-medical intervention, providing ARV drugs to mother and child at birth, to a highly visible and easy to reach target population. Research into improved design of vertical transmission services at birth and during breastfeeding remain an important goal in reducing infant HIV infection.
Vertical Transmission Prevention Investment
Funding for research related to prevention of vertical transmission of HIV from mother to child at birth and during breastfeeding increased nominally between 2012 and 2013, from US$43.8 million to US$44 million. The public sector accounted for most of this funding, with the US, through NIH and USAID, contributing nearly 95 percent.
In July 2013, the WHO issued new guidelines on treatment for preventing mother-to-child transmission and on HIV and breastfeeding. These 2013 guidelines recommend that countries follow Option B+, and in countries where this is not feasible, Option B (Box 9). Option B+ recommends that all HIV-infected pregnant and breastfeeding women are eligible for lifelong antiretroviral therapy (ART) regardless of CD4 count. The largest research grants towards vertical transmission prevention R&D in 2013 continued to look at program optimization in order to meet the WHO recommendations.
Benefits of Option B+ include provision of more effective treatment regimens for pregnant women, reduction in vertical transmission through early treatment access, reduced morbidity and mortality of those on treatment and fewer orphans and vulnerable children. Combining these benefits, PEPFAR funded the Futures Group to look at the long-term effects of implementing Option B+, and projections showed that vertical transmission can be nearly eliminated. However, the question remains as to how countries will fund Option B+.
Additional research endeavors are exploring: the ways ARVs function in prevention of vertical transmission, both at birth and through breastfeeding; retention and recruitment of women and infants in prevention of vertical transmission; and basic research, such as functional correlates of vertical transmission and mechanisms of transmission in breast milk.