BOX 4-3

Selected Examples of PEPFAR-Supported Activities Aimed at Preventing Mother-to-Child Transmission

In Kenya, PEPFAR-supported programs are adopting a family approach to reduce stigma, increase uptake of services, and improve adherence to ART through couples counseling and testing, male involvement, and community-based promotion of HIV care. In addition, pregnant women with World Health Organization (WHO) stage III and IV disease will be referred to comprehensive care centers for ART as a strategy for preventing mother-to-child transmission; these services will be provided in provincial, district, and high-volume health centers.

In Rwanda, PEPFAR is supporting the national program through interpersonal and mass media communications that promote early antenatal clinic attendance, delivery in health care facilities, safe infant feeding practices, early infant diagnosis, and male involvement.

In Nigeria, PEPFAR is supporting antenatal services, laboratories, and training of personnel involved in counseling and testing and obstetric and gynecologic services at designated hospitals. PEPFAR funding also covers the procurement of prophylactic antiretroviral medications and breastmilk substitutes, as well as the costs of laboratory tests for diagnosis and monitoring.

In Botswana, PEPFAR is supporting the expansion of psychosocial support services for women who are HIV-positive, their partners, and their families that include encouraging partners to be tested. This multicomponent project also supports a peer-counseling program, trains counselors to promote adherence to ART, offers support services to other people living with HIV/AIDS who are receiving ART, and links between ART programs and programs focused on prevention of mother-to-child transmission.

SOURCE: OGAC, 2006c.

According to OGAC, since the start of the program, PEPFAR has supported services to women during 6 million pregnancies to prevent mother-to-child transmission of HIV; and more than 533,000 of these women received antiretroviral prophylaxis. Overall, in the focus countries the proportion of eligible women who are receiving services to prevent mother-to-child transmission has increased from 2004 to 2006. Specifically, the proportion of eligible pregnant women receiving services such as counseling and testing has increased from 7 to 16 percent, and the proportion of HIV-positive pregnant women receiving antiretroviral prophylaxis has increased from 9 to 21 percent (OGAC, 2007).

Prevention of mother-to-child transmission is the only subcategory of prevention activities that has specific targets per country per year. Yet it is unclear how PEPFAR will factor these results into the model being used to

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