was moderately correlated with HIV-free survival of 24-month-old children, and that a potent ARV regimen was the co-factor most strongly associated with the prevention of vertical transmission and child survival at 24 months (Stringer et al., 2013).

Interviewees from country visits consistently noted the increase in PMTCT services over time and the impact of this on reducing HIV transmission to infants, and they emphasized PEPFAR’s contribution to this achievement (240-13-PCGOV; 331-38-USPS; 587-2-USG; 587-5-PCGOV; 636-2-USG; 636-9-USACA; 636-16-USG; 272-22-USG; 272-24-USG; 461-4-USG; 461-17-PCNGO; 934-17-PCGOV).

Conclusion: PEPFAR support for the scale-up of services for prevention of MTCT has made a major contribution to meeting the need in partner countries.

Even with the major increase over time in the number of pregnant women receiving services, the data in Figure 5-4 and Table 5-4 also show that overall coverage for PMTCT is still well below what is needed in PEPFAR partner countries. Overall coverage of PMTCT services from all actors in the response was less than 50 percent in 2009 in the 31 countries under review, which is well below PEPFAR’s stated goal of supporting the provision of ARV prophylaxis for PMTCT for 85 percent of eligible women by 2013. This is consistent with the reality that, given the current rate of global scale-up, the world is not on track to meet the global target of 80 percent coverage in the near future.

Indeed, despite the large scale-up and increase in access to PMTCT, challenges remain with PMTCT service delivery and access. Studies on PMTCT services in PEPFAR partner countries have identified sub-optimal coverage and follow-up rates and have noted contributing factors such as socioeconomic factors, staff shortages, adherence, and other service delivery factors (Azcoaga-Lorenzo et al., 2011; Bancheno et al., 2010; Colvin et al., 2007; Doherty et al., 2005; Lussiana et al., 2012). Challenges with access and service delivery were also highlighted by interviewees across countries. In many locations, part of this challenge was due to women being more likely to seek prenatal care in places other than at an antenatal clinic or hospital, which then limits access to PMTCT if it is provided only in those facilities. The cultural practice of having children at home was identified as one driver of this decision (240-12-USG). In several countries, interviewees highlighted difficulties in reaching pregnant women in geographically remote regions (587-5-PCGOV) and pointed to distance and transportation as challenges for women in accessing PMTCT services (240-2-USG; 240-13-PCGOV; 240-19-USACA; 240-24-USG; 636-2-USG; 461-7-PCNGO; 396-42-PCGOV). Lack of road infrastructure (461-7-PCNGO) and topographical barriers such as mountains prevented patients from reaching facilities. Additionally, participants

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