A new study outlines useful steps in reaching the World Health Organization goal to eliminate pediatric HIV in Zimbabwe by improving the access to antiretroviral medications, helping HIV-infected mothers continue to take their medication and to safely reduce or eliminate breastfeeding.

"Pediatric HIV infection has been nearly eliminated in resource-rich settings, such as the U.S. and Europe, through a combination of anti-HIV drugs and avoidance of breastfeeding," says Andrea Ciaranello, MD, MPH, of the Massachusetts General Hospital division of Infectious Diseases. He is also the lead author of a study on the matter published in the journal PLOS.

MGH said in a statement released Wednesday that the World Health Organization has urged health programs throughout the world to aim for the same successes, calling for the 'virtual elimination' defined as reducing transmission risk to less than 5 percent of mother to child HIV transmission.

The researchers said that successful completion of a series of steps are required for prevention of mother-to-child transmission, including prenatal care, HIV testing and follow-up, and access and adherence to antiviral drug therapy throughout pregnancy and breastfeeding.

The authors explained that while resource-poor areas like sub-Saharan Africa that has as much as 90 percent of worldwide mother-to-child HIV transmitted diseases the efforts of care can be particularly challenging.

The MGH study was designed to evaluate the factors required to meet the WHO goal in Zimbabwe, where 16 percent of pregnant women are HIV infected and most mothers breastfeed their infants, which is one means of viral transmission.

The study found that a transmission rate of 18 percent in 2009 can be reduced to 14 percent with even greater participation and the use of newer medications.

Another finding showed that mother to child transmission could be further reduced to 6 to 7 percent – approaching "virtual elimination."

To do so the researchers said three goals need to be reached.

  • More than 95 percent of infected pregnant women receive the most effective available medications.
  • Excellent medication adherence is maintained for both mothers and infants throughout pregnancy and breastfeeding.
  • Breastfeeding is safely reduced or avoided altogether, an achievement that requires access to both adequate infant formula and safe drinking water.

"Ambitious public health targets are critical to spurring major expansions of global health care services, but it is important to understand what it would take to reach these goals," said senior author Kenneth A. Freedberg, MD, MSc, also of the MGH division of Infectious Diseases and professor of medicine.

"Achieving 'virtual elimination' will require increased access to WHO-recommended medications, dedicated support for long-term medication adherence and safer infant feeding options."