Fabio Buelli, Virginio Pietra, Richard Fabian Schumacher, Jacques Simpore, Salvatore Pignatelli, Francesco Castelli.
the book Understanding HIV/AIDS Management and Care. Pandemic Approaches in the 21st Century, ISBN 978-953-307-603-4, edited by Fyson Hanania Kasenga. p. 87-98
Since the 90s, many developing countries have introduced health strategies aimed at reducing Mother-to-Child transmission rate of HIV. These strategies (PMTCT – Prevention of Mother-to-Child Transmission) are based on (i) adequate counselling for HIV voluntary
testing during antenatal care visits, (ii) single dose or a short antiretroviral therapy treatment to the mother and the newly-born baby (WHO, 2001 ; WHO, 2004 ; WHO, 2006) and (iii) formula feeding or (iv) exclusive breast-feeding with early weaning (WHO, 2003a ; WHO, 2006). During the last years, thanks to the increase of the PMTCT program coverage, the aim of the program was enlarged to address the needs of all the family members of the HIV-positive
women detected by the program. The World Health Organization (WHO) then introduced the Mother-to-Child Transmission Plus (MTCT-plus) program aimed at promoting health, eventually including the use of Highly Active Antiretroviral Treatment (HAART) for the
infected mothers, their children, even those whose father is different from the current partner, and the partners themselves (WHO, 2003b).
Aims of the program are, therefore, (i) to reduce HIV vertical transmission rates through specific antiretroviral therapies for the HIV-infected pregnant women, (ii) to involve a larger number of children and partners in the early stage of the disease and (iii) to increase the children survival rates by improving the HIV-positive mothers’ life expectancy. (Berer, 1999 ; Brahmbatt et al, 2006). Psychosocial and nutritional supports and family planning are also
integral components of MTCT-plus activities. Programs also focus on health education, including best breastfeeding practices to reduce transmission risk and nutrition. Another important expectation of the program is to raise awareness and acceptability of HIV testing and early antiretroviral therapy, thus curbing the incidence of overt AIDS. Since 2003, many MTCT-plus programs have been implemented in HIV endemic developing countries, yielding conflicting results in different settings (Tonwe-Gold et al, 2009). In Burkina Faso, where a stable HIV-prevalence of 1.8% is recorded (UNAIDS, 2006), the PMTCT program started in 2002 and the MTCT-plus program was introduced later on thanks to the World Bank (TAP-Treatment Acceleration Program) and the Global Fund funding, which increased the availability of antiretroviral drugs. Aim of our work is to describe the achievements and the constraints faced by the real-life implementation of MTCT-plus program at the St. Camille Medical Center in Ouagadougou, Burkina Faso.