Partnership for HIV-Free Survival

An estimated 1.5 million pregenant women are living with HIV globally and 90% of pediatric HIV infections are the result of mother to child transmission.

In response, the World Health Organization (WHO) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) have initiated the Partnership for HIV-Free Survival to accelerate the adoption and implementation by countries of the WHO 2010 guidelines, with the ultimate goal of increasing HIV- free survival.

The PHFS was officially launched in Pretoria, South Africa in March 2013, with participation of six member countries: Kenya, Lesotho, Mozambique, South Africa, Tanzania, and Uganda. The Partnership grew out of a recognition that:

  1. There had been significant success in reducing the transmission of HIV from mother to child during the antenat al and perinatal periods of pregnancy, but that postnatal transmission rates, via breast milk, were still alarmingly high; and
  2. Infants born to HIV - infected mothers were at higher risk of mortality due to traditional causes of infant mortality such as diarrhea, pneumonia, malaria, and malnutrition.

Fortunately, the landscape of prevention of mother-to-children transmission of HIV (PMTCT) is gradually changing. With the Global Plan towards the Elimination of New Infections among Children by 2015 and Keeping their Mothers Alive, by the Joint U.N. Program on HIV/AIDS (UNAIDS), and the gradual adoption of the 2010 WHO updated guidelines, many countries have moved to options B or B+ in order to ensure that mothers and infants receive maximum antiretroviral (ARV) protection during pregnancy and throughout the postpartum period.

With WHO guidelines in place, and countries adjusting national policies to adhere to those guidelines, a primary challenge that remains is to bridge the gap between what’s possible under the WHO guidelines (i.e., 1% or less postnatal transmission) and the current unacceptable postnatal transmission rates in the PHFS countries (as high as 15% without interventions). Uptake of the WHO guidelines by countries has been slow, and health care systems and community outreach services have struggled to support the necessary integration of PMTCT; maternal, newborn, and child health; and nutrition services for mother-infant pairs. To date, systems remain lacking in most resource-limited settings, and mothers do not receive adequate knowledge, skills, and support to improve the likelihood of HIV-free survival for their infants during their first two years of life. While impressive advances have been made in reducing antenatal and perinatal transmission (of HIV), reduction in transmission during the postnatal period (0–24 months) has lagged behind.

Closing this gap between “what we know is possible” and “our current reality” is the overarching goal of the PHFS, and the reason that the quality improvement (QI) methodology has been selected as its implementation tool. Through use of QI methods and the establishment of a cross-country learning platform, the Partnership intends to improve implementation of the WHO 2010 guidelines, and thus accelerate reductions in mortality and HIV infection among infants exposed to HIV.

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