Prevention of mother-to-child transmission of HIV in developing countries:recommendations for practice

Objectives: Different approaches to prevent mother-to-child transmission of HIV are being evaluated in developing countries. The first trials using a short regimen of zidovudine have been successful in Thailand, Cote d'lvoire and Burkina Faso. International and local strategies are now being conside red. The Ghent International Working Group on Mother-to-Child Transmission of HIV developed public health policy options to integrate these interventi ons into basic and maternal and child health (MCH) services. Methods: The following tasks were undertaken: a critical review of randomiz ed trials; an international pooled analysis of late postnatal transmission of HIV through breastfeeding; a review of the cost-effectiveness and cost-b enefit of antiretroviral prophylaxis; a feasibility assessment of preventiv e strategies, including a postal survey on HIV voluntary counselling and te sting (VCT) of pregnant women; the identification of requirements and resea rch priorities for prenatal, obstetric and paediatric care. These projects provided the background for a three-day workshop in Ghent, Belgium, in Nove mber 1997. Conclusions were further refined, based on 1998 research finding s. Results: A summary of relevant evidence and ten public health recommendatio ns are reported. VCT for pregnant women, a short regimen of zidovudine toge ther with alternatives to breastfeeding currently represent the best option to reduce vertical transmission in most developing countries. The primary goal of the integrated package supporting these interventions is to allevia te overall maternal and infant morbidity and mortality. Conclusion: Prevention of mother-to-child transmission of HIV should now be considered for integration into basic health and MCH services of selected countries, with the involvement of governments and donor agencies.