Abstract
Abstract. Sub-Saharan Africa is home of 85 % of pregnant women living with HIV and 90 % of HIV-infected children. WHO issued the first prevention of mother-to-child transmission of HIV (PMTCT) recommendations in 2000. These guidelines have been revised to incorporate new evidence and align with the goal of universal treatment access and zero infections among children. Currently, 82 % of HIV-infected pregnant women receive antiretroviral treatment, and infections among children have halved since 2010. However, in 2018, 160,000 children became infected. Reasons hindering the success of PMTCT are: a) non-universal HIV testing during pregnancy; b) low retention through the PMTCT cascade; and c) missed opportunities to diagnose women who acquire HIV while pregnant or breastfeeding. To address these gaps innovative strategies are needed.
Zusammenfassung. In Subsahara-Afrika leben 85 % der schwangeren Frauen mit HIV und 90 % der HIV-infizierten Kinder. Die WHO hat im Jahr 2000 die erste Empfehlung zur Prävention der Mutter-Kind-Übertragung von HIV (PMTCT) herausgegeben. Diese Leitlinien wurden überarbeitet, um neue Erkenntnisse zu integrieren und mit dem Ziel eines universellen Behandlungszugangs und einer Null-Infektion bei Kindern. Derzeit werden 82 % der HIV-infizierten Schwangeren antiretroviral behandelt, und die Infektionen bei Kindern haben sich seit 2010 halbiert. Im Jahr 2018 infizierten sich jedoch 160 000 Kinder. Gründe, die den Erfolg von PMTCT behindern, sind: a) nicht-universelle HIV-Tests während der Schwangerschaft, b) geringe Retention durch die PMTCT-Kaskade und c) verpasste Möglichkeiten zur Diagnose von Frauen, die HIV während der Schwangerschaft oder des Stillens erwerben. Um diese Lücken zu schliessen, bedarf es innovativer Strategien.
Résumé. L’Afrique subsaharienne abrite 85 % des femmes enceintes vivant avec le VIH et 90 % des enfants infectés par le VIH. L’OMS a publié les premières recommandations en matière de prévention de la transmission du VIH de la mère à l’enfant (PTME) en 2000. Ces lignes directrices ont été révisées afin d’y intégrer de nouvelles données probantes et de les harmoniser avec l’objectif d’accès universel aux traitements et de zéro infection chez les enfants. Actuellement, 82 % des femmes enceintes infectées par le VIH reçoivent un traitement antirétroviral et les infections chez les enfants ont diminué de moitié depuis 2010. Cependant, en 2018, 160 000 enfants étaient infectés. Les raisons qui entravent le succès de la PTME sont: a) le dépistage non universel du VIH pendant la grossesse; b) la faible rétention grâce à la cascade de PTME; et c) les occasions manquées de diagnostiquer les femmes enceintes ou allaitantes qui contractent le VIH. Pour combler ces lacunes, des stratégies novatrices sont nécessaires.
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