Prevention of mother-to-child transmission of HIV in Guatemala (2004-2009)

Mother-to-child transmission (MTCT) of HIV, also known as vertical transmission, refers to the passing of HIV from a mother to her child during pregnancy, labour and delivery, or through breastfeeding. Without interventions, the risk of MTCT is significant, but with the access to effective antiretroviral therapy and other preventative measures, evidence (emerging at that time and now confirmed) shows that virtual elimination of MTCT is feasible.

Guatemalan clinicians involved in clinical and social services for children living with HIV wanted to ensure that in future, no Guatemalan child would face these bleak circumstances - a life marked by orphanhood, illness, and social discrimination. Leveraging the increase in global access to highly active antiretroviral therapy, we sought to strengthen state-of-the-art prevention of MTCT for HIV in Guatemala.

Photo: Healthy Guatemalan children in traje tipico (traditional indigenous clothing).

Project

• With a team of Guatemalan clinicians at the Hospital San Juan de Dios in Guatemala City, I co-led an initiative to design, implement and evaluate a programme to prevent mother-to-child transmission (MTCT) of HIV

• Ours was the second initiative to prevent MTCT in Guatemala, and the first in the delivery room.

  
  

Findings

• The  evaluation showed that the intervention was a clinical success, saving an estimated 12-22 children from HIV infection in a single year.

• The evaluation also provided data on intervention feasibility, resource requirements, and costs.

Impacts

• The model was adopted and scaled by the Guatemalan Ministry of Health with support from the Global Fund.

• To inform research and decision-making , the strategy also contributed to a systematic review and a Copenhagen Consensus priority-setting exercise on HIV prevention.

Selected research

• Johri M, Morales RE, Hoch JS, Samayoa BE, Sommen C, Grazioso CF, Boivin JF, Barrios IJ, Baide E and Arathoon E: A cross-sectional study of risk factors for HIV among pregnant women in Guatemala City, Guatemala: Lessons for prevention. Int J STD AIDS 2010, 21:789-796. https://doi.org/10.1258/ijsa.2009.009355

• Johri M. & Ako-Arrey D* (2011). The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review. Cost Eff Resour Alloc 2011;9:3. https://doi.org/10.1186/1478-7547-9-3

• Johri M. Alternative perspective: prevention of non-sexual transmission. In : Rethink HIV - Smarter Ways to Invest in Ending HIV in Sub-Saharan Africa Edited by Bjørn Lomborg. Cambridge University Press, 2012. Paperback  (ISBN-13: 9781107679320) https://copenhagenconsensus.com/publication/rethink-hiv-prevention-non-sexual-transmission-hiv-perspective-johri