MTCT-Plus operates in Cote D’Ivoire, Kenya, Mozambique, Rwanda, South Africa, Thailand, Uganda and Zambia

Polly Clayden HIV i-Base

The MTCT-Plus initiative provides HIV care including antiretrovirals to HIV-positive women identified during pregnancy, and their families. This project was launched in 2001 as a response to Kofi Annan’s “Call to Action”. It utilises antenatal care as an entry point to HIV treatment and acknowledges that MTCT programmes in resource poor settings have generated cohorts of HIV-positive women without access to treatment for their own health.

Representatives from MTCT-Plus, including principal investigator Wafaa El-Sadr, provided an overview of the project since enrollment started in February of this year. Sites have now been established in Cote D’Ivoire, Kenya, Mozambique, Rwanda, South Africa, Thailand, Uganda and Zambia and a multidisciplinary “essential package” has been developed that is family focused and includes both clinical and psychosocial services, including adherence support, for adults and children.

Training of healthcare teams has been conducted and a central procurement system established for medications, including antiretrovirals, and supplies through UNICEF. Medications, including generics, on the WHO pre-qualified list are used. They have developed a system of data collection and programme evaluation that includes sharing information between sites to assist in programme development.

As of 30 May, 574 patients have been enrolled at seven MTCT-Plus programme sites including 405 adults and 169 children.

In a completely uplifting presentation, Dr Sylvester Kimaio from Eldoret, Kenya described his experiences. So far, 240 adults and 90 children have been enrolled into Eldoret’s programme.

Recently they have begun initiating HAART in the second trimester for their pregnant patients and unsurprisingly the transmission rate in his cohort has gone into freefall. “In the west they don’t use nevirapine for MTCT they use full HAART,” he explained. “We thought: ‘Why not us?’ We have already started that programme so we will be very successful with our PMTCT.” In fact, he continued: “We are hoping that our PMTCT is so successful that we can take some of the spaces for the children and give them to the mothers.”

He concluded his talk with a picture of one of his patients: “She has five children… we don’t have to look after orphans… she looks after them herself.”


El-Sadr W, Kimaio S, Hardy T et al. The MTCT-Plus initiative: A model for comprehensive family-focused HIV care and treatment in resource limited settings



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