As part of a number of International programs of which AIDSRelief is the largest, the Institute of Human Virology and the University of Maryland School of Medicine is involved in the provision of prevention, care and treatment services for HIV affected women and children. This support is provided on different levels including direct supervision and support to facilities, training of health care workers, technical assistance and expert consultation to governing, regulatory and guideline developing bodies, and research.
One key attribute of our approach to the prevention and treatment of HIV infection in children is our reluctance to see things from a ‘PMTCT’ paradigm - which to us implies a narrowing of the boundaries within which mothers and children receive these critical services, and in many cases, an abrupt end to the delivery of these services.
We are more inclined to embrace a maternal-child concept that incorporates the involvement of the mother-child pair in care as early as possible, and continues to provide long term services that seek not just to prevent infection, but ensure survival in both exposed and infected children, as well as providing continued care for the infected child and mother and their present and future family.
Such an approach involves a good integration of antenatal, delivery, child health, reproductive health and HIV services in preference over systems which merely ‘refer’ women and their children within these services – which along with other factors, is a major reason for high dropout rates experienced in PMTCT cascades in many countries today.
On this basis, the IHV strives to incorporate as much evidence based practices for care and program implementation as is possible into the public health contexts within which we operate while producing and providing tools and systems necessary for the reliable incorporation and delivery of these evidence based practices.
We are also a key player in the development of guidelines and recommendations for care in the countries we operate in and in addition to WHO and national guidelines, we produce our own set of recommendations based on evidence from recent research and other reliable data – which at this point in time is still in a growth phase for maternal-child care.
There is still a lot to be done in providing services in resource constrained settings in a bid to bring transmission and care rates for children, and long term engagement and treatment success rates for women to desirable and yet realistic levels. Research is still needed for defining the best clinical and programmatic models for enhancing success and the IHV and the University of Maryland School of Medicine is committed to the research, implementation and training necessary for achieving this.