Botswana Reduces Mother-to-Child HIV Transmission Rate to Less Than 4%, Boston Globe Reports

Botswana this year has reduced its rate of mother-to-child HIV transmission to less than 4%, the Boston Globe reports. According to some experts, the decrease is the result of policy changes and political support for programs aimed at preventing MTC transmission. About 500,000 infants worldwide contract HIV from their mothers annually, accounting for about 12% of new HIV cases in 2006, according to UNAIDS.

Under the country's program, which began in 2001, all pregnant women receive an HIV test unless they refuse it, and results are available within 20 minutes. All women who test HIV-positive receive a combination therapy that includes zidovudine, also known as AZT, for four weeks during pregnancy and a single dose of nevirapine during labor. According to the Globe, without treatment, an HIV-positive pregnant woman has a 30% to 35% chance of transmitting HIV to her infant, and that risk is reduced by 50% if nevirapine is administered during labor, according to the Globe. About 34% of pregnant women in Botswana are HIV-positive, the Globe reports.

In 2005, Botswana's government changed its HIV testing methods for infants and began using a technique developed in South Africa that tests infants' dried blood spots for the virus. Earlier tests checked infants for antibodies, which could be passed on from the mother and be detectable for up to 18 months after birth. During a pilot project of the dried blood spot test in 2005, the government found that 7% of 1,917 infants born to HIV-positive women had the virus. The government last year offered the test nationwide, and a follow-up study conducted from November 2006 to February found that 51 of 1,300 infants, or 3.9%, were HIV-positive. The new test also allows infants' HIV statuses to be known within six weeks after birth, according to Tracy Creek, a medical epidemiologist at CDC. "The testing is serving as a powerful morale booster for everybody -- for health workers, who are finally seeing their work succeeding, and for the mother, who almost all are being rewarded with an (HIV)-negative baby," Creek said, adding, "With the dramatic increase in HIV funding around the world, this can be done anywhere."

According to the Globe, the MTC transmission rate in Botswana is slightly higher than MTC transmission rates in the U.S. and Europe, where fewer than 2% of infants born to HIV-positive women have the virus. About two-thirds of MTC cases occur during birth, and about one-third occur during breast-feeding, the Globe reports. Botswana provides infant formula at no cost for one year to reduce the chances of MTC transmission, although some experts have said that HIV-positive women should breast-feed their infants to protect them from infectious diseases.

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Catherine Wilfert, scientific director of the Elizabeth Glaser Pediatric AIDS Foundation's prevention of MTC transmission program, said that Botswana's efforts to prevent MTC transmission have been effective because the government has made it a priority. "Botswana has had the political will to roll out a national program," Wilfert said. She added that the benefits of AZT and nevirapine have been known since 1994 and 1999, respectively, but "logistic issues and the political commitment" have been "challenges" for African countries.

Mark Dybul, who serves as the U.S. global AIDS coordinator and administers the President's Emergency Plan for AIDS Relief, said Botswana's progress is "extremely impressive," adding, "It's a great model of how you can" prevent MTC transmission in Africa. The U.S. government is encouraging other countries to implement parts of the Botswana program. Cameroon, Kenya, Zambia and other countries already have begun testing all pregnant women for HIV unless they decline the tests, according to the Globe (Donnelly, Boston Globe, 8/27).