Emily's Worldview

I'm handing in my first full draft tomorrow and had to provide a lay summary. Thought it might be interesting to those of you who have been watching my page count go up (73!)

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HIV can be transmitted from mother to infant during pregnancy, in labor, or after delivery during breastfeeding. In developed countries, mothers who test positive for HIV receive a combination of at least three antiretroviral medications and use replacements for breastmilk to feed their infants. With these interventions, fewer than 1% of HIV infected mothers transmit HIV to their babies. In sub-Saharan African countries, however, only 10% of pregnant women have access to antiretroviral medications or breastmilk replacements. Without interventions, 30-40% of these women will transmit HIV to their infants.
WHO recommendations for prevention of mother to child transmission of HIV (PMTCT) in low resource settings is a combination of two to three drugs taken for a few weeks prior to labor and delivery. This efficacious regimen reduces transmission to below 5% in these settings. But the majority of the women in Africa who have access to PMTCT receive single-dose nevirapine, where they take one pill during labor and the infant receives one dose of liquid medicine after delivery. With this regimen, roughly 8 to 15% of infants will be infected. This thesis asks the question: What policy changes are necessary to move away from the single dose nevirapine strategy towards wider implementation of the more efficacious regimens?
On the international level, there are UN agencies, multilateral donors, bilateral donors, and international non-governmental level. Governments of the countries in Africa also play a key role in policy making and goal setting for PMTCT. Finally, a number of factors affect the effective implementation of the PMTCT programs. By looking at a case study of a change in the choice of primary drugs for malaria in several countries, I will provide analysis and recommendations for each of these levels of action—international, national, and implementation level.