Economic Strengthening Interventions to Address Known Barriers to PMTCT and Improve Health Outcomes: Review of the Evidence

The human immunodeficiency virus (HIV) is known to be a significant contributor to infant morbidity and mortality in many countries, particularly in sub-Saharan Africa. Strategies for the prevention of mother-to-child transmission (PMTCT) dramatically reduce the risk of HIV transmission to an infant—from nearly 40 percent to less than five percent. The PMTCT services can also serve as a gateway for HIV prevention, treatment, care, and support services for the mother and the whole family. However, a number of barriers, including economic factors, prevent women from accessing PMTCT services and following recommended PMTCT interventions. Identifying economic barriers to PMTCT and economic strengthening (ES) interventions that may improve access and adherence to the PMTCT cascade — which refers to each step of PMTCT service delivery from the first contact, through counseling, HIV testing, collecting results, receiving antiretroviral therapy (ART) or prophylaxis, safe delivery practices, infant feeding recommendations up to postnatal follow-up — can strengthen PMTCT programs, contributing to better health outcomes and further reduction in mother-to-child transmission of HIV.

This literature review was conducted by the Accelerating Strategies for Practical Innovation & Research in Economic Strengthening (ASPIRES) project of FHI 360. The ASPIRES project supports evidence-based, gender-sensitive programming to improve the economic security and wellbeing of vulnerable families and children, particularly those infected with or affected by HIV/AIDS, and others at high risk of acquiring HIV. The project is supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID).

The purpose of this review is to: 1) assess the evidence associated with economic barriers to PMTCT services and the effects that economic strengthening interventions have on access to PMTCT services, retention in the PMTCT cascade, and adherence to PMTCT prophylaxis/treatment regimens for mother and infant; 2) identify the effects that ES interventions have on the use of and adherence to health services that are relevant to the PMTCT cascade, such as antenatal care (ANC) services, HIV care and treatment programs or HIV testing and counseling; and 3) identify evidence gaps to inform future research and programming of ES interventions for PMTCT.