The MTCT-Plus Initiative: Reaching Individuals with Early HIV Disease through Family

BACKGROUND: Providing HIV treatment in less developed countries is a global priority. Most programs focus exclusively on antiretroviral therapy (ART) and on patients with advanced HIV disease. In contrast, the MTCT-Plus Initiative has established comprehensive family-centered HIV programs in less developed countries.

METHODS: In 8 African countries and in Thailand, 11 programs were established. HIV-infected women were identified by programs for prevention of mother-to-child transmission; they, their children, and their partners were invited to enroll in MTCT-Plus. Programs provide HIV care (including ART), lab tests (CD4 count, infant diagnosis), medication procurement, and adherence/prevention/psychosocial support. Adult eligibility for ART includes: WHO stage IV; CD4 <200; or WHO stage II/III with CD4 <350 cells/mm3. Demographic, clinica, and laboratory data are collected with standardized forms. Adherence is assessed via self-report.

RESULTS: We enrolled 1088 individuals between February and August 2003, including 765 adults (75% women, 25% partners/others) and 323 children (88% of last pregnancy); 42% of women were enrolled during pregnancy and 56% postpartum. Adults had baseline median CD4+ cell count of 296 cells/mm3 (range 1 to 1741) and were: 63% WHO stage I, 19% stage II, 15% stage III, and 3% stage IV; 6% had prior TB. Among 323 children enrolled, 53(16%) had confirmed HIV and 84% were of indeterminate status. Of 53 children with confirmed HIV, 32% were of most recent pregnancy. Based on MTCT-Plus ART eligibility criteria, 41% adults were eligible for ART while only 30% would have been eligible by WHO criteria. Mean follow-up at the time of this report is 3.2 months. At follow-up, 29% of adults and 57% of HIV-infected children were on ART; 92% of adults on ART reported adherence with all their doses at their last assessment; 29% of adults were on cotrimoxazole; and 20% on isoniazid preventive therapy.

CONCLUSIONS: MTCT-Plus has successfully enrolled women identified through pMTCT programs with their families in preventive, supportive, and therapeutic services including ART. Patients are at earlier HIV disease stages than in other programs and more patients are ART eligible using MTCT-Plus criteria.
By committing to long-term family-based care, early identification of medical and psychosocial needs, and providing ongoing preventive, supportive, and therapeutic services (including ART), the MTCT-Plus Initiative provides a unique model for expanding access to HIV care in less developed countries.

The MTCT-Plus Initiative: Reaching Individuals with Early HIV Disease through Family-focused HIV Care and Treatment in Less Developed Countries.

El-Sadr WM, Rabkin M, Abrams EJ, Day J, Hardy T, Myer L, Rosenfield A.
11th Conf Retrovir Opportunistic Infect Febr 8 11 2004 San Franc CA Conf Retrovir Opportunistic Infect 11th 2004 San Franc Calif. 2004 Feb 8-11; 11: abstract no. 893.
Harlem Hosp., New York, NY, USA