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Abstract
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The success of highly active antiretroviral therapy (ART) led to the establishment of the 2011 global goal to eliminate new infant HIV infections. By 2016, multiple countries achieved this goal, and, in 2021, Botswana was the first high-burden country to do so. These gains were driven, in part, by the Option B+ strategy to immediately initiate all pregnant women on ART, regardless of their health status. Although ART provision around the time of pregnancy through Option B+ has been an impressive public health advance, coverage of perinatal treatment and rates of vertical transmission have plateaued.2
Health systems are one core element of ensuring early and consistent access to perinatal treatment. However, increased attention to the social and contextual drivers of perinatal ART access will be required to prevent vertical transmission and ensure the health and wellbeing of pregnant women. In this issue of The Lancet HIV, Salome Kuchukhidze and colleagues do a remarkable job of estimating how violence around the time of pregnancy relates to new infant HIV infections.3
The careful work of modelling real-world epidemiological data is compelling. Kuchukhidze and colleagues use an in-depth modelling approach to assess the contribution of intimate partner violence (IPV) to vertical HIV transmission. They define IPV as any physical or sexual act of violence from a relationship partner, and they gathered data from UNAIDS and WHO estimates among women in 46 African countries.
The study found that one in eight paediatric infections are attributable to maternal IPV exposure. An estimated 22 000 paediatric infections could be attributed to IPV in 2022, with the population attributable fraction ranging from 4% in Niger to 28% in Uganda. In settings such as southern and eastern Africa, the proportion of new infant HIV infections attributed to IPV rises to one-fifth of vertical infections. These estimates are driven by high HIV incidence and high ART uptake. In other words, as the health system is effective in delivering medication to patients living with HIV, new infant infections that do occur are disproportionately more likely to be due to extra-clinical causes, such as IPV. Importantly, this paper also creates a foundation for mitigating the pronounced effect of violence on vertical transmission.
New infant infections attributable to IPV occur at higher rates among
Language: en |