Achievable Standard of Care in Low‐Resource Settings

A bstract : The gap between rich and resource‐poor countries has continued to grow as reproductive care providers integrate interventions to limit mother‐to‐child transmission (MTCT) of HIV in a manner consistent with existing information. There are two major reasons for this difference: access to prophylactic antiretroviral therapy (ARV) for HIV‐infected pregnant mothers and availability of alternative feeding for babies. In resource‐poor settings, these options are beyond reach for the majority of the women. Infant and under‐five mortality rates from other infections are high in these settings and breastfeeding remains the norm. Answering the question, What is an achievable standard of care in resource‐poor settings? still remains a major challenge today. Dialogue has begun in most resource‐poor settings to address the key elements in the package of interventions to reduce MTCT of HIV. These elements include the following: (1) overall prevention of HIV in mothers and fathers; (2) provision of good‐quality voluntary testing and counseling (VCT) in antenatal clinics; (3) a comprehensive package of interventions during pregnancy, during labor, and after delivery, including screening for sexually transmitted diseases (STDs), family planning, and‐where possible‐ARVs; (4) provision of infant and maternal nutrition within the socioeconomic realities; (5) advocacy and program communication; and (6) other supportive measures, including community mobilization to address issues such as stigmatization of and violence against HIV‐infected women. This paper discusses the challenges faced by most resource‐poor settings in integrating some of these activities into reproductive care services.