ENORMOUS PROGRESS IN PMTCT
Over the last 3 decades, prevention of mother-to-child transmission (PMTCT) of HIV programs have been at the forefront of HIV care and treatment innovation. The Global Plan Towards Eliminating New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive, launched in 2011, set a series of ambitious targets for 2015 including the reduction of new HIV infections among children by 90% and AIDS-related maternal mortality by 50% from 2009 through 2015.1 The successful global movement to start all pregnant and breastfeeding women on antiretroviral therapy (ART) regardless of CD4 T-cell count or clinical staging (known as Option B+)2,3 set the stage for the World Health Organization's (WHO's) aptly named “Treat All” guidelines, which eliminated many long-standing barriers to HIV treatment.4 Meanwhile, data from several clinical trials—PROMISE, TEMPRANO, START, and HPTN 052—further demonstrated how outcomes improve with ART initiation at any CD4 T-cell count.5–8 These studies demonstrated lower morbidity and mortality, increased linkages to care, faster immune system reconstitution, and decreased HIV transmission in those starting ART sooner. The rapid scale up of Option B+ to more than 21 countries has demonstrated that programs designed to test and then quickly start treatment in all pregnant and breastfeeding women with HIV lead to increased enrollment, infections averted, and lives saved.9 The elimination of mother-to-child transmission of HIV in Armenia, Belarus, the Caribbean, …