Moving towards elimination: findings from the South Africa prevention of mother to child transmission evaluation (SAPMTCTE)

It is remarkable that we find ourselves at a point in history where we can seriously consider the possibility of virtual elimination of mother-to-child HIV transmission (MTCT). Effective antiretroviral strategies, carefully honed through randomized clinical trials, provide the means to almost entirely prevent the transmission of HIV from an HIV-infected woman to her infant during pregnancy, delivery and breastfeeding - if started timeously and sustained through the full period of risk. Massive mobilization of governments, policy-makers, health service managers, clinicians, researchers and communities have led to implementation of Prevention of Mother To Child Transmission (PMTCT) interventions on an impressive scale. South Africa, which faces the world’s highest adult HIV prevalence, has risen to the challenge, also implementing the one of the world’s largest antiretroviral drug treatment program. In so doing, South Africa has made impressive gains in mitigating the tragedy of its generalized and substantial HIV epidemic.