Elizabeth Glaser Pediatric AIDS Foundation

Not One More – Ensuring a Generation Born without HIV Highly Ranked

Lead Organization

Elizabeth Glaser Pediatric AIDS Foundation

Washington, D.C., United States


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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Not one infant should ever be born with HIV, yet every day, over 400 children are newly infected. This is 100% preventable. Without treatment, 50% of these children will die by age five, and all will require lifelong care. The majority of HIV infections are in sub-Saharan Africa where socio-economic factors create disproportionate risk of contracting HIV, especially for young pregnant women. In addition to devastating health impacts, the collateral consequences of a generation lost to HIV infection are profound, including social marginalization from stigma, reduced school enrollment and employment, increased poverty, and even negative effects on GDP growth. We can ensure that not one more baby is infected with HIV and set the world on the path to ending pediatric HIV. The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) will achieve this goal through a proven solution set focused on timely diagnosis and retention on treatment for women in Africa.

Problem Statement

In 2017, 180,000 infants acquired HIV during pregnancy, birth, and breastfeeding, and 300,000 pregnant women living with HIV did not receive the necessary treatment to prevent transmission to their babies. Each infection was 100% preventable, but women, especially in sub-Saharan Africa, are not uniformly receiving the services they need to ensure not one more baby is born with HIV. Children born with HIV require expensive, life-long care that can strain families, communities, and health systems. The impact of these HIV infections has a trickle-down effect on the productivity of an entire generation, leading to lower educational attainment, reduced participation in the workforce, and significant rates of depression. Furthermore, without appropriate treatment, children born with HIV can grow up to transmit the virus to others, threatening future generations and reversing decades of progress. Despite this threat of epidemic resurgence, international funding for HIV has declined in recent years and current investments are not focused on children. Solutions that prevent mother-to-child transmission are relatively simple, proven, and cost effective, but additional innovation is required to reach the most marginalized, such as adolescents and rural populations. Recent data indicate an alarming drop in progress - pregnant women receiving PMTCT increased by only 3% from 2014-2017, compared to a 26% increase between 2010-2014. PMTCT is a lever for major systemic change, ensuring a generation is born healthy, alleviating burdens on health systems and other infrastructure, and ensuring that the costs associated with HIV/AIDS do not deepen poverty in communities that already lack resources.

Solution Overview

“Not One More” will address two critical gaps in five countries where the concentration of children acquiring HIV is so significant that improvements will massively influence the global trend. Special attention will be given to the breastfeeding period when 39% of new infections occur in babies. While not a current priority for donors, new data identify this as an area for additional investment and reveals an opportunity for major impact. Addressing diagnosis and treatment during this period alone would eliminate over 70,000 new HIV infections each year globally.1.Diagnosis and Treatment: Women are not routinely tested and then re-tested for HIV during pregnancy and put on treatment. 53% of new HIV infections in children occur because their mothers were not diagnosed with HIV and put on treatment. “Not One More” will tailor and scale proven innovations and approaches to increase rates of diagnosis and initiation on treatment as described below. 2.Retention on Treatment: 16% of new HIV infections in children occur because their mothers do not remain on treatment post-delivery. “Not One More” will improve tracking of mothers and babies to ensure they remain linked to services that meet their unique needs. When women are retained on HIV treatment, transmission is reduced to less than 2%.The blueprint for success is well understood. Specifically in Africa, EGPAF has had proven success in delivering innovative solutions with catalytic funding, reducing mother-to-child transmission of HIV from 28% to 6.7% in Zimbabwe over the course of six years.

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