# Informing optimal investments along the preconception to postpartum eMTCT continuum

> **NIH NIH DP1** · UNIVERSITY OF MINNESOTA · 2024 · $539,000

## Abstract

PROJECT SUMMARY/ABSTRACT
While expansion of antiretroviral therapy (ART) coverage over the past two decades has significantly decreased
mother-to-child, or “vertical,” transmission, progress has stagnated in recent years. To address the remaining
130,000 new infections among children each year, we must take a broader approach, promoting maternal ART
coverage within the context of additional interventions. The key question is, which additional interventions
will most benefit elimination of mother-to-child transmission (eMTCT) efforts while also being
economically feasible for a country to implement? Simulation-based modeling and decision science have
played an important role in evaluating the benefits and costs of HIV treatment and prevention strategies, in order
to inform guidelines and policy decisions. We propose to apply these methods to guide eMTCT health policy in
sub-Saharan Africa, where the majority of infant infections occur. Most decision science work in this area has
focused on adult HIV, while the limited number of eMTCT studies have largely focused on interventions
downstream of ART initiation, despite the potential for interventions upstream of ART initiation to have significant
impact. We have identified an eMTCT toolbox of six interventions that span the entire reproductive continuum,
from preconception to postpartum: access to contraception to more safely time pregnancies, pre-exposure
prophylaxis to prevent HIV infection among pregnant and breastfeeding women (PBFW), HIV re-testing to
ensure prompt ART initiation among PBFW who acquire HIV, and long-acting ART, mentor mother programs,
and viral load testing to increase viral suppression rates among PBFW who initiate ART. Implementing all six
interventions at full-scale is ideal but not feasible given resource limitations. To identify implementation priorities,
we will evaluate the population-level effectiveness and cost-effectiveness of each of these interventions, alone
and in different combinations or “portfolios” of various sizes. Because the cost-effectiveness and affordability of
an intervention will depend on country-specific factors, including economic resources, demographics, epidemic
characteristics, and eMTCT progress to date, we will tailor our evaluation to the specific country contexts of
Kenya, Nigeria, and Botswana. These three African countries all have a high HIV burden but also represent
diversity in key relevant characteristics, making them useful case studies for a wide range of other African
countries. Our findings from this comprehensive eMTCT intervention analysis will provide urgently-needed
support for eMTCT policymaking in each of our three focus countries, paving the way for a new frontier in eMTCT
progress in these and other African settings.

## Key facts

- **NIH application ID:** 10916709
- **Project number:** 1DP1HD115428-01
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** Horacio Adrian Duarte
- **Activity code:** DP1 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $539,000
- **Award type:** 1
- **Project period:** 2024-08-22 → 2029-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10916709

## Citation

> US National Institutes of Health, RePORTER application 10916709, Informing optimal investments along the preconception to postpartum eMTCT continuum (1DP1HD115428-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10916709. Licensed CC0.

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