BACKGROUND : Development of country plans for prevention of mother-to-
child HIV transmission (PMTCT), including expansion of comprehensive,
integrated services, was key to Global Plan achievements.
APPROACHES : Use of the PMTCT cascade, an evolving series of
sequential steps needed to maximize the health of women and HIV-free
survival of infants, was critical for development and implementation of
PMTCT plans. Regular review of cascade data at national/subnational
levels was a tool for evidence-based decision making, identifying areas
of greatest need at each level, and targeting program interventions to
address specific gaps. Resulting improvements in PMTCT service
delivery contributed to success. Populating the cascade highlighted
limitations in data availability and quality that focused attention on
improving national health information systems.
LIMITATIONS : Use of aggregate, cross-sectional data in the PMTCT
cascade presents challenges in settings with high mobility and weak
systems to track women and children across services. Poor postnatal
follow-up and losses at each step of the cascade have limited use of
the cascade approach to measure maternal and child health outcomes
beyond the early postnatal period.
LESSONS LEARNED : A cascade approach was an effective means for
countries to measure progress, identify suboptimal performance areas, and be held accountable for progress toward achievement of Global
Plan goals. Using the cascade requires investment of time and effort to
identify the type, source, and quality of data needed as programs
evolve. Ongoing review of cascade data, with interventions to address
discontinuities in the continuum of care, can translate across health
areas to improve health care quality and outcomes.