Remarks by U.S. Ambassador Natalie E. Brown at PMTCT Impact Evaluation Report Launch 

Remarks by U.S. Ambassador Natalie E. Brown at PMTCT Impact Evaluation Report Launch 

May 31, 2022 | Ministry of Health Compound, Kampala, Uganda | (As prepared for delivery)

Good morning!  I am delighted to be here today as we share findings from the Prevention of Mother-to-Child Transmission (PMTCT) Impact Evaluation, which was conducted with funding from the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR.  Congratulations to the Ministry of Health and partners, including the U.S. Centers for Disease Control and Prevention (CDC), Rakai Health Sciences Program (RHSP), WHO, and UNICEF, for supporting the successful implementation of this important study.  The results are being used to reach the ultimate goal: elimination of mother to child transmission of HIV in Uganda.

Honorable Minister, PEPFAR has four guiding principles: accountability, transparency, equity, and impact.  At the center of it all are people, not only those living with HIV but also their families, communities, countries, and indeed, our global family.  In January, PEPFAR celebrated its 19th anniversary with remarkable global achievements.  Worldwide, PEPFAR supports almost 19 million people on HIV treatment, which not only saves the lives of those living with HIV, who now live healthy, productive lives, but also helps prevent HIV transmission.  Through investments to improve maternal and child health, PEPFAR has helped more than 2.8 million babies to be born HIV-free, a milestone toward an HIV-free generation.  These remarkable successes, unimaginable 20 years ago, bring new hope to the world, founded on PEPFAR’s guiding principles and fueled by science and continuous use of data that allow us to do more with the funds generously provided by U.S. taxpayers.

Here in Uganda, PEPFAR has invested more than $4 billion – almost 15 trillion shillings – in HIV programs since 2003.  Now, more than 1.27 million Ugandans living with HIV are on PEPFAR-supported treatment.  Besides direct investments in provision of health services and treatment, PEPFAR has also invested in data systems and science to ensure the success of the HIV response.  For example, in February, we were together as MOH released the preliminary results of the second round of the Uganda Population HIV Impact Assessment (UPHIA) survey.  This nationally representative survey estimated there are 1.4 million Ugandans living with HIV.  Almost all people who had tested and became aware they have HIV were on effective treatment.  The UPHIA results are already being used to adapt the HIV program for impact, toward reaching HIV epidemic control.

Today, we launch the results of another important PEPFAR-supported investigation: the Prevention of Mother-to-Child Transmission Impact Evaluation.  Effective treatment during pregnancy, childbirth, and while breastfeeding prevents transmission of the virus to infants.  Thus, the prevention of mother-to-child transmission of HIV, or PMTCT, is achievable.  At the recent Candlelight Memorial ceremony in Teso, we heard testimonies from many mothers who, while HIV positive, were on treatment and gave birth to children who are negative, proving no child needs to be born with HIV or contract HIV in the first months of life through breastfeeding.

PEPFAR has supported the Government of Uganda with more than $260 million invested in PMTCT program activities, and we are delighted that these collaborative efforts have yielded great impact over the years, as demonstrated by the PMTCT Impact Evaluation.  For instance, most pregnant women who were diagnosed with HIV were on HIV treatment, which is critical to minimize the risk of transmitting HIV to their children.  Further, mother-to-child HIV transmission rates have reduced from 18% in 2003 to less than 2% in 2021.  This is truly exceptional progress!  

However, PEPFAR’s true definition of PMTCT success as a program is ZERO mother-to-child HIV transmission.  To better understand the impact of PMTCT investments, the U.S. Government provided $3.25 million for this rigorous study, which was conducted from 2017 to 2019.  The evaluation systematically assessed key PMTCT indicators, including: mother-to-child transmission rates, rates of new HIV infections among mothers during pregnancy and the breastfeeding period, and infant death rates.  Just as UPHIA provided granular data on the national HIV epidemic, this PMTCT Impact Evaluation has provided specific insights about progress and where we need to focus to address remaining gaps to eliminate mother-to-child transmission of HIV.

The PMTCT Impact Evaluation has helped us identify and address challenges, including those that were worsened during the COVID-19 pandemic.  As shown by the Impact Evaluation, adolescent girls and young women are particularly at risk of transmitting HIV to their infants.  From January to March 2022, pregnant adolescent girls and young women accounted for 51% (1,997) of mothers newly identified as having HIV.  Access to quality antenatal care and HIV services is another challenge identified by the PMTCT Impact Evaluation.  While PMTCT programs are available throughout Uganda, barriers remain a critical challenge, especially for those mothers who only receive care from lower-level health centers.  Only two-thirds of infants born to mothers living with HIV receive an HIV test within the first two months of life.  The roles of Health Centre IIs and IIIs need to be defined, PMTCT services need to be where the clients are, and strong referral systems should ensure all can access quality care.  Most importantly, Honorable Minister, increased MOH investments are needed toward ensuring that all women receive both quality antenatal care and effective HIV testing and treatment services.  

Finally, we need to acknowledge the impacts of stigma and gender-based violence that have interfered with many mothers receiving PMTCT services.  This was reinforced for me last week when I was in Gulu.  In Oyam district, I met youth peer leaders who told the story of an 18-year-old pregnant woman who tested positive for HIV.  Because of stigma, and fear of being shunned by her family and future husband, she was apprehensive about getting on treatment and disclosing her status, despite the consequences for herself, her unborn baby, and fiancé.  Fortunately, the peer leaders are deeply engaged and if their commitment is any indication of success, this woman will soon disclose and embrace treatment.  Additionally, for orphans and vulnerable children and their families, PEPFAR provides support through robust layered programming.  And through PEPFAR’s DREAMS program, we are helping to empower adolescent girls and young women to be resilient, access HIV prevention services, and live healthier lives.  My very first trip outside of Kampala was to Masaka to announce the expansion of the DREAMS program there.  It’s memorable for two reasons:  I had a chance to talk to some of the young women about the positive changes in their lives because of the program and it’s where I first met the legendary and inspiring Dr. Serwadda.

As we share our PMTCT Impact Evaluation findings and officially launch the report today, may we commit to ensuring the insights and recommendations from this study are implemented and supported financially so that we can eliminate mother-to-child transmission of HIV in Uganda and have the AIDS-free generation to which we all aspire.  Together, we can do this!  Thank you.