In 2018, researchers Elie Nkwabong, Romuald Meboulou Nguel, Nelly Kamgaing, and Anne Sylvie Keddi Jippe published, “Knowledge, Attitudes, and Practices of Health Personnel of Maternities in the Prevention of Mother-To-Child Transmission of HIV in a sub-Saharan African Region with High Transmission Rate: Some Solutions Proposed,” in BMC Pregnancy and Childbirth. In their article, hereafter “Knowledge, Attitudes, and Practices,” the authors state the aim of their study was to establish the knowledge, attitudes, and practices held by health professionals who worked in numerous maternal departments throughout Cameroon. They claimed that effective knowledge, attitudes, and practices would likely reduce mother-to-child, hereafter MTC, transmission of HIV. After finding a deficit in the knowledge, attitudes, and practices among a subset of health professionals, the authors recommended increased training, funding, and supervision to reduce MTC transmission of HIV throughout Cameroon.

Joseph Bolivar DeLee was an obstetrician in the US between the nineteenth and twentieth centuries who advocated for the specialized teaching of medical students in the field of obstetrics to address problems occurring during pregnancy. He claimed obstetricians maintained a wider skillset than midwives, and founded the Chicago Lying-In Hospital to provide affordable obstetric care to women in Chicago, Illinois. According to Carolyn Herbst Lewis, critics of DeLee’s practices often cite his 1920 article, “The Prophylactic Forceps Operation,” as catalyzing a cultural shift toward overly clinical birthing practices. However, rather than solely advocating for its use, he had cautioned against the extreme use of forceps during delivery, and emphasized that obstetricians needed to know the information in the case it could ever save a woman’s life. Though some of DeLee’s philosophies were controversial, such as his disapproval of midwifery, he provided the emerging specialization of obstetrics with new technologies and interventions, cleanliness standards, and the introduction of film as a teaching method.

To address the international Human Immunodeficiency Virus epidemic, the World Health Organization, or WHO, developed three drug treatment regimens between 2010 and 2012 specifically for HIV-positive pregnant women and their infants. WHO developed the regimens, calling them Option A, Option B, and Option B+, to reduce or prevent mother-to-child, abbreviated MTC, transmission of HIV. Each option comprises of different types and schedules of antiretroviral medications. As of 2018, WHO reported that in Africa alone about 1,200,000 pregnant women were living with untreated HIV. Those women have up to a forty-five percent chance of transmitting HIV to their offspring if they do not receive treatment. Option B+ has decreased the overall maternal mortality rates in many low- and middle-income countries, and numerous studies have supported the notion that it is the most effective of the three regimens for preventing MTC transmission of HIV.

In 1920, Joseph Bolivar DeLee published the article, “The Prophylactic Forceps Operation,” in which he describes how physicians can manually remove a neonate from a laboring woman’s vagina with the use of sedating drugs and forceps. The procedure, according to DeLee, resulted in decreased rates of complications and mortality for both the woman and neonate. DeLee claimed the procedure could reduce damage to the woman such as prolapse, or when internal pelvic organs push down and sometimes protrude from the vagina, and fatal infant brain bleeding. He also suggested that physicians make an incision from the woman’s anus to vagina to accommodate the use of forceps, a procedure later known as an episiotomy. In “The Prophylactic Forceps Operation,” DeLee proposed the technique and use of his procedure, adding to the growing debate in the early twentieth century on the best way to medically assist women during delivery.

In 2011, Inga Kristen, Julius Sewangi, Andrea Kunz, Festo Dugange, Judith Ziske, Brigitte Jordan-Harder, Gundel Harms, and Stefanie Theuring published the article, “Adherence to Combination Prophylaxis for Prevention of Mother-to-Child-Transmission of HIV in Tanzania,” in PLoS ONE. Hereafter, “Adherence to Combination Prophylaxis,” the article details the authors’ investigation into the efficacy of a medication regimen called combination prophylaxis to prevent mother-to-child, or MTC, transmission of Human Immunodeficiency Virus, or HIV, before, during, and after delivery. They included pregnant women who had HIV, in Kyela, Tanzania. However, through interviews and surveys, the authors found that many women had difficulty adhering to the regimen, which made the medication less effective. Kristen and colleagues suggest that healthcare professionals who treat HIV-positive pregnant women increase hospital resources and prescribe medication to those women early in the pregnancy to reduce MTC transmission of HIV.

Human Immunodeficiency Virus, or HIV, is a global epidemic, costing over 9.51 million individuals their lives since 2000. There are different modes of transmission of HIV, one such mode being from an HIV positive woman to her child before, during, or after delivery (SIC Curriculum, 2006). Though a global epidemic, not all countries have the same prevalence of mother to child, or MTC, transmission of HIV. In 2016, over 160,000 children under the age of five were newly infected with HIV in sub-Saharan Africa. That is compared to the United States of America, where it is estimated that fewer than 150 new infant HIV infections occur yearly (Glaser Foundation, 2020). Those differences exist despite both countries having access to preventative medication as of 1998.
Additionally, the World Health Organization, or WHO, developed three treatment plans for prevention of MTC transmission of HIV, globally available as of 2010 (WHO, 2010). The goal of the WHO was to globally standardize care of HIV-positive pregnant women and their infants in order to decrease the global prevalence of HIV. The first plan was called Option A, then came Option B, and lastly Option B+. While preventative medication has been available for over twenty years and at least one of these theoretically effective treatment plans has been implemented and is readily available in each country of sub-Saharan Africa, the overall prevalence of MTC transmission of HIV in sub-Saharan Africa has continued to be notably high compared to other countries. Thus, the aim of this thesis is to explore some of the significant obstacles to implementation of the WHO’s treatment plans in sub-Saharan Africa that contribute to that high prevalence. I also suggest possible solutions to those barriers in order to effectively decrease the prevalence of MTC transmission of HIV.