Leaders of private philanthropic foundations from around the world met with United Nations Secretary General Kofi Annan on Dec. 6 to announce that they and the larger global community of foundations expect to commit $100 million in new funding for a five-year demonstration project which will link prevention and care of HIV/AIDS in developing countries in Africa, Asia and Latin America. Columbia President George Rupp and Mailman School Dean Allan Rosenfield were also in attendance at the meeting. The project, MTCT-Plus, to be focused initially on sub-Saharan Africa, will work through partners already engaged in the prevention of maternal-to-child transmission (MTCT) of HIV. MTCT-Plus represents a direct response by foundations to the Secretary General's "Call to Action" on HIV/AIDS issued earlier this year.

Allan Rosenfield, dean of the Mailman School of Public Health, has been asked by the foundations to coordinate MTCT-Plus, including the technical and operational challenges of the program. Rosenfield will lead a broad partnership coalition ranging from technical and service delivery organizations in developing countries to international institutions and non-governmental organizations.

MTCT-Plus builds on the efforts in Africa, rapidly expanding over the last several years, to prevent the transmission of HIV using a well-established package of low-cost and effective practices, including anti-retroviral drugs. Although groundbreaking progress is being made in preventing infection of children, the absence of care for mothers has been identified both as a moral dilemma and as a disincentive to participation. MTCT-Plus seeks to extend HIV treatment to women, so they will have the possibility of surviving their own HIV infections for a substantially extended period.

Each year, worldwide nearly 1.5 million women of child-bearing age die from AIDS, and 2.5 million others become newly infected. In sub-Saharan Africa, among the 26 million women who were pregnant in 2001, more than 2.5 million carried HIV.

While many U.S. and international foundations are contemplating funding, commitments have already been received from the Bill & Melinda Gates, William and Flora Hewlett, Robert Wood Johnson, Henry J. Kaiser Family, John D. and Catherine T. MacArthur, David and Lucile Packard, Rockefeller and UN foundations.

The MTCT-Plus demonstration project was created in direct response to the Declaration of Commitment on HIV/AIDS by the United Nations General Assembly Special Session held in June 2001 and is also intended to compliment the Global Fund to Fight AIDS, Tuberculosis & Malaria inspired by UN Secretary General Kofi Annan. The UN's June declaration calls for a 50 percent reduction in the number of infected infants by 2010 by ensuring that 80 percent of pregnant women in antenatal care have information, counseling and other HIV services available to them.

Foundations have been a crucial component of the international response to AIDS. Yet these foundations have acknowledged that they can and must do more, which inspired the emergence of the multi-foundation funded MTCT-Plus demonstration project. Foundations that have committed funds, as well as many that are considering funding, come from the wider community of global philanthropies, not just from foundations that traditionally operate in the arena of international health.

In order for the demonstration project to become operational as quickly as possible, and so as to avoid creating new administrative and funding structures, MTCT-Plus will be piloted as an extension of programs that are currently providing MTCT prevention services including programs administered by UNICEF, the Elizabeth Glaser Pediatric AIDS Foundation, Médecins Sans Frontières (MSF) and other organizations.

Participating MTCT sites currently offer voluntary counseling and testing for HIV, providing HIV negative mothers with information about how to protect themselves and prevent infection. Mothers who are found to be HIV-infected are enrolled in maternal-to-child transmission prevention protocols and followed over time. The MTCT-Plus project will add a treatment component, the "Plus," and these HIV-infected mothers will be provided an essential care package with appropriate therapies initiated as indicated. The "Plus" strategy therapies will include basic care for prevention and/or treatment of related opportunistic infections – of which tuberculosis is the most common – and, when indicated, treatment with anti-retroviral drugs. Over time, MTCT-Plus intends to include the HIV-infected family members of participating mothers and children.