3. Pilot projects

In many places it will be a good idea to introduce prenatal voluntary counselling and testing and the use of antiretroviral drugs and replacement feeding in a limited way in pilot programmes initially, so that lessons can be learnt about how best to operate the new service before it is introduced more widely. Careful monitoring and evaluation of such an exercise are essential and must be planned for from the start. Pilot programmes are specially important in places where stigmatization of people with HIV/AIDS is common, and where there is uncertainty about the safety of replacement feeding, or the acceptability of voluntary counselling and testing. Pilot sites should be selected on the basis of having good basic health services (as described above) already in place and efficient referral systems. Only if the projects are successful under these carefully chosen pilot conditions will further testing be tried in more challenging environments.

Integration of services is a key requirement: measures to prevent MTCT of HIV are one part of the wider programme to cope with HIV/AIDS in a country, and should have strong links to all other aspects of the programme, such as primary prevention of infection, care of infected people, and the support of orphans.