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Improving retention of breastfeeding women LWHIV on ART


Challenge Summary

This challenge is seeking to Identify effective solutions at the community level to improve retention of mothers living with HIV on ART through pregnancy, delivery, breastfeeding and beyond to prevent mother-to-child transmission of HIV. 

Challenge Status: This challenge is now closed. See the Winners Page for information on the winning submissions.

Prize amount: $65,000 to each winner

In Collaboration With: Elizabeth Glaser Paediatric AIDS Foundation & Every Woman Every Child 

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) is a non-profit organisation dedicated to preventing paediatric HIV infection and eliminating paediatric AIDS through research, advocacy, and prevention, care and treatment programs. Founded in 1988, EGPAF supports activities in 19 countries around the world.

Every Woman Every Child is an unprecedented global effort to intensify national and international commitment and action by governments, the United Nations, multilaterals, the private sector and civil society to ensure that women, children and adolescents are at the heart of development. As a platform to operationalize the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health, the movement mobilizes coordinated efforts across sectors to deliver on the promises of a sustainable future for all.  


While significant global progress has been made in reducing new HIV infections and AIDS-related deaths among newborns and children, critical gaps remain; especially for young women and breastfeeding mothers in developing countries. Breastfeeding is essential to the growth and healthy development of young infants but carries an enormous risk of mother-to-child transmission of HIV when a mother living with HIV is not on sustained antiretroviral therapy (ART). In some countries in sub-Saharan Africa, as few as 50% of pregnant and breastfeeding women living with HIV are retained on ART 12 months after initiation.

In adopting the Sustainable Development Goals, the global community set an ambitious target of ending the AIDS epidemic by 2030. To reach this target, a super-fast-track approach is being implemented to access HIV prevention, treatment, care and support services for children, adolescents and young women. 


Start Free Stay Free AIDS Free is being led by UNAIDS and PEPFAR and aims to end the AIDS epidemic among children, adolescents and young women by 2020. Part of this approach includes a special focus on initiating pregnant women living with HIV on lifelong antiretroviral therapy, while ensuring that breastfeeding mothers are retained in care during the full breastfeeding period.

The Challenge

Initiating and retaining pregnant and breastfeeding women living with HIV on ART is critical to supporting them to stay healthy and prevent the transmission of HIV to their infants. The introduction of lifelong ART for all pregnant women living with HIV in 2013, known as “Option B+,” has significantly increased the number of women receiving ART, from 36% in 2009 to more than 80% in 2015 across 21 priority countries in sub-Saharan Africa. We are therefore seeking innovative solutions to improve the retention of breastfeeding women on ART in resource limited settings where national guidelines support this approach. 

Challenge statement: Identify effective solutions at the community level to improve retention of mothers living with HIV on ART through pregnancy, delivery, breastfeeding and beyond to prevent mother-to-child transmission of HIV.

This may include development of innovative approaches or scale-up of proven interventions. Innovative and novel approaches are particularly encouraged. Solutions may include service delivery methods, adherence/clinical support, educational interventions and/or new technologies but should not contradict national breastfeeding guidelines for women living with HIV.

Success measures may include:

  • Increased retention of women living with HIV on ART during entire period of pregnancy, delivery and breastfeeding
  • Reduced incidence of HIV infection of infants during breastfeeding period by women living with HIV
  • Improved viral suppression of breastfeeding mothers on ART during breastfeeding period
  • Increase in HIV-negative testing status of infants at the end of breastfeeding period




In addition to the below criteria, solutions must demonstrate how the challenge statement is met in the context of resource-limited settings without contradicting national breastfeeding guidelines for women living with HIV in the resource-limited settings targeted.

  • People Centred: Entries may focus on a process, technology or other method but the ultimate benefit must be measurable in terms of impact on people’s lives. Must ensure privacy, demonstrate an ability to not perpetuate stigma and discrimination associated with HIV and enhance active community participation in solution development.
  • Replicable: Entries can be replicated and adapted by others at low cost to ensure broader implementation and uptake as quickly as possible in similar settings.
  • Scalable: Entries must demonstrate how they can be scaled beyond pilot programmes to large scale responses that can be implemented at greater/national scale.
  • Affordable: Entries must demonstrate affordability (low-cost or no-cost to the end users) within resource limited settings or other similar settings as detailed in the individual challenges.
  • Sustainable: Entries must demonstrate how they are implementable in the longer term (beyond the lifecycle of prize funding) using the resources that already exist or which can be incremental to existing service delivery.
  • Achieving substantive change: Successful entries are expected to change the thoughts, processes and other barriers that prevent people living in resource limited settings from receiving the best care possible within the resources (financial and other) available, demonstrating a clear benefit to the people and systems targeted.



Executive Director, International AIDS Society, Geneva; IAS non-voting Governing Council member; IAS non-voting Executive Committee officer.


Senior Programme Manager, International Development and UK Prizes, Centre for Challenge Prizes, Nesta, London.


Divison Chief: Applied Innovation, U.S. Global Development Lab, USAID


Founder and CEO, JustActions; Chair, Breastfeeding Innovations Team




    Click Apply Now to access the PAC Community portal where you can register or log in to start an application. Once registered you can connect with fellow solvers to share ideas, find collaborators and work on applications.
    Submit a Concept Note to provide a summary of your innovation. You can seek input/feedback from other community members or submit right away. Concepts are shortlisted to progress to the next stage by the PAC team based on the challenge criteria.
    The best eligible Concept Notes are invited to submit a Full Application. This stage requires more detail about the development and implementation of your innovation. This is the final stage for applicants before the judging process begins.

For more detail, see How it Works.