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Sample records for child hiv transmission

  1. Reducing mother-to-child HIV transmission

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    In developing countries,mother-to-child trans mission of human immune deficiency virus (HIV)is responsible for 5 to 10 percen t o f all new HIV infections.Most children born to HIV-positive mothers are not HIV positive,but one quarter to one third are.The following instert looks at the p o ssibilities for reducing mother-to-child HIV transmission,and discusses some of the questions that are still unanswered.

  2. Preventing Mother-to-Child Transmission of HIV during Childbirth

    Science.gov (United States)

    HIV and Pregnancy Preventing Mother-to-Child Transmission of HIV During Childbirth (Last updated 8/17/2015; last reviewed ... a scheduled cesarean delivery even if she took HIV medicine during pregnancy. The cesarean delivery should be performed before a ...

  3. The spectrum of HIV mother-to-child transmission risk

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    Veronique Reliquet

    2014-11-01

    Full Text Available Introduction: With the implementation of combined antiretroviral therapy (cART and prevention of mother-to-child transmission (MTCT we observed dramatic decreases in rates of perinatal MTCT of HIV, 0.3% in France in women with plasma viral load (pVL <50 c/mL at delivery. We describe a case of MTCT which occurred despite virologic suppression of the mother at delivery, the first case in our centre since 2002. Description of the case: A 26-year-old black woman, Guinea-native, living in France since 2007, was diagnosed with HIV-1 CRF02 in 2008 and lost to follow-up since November 2012 after second delivery (2 female born in March 2009 and October 2012, uninfected. Third pregnancy began in July 2013 and baseline characteristics in September were as follows: week 13 of gestational age (GA, CDC stage A, CD4 317/mm3, pVL 4.89 log c/mL. cART with abacavir/lamivudine and atazanavir/ritonavir 300/100 mg daily (qd was introduced. VL decreased to 2.4 log c/mL in 4 weeks and CD4 increased to 456/mm3. In December, at week 22 of GA, viral rebound at 4.14 log c/mL due to sub-optimal maternal adherence was observed. After counselling, pVL decreased to 1.69 log c/mL in March 2014, at week 35 of GA and 1.3 log c/mL at delivery. As pVL was <400 c/mL at week 36 of GA, vaginal delivery with IV zidovudine was decided. However, because of poor/uncertain maternal adherence to cART, the neonate was treated with a combination of 2 drugs (lamivudine-nevirapine with the 4-week zidovudine regimen, until the result of delivery pVL. This combination was stopped at day 2 when maternal delivery pVL (22 c/mL was received and standard oral zidovudine prophylaxis was continued. Infant was tested for HIV infection at baseline (day 3 and found to be HIV-infected (HIV-RNA 60 c/mL attesting in-utero HIV transmission. On day 15, zidovudine prophylaxis was discontinued and treatment for HIV infection initiated with standard cART according to the French Paediatric Antiretroviral

  4. HIV Transmission

    Science.gov (United States)

    ... Abroad Treatment Basic Statistics Get Tested Find an HIV testing site near you. Enter ZIP code or city Follow HIV/AIDS CDC HIV CDC HIV/AIDS See RSS | ... on HIV Syndicated Content Website Feedback HIV/AIDS HIV Transmission Language: English Español (Spanish) Recommend on Facebook ...

  5. Preventing mother to child transmission of HIV in Vietnam and Indonesia: diverging care dynamics

    NARCIS (Netherlands)

    A.P. Hardon; P. Oosterhoff; J.D. Imelda; N.T. Anh; I. Hidayana

    2009-01-01

    How do women and frontline health workers engage in preventing mother-to-child HIV transmission (PMTCT) in urban areas of Vietnam and Indonesia, where HIV is highly stigmatized and is associated with injecting drug use and sex work? This qualitative study explores local dynamics of care, using a mix

  6. Outcomes of prevention of HIV mother-to-child transmission in Cipto Mangunkusumo Hospital

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    Dina Muktiarti

    2012-09-01

    Full Text Available Background Human immunodeficiency virus (HIV infection is increasing worldwide. One route of HIV transmission is from mother to child, during pregnancy, delivery or breastfeeding. Prevention of mother-to-child transmission may be an effective strategy to reduce the cases of new HIV infections. Objectives To investigate the incidence of HIV infection in infants born to mothers with HIV and who received prophylactic therapy at birth, as well as to note the outcomes of HIV-infected children in this program. Methods This retrospective study was carried out over a 9-year period, from January 2003 to December 2011. The participants were HIV-exposed infants who attended the HIV clinic, at the Department of Child Health, Cipto Mangunkusumo Hospital Jakarta. Infants were treated according to the prevention of mother-to-child transmission (PMTCT protocol at CMH. Parents’ and infants’ data was recorded. The end point of this study was recording of HIV-infection status in the infants. Results There were 238 infants included in this study. HIV infection was confirmed in 6 (2.5% infants, while 170 (72.4% subjects were uninfected, and 62 (26.1% subjects were lost to foloow-up. No subjects who underwent complete PMTCT management were infected. Most subjects were male, full-term, and delivered by caesarean section in our hospital. The most frequently observed parental risk factor was intravenous drug use. Maternal antiretroviral theraphy (ART was given during pregnancy in most cases. Morbidities in all subjects were low. Conclusion The PMTCT program at CMH was effective for reducing the number of HIV-infected infants from mothers with HIV

  7. Functionally-Impaired HIV-1 Nef Alleles from a Mother-Child Transmission Pair

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    Vincent C. Bond

    2002-10-01

    Full Text Available Abstract: Unusual HIV-1 nef alleles were isolated from a woman and her vertically infected child. Both patients eventually progressed to develop AIDS. The child died at age 6.5 years, while the mother is currently alive, 13 years since her diagnosis with HIV-1. Predicted amino acid sequences of both mother and child Nefs diverged from the HIV-1 clade B consensus. In particular, they exhibited two separate 5-amino acid deletions bracketing a Cterminal dileucine regulatory motif and Trp-Gly mutations at the site for cleavage by the HIV-1 protease. The child’s Nef showed a modest ability to enhance HIV-1 infectivity in MAGI cells, whereas the mother’s Nef did not alter HIV-1 infectivity in the assay. Both Nefs were partially functional for CD4 down-regulation. The child’s Nef was fully functional for MHC-1 down-regulation, while the maternal Nef was non-functional. To our knowledge this study is the first to describe a functional divergence between Nef alleles in a case of mother-to-child HIV-1 transmission.

  8. Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda. : Prevention of postnatal HIV transmission

    OpenAIRE

    Peltier, Cécile-Alexandra; Ndayisaba, Gilles-François; Lepage, Philippe; VAN GRIENSVEN, Johan; Leroy, Valériane; Omes, Christine; Ndimubanzi, Patrick-C; Courteille, Olivier

    2009-01-01

    International audience OBJECTIVE: To assess the 9-month HIV-free survival of children with two strategies to prevent HIV mother-to-child transmission. DESIGN: Nonrandomized interventional cohort study. SETTING: Four public health centres in Rwanda. PARTICIPANTS: Between May 2005 and January 2007, all consenting HIV-infected pregnant women were included. INTERVENTION: Women could choose the mode of feeding for their infant: breastfeeding with maternal HAART for 6 months or formula feeding. ...

  9. Antiretroviral Strategies to Prevent Mother-to-Child Transmission of HIV: Striking a Balance between Efficacy, Feasibility, and Resistance

    OpenAIRE

    McIntyre, James A; Hopley, Mark; Moodley, Daya; Eklund, Marie; Gray, Glenda E.; Hall, David B.; Robinson, Patrick; Mayers, Douglas; Martinson, Neil A

    2009-01-01

    Editors' Summary Background Currently, about 33 million people are infected with the human immunodeficiency virus (HIV), which causes AIDS. HIV can be treated with combination antiretroviral therapy (ART), commonly three individual antiretroviral drugs that together efficiently suppress the replication of the virus. HIV infection of a child by an HIV-positive mother during pregnancy, labor, delivery, or breastfeeding is called mother-to-child transmission (MTCT). In 2007, an estimated 420,000...

  10. Role of male partners in the prevention of mother-to-child HIV transmission

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    Osoti A

    2014-07-01

    Full Text Available Alfred Osoti,1–3 Hannah Han,4 John Kinuthia,1,5 Carey Farquhar3,4,6 1Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya; 2Department of Obstetrics and Gynecology, AIC Kijabe Hospital, Kijabe, Kenya; 3Department of Epidemiology, 4Department of Global Health, University of Washington, Seattle, USA; 5Department of Obstetrics and Gynecology, Kenyatta National Hospital, Nairobi, Kenya; 6Department of Medicine, University of Washington, Seattle, USA Abstract: There is emerging evidence that in resource-limited settings with a high human immunodeficiency virus (HIV burden, male partner involvement in prevention of mother-to-child HIV transmission (PMTCT is associated with improved uptake of effective interventions and infant HIV-free survival. There is also increasing evidence that male partner involvement positively impacts non-HIV related outcomes, such as skilled attendance at delivery, exclusive breastfeeding, uptake of effective contraceptives, and infant immunizations. Despite these associations, male partner involvement remains low, especially when offered in the standard antenatal clinic setting. In this review we explore strategies for improving rates of antenatal male partner HIV testing and argue that the role of male partners in PMTCT must evolve from one of support for HIV-infected pregnant and breastfeeding women to one of comprehensive engagement in prevention of primary HIV acquisition, avoidance of unintended pregnancies, and improved HIV-related care and treatment for the HIV-infected and uninfected women, their partners, and children. Involving men in all components of PMTCT has potential to contribute substantially to achieving virtual elimination of mother-to-child HIV transmission; promoting partner-friendly programs and policies, as well as pursuing research into numerous gaps in knowledge identified in this review, will help drive this process. Keywords: male involvement, limited-resource settings

  11. History of the prevention of mother-to-child transmission of HIV in Thailand.

    Science.gov (United States)

    Phanuphak, Nittaya; Phanuphak, Praphan

    2016-01-01

    Strategies for the prevention of mother-to-child transmission (PMTCT) of HIV have undergone considerable evolution based on scientific evidence, both at global and local levels. Because of the rapid expansion of the HIV epidemic among the heterosexual population, and the relatively advanced mother and child health infrastructure, Thailand has been the site of international study for more efficacious and cost-effective PMTCT regimens since mid-1990. The example of the Thai Red Cross Society in providing standard PMTCT care through public donations under the patronage of Her Royal Highness Princess Soamsawali is an example that non-governmental organisations in other countries can follow to accelerate access to standard PMTCT care. However, there are still many challenges before vertical transmission of HIV is completely eradicated. PMID:27482444

  12. Nurses’ counseling to mothers to prevent mother to child transmission of HIV through breastfeeding : A qualitative study

    OpenAIRE

    Staflin, Emma; Lundkvist, Jennie

    2011-01-01

    Introduction: HIV is a serious problem in Namibia, 13.1% of the adult population is HIV-positive or is a carrier of AIDS. This is one of the highest numbers in the world. HIV is passed from mother to child during pregnancy, during labour or through breast milk. 18.8 % of the pregnant mothers in Namibia who is in contact with the maternity welfare have HIV. Aim: The aim of the study was to describe nurses’ counseling to mothers to prevent mother to child transmission of HIV through breastfeedi...

  13. Prevention of mother-to-child transmission in HIV audit in Xhosa clinic, Mahalapye, Botswana

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    Stephane Tshitenge

    2014-01-01

    Full Text Available Background: The Mahalapye district health management team (DHMT conducts regular audits to evaluate the standard of services delivered to patients, one of which is the prevention of mother-to-child-transmission (PMTCT programme. Xhosa clinic is one of the facilities in Mahalapye which provides a PMTCT programme.Aim: This audit aimed to identify gaps between the current PMTCT clinical practice in Xhosa clinic and the Botswana PMTCT national guidelines.Setting: This audit took place in Xhosa clinic in the urban village of Mahalapye, in the Central District of Botswana.Methods: This was a retrospective audit using PMTCT Xhosa clinic records of pregnant mothers and HIV-exposed babies seen from January 2013 to June 2013.Results: One hundred and thirty-three pregnant women registered for antenatal care. Twenty-five (19% knew their HIV-positive status as they had been tested before their pregnancy or had tested HIV positive at their first antenatal clinic visit. More than two-thirds of the 115 pregnant women (69% were seen at a gestational age of between 14 and 28 weeks. About two-thirds of the pregnant women (67% took antiretroviral drugs. Of the 44 HIV-exposed infants, 39 (89% were HIV DNA PCR negative at 6 weeks. Thirty-two (73% children were given cotrimoxazole prophylaxis between 6 and 8 weeks.Conclusion: The PMTCT programme service delivery was still suboptimal and could potentially increase the mother-to-child transmission of HIV. Daily monitoring mechanism to track those eligible could help to close the gap.

  14. Incident HIV during Pregnancy and Postpartum and Risk of Mother-to-Child HIV Transmission: A Systematic Review and Meta-Analysis

    OpenAIRE

    Alison L Drake; Anjuli Wagner; Barbra Richardson; Grace John-Stewart

    2014-01-01

    Editors' Summary Background Worldwide, about 3.4 million children younger than 15 years old (mostly living in sub-Saharan Africa) are infected with HIV, the virus that causes AIDS by gradually destroying immune system cells, thereby leaving infected individuals susceptible to other serious infections. In 2012 alone, 230,000 children (more than 700 every day) were newly infected with HIV. Most HIV infections among children are the result of mother-to-child HIV transmission (MTCT) during pregna...

  15. Prevention of HIV infection transmission from mother to child in Romania - a simultaneous objective and challenge

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    M Mitran

    2012-11-01

    Full Text Available The latest WHO data regarding HIV/AIDS infection have revealed the real dimension of this epidemic. In Romania, in 2011 out of 619 new detected cases, 19 represented children between 0–14 years. Vertical transmission was recorded for 16 (2.6% of these cases. Within this epidemiological context, mother to child transmission continues to represent a top theme, which determined us to continue with the observations initiated in 2000 on this phenomenon. Purpose of the study: The follow up of the evolution of a certain number of perinatally exposed children to HIV infection throughout 11 years, based on several risk factors: time of birth, time of the mother's and child's diagnosis; type of birth; type of nourishment for the newborn. Methods: During 01.01.2000–31.12.2011, 435 children from all around the country were included in the study and assessed at I.N.B.I “Prof. Dr. M. Bals” in Bucharest, with ages between 0–18 months. They were clinically and biologically evaluated until the age of 18 months. Relevant data on the children were recorded: gender, age, time of diagnosis, ART prophylaxis (YES or NO, type of birth and nourishment, CD4 count, VL at the initial time and at the end of the surveillance period. For mothers we focused on: age, environment, level of education, occupation, time of HIV diagnosis, treatment/prophylaxis, type of birth, CD4 and VL at birth (data obtained from medical records or anamnesis. Results: Out of the surveyed 435 children, 16% were considered infected with HIV. This rate decreased in stages, from 45% in 2005 to 17% in 2010. The main transmission causes were late HIV diagnosis in the mother, lack of prophylaxis/treatment for mothers, natural birth, breastfeeding, lack of prophylaxis in children or tardiness in initiating it. Conclusions: The rate of HIV transmission is still very high. The elimination of this infection route is globally considered a realistic objective of public health policies. In this sense

  16. Association of HIV-1 Envelope-Specific Breast Milk IgA Responses with Reduced Risk of Postnatal Mother-to-Child Transmission of HIV-1

    Science.gov (United States)

    Pollara, Justin; McGuire, Erin; Fouda, Genevieve G.; Rountree, Wes; Eudailey, Josh; Overman, R. Glenn; Seaton, Kelly E.; Deal, Aaron; Edwards, R. Whitney; Tegha, Gerald; Kamwendo, Deborah; Kumwenda, Jacob; Nelson, Julie A. E.; Liao, Hua-Xin; Brinkley, Christie; Denny, Thomas N.; Ochsenbauer, Christina; Ellington, Sascha; King, Caroline C.; Jamieson, Denise J.; van der Horst, Charles; Kourtis, Athena P.; Tomaras, Georgia D.; Ferrari, Guido

    2015-01-01

    responses in plasma and breast milk of HIV-1-transmitting and -nontransmitting mothers to identify responses that correlated with reduced risk of postnatal HIV-1 transmission. We found that neither plasma nor breast milk IgG antibody responses were associated with risk of HIV-1 transmission. In contrast, the magnitudes of the breast milk IgA and secretory IgA responses against HIV-1 envelope proteins were associated with reduced risk of postnatal HIV-1 transmission. The results of this study support further investigations of the mechanisms by which mucosal IgA may reduce the risk of HIV-1 transmission via breastfeeding and the development of strategies to enhance milk envelope-specific IgA responses to reduce mother-to-child HIV transmission and promote an HIV-free generation. PMID:26202232

  17. Prevention of mother-to-child transmission of HIV in Latvia, 2008–2011

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    A Sangirejeva

    2012-11-01

    Full Text Available Purpose of the study: The aim of this study was to describe trends in the management of pregnancies in HIV-infected women and their outcomes, over a 4-year period in Latvia on an Infectology Center of Latvia (LIC basis. Methods: The study of HIV-infected women in Latvia giving birth to one or more children between 1 Jan 2008 and 31 Dec 2011. Results: We identified 199 HIV-infected women with 210 pregnancies. Mean age was 27 years, median baseline pregnancy CD4 count was 452 cells/mm3, the baseline pregnancy plasma viral load (VL was 53,066 copies/ml. Knowledge of HIV status before pregnancy was 60.5%, but 32.5% HIV-positive diagnosis was confirmed during pregnancy and 7.1% after delivery. One pregnant woman's HIV disease progressed to AIDS and death. Women on antiretroviral therapy (ART were 82.3%. Maternal monotherapy with the zidovudine (ZDV rate was 10.4%, dual therapy with nucleoside reverse-transcriptase inhibitor (NRTI - 2.3%, triple therapy with the protease-inhibitor (PI plus NRTI - 87.3%. Median VL at delivery was 1349. A greater proportion of cases 91.5% had a VL <1000 copies/ml, from them 47.4% <40 copies/ml. Vaginal deliveries range was 20.8% of pregnancies and elective cesarean delivery 68.6%. Preterm delivery occurred in 12.1%. Overall mother-to-child transmission (MTCT of HIV rate was 4.3%. Among the 35.5% of mothers initiating ART at 14 weeks’ gestation, MTCT was 1.4%, compared with 1.5% and 3.1% for those initiating ART at <14 weeks (n=67, 31.9% and >24 weeks (n=32, 15.2%. Among 17.6% women, who did not receive prophylactic ART, MTCT rate was 16.2%. 7 of 9 women giving birth to an HIV-positive child were diagnosed with HIV before pregnancy, 1 of 9 during pregnancy, 1 of 9 after delivery. From women giving birth to an HIV-positive child 6 did not receive prophylactic ART, 1 started ART at week 14, 2 after week 14. Conclusions: Women's low education, recurrent pregnancies, intravenous drug use, vaginal deliveries, not receiving

  18. Increasing adolescent HIV prevalence in Eastern Zimbabwe--evidence of long-term survivors of mother-to-child transmission?

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    Jeffrey W Eaton

    Full Text Available Recent data from the Manicaland HIV/STD Prevention Project, a general-population open HIV cohort study, suggested that between 2004 and 2007 HIV prevalence amongst males aged 15-17 years in eastern Zimbabwe increased from 1.20% to 2.23%, and in females remained unchanged at 2.23% to 2.39%, while prevalence continued to decline in the rest of the adult population. We assess whether the more likely source of the increase in adolescent HIV prevalence is recent sexual HIV acquisition, or the aging of long-term survivors of perinatal HIV acquisition that occurred during the early growth of the epidemic. Using data collected between August 2006 and November 2008, we investigated associations between adolescent HIV and (1 maternal orphanhood and maternal HIV status, (2 reported sexual behaviour, and (3 reporting recurring sickness or chronic illness, suggesting infected adolescents might be in a late stage of HIV infection. HIV-infected adolescent males were more likely to be maternal orphans (RR = 2.97, p<0.001 and both HIV-infected adolescent males and females were more likely to be maternal orphans or have an HIV-infected mother (male RR = 1.83, p<0.001; female RR = 16.6, p<0.001. None of 22 HIV-infected adolescent males and only three of 23 HIV-infected females reported ever having had sex. HIV-infected adolescents were 60% more likely to report illness than HIV-infected young adults. Taken together, all three hypotheses suggest that recent increases in adolescent HIV prevalence in eastern Zimbabwe are more likely attributable to long-term survival of mother-to-child transmission rather than increases in risky sexual behaviour. HIV prevalence in adolescents and young adults cannot be used as a surrogate for recent HIV incidence, and health systems should prepare for increasing numbers of long-term infected adolescents.

  19. Five-year trends in epidemiology and prevention of mother-to-child HIV transmission, St. Petersburg, Russia: results from perinatal HIV surveillance

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    Kissin Dmitry M

    2011-10-01

    Full Text Available Abstract Background The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission. Methods Standard HIV case-reporting and enhanced perinatal HIV surveillance systems were used for prospective assessment of HIV-infected women giving birth in St. Petersburg, Russia, during 2004-2008. Trends in social, perinatal, and clinical factors influencing mother-to-child HIV transmission stratified by history of injection drug use, and rates of perinatal HIV transmission were assessed using two-sided χ2 or Cochran-Armitage tests. Results Among HIV-infected women who gave birth, the proportion of women who self-reported ever using injection drugs (IDUs decreased from 62% in 2004 to 41% in 2008 (P P P P for trend Conclusions Reduced proportion of IDUs and improved clinical services among HIV-infected women giving birth were accompanied by decreased perinatal HIV transmission, which can be further reduced by increasing outreach and HIV testing of women before and during pregnancy.

  20. Functionally-Impaired HIV-1 Nef Alleles from a Mother-Child Transmission Pair

    OpenAIRE

    Bond, Vincent C; Michael Powell; Greene, Warner C.; Jalal A. Zuberi; Stringer, Harold G.; Romas Geleziunas; Mafhuz Khan; Roth, William W.

    2002-01-01

    Abstract: Unusual HIV-1 nef alleles were isolated from a woman and her vertically infected child. Both patients eventually progressed to develop AIDS. The child died at age 6.5 years, while the mother is currently alive, 13 years since her diagnosis with HIV-1. Predicted amino acid sequences of both mother and child Nefs diverged from the HIV-1 clade B consensus. In particular, they exhibited two separate 5-amino acid deletions bracketing a Cterminal dileucine regulatory motif and Trp-Gly mut...

  1. Mother-to-Child HIV-1 Transmission Events Are Differentially Impacted by Breast Milk and Its Components from HIV-1-Infected Women.

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    Ruizhong Shen

    Full Text Available Breast milk is a vehicle of infection and source of protection in post-natal mother-to-child HIV-1 transmission (MTCT. Understanding the mechanism by which breast milk limits vertical transmission will provide critical insight into the design of preventive and therapeutic approaches to interrupt HIV-1 mucosal transmission. However, characterization of the inhibitory activity of breast milk in human intestinal mucosa, the portal of entry in postnatal MTCT, has been constrained by the limited availability of primary mucosal target cells and tissues to recapitulate mucosal transmission ex vivo. Here, we characterized the impact of skimmed breast milk, breast milk antibodies (Igs and non-Ig components from HIV-1-infected Ugandan women on the major events of HIV-1 mucosal transmission using primary human intestinal cells and tissues. HIV-1-specific IgG antibodies and non-Ig components in breast milk inhibited the uptake of Ugandan HIV-1 isolates by primary human intestinal epithelial cells, viral replication in and transport of HIV-1- bearing dendritic cells through the human intestinal mucosa. Breast milk HIV-1-specific IgG and IgA, as well as innate factors, blocked the uptake and transport of HIV-1 through intestinal mucosa. Thus, breast milk components have distinct and complementary effects in reducing HIV-1 uptake, transport through and replication in the intestinal mucosa and, therefore, likely contribute to preventing postnatal HIV-1 transmission. Our data suggests that a successful preventive or therapeutic approach would require multiple immune factors acting at multiple steps in the HIV-1 mucosal transmission process.

  2. Tracing defaulters in HIV prevention of mother-to-child transmission programmes through community health workers: results from a rural setting in Zimbabwe.

    OpenAIRE

    Florian Vogt; Cecilia Ferreyra; Andrea Bernasconi; Lewis Ncube; Fabian Taziwa; Winnie Marange; David Wachi; Heiko Becher

    2015-01-01

    Introduction: High retention in care is paramount to reduce vertical human immunodeficiency virus (HIV) infections in prevention of mother-to-child transmission (PMTCT) programmes but remains low in many sub-Saharan African countries. We aimed to assess the effects of community health worker–based defaulter tracing (CHW-DT) on retention in care and mother-to-child HIV transmission, an innovative approach that has not been evaluated to date. Methods: We analyzed patient records of 1878 HIV-pos...

  3. Comparing HIV prevalence estimates from prevention of mother-to-child HIV transmission programme and the antenatal HIV surveillance in Addis Ababa

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    Mirkuzie Alemnesh H

    2012-12-01

    Full Text Available Abstract Background In the absence of reliable data, antenatal HIV surveillance has been used to monitor the HIV epidemic since the late 1980s. Currently, routine data from Prevention of Mother-to-child HIV transmission (PMTCT programmes are increasingly available. Evaluating whether the PMTCT programme reports provide comparable HIV prevalence estimates with the antenatal surveillance reports is important. In this study, we compared HIV prevalence estimates from routine PMTCT programme and antenatal surveillance in Addis Ababa with the aim to come up with evidence based recommendation. Methods Summary data were collected from PMTCT programmes and antenatal surveillance reports within the catchment of Addis Ababa. The PMTCT programme data were obtained from routine monthly reports from 2004 to 2009 and from published antenatal HIV surveillance reports from 2003 to 2009. Data were analysed using descriptive statistics. Results In Addis Ababa, PMTCT sites had increased from six in 2004 to 54 in 2009. The site expansion was accompanied by an increased number of women testing. There were marked increases in the rate of HIV testing following the introduction of routine opt-out HIV testing approach. Paralleling these increases, the HIV prevalence showed a steady decline from 10.0% in 2004 to 4.5% in 2009. There were five antenatal surveillance sites from 2003 to 2007 in Addis Ababa and they increased to seven by 2009. Four rounds of surveillance data from five sites showed a declining trend in HIV prevalence over the years. The overall antenatal surveillance data also showed that the HIV prevalence among antenatal attendees had declined from 12.4% in 2003 to 5.5% in 2009. The HIV prevalence estimates from PMTCT programme were 6.2% and 4.5% and from antenatal surveillance 6.1 and 5.5% in 2008 and 2009 respectively. Conclusions There were consistent HIV prevalence estimates from PMTCT programme and from antenatal surveillance reports. Both data sources

  4. Mother-to-child transmission of HIV: the pre-rapid advice experience of the university of Nigeria teaching hospital Ituku/Ozalla, Enugu, South-east Nigeria

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    Ibeziako Ngozi S

    2012-06-01

    Full Text Available Abstract Background Mother-to-child transmission of human immune deficiency virus (HIV is the most common route of HIV transmission in the pediatric age group. A number of risk factors contribute to the rate of this transmission. Such risk factors include advance maternal HIV disease, lack of anti-viral prophylaxis in the mother and child, mixing of maternal and infant blood during delivery and breastfeeding. This study aims to determine the cumulative HIV infection rate by 18 months and the associated risk factors at the University of Nigeria Teaching Hospital, Enugu. Results A retrospective study, involving HIV exposed infants seen at the pediatric HIV clinic of UNTH between March 2006 and September 2008. Relevant data were retrieved from their medical records. The overall rate of mother to child transmission of HIV in this study was 3.9% (95% CI 1.1%- 6.7%. However, in children breastfed for 3 months or less, the rate of transmission was 10% (95% CI −2.5%-22.5%, compared to 3.5% (95% CI 0.5%-6.5% in children that had exclusive replacement feeding. Conclusions This retrospective observational study shows a 3.9% cumulative rate of mother-to-child transmission of HIV by 18 months of age in Enugu. Holistic but cost effective preventive interventions help in reducing the rate of mother-to-child transmission of HIV even in economically-developing settings like Nigeria.

  5. Prevention of mother-to-child HIV-1 transmission in Burkina Faso: evaluation of vertical transmission by PCR, molecular characterization of subtypes and determination of antiretroviral drugs resistance

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    Sagna, Tani; Bisseye, Cyrille; Compaore, Tegewende R.; Kagone, Therese S.; Djigma, Florencia W.; Ouermi, Djeneba; Pirkle, Catherine M.; Zeba, Moctar T. A.; Bazie, Valerie J. T.; Douamba, Zoenabo; Moret, Remy; Pietra, Virginio; Koama, Adjirita; Gnoula, Charlemagne; Sia, Joseph D.; Nikiema, Jean-Baptiste; Simpore, Jacques

    2015-01-01

    Background Vertical human immunodeficiency virus (HIV) transmission is a public health problem in Burkina Faso. The main objective of this study on the prevention of mother-to-child HIV-1 transmission was to determine the residual risk of HIV transmission in infants born to mothers receiving highly active antiretroviral therapy (HAART). Moreover, we detect HIV antiretroviral (ARV) drug resistance among mother–infant pairs and identify subtypes and circulating recombinant forms (CRF) in Burkina Faso. Design In this study, 3,215 samples of pregnant women were analyzed for HIV using rapid tests. Vertical transmission was estimated by polymerase chain reaction in 6-month-old infants born to women who tested HIV positive. HIV-1 resistance to ARV, subtypes, and CRFs was determined through ViroSeq kit using the ABI PRISM 3,130 sequencer. Results In this study, 12.26% (394/3,215) of the pregnant women were diagnosed HIV positive. There was 0.52% (2/388) overall vertical transmission of HIV, with rates of 1.75% (2/114) among mothers under prophylaxis and 0.00% (0/274) for those under HAART. Genetic mutations were also isolated that induce resistance to ARV such as M184V, Y115F, K103N, Y181C, V179E, and G190A. There were subtypes and CRF of HIV-1 present, the most common being: CRF06_CPX (58.8%), CRF02_AG (35.3%), and subtype G (5.9%). Conclusions ARV drugs reduce the residual rate of HIV vertical transmission. However, the virus has developed resistance to ARV, which could limit future therapeutic options when treatment is needed. Resistance to ARV therefore requires a permanent interaction between researchers, physicians, and pharmacists, to strengthen the network of monitoring and surveillance of drug resistance in Burkina Faso. PMID:25630709

  6. Prevention of mother-to-child HIV-1 transmission in Burkina Faso: evaluation of vertical transmission by PCR, molecular characterization of subtypes and determination of antiretroviral drugs resistance

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    Tani Sagna

    2015-01-01

    Full Text Available Background: Vertical human immunodeficiency virus (HIV transmission is a public health problem in Burkina Faso. The main objective of this study on the prevention of mother-to-child HIV-1 transmission was to determine the residual risk of HIV transmission in infants born to mothers receiving highly active antiretroviral therapy (HAART. Moreover, we detect HIV antiretroviral (ARV drug resistance among mother–infant pairs and identify subtypes and circulating recombinant forms (CRF in Burkina Faso. Design: In this study, 3,215 samples of pregnant women were analyzed for HIV using rapid tests. Vertical transmission was estimated by polymerase chain reaction in 6-month-old infants born to women who tested HIV positive. HIV-1 resistance to ARV, subtypes, and CRFs was determined through ViroSeq kit using the ABI PRISM 3,130 sequencer. Results: In this study, 12.26% (394/3,215 of the pregnant women were diagnosed HIV positive. There was 0.52% (2/388 overall vertical transmission of HIV, with rates of 1.75% (2/114 among mothers under prophylaxis and 0.00% (0/274 for those under HAART. Genetic mutations were also isolated that induce resistance to ARV such as M184V, Y115F, K103N, Y181C, V179E, and G190A. There were subtypes and CRF of HIV-1 present, the most common being: CRF06_CPX (58.8%, CRF02_AG (35.3%, and subtype G (5.9%. Conclusions: ARV drugs reduce the residual rate of HIV vertical transmission. However, the virus has developed resistance to ARV, which could limit future therapeutic options when treatment is needed. Resistance to ARV therefore requires a permanent interaction between researchers, physicians, and pharmacists, to strengthen the network of monitoring and surveillance of drug resistance in Burkina Faso.

  7. Where are the men? Targeting male partners in preventing mother-to-child HIV transmission.

    Science.gov (United States)

    Koo, Kevin; Makin, Jennifer D; Forsyth, Brian W C

    2013-01-01

    Involvement of male partners may increase adherence to and improve outcomes of programs to prevent mother-to-child HIV transmission (PMTCT). Greater understanding of factors impeding male voluntary HIV counseling and testing (VCT) is needed. A cross-sectional study was conducted in Tshwane, South Africa. Semi-structured interviews were completed with men whose partners had recently been pregnant. Of 124 men who participated, 94% believed male HIV testing was important, but 40% had never been tested. Of those tested, 32% were tested during the pregnancy, while 37% were tested afterward. Fifty-eight percent of men reported that their female partners had disclosed their test results during pregnancy. A man's likelihood of testing during pregnancy was associated with prior discussion of testing in PMTCT, knowing the female partner had tested, and her disclosure of the test result (all pcards to encourage male involvement in PMTCT were designed. Responses to the cards were elicited from 158 men and 409 women. One invitation card framed by the themes of fatherhood and the baby was selected by 41% of men and 31% of women as the most likely for women undergoing PMTCT to bring to their male partners and the most successful at encouraging men to be tested. In conclusion, this study found that a substantial proportion of men whose partners were recently pregnant had never been tested themselves; of those who had tested, most had done so only after the pregnancy. Encouraging partner communication and clinic attendance using an invitation card could facilitate increased male testing and participation in PMTCT. PMID:22670795

  8. Evidence of long-lived founder virus in mother-to-child HIV transmission.

    Directory of Open Access Journals (Sweden)

    Sivapragashini Danaviah

    Full Text Available Exposure of the infant's gut to cell-associated and cell-free HIV-1 trafficking in breast milk (BM remains a primary cause of mother-to-child transmission (MTCT. The mammary gland represents a unique environment for HIV-1 replication and host-virus interplay. We aimed to explore the origin of the virus transmitted during breastfeeding, and the link with quasi-species found in acellular and cellular fractions of breast-milk (BM and in maternal plasma. The C2-V5 region of the env gene was amplified, cloned and sequenced from the RNA and DNA of BM, the RNA from the mother's plasma (PLA and the DNA from infant's dried blood spot (DBS in 11 post-natal mother-infant pairs. Sequences were assembled in Geneious, aligned in ClustalX, manually edited in SeAL and phylogenetic reconstruction was undertaken in PhyML and MrBayes. We estimated the timing of transmission (ETT and reconstructed the time for the most recent common ancestor (TMRCA of the infant in BEAST. Transmission of single quasi-species was observed in 9 of 11 cases. Phylogenetic analysis illustrated a BM transmission event by cell-free virus in 4 cases, and by cell-associated virus in 2 cases but could not be identified in the remaining 5 cases. Molecular clock estimates, of the infant ETT and TMRCA, corresponded well with the timing of transmission estimated by sequential infant DNA PCR in 10 of 11 children. The TMRCA of BM variants were estimated to emerge during gestation in 8 cases. We hypothesize that in the remaining cases, the breast was seeded with a long-lived lineage latently infecting resting T-cells. Our analysis illustrated the role of DNA and RNA virus in MTCT. We postulate that DNA archived viruses stem from latently infected quiescent T-cells within breast tissue and MTCT can be expected to continue, albeit at low levels, should interventions not effectively target these cells.

  9. Pregnant women’s knowledge about Mother-to-Child Transmission (MTCT of HIV infection through breast feeding

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    MS Maputle

    2008-09-01

    Full Text Available The HIV and AIDS epidemic in South Africa has reached serious proportions. Over 5, 5 million South Africans are infected with HIV (Department of Health, 2004:10. Mother to Child Transmission (MTCT is a well-established mode of HIV transmission and these infections may occur during pregnancy, labour, delivery and breastfeeding. According to the Department of Health (2000:2, breastfeeding constitutes a significant risk of MTCT HIV transmission. Studies in Africa have also shown that breast-feeding increases the risk of MTCT by 12%-43% (Department of Health, 2000:13; Department of Health, 2000:3. Since breastfeeding is a significant and preventable mode of HIV transmission to infants, there is an urgent need to educate, counsel and support women and families to make informed decisions about how best to feed their infants in the context of HTV. To achieve a reduction in MTCT, there is an urgent need to empower women with information on MTCT for informed decision-making. However, cultural factors and the stigma associated with HIV and AIDS might contribute to limited knowledge about MTCT through breastfeeding.

  10. [Evaluation of the cascade of care in prevention of mother-to-child HIV transmission in Brazil].

    Science.gov (United States)

    Miranda, Angelica Espinosa; Pereira, Gerson Fernando Mendes; Araujo, Maria Alix Leite; Silveira, Mariangela Freitas da; Tavares, Leonor De Lannoy; Silva, Leila Cristina Ferreira da; Moreira-Silva, Sandra Fagundes; Saraceni, Valéria

    2016-01-01

    This study aimed to assess the cascade of care in the reduction of mother-to-child HIV transmission in the states of Amazonas, Ceará, Espírito Santo, Rio de Janeiro, and Rio Grande do Sul and the Distrito Federal, Brazil, using data from the Brazilian Information System on Diseases of Notification (SINAN). From 2007 to 2012, there was an increase (from 7.3% in Distrito Federal to 46.1% in Amazonas) in intra-gestational detection of HIV in 5 states, with a 18.6% reduction in Rio de Janeiro. Fewer than 90% of the women received antiretroviral therapy during their prenatal care, including those that already knew they were HIV-positive. The elective cesarean rate was low. The AIDS detection rate in children under 5 years as a proxy for mother-to-child HIV transmission showed a reduction of 6.3% from 2007 to 2012, and was highest in Rio Grande do Sul (50%), the state with the highest rates in the period, while Espírito Santo showed the highest increase (50%). Evaluation of the cascade of HIV care in pregnant women identified flaws in all the points. A link is needed between primary care and referral centers for HIV/AIDS, organizing care for the family and better outcomes for the children. PMID:27653199

  11. Evaluation of preventive measures for mother-to-child transmission of HIV in Aracaju, State of Sergipe, Brazil

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    Lígia Mara Dolce de Lemos

    2012-12-01

    Full Text Available INTRODUCTION: The main route of human immunodeficiency virus (HIV infection in children is from mother to child. The preventive measures established for the Aids Clinical Trial Group protocol 076 (ACTG 076 significantly reduces HIV vertical transmission rates. This study aims to evaluate the implementation of the ACTG 076 protocol in the maternity units of State of Sergipe, Brazilian northeast. METHODS: This is a descriptive, retrospective study with a quantitative approach, with HIV positive women and children exposed, attending a Maternity reference for high-risk pregnancies. Data were obtained from patient records registered in the years 1994 to 2010. RESULTS: Amongst the 110 pregnant women and exposed newborns, the ACTG 076 protocol was fully utilized in only 31.8% of the participants. During the prenatal period, zidovudine (ZDV was taken by 79.1% of the pregnant women. Only 49.1% of HIV seropositive patients used ZDV during delivery. Two (1.8% children were considered infected and 50 (45.5% do not have a conclusive diagnosis to date. CONCLUSIONS: There were significant deficiencies in the prevention of mother-to-child transmission of HIV, including lack of compliance with the three phases of the ACTG 076 protocol; inadequacies in prenatal care; inappropriate mode of delivery and lack of adequate follow up of exposed children.

  12. Prevention of Parent to Child Transmission (PPTCT program data in India: an emerging data set for appraising the HIV epidemic.

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    Sema K Sgaier

    Full Text Available BACKGROUND: Evidence based resource allocation and decentralized planning of an effective HIV/AIDS response requires reliable information on levels and trends of HIV at national and sub-national geographic levels. HIV sentinel surveillance data from antenatal clinics (HSS-ANC has been an important data source to assess the HIV/AIDS epidemic in India, but has a number of limitations. We assess the value of Prevention of Parent to Child Transmission (PPTCT programme data to appraise the HIV epidemic in India. METHODS/FINDINGS: HIV data from PPTCT sites were compared to HSS-ANC and general population level surveys at various geographic levels in the states of Karnataka, Maharashtra and Andhra Pradesh. Chi-square tests were used to ascertain statistical significance. PPTCT HIV prevalence was significantly lower than HSS-ANC HIV prevalence (0.92% vs. 1.22% in Andhra Pradesh, 0.65% vs. 0.89% in Karnataka, 0.52% vs. 0.60% in Maharashtra, p<0.001 for all three states. In all three states, HIV prevalence from PPTCT centres that were part of the sentinel surveillance was comparable to HSS-ANC prevalence but significantly higher than PPTCT centres that were not part of the sentinel surveillance. HIV prevalence from PPTCT data was comparable to that from general population surveys. In all three states, significant declines in HIV prevalence between 2007 and 2010 were observed with the PPTCT data set. District level analyses of HIV trends and sub-district level analysis of HIV prevalence were possible using the PPTCT and not the HSS-ANC data sets. CONCLUSION: HIV prevalence from PPTCT may be a better proxy for general population prevalence than HSS-ANC. PPTCT data allow for analysis of HIV prevalence and trends at smaller geographic units, which is important for decentralized planning of HIV/AIDS programming. With further improvements to the system, India could replace its HSS-ANC with PPTCT programme data for surveillance.

  13. Prevention of mother to child HIV transmission Prevención de la transmisión perinatal de HIV

    OpenAIRE

    Adriana S. Duran; Ivalo, Silvina A.; Alejandro Hakim; Florencia M. Masciottra; Rafael Zlatkes; Lelia Adissi; Neaton, James D; Losso, Marcelo H.

    2006-01-01

    We describe the impact of strategies to reduce HIV-1 vertical transmission on a cohort of pregnant women and evaluate toxicity related to antiretroviral (ARV) therapy and prevalence of birth defects. In this observational, retrospective, longitudinal and descriptive study, we have reviewed the data base and clinical charts from a cohort of 351 pregnant women with HIV infection admitted to a public hospital in Buenos Aires from April 1994 to August 2003. Eighty percent of women were infected b...

  14. Integrating mental health screening into routine community maternal and child health activity: experience from Prevention of Mother-to-child HIV transmission (PMTCT) trial in Nigeria

    OpenAIRE

    Iheanacho, Theddeus; Obiefune, Michael; Ezeanolue, Chinenye O.; Ogedegbe, Gbenga; Nwanyanwu, Okey C.; Ehiri, John E.; Ohaeri, Jude; Echezona E Ezeanolue

    2014-01-01

    Purpose Although the prevalence of mental health disorders in Nigeria is comparable to most developed countries, access to mental health care in Nigeria is limited. Improving access to care requires innovative approaches that deliver mental health interventions at the community level. The aim of this study was to determine the feasibility and acceptability of integrating mental health screening into an existing community-based program for prevention of mother-to-child transmission of HIV targ...

  15. HIV Mother-to-Child Transmission, Mode of Delivery, and Duration of Rupture of Membranes: Experience in the Current Era

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    Siobhan Mark

    2012-01-01

    Full Text Available Objective. To evaluate whether the length of time of rupture of membranes (ROM in optimally managed HIV-positive women on highly active antiretroviral therapy (HAART with low viral loads (VL is predictive of the risk of mother to child transmission (MTCT of the human immunodeficiency virus (HIV. Study Methods. A retrospective case series of all HIV-positive women who delivered at two academic tertiary centers in Toronto, Canada from January 2000 to November 2010 was completed. Results. Two hundred and ten HIV-positive women with viral loads <1,000 copies/ml delivered during the study period. VL was undetectable (<50 copies/mL for the majority of the women (167, 80%, and <1,000 copies/mL for all women. Mode of delivery was vaginal in 107 (51% and cesarean in 103 (49%. The median length of time of ROM was 0.63 hours (range 0 to 77.87 hours for the entire group and 2.56 hours (range 0 to 53.90 hours for those who had a vaginal birth. Among women with undetectable VL, 90 (54% had a vaginal birth and 77 (46% had a cesarean birth. Among the women in this cohort there were no cases of MTCT of HIV. Conclusions. There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women.

  16. Looking beyond prevention of parent to child transmission: Impact of maternal factors on growth of HIV-exposed uninfected infant

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    Sangeeta Trivedi

    2014-01-01

    Full Text Available Background: Compared to HIV-infected children, relatively little has been described regarding the health status, particularly growth of HIV-exposed but uninfected children in resource-limited settings. This is particularly relevant with widespread implementation of the prevention of parent to child transmission program. Methods: At a tertiary care health institute in India, a cohort of 44 HIV-exposed but uninfected children were followed through 6 months of age. The anthropometric parameters weight, length, and head circumference were investigated at birth, 3 weeks, 6 weeks, 3 months, and 6 months point of time. The information on maternal characteristics such as HIV clinical staging, CD4 count, and maternal weight were recorded. The linear regression analysis was applied to estimate the influence of maternal characteristics on infant anthropometric parameters. Results: Anthropometric parameters (weight, length and head circumference were significantly reduced in uninfected new-borns of mothers in HIV Clinical stage III and IV and weight 50 kg. Analysis conducted to find the effect of maternal immunosuppression on infant growth reveals a significant difference at CD4 300 cells/mm 3 and not at established cut-off of CD4 350 cells/mm 3 . This trend of difference continued at 6 weeks, 3 months, and 6 months. The multiple linear regression analysis model demonstrated maternal HIV clinical stage and weight as predictors for birth weight and length, respectively. Conclusions: Advanced HIV disease in the mother is associated with poor infant growth in HIV-exposed, but uninfected children at a critical growth phase in life. These results underscore the importance, especially in resource-constrained settings, of early HIV diagnosis and interventions to halt disease progression in all pregnant women.

  17. Eliminating Perinatal HIV Transmission

    Centers for Disease Control (CDC) Podcasts

    2012-11-26

    In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.  Created: 11/26/2012 by Division of HIV/AIDS Prevention.   Date Released: 11/26/2012.

  18. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention

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    Julie Ambia

    2016-04-01

    Full Text Available Introduction: The success of prevention of mother-to-child transmission of HIV (PMTCT is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Methods: Selected databases were searched for studies published in English (up to September 2015. Outcomes of interest included antiretroviral (ARV drugs or antiretroviral therapy (ART initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Results: Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs, mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I2=83% in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I2=0% in four studies (one randomized. Four studies (three randomized that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I2=69% in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I2=45%. The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Conclusions: Our findings indicate that mobile

  19. Bidirectional links between HIV and intimate partner violence in pregnancy: implications for prevention of mother-to-child transmission

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    Abigail M Hatcher

    2014-11-01

    Full Text Available Introduction: Prevention of mother-to-child transmission (PMTCT has the potential to eliminate new HIV infections among infants. Yet in many parts of sub-Saharan Africa, PMTCT coverage remains low, leading to unacceptably high rates of morbidity among mothers and new infections among infants. Intimate partner violence (IPV may be a structural driver of poor PMTCT uptake, but has received little attention in the literature to date. Methods: We conducted qualitative research in three Johannesburg antenatal clinics to understand the links between IPV and HIV-related health of pregnant women. We held focus group discussions with pregnant women (n=13 alongside qualitative interviews with health care providers (n=10, district health managers (n=10 and pregnant abused women (n=5. Data were analysed in Nvivo10 using a team-based approach to thematic coding. Findings: We found qualitative evidence of strong bidirectional links between IPV and HIV among pregnant women. HIV diagnosis during pregnancy, and subsequent partner disclosure, were noted as a common trigger of IPV. Disclosure leads to violence because it causes relationship conflict, usually related to perceived infidelity and the notion that women are “bringing” the disease into the relationship. IPV worsened HIV-related health through poor PMTCT adherence, since taking medication or accessing health services might unintentionally alert male partners of the women's HIV status. IPV also impacted on HIV-related health via mental health, as women described feeling depressed and anxious due to the violence. IPV led to secondary HIV risk as women experienced forced sex, often with little power to negotiate condom use. Pregnant women described staying silent about condom negotiation in order to stay physically safe during pregnancy. Conclusions: IPV is a crucial issue in the lives of pregnant women and has bidirectional links with HIV-related health. IPV may worsen access to PMTCT and secondary

  20. The Social Context of Prevention of Mother to Child Transmission of HIV (PMTCT) in Uganda: Mothers’ and health care providers’ experiences and lessons for programme improvement

    OpenAIRE

    Rujumba, Joseph

    2012-01-01

    Introduction: The prevention of mother-to-child transmission of HIV (PMTCT) programme has been operational in Uganda since the year 2000, but its performance remains sub-optimal. The objective of this thesis is to increase understanding of the role of the social context in the delivery and utilization of PMTCT services, focusing on how pregnant women experience routine HIV counselling and testing as part of antenatal care, HIV status disclosure to partners and lessons leant by ...

  1. Prevention of mother to child HIV transmission Prevención de la transmisión perinatal de HIV

    Directory of Open Access Journals (Sweden)

    Adriana S. Duran

    2006-02-01

    Full Text Available We describe the impact of strategies to reduce HIV-1 vertical transmission on a cohort of pregnant women and evaluate toxicity related to antiretroviral (ARV therapy and prevalence of birth defects. In this observational, retrospective, longitudinal and descriptive study, we have reviewed the data base and clinical charts from a cohort of 351 pregnant women with HIV infection admitted to a public hospital in Buenos Aires from April 1994 to August 2003. Eighty percent of women were infected by sexual transmission. Diagnosis of HIV infection was performed before pregnancy in 38.5% of cases; 241 patients received some kind of ARV therapy, combined therapy was administered in 123 of cases. The overall transmission rate was 9.6%, and antiretroviral therapy was the most significant factor associated with the transmission rate. HIV transmission odds were 0.04 for any ARV treatment versus no therapy. No cases of HIV transmission were observed among women given combination ARV therapy. More prevalent secondary effects associated to ARV therapy were anemia, hypercholesterolemia, increase of ALP and hypertrigliceridemia. In conclusion, antiretroviral therapy, particularly combined ARV therapy, irrespective of type of delivery, was associated with a reduced risk of HIV transmission without an increase in toxicity or incidence of congenital abnormalities in the short-term.En este estudio se describe el impacto de las estrategias implementadas para reducir la trasmisión vertical de HIV en una cohorte de mujeres embarazadas. Se evaluó, también, la toxicidad relacionada a la terapia antirretroviral y la prevalencia de malformaciones congénitas. Se revisaron, retrospectivamente, las historias clínicas y la base de datos de 351 mujeres embarazadas, con infección por HIV, admitidas en un hospital público de la Ciudad de Buenos Aires, entre abril de 1994 y agosto de 2003. Se obtuvieron datos completos de 351 pacientes. El 80% de las mujeres adquirieron la

  2. Protective Role of BST2 Polymorphisms in Mother-to-Child Transmission of HIV-1 and Adult AIDS Progression.

    Science.gov (United States)

    Kamada, Anselmo J; Bianco, Anna M; Zupin, Luisa; Girardelli, Martina; Matte, Maria C C; Medeiros, Rúbia Marília de; Almeida, Sabrina Esteves de Matos; Rocha, Marineide M; Segat, Ludovica; Chies, José A B; Kuhn, Louise; Crovella, Sergio

    2016-07-01

    Bone marrow stromal cell antigen-2 (BST-2)/Tetherin is a restriction factor that prevents Human immunodeficiency virus type 1 (HIV-1) release from infected cells and mediates pro-inflammatory cytokine production. This study investigated the risk conferred by single nucleotide polymorphisms (rs919266, rs9192677, and rs9576) at BST-2 coding gene (BST2) in HIV-1 mother-to-child transmission and in disease progression. Initially, 101 HIV-1+ pregnant women and 331 neonates exposed to HIV-1 from Zambia were enrolled. Additional BST2 single nucleotide polymorphism analyses were performed in 2 cohorts with acquired immunodeficiency syndrome (AIDS) progression: an adult Brazilian cohort (37 rapid, 30 chronic and 21 long-term non-progressors) and an Italian pediatric cohort (21 rapid and 67 slow progressors). The rs9576A allele was nominally associated with protection during breastfeeding (P = 0.019) and individuals carrying rs919266 GA showed slower progression to AIDS (P = 0.033). Despite the influence of rs919266 and rs9576 on BST2 expression being still undetermined, a preventive role by BST2 polymorphisms was found during HIV-1 infection. PMID:26885809

  3. HIV-1 Drug Resistance Emergence among Breastfeeding Infants Born to HIV-Infected Mothers during a Single-Arm Trial of Triple-Antiretroviral Prophylaxis for Prevention of Mother-To-Child Transmission: A Secondary Analysis

    OpenAIRE

    Thomas, Timothy K; Rose Masaba; Craig B Borkowf; Richard Ndivo; Clement Zeh; Ambrose Misore; Juliana Otieno; Denise Jamieson; Michael C Thigpen; Marc Bulterys; Laurence Slutsker; De Cock, Kevin M.; Amornkul, Pauli N.; Greenberg, Alan E.; Mary Glenn Fowler

    2011-01-01

    Editors' Summary Background Every year, about half a million children become infected with human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). Nearly all these newly infected children live in resource-limited countries and most acquire HIV from their mother, so-called mother-to-child transmission (MTCT). Without intervention, 25%–50% of babies born to HIV-positive mothers become infected with HIV during pregnancy, delivery, or breastfeeding. This infect...

  4. Status of prevention of parent to child transmission services among HIV-positive mothers from rural South India

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    Anbarasi Subramaniyan

    2014-01-01

    Full Text Available Background: Tamil Nadu comes under group I high-prevalence state, with <1% prevalence of HIV infection in ante-natal women but above 5% prevalence in high-risk group. One of the ways to control HIV/AIDS in India is through prevention of parent to child transmission (PPTCT, the success of which lies in the utilization of services. Materials and Methods: A descriptive qualitative study was conducted to explore the status of utilization of PPTCT services by rural HIV-positive mothers, in the Gingee Block of Villupuram district, Tamil Nadu. All the mothers who tested positive between June 2006 and May 2010 were interviewed in-depth using an interview guide. Results: There were 21 HIV-positive mothers during this period, 19 of whom gave consent for the study. Thirteen out of 19 mothers (68% received Nevirapine prophylaxis, while 15 out of 20 infants born to these mothers (75% received Nevirapine syrup. During the study period, it was found that 61% of the mothers were not compliant to antiretroviral therapy (ART. Conclusion: Poor access to the ART centers was reflected in majority of the cases (79%. There is a pressing need to improve access to quality PPTCT services especially during the intranatal period.

  5. Improving a mother to child HIV transmission programme through health system redesign: quality improvement, protocol adjustment and resource addition.

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    Michele S Youngleson

    Full Text Available BACKGROUND: Health systems that deliver prevention of mother to child transmission (PMTCT services in low and middle income countries continue to underperform, resulting in thousands of unnecessary HIV infections of newborns each year. We used a combination of approaches to health systems strengthening to reduce transmission of HIV from mother to infant in a multi-facility public health system in South Africa. METHODOLOGY/PRINCIPAL FINDINGS: All primary care sites and specialized birthing centers in a resource constrained sub-district of Cape Metro District, South Africa, were enrolled in a quality improvement (QI programme. All pregnant women receiving antenatal, intrapartum and postnatal infant care in the sub-district between January 2006 and March 2009 were included in the intervention that had a prototype-innovation phase and a rapid spread phase. System changes were introduced to help frontline healthcare workers to identify and improve performance gaps at each step of the PMTCT pathway. Improvement was facilitated and spread through the use of a Breakthrough Series Collaborative that accelerated learning and the spread of successful changes. Protocol changes and additional resources were introduced by provincial and municipal government. The proportion of HIV-exposed infants testing positive declined from 7.6% to 5%. Key intermediate PMTCT processes improved (antenatal AZT increased from 74% to 86%, PMTCT clients on HAART at the time of labour increased from 10% to 25%, intrapartum AZT increased from 43% to 84%, and postnatal HIV testing from 79% to 95% compared to baseline. CONCLUSIONS/SIGNIFICANCE: System improvement methods, protocol changes and addition/reallocation of resources contributed to improved PMTCT processes and outcomes in a resource constrained setting. The intervention requires a clear design, leadership buy-in, building local capacity to use systems improvement methods, and a reliable data system. A systems improvement

  6. Infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions, Northwest Ethiopia

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    Muluye Dagnachew

    2012-03-01

    Full Text Available Abstract Background It has been estimated that 430,000 children under 15 years of age were newly infected with HIV in 2008, and more than 71% are living in sub-Saharan Africa. In the absence of intervention to prevent mother-to-child transmission, 30-45% of infants born to HIV-positive mothers in developing countries become infected during pregnancy, delivery and breastfeeding. The aim of this study was to assess infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics of Northwest Ethiopia. Methods Institution based cross sectional study was conducted from January to May 2011 among all HIV positive mothers with less than two years old child attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions. A structured pre-tested questionnaire using interview technique was used for data collection. The data was entered and analyzed using SPSS version 16 statistical package. Results A total of 209 HIV positive mothers were included in the study. Of these, 187 (89.5% had followed the recommended way of infant feeding practice while significant percentage (10.5% had practiced mixed breast feeding. In multivariate analysis, disclosure of HIV status with their spouse, insufficient breast milk and occupational status were found to be independently associated (p-value of Conclusions Higher proportion of respondents used the recommended way of infant feeding practice by WHO as well as by Ethiopian Ministry of Health. However, mixed feeding in the first 6 months of age, an undesirable practice in infant feeding, were reported in this study. Infant feeding education that is aligned to national policy should be strengthened in primary health care, particularly in situations where prevention of mother to child transmission of HIV is prioritized.

  7. Prevention of mother-to-child transmission of HIV in Zambia: implementing efficacious ARV regimens in primary health centers

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    Mandala Justin

    2009-08-01

    Full Text Available Abstract Background Safety and effectiveness of efficacious antiretroviral (ARV regimens beyond single-dose nevirapine (sdNVP for prevention of mother-to-child transmission (PMTCT have been demonstrated in well-controlled clinical studies or in secondary- and tertiary-level facilities in developing countries. This paper reports on implementation of and factors associated with efficacious ARV regimens among HIV-positive pregnant women attending antenatal clinics in primary health centers (PHCs in Zambia. Methods Blood sample taken for CD4 cell count, availability of CD4 count results, type of ARV prophylaxis for mothers, and additional PMTCT service data were collected for HIV-positive pregnant women and newborns who attended 60 PHCs between April 2007 and March 2008. Results Of 14,815 HIV-positive pregnant women registered in the 60 PHCs, 2,528 (17.1% had their CD4 cells counted; of those, 1,680 (66.5% had CD4 count results available at PHCs; of those, 796 (47.4% had CD4 count ≤ 350 cells/mm3 and thus were eligible for combination antiretroviral treatment (cART; and of those, 581 (73.0% were initiated on cART. The proportion of HIV-positive pregnant women whose blood sample was collected for CD4 cell count was positively associated with (1 blood-draw for CD4 count occurring on the same day as determination of HIV-positive status; (2 CD4 results sent back to the health facilities within seven days; (3 facilities without providers trained to offer ART; and (4 urban location of PHC. Initiation of cART among HIV-positive pregnant women was associated with the PHC's capacity to provide care and antiretroviral treatment services. Overall, of the 14,815 HIV-positive pregnant women registered, 10,015 were initiated on any type of ARV regimen: 581 on cART, 3,041 on short course double ARV regimen, and 6,393 on sdNVP. Conclusion Efficacious ARV regimens beyond sdNVP can be implemented in resource-constrained PHCs. The majority (73.0% of women identified

  8. High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting.

    OpenAIRE

    Manzi, M; Zachariah, R.; Teck, R; Buhendwa, L.; Kazima, J.; Bakali, E; Firmenich, Peter; Humblet, P

    2005-01-01

    SETTING: Thyolo District Hospital, rural Malawi. OBJECTIVES: In a prevention of mother-to-child HIV transmission (PMTCT) programme, to determine: the acceptability of offering 'opt-out' voluntary counselling and HIV-testing (VCT); the progressive loss to follow up of HIV-positive mothers during the antenatal period, at delivery and to the 6-month postnatal visit; and the proportion of missed deliveries in the district. DESIGN: Cohort study. METHODS: Review of routine antenatal, VCT and PMTCT ...

  9. Cabergoline for suppression of puerperal lactation in a prevention of mother-to-child HIV-transmission programme in rural Malawi.

    OpenAIRE

    Buhendwa, L.; Zachariah, R.; Teck, R; Massaquoi, M; Kazima, J.; Firmenich, Peter; Harries, A. D.

    2008-01-01

    This study shows that cabergoline (single oral-dose) is an acceptable, safe and effective drug for suppressing puerperal lactation. It could be of operational benefit not only for artificial feeding, but also for weaning in those that breast-feed within preventive mother-to-child HIV transmission programmes in resource-limited settings.

  10. Timely antiretroviral prophylaxis during pregnancy effectively reduces HIV mother-to-child transmission in eight counties in China: a prospective study during 2004–2011

    Science.gov (United States)

    Wang, Qian; Wang, Linhong; Fang, Liwen; Wang, Ailing; Jin, Xi; Wang, Fang; Wang, Xiaoyan; Qiao, Yaping; Sullivan, Sheena G.; Rutherford, Shannon; Zhang, Lei

    2016-01-01

    This study investigates the improvement of the prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in China during 2004–2011. A clinic-based prospective study was conducted among HIV-positive pregnant women and their children in eight counties across China. Associated factors of mother-to-child transmission were analyzed using regression analysis. A total of 1,387 HIV+ pregnant women and 1,377 HIV-exposed infants were enrolled. The proportion of pregnant women who received HIV testing increased significantly from 45.1% to 98.9% during 2004–2011. Among whom, the proportion that received antiretroviral (ARV) prophylaxis increased from 61% to 96%, and the corresponding coverage in children increased from 85% to 97% during the same period. In contrast, single-dose nevirapine treatment during delivery declined substantially from 97.9% to 12.7%. Vertical transmission of HIV declined from 11.1% (95% confidence interval [CI]: 5.7–23.3%) in 2004 to 1.2% (95% CI: 0.1–5.8%) in 2011. Women who had a vaginal delivery (compared to emergency caesarian section (odds ratio [OR] = 0.46; 0.23–0.96)) and mothers on multi-ARVs (OR = 0.11; 0.04–0.29) were less likely to transmit HIV to their newborns. Increasing HIV screening enabled timely HIV care and prophylaxis to reduce vertical transmission of HIV. Early and consistent treatment with multi-ARVs during pregnancy is vital for PMTCT. PMID:27721453

  11. Luba-Kasai Men and the Prevention of Mother to Child Transmission (PMTCT) of HIV program in Lusaka.

    Science.gov (United States)

    Auvinen, Jaana; Kylmä, Jari; Välimäki, Maritta; Bweupe, Max; Suominen, Tarja

    2015-09-01

    Male participation in the prevention of mother-to-child transmission (PMTCT) of HIV has been determined as one of the key factors in sub-Saharan African countries, but its realization is challenging because of male-related and institutional factors. The purpose of this study is two-fold: first, we explored the views of Luba-Kasai men, living in Zambia in the Lusaka Province, on the factors that encourage, inconvenience or inhibit them in accompanying their wives to the antenatal clinic and their ideas to improve their experience. Secondly, the study considered their knowledge of the PMTCT program and how such knowledge conformed to the Zambian National Protocol Guidelines Integrated PMTCT of HIV /: AIDS. Twenty-one interviews were analyzed using qualitative inductive content analysis. The National Protocol Guidelines Integrated PMTCT of HIV/AIDS were analyzed using the deductive content analysis. The encouraging factors that emerged were involvement in the program, the time of delivery, love and care, and also the suspicion of corruption. The inconveniencing factors were the arrangements and working culture of the clinic, together with stigma and guilt. A lack of motivation, fear of death, socioeconomic circumstances and again the arrangements and working culture at the clinic were held as inhibiting factors. The ideas to remove inconvenient factors were maintaining a spiritual outlook on life, education, interaction, a good mood and a sense of meaningfulness. Considering such male views and paying attention to minorities in the development of national PMTCT of HIV Programs may enhance male participation in the process.

  12. Luba-Kasai Men and the Prevention of Mother to Child Transmission (PMTCT) of HIV program in Lusaka.

    Science.gov (United States)

    Auvinen, Jaana; Kylmä, Jari; Välimäki, Maritta; Bweupe, Max; Suominen, Tarja

    2015-09-01

    Male participation in the prevention of mother-to-child transmission (PMTCT) of HIV has been determined as one of the key factors in sub-Saharan African countries, but its realization is challenging because of male-related and institutional factors. The purpose of this study is two-fold: first, we explored the views of Luba-Kasai men, living in Zambia in the Lusaka Province, on the factors that encourage, inconvenience or inhibit them in accompanying their wives to the antenatal clinic and their ideas to improve their experience. Secondly, the study considered their knowledge of the PMTCT program and how such knowledge conformed to the Zambian National Protocol Guidelines Integrated PMTCT of HIV /: AIDS. Twenty-one interviews were analyzed using qualitative inductive content analysis. The National Protocol Guidelines Integrated PMTCT of HIV/AIDS were analyzed using the deductive content analysis. The encouraging factors that emerged were involvement in the program, the time of delivery, love and care, and also the suspicion of corruption. The inconveniencing factors were the arrangements and working culture of the clinic, together with stigma and guilt. A lack of motivation, fear of death, socioeconomic circumstances and again the arrangements and working culture at the clinic were held as inhibiting factors. The ideas to remove inconvenient factors were maintaining a spiritual outlook on life, education, interaction, a good mood and a sense of meaningfulness. Considering such male views and paying attention to minorities in the development of national PMTCT of HIV Programs may enhance male participation in the process. PMID:24449707

  13. Mother-to-Child Transmission of HIV Infection and Its Determinants among Exposed Infants on Care and Follow-Up in Dire Dawa City, Eastern Ethiopia

    Directory of Open Access Journals (Sweden)

    Fisseha Wudineh

    2016-01-01

    Full Text Available Since the scale-up for prevention of mother-to-child transmission (PMTCT services, rates of HIV infection among exposed infants have significantly declined. However, current achievements fell short of achieving the target sets. We investigated mother-to-child transmission (MTCT of HIV infection and its determinants among HIV-exposed infants on care at Dilchora Referral Hospital in Dire Dawa City Administration. A retrospective institutional cohort study was conducted by reviewing follow-up records of HIV-exposed infants who were enrolled into care. Infants’ HIV serostatus was the outcome measure of the study. Bivariate and multivariate logistic regressions were employed to identify significant determinants. Of the 382 HIV-exposed infants enrolled into care, 60 (15.7% became HIV positive. Rural residence (AOR: 3.29; 95% CI: 1.40, 7.22, home delivery (AOR: 3.35; 95% CI: 1.58, 8.38, infant not receiving ARV prophylaxis at birth (AOR: 5.83; 95% CI: 2.84, 11.94, mixed feeding practices (AOR: 42.21; 95% CI: 8.31, 214.38, and mother-child pairs neither receiving ARV (AOR: 4.42; 95% CI: 2.01, 9.82 were significant independent determinants of MTCT of HIV infection. Our findings suggest additional efforts to intensify scale-up of PMTCT services in rural setting and improve institutional delivery and postnatal care for HIV positive mothers and proper follow-up for HIV-exposed infants.

  14. Prevention of Mother-to-Child Transmission-Precarious Hopes and Childbearing Choices Among HIV-Infected Women in a Northern Province of Vietnam

    DEFF Research Database (Denmark)

    Hạnh, Nguyễn Thị Thúy; Rasch, Vibeke; Chi, Bùi Kim;

    2012-01-01

    women's faith in their futures and childbearing capacities. Based on the findings, the authors discuss the new forms of gendered uncertainty that arise in the era of HIV/AIDS in Vietnam. They conclude that prevention of mother-to-child transmission, including the counseling offered by health providers....... The results reported here are derived from ethnographic research conducted in a northern province of Vietnam in 2007. The authors interviewed 32 HIV-positive women, exploring the hopes that they invested in prevention of mother-to-child transmission, and examining how this new technology enhanced the......, plays an important role in building and strengthening reproductive hopes for women living with HIV, while also generating new concerns....

  15. Effectiveness of the prevention of mother-to-child transmission of HIV protocol applied at Saint Camille Medical Centre in Ouagadougou, Burkina Faso

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    Serge Theophile Soubeiga

    2014-11-01

    Full Text Available Introduction: Despite many prevention efforts, the number of children infected by HIV in sub-Saharan Africa through vertical transmission remains high. This infection can be reduced through programmes of prevention of mother-to-child HIV transmission (PMTCT. The objective of this study was to evaluate the effectiveness of the PMTCT protocol at Saint Camille Medical Centre in Ouagadougou, Burkina Faso. Methods: From August 2012 to September 2013, samples of dried blood spot (DBS were collected from 160 children aged 6 weeks born to HIV-1 positive mothers who were under PMTCT protocol at Saint Camille Medical Centre and 40 children of the same age group from orphanages and whose mothers were dead or unknown. The samples were tested using the Abbott Real Time HIV-1 Qualitative kit. The clinical data of mothers were collected and analyzed using SPSS Version 17.0 and Epi Info Version 6.0 softwares. Results: Among pregnant women in this study, 52.5% were predominantly young (24–29 years and 60.62% were housewives. In total, 50.5% (101/200 were in combination of AZT/3TC/NVP and 29.5% (59/200 were on prophylaxis (AZT/3TC. The rate of vertical transmission of HIV-1 was 0.0% (p<0.001 in children whose mothers were taking a combination of AZT/3TC/NVP (0/101 or were on a prophylaxis AZT/3TC treatment (0 /59. The rate of HIV-1 transmission in orphaned children was 15.0% (6/40. Conclusions: The PMTCT protocol is effective and reduces very significantly (p<0.001 the risk of transmission of HIV-1 from mother to child. In addition, screening by PCR of orphaned children vertically infected with HIV, enabled them to receive an early treatment.

  16. Attitudes to routine HIV counselling and testing, and knowledge about prevention of mother to child transmission of HIV in eastern Uganda: a cross-sectional survey among antenatal attendees

    Directory of Open Access Journals (Sweden)

    Byamugisha Robert

    2010-12-01

    Full Text Available Abstract Background HIV testing rates have exceeded 90% among the pregnant women at Mbale Regional Referral Hospital in Mbale District, eastern Uganda, since the introduction of routine antenatal counselling and testing for HIV in June 2006. However, no documented information was available about opinions of pregnant women in eastern Uganda about this HIV testing approach. We therefore conducted a study to assess attitudes of antenatal attendees towards routine HIV counselling and testing at Mbale Hospital. We also assessed their knowledge about mother to child transmission of HIV and infant feeding options for HIV-infected mothers. Methods The study was a cross-sectional survey of 388 women, who were attending the antenatal clinic for the first time with their current pregnancy at Mbale Regional Referral Hospital from August to October 2009. Data were collected using a pre-tested questionnaire and analysed using descriptive statistics and logistic regression. Permission to conduct the study was obtained from the Makerere University College of Health Sciences, the Uganda National Council of Science and Technology, and Mbale Hospital. Results The majority of the antenatal attendees (98.5%, 382/388 had positive attitudes towards routine HIV counselling and testing, and many of them (more than 60% had correct knowledge of how mother to child transmission of HIV could occur during pregnancy, labour and through breastfeeding, and ways of preventing it. After adjusting for independent variables, having completed secondary school (odds ratio: 2.5, 95% confidence interval: 1.3-4.9, having three or more pregnancies (OR: 2.5, 95% CI: 1.4-4.5 and belonging to a non-Bagisu ethnic group (OR: 1.7, 95% CI: 1.0-2.7 were associated with more knowledge of exclusive breastfeeding as one of the measures for prevention of mother to child transmission of HIV. Out of 388 antenatal attendees, 386 (99.5% tested for HIV and 382 (98.5% received same-day HIV test results

  17. Prevention of mother-to-child transmission of HIV in Denmark, 1994-2008

    DEFF Research Database (Denmark)

    von Linstow, M L; Rosenfeldt, V; Lebech, A M;

    2010-01-01

    during or after delivery and did not receive prophylactic ART. Conclusions The annual number of HIV pregnancies increased fivefold during this 14-year period and substantial changes in pregnancy management were seen. No woman treated according to the national guidelines, i.e. ART before week 22......Objectives The aim of this study was to describe trends in the management of pregnancies in HIV-infected women and their outcomes over a 14-year period in Denmark on a national basis. Methods The study was a retrospective cohort study of all HIV-infected women in Denmark giving birth to one or more...

  18. Сost assessment of HIV prophylaxis of mother to child transmission and family planning program among HIV infected women

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    A. V. Samarina

    2014-01-01

    Full Text Available The manuscript provides comparative cost assessment of HIV PMTCT and family planning program among HIV infected women.Materials and Methods: calculation is based on the state healthcare system costs of complex/combined 3-stage perinatal HIV prophylaxis, follow up antiretroviral therapy and social costs related to rehabilitation and education HIV infected children. Cost benefit analysis is conducted on utility per 1 RUB of budget investment.Results and discussion: HIV PMTCT cost benefit is 3,33 per 1 RUB of investment in long-term perspective. Analysis stated average family planning expenditure will be 3,69 K RUB despite 21,72 K RUB per patient without family planning service. As result cost benefit family planning program among HIV infected women is 4,89 RUB per 1 RUB of investment.Conclusion. Broad access to reproductive health service is key milestone of quality of life among HIV infected patients and it would be positioning as economically reasonable HIV prevention and cost containment measure.

  19. Prevention of mother-to-child transmission of HIV in Denmark, 1994-2008

    DEFF Research Database (Denmark)

    von Linstow, M L; Rosenfeldt, Vibeke; Kjær, Anne-Mette Lebech;

    2010-01-01

    The aim of this study was to describe trends in the management of pregnancies in HIV-infected women and their outcomes over a 14-year period in Denmark on a national basis.......The aim of this study was to describe trends in the management of pregnancies in HIV-infected women and their outcomes over a 14-year period in Denmark on a national basis....

  20. Systematic review of public health research on prevention of mother-to-child transmission of HIV in India with focus on provision and utilization of cascade of PMTCT services

    NARCIS (Netherlands)

    Darak, Shrinivas; Panditrao, Mayuri; Parchure, Ritu; Kulkarni, Vinay; Kulkarni, Sanjeevani; Janssen, Fanny

    2012-01-01

    Background: In spite of effective strategies to eliminate mother-to-child-transmission of HIV, the implementation of such strategies remains a major challenge in developing countries. In India, programs for the prevention of mother-to-child transmission (PMTCT) have been scaled up widely since 2005.

  1. Assessment of utilization of provider-initiated HIV testing and counseling as an intervention for prevention of mother to child transmission of HIV and associated factors among pregnant women in Gondar town, North West Ethiopia

    Directory of Open Access Journals (Sweden)

    Malaju Marelign

    2012-05-01

    Full Text Available Abstract Background Detection of maternal HIV infection early in pregnancy is critical for prevention of mother to child transmission of HIV/AIDS. Most efforts have focused on VCT as the primary means of encouraging people to become aware of their HIV status. However, its uptake is low in many parts of sub-Saharan Africa including Ethiopia. Provider-initiated HIV testing and counseling provides a critical opportunity to diagnose HIV infection, to begin chronic care, and to prevent mother to child transmission. However, little is known about its acceptance and associated factors among pregnant women in the country and particularly in the present study area. Methods Health institution based cross-sectional quantitative study was conducted in Gondar town from July 22-August 18, 2010. A total of 400 pregnant women were involved in the study using stratified sampling technique and multiple logistic regression analysis was employed using SPSS version 16. Results A total of 400 pregnant women actively participated in this study and 330 (82.5% of them accepted provider-initiated HIV testing and counseling to be tested for HIV and 70(17.5% of them refused. Acceptance of provider-initiated HIV testing and counseling was positively associated with greater number of antenatal care visits [Adj. OR (95%CI=2.64(1.17, 5.95], residing in the urban areas[Adj. OR (95%CI=2.85(1.10, 7.41], having comprehensive knowledge on HIV [Adj. OR (95%CI=4.30(1.72, 10.73], positive partners reaction for HIV positive result [Adj. OR (95%CI=8.19(3.57, 18.80] and having knowledge on prevention of mother to child transmission of HIV[Adj. OR (95%CI=3.27(1.34, 7.94], but negatively associated with increased maternal age and education level. Conclusion Utilization of provider-initiated HIV testing and counseling during antenatal care was relatively high among pregnant women in Gondar town. Couple counseling and HIV testing should be strengthened to promote provider-initiated HIV

  2. Partner testing, linkage to care, and HIV-free survival in a program to prevent parent-to-child transmission of HIV in the Highlands of Papua New Guinea

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    Andy Carmone

    2014-08-01

    Full Text Available Background: To eliminate new pediatric HIV infections, interventions that facilitate adherence, including those that minimize stigma, enhance social support, and mitigate the influence of poverty, will likely be required in addition to combination antiretroviral therapy (ART. We examined the relationship between partner testing and infant outcome in a prevention of parent-to-child transmission of HIV program, which included a family-centered case management approach and a supportive environment for partner disclosure and testing. Design: We analyzed routinely collected data for women and infants who enrolled in the parent-to-child transmission of HIV program at Goroka Family Clinic, Eastern Highlands Provincial Hospital, Papua New Guinea, from 2007 through 2011. Results: Two hundred and sixty five women were included for analysis. Of these, 226 (85% had a partner, 127 (56% of whom had a documented HIV test. Of the 102 HIV-infected partners, 81 (79% had been linked to care. In adjusted analyses, we found a significantly higher risk of infant death, infant HIV infection, or loss to follow-up among mother–infant pairs in which the mother reported having no partner or a partner who was not tested or had an unknown testing status. In a second multivariable analysis, infants born to women with more time on ART or who enrolled in the program in later years experienced greater HIV-free survival. Conclusions: In a program with a patient-oriented and family-centered approach to prevent vertical HIV transmission, the majority of women's partners had a documented HIV test and, if positive, linkage to care. Having a tested partner was associated with program retention and HIV-free survival for infants. Programs aiming to facilitate diagnosis disclosure, partner testing, and linkage to care may contribute importantly to the elimination of pediatric HIV.

  3. Health system barriers to implementation of collaborative TB and HIV activities including prevention of mother to child transmission in South Africa.

    Science.gov (United States)

    Uwimana, J; Jackson, D; Hausler, H; Zarowsky, C

    2012-05-01

    In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers' and community care workers' (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB/HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility- and community-based organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB/HIV activities including PMTCT will require political will and leadership to address these health systems barriers. PMID:22394016

  4. HIV阳性育龄妇女的抗病毒治疗及HIV母婴阻断%Antiretroviral therapy in HIV positive women and prevention of mother-to-child HIV transmission

    Institute of Scientific and Technical Information of China (English)

    王敏

    2013-01-01

    Along with the rapid spread of AIDS globally, the prevalence of HIV infection in women and children and how to control the further spread has also been paid more and more attention. At present, women now comprise approximately 50%of the HIV-infected population and 90%of children under the age of 15 be infected by Mother-to-Child vertical transmission. In view of the antiretroviral therapy in HIV positive women plays an extremely important role in prevention of mother-to-child HIV transmission (PMTCT) and HIV spread control. This article will review the prevalence of HIV infection in women and maternal infant transmission, antiretroviral therapy in HIV positive women, as well as prevention of mother-to-child HIV transmission.%随着艾滋病在全球范围的迅速蔓延,妇女儿童中HIV的感染流行情况以及如何控制其进一步传播扩散也受到越来越多的关注。目前,全球存活的HIV感染者中约有50%为育龄妇女,而15岁以下儿童感染HIV的90%经母婴垂直传播。鉴于HIV阳性育龄妇女的抗病毒治疗对于阻断HIV的母婴传播以及控制HIV感染进一步扩散蔓延具有极其重要的作用,本文将从育龄妇女HIV感染及母婴传播情况、HIV阳性育龄妇女的抗病毒治疗以及HIV母婴阻断等方面进行综述。

  5. Lack of knowledge about mother-to-child HIV transmission prevention in pregnant women at Tijuana General Hospital, Baja California, Mexico.

    Science.gov (United States)

    Becka, Chandra M; Chacón-Cruz, Enrique; Araneta, Maria Rosario; Viani, Rolando M

    2015-01-01

    The objective of this study was to identify determinants of human immunodeficiency virus (HIV) knowledge regarding mother-to-child transmission (MTCT) among pregnant women at Tijuana General Hospital, Baja California, Mexico. Between March and November 2003, patients from the prenatal care (n = 1294) and labor and delivery (L&D) units (n = 495) participated in a cross-sectional study to measure HIV knowledge. Less than one-third (30%) knew that HIV could be transmitted to a child during delivery, and 36% knew that HIV could be transmitted by breast-feeding. Only 27% knew that an MTCT could be prevented. Prenatal patients were more likely to know that MTCT was preventable (prenatal: 31% versus L&D 25%; P = .02). Logistic regression indicated that prenatal patients (odds ratio = 1.49, confidence interval 1.07-2.07) were more likely to know that HIV could be transmitted through breast-feeding. Overall, both groups had poor knowledge regarding MTCT of HIV.

  6. Minimizing the risk of non-vertical, non-sexual HIV infection in children – beyond mother to child transmission

    Directory of Open Access Journals (Sweden)

    Hendrik Simon Schaaf

    2012-11-01

    Full Text Available After witnessing an episode of poor injection safety in large numbers of children in a rural under-resourced hospital in Uganda, we briefly review our own experience and that of others in investigating HIV infection in children considered unlikely to be through commonly identified routes such as vertical transmission, sexual abuse or blood transfusion. In the majority of cases, parents are HIV uninfected. The cumulative experience suggests that the problem is real, but with relatively low frequency. Vertical transmission is the major route for HIV to children. However, factors such as poor injection safety, undocumented surrogate breast feeding, an HIV-infected adult feeding premasticated food to a weaning toddler, poor hygienic practice in the home and using unsterilised equipment for minor surgical or traditional procedures are of cumulative concern.

  7. Use of service data to inform pediatric HIV-free survival following prevention of mother-to-child transmission programs in rural Malawi

    Science.gov (United States)

    2012-01-01

    Background Recent years have seen rapid and significant progress in science and implementation of programs to prevent mother-to-child transmission of HIV. Programs that support PMTCT routinely monitor service provision but very few have measured their effectiveness. The objective of the study was to use service data to inform HIV-free survival among HIV exposed children that received antiretroviral drugs to prevent mother-to-child transmission (PMTCT) of HIV. The study was conducted in two rural districts in Malawi with support from FHI 360. Methods A descriptive observational study of PMTCT outcomes was conducted between June 2005 and June 2009. The dataset included patient-level data of all pregnant women 1) that tested HIV-positive, 2) that were dispensed with antiretroviral prophylaxis, and 3) whose addresses were available for home visits. The data were matched to each woman’s corresponding antenatal clinic data from home visit registers. Results Out of 438 children whose home addresses were available, 33 (8%) were lost to follow-up, 35 (8%) were alive but not tested for HIV by the time home visit was conducted, and 52 (12%) were confirmed deceased. A total of 318 children were alive at the time of the home visit and had an HIV antibody test done at median age 15 months. The resulting estimated 24-month probability of HIV-free survival over all children was 78%. Among children who did not receive nevirapine, the estimated 24-month probability of HIV-free survival was 61%, and among those who did receive NVP syrup the estimate was 82%. Conclusions When mothers and newborns received nevirapine, the estimated 24-month probability of HIV-free survival among children was high at 82% (CI: 54% to 99%). However this conclusion should be interpreted cautiously 1) due to the wide confidence interval; and 2) because the confidence interval range includes 55%, which is the natural HIV-free survival rate in the absence of a PMTCT intervention. This analysis highlighted

  8. Use of service data to inform pediatric HIV-free survival following prevention of mother-to-child transmission programs in rural Malawi

    Directory of Open Access Journals (Sweden)

    Mandala Justin

    2012-06-01

    Full Text Available Abstract Background Recent years have seen rapid and significant progress in science and implementation of programs to prevent mother-to-child transmission of HIV. Programs that support PMTCT routinely monitor service provision but very few have measured their effectiveness. The objective of the study was to use service data to inform HIV-free survival among HIV exposed children that received antiretroviral drugs to prevent mother-to-child transmission (PMTCT of HIV. The study was conducted in two rural districts in Malawi with support from FHI 360. Methods A descriptive observational study of PMTCT outcomes was conducted between June 2005 and June 2009. The dataset included patient-level data of all pregnant women 1 that tested HIV-positive, 2 that were dispensed with antiretroviral prophylaxis, and 3 whose addresses were available for home visits. The data were matched to each woman’s corresponding antenatal clinic data from home visit registers. Results Out of 438 children whose home addresses were available, 33 (8% were lost to follow-up, 35 (8% were alive but not tested for HIV by the time home visit was conducted, and 52 (12% were confirmed deceased. A total of 318 children were alive at the time of the home visit and had an HIV antibody test done at median age 15 months. The resulting estimated 24-month probability of HIV-free survival over all children was 78%. Among children who did not receive nevirapine, the estimated 24-month probability of HIV-free survival was 61%, and among those who did receive NVP syrup the estimate was 82%. Conclusions When mothers and newborns received nevirapine, the estimated 24-month probability of HIV-free survival among children was high at 82% (CI: 54% to 99%. However this conclusion should be interpreted cautiously 1 due to the wide confidence interval; and 2 because the confidence interval range includes 55%, which is the natural HIV-free survival rate in the absence of a PMTCT intervention. This

  9. The challenges of adherence to infant feeding choices in prevention of mother-to-child transmission of HIV infections in South East Nigeria

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    Lawani LO

    2014-03-01

    Full Text Available Lucky O Lawani,1 Azubuike K Onyebuchi,2 Chukwuemeka A Iyoke,3 Robinson C Onoh,2 Peter O Nkwo31School of Postgraduate Studies, Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu State, Nigeria; 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; 3Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Enugu State, NigeriaBackground: Global and national efforts in the 21st century are directed toward the elimination of new pediatric HIV infections through evidence-based infant feeding interventions for the prevention of mother-to-child-transmission, with patient preference, motivation, and adherence identified as key factors for success.Objectives: This study assessed the challenges faced by HIV-infected parturients in adhering to the national infant feeding recommendations and their infant feeding preference for prevention of mother-to-child transmission in South East Nigeria.Methods: This is a cross-sectional, descriptive, questionnaire-based study of 556 parturients infected with HIV/AIDS.Results: The mean age of the participants was 28.0±5.3 years. The infant feeding choices were made jointly by both partners (61.1% in the antepartum period. The HIV status disclosure rate was 89.2%. A large proportion (91.7% practiced exclusive breastfeeding with highly active antiretroviral therapy, and 7.6% practiced mixed feeding because of nonadherence to their choice and national/international recommendations on infant feeding in the context of HIV/AIDS. This was mainly a result of pressure from family members (42.8% and cultural practices (28.5%. Multivariate logistic regression analysis indicates that adherence was strongly associated with age, marital status, and employment status, but not with residence, educational status, or parity.Conclusion: Exclusive breastfeeding is predominately the infant feeding choice among HIV

  10. Reuse of single-dose nevirapine in subsequent pregnancies for the prevention of mother-to-child HIV transmission in Lusaka, Zambia: A cohort study

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    Sinkala Moses

    2008-12-01

    Full Text Available Abstract Background Single-dose nevirapine (SDNVP for the prevention of mother-to-child HIV transmission (PMTCT results in the selection of resistance mutants among HIV-infected mothers. The effects of these mutations on the efficacy of SDNVP use in a subsequent pregnancy are not well understood. Methods We compared risks of perinatal HIV transmission between multiparous women who had previously received a dose of SDNVP (exposed and those that had not (unexposed and who were given SDNVP for the index pregnancy within a PMTCT clinical study. We also compared transmission risks among exposed and unexposed women who had two consecutive pregnancies within the trial. Logistic regression modeling was used to adjust for possible confounders. Results Transmission risks did not differ between 59 SDNVP-exposed and 782 unexposed women in unadjusted analysis or after adjustment for viral load and disease stage (adjusted odds ratio 0.6, 95% confidence interval [CI] 0.2 to 2.0. Among 43 women who had two consecutive pregnancies during the study, transmission risks were 7% (95% CI 1% to 19% at both the first (unexposed and second (exposed delivery. The results were unchanged, if infant death was included as an outcome. Conclusion These data suggest that the efficacy of SDNVP may not be diminished when reused in subsequent pregnancies.

  11. Prevention of mother-to-child transmission of HIV infection: Views and perceptions about swallowing nevirapine in rural Lilongwe, Malawi

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    Nyirenda Lot J

    2010-06-01

    Full Text Available Abstract Background In 2006 the World Health Organization described the status of prevention of mother to child transmission (PMTCT service implementation as unacceptable, with an urgent need for a renewed public health approach to improve access. For PMTCT to be effective it needs to be accessible, acceptable and affordable; however research in Africa into accessibility, uptake and acceptability of PMTCT services has been predominately urban based and usually focusing on women who deliver in hospitals. The importance of involving other community members to strengthen both PMTCT uptake and adherence, and to support women emotionally, has been advocated. Urban men's and rural traditional birth attendants' (TBAs involvement have improved uptake of HIV testing and of nevirapine. Methods A qualitative study was carried out in a rural district of Malawi's central region to explore the views about and perceptions of PMTCT antiretroviral treatment. Semi-structured interviews and focus group discussions were held with antenatal and postnatal women, fathers, grandmothers, TBAs, community leaders and PMTCT health workers. Results Two broad themes of findings emerged: those that relate to the hospital PMTCT service, and those that relate to the community. Trust in the hospital was strong, but distance, transport costs and perceived harsh, threatening health worker attitudes were barriers to access. Grandmothers were perceived to have influence on the management of labour, unlike fathers, but both were suggested as key people to ensure that babies are brought to the hospital for nevirapine syrup. TBAs were seen as powerful, local, and important community members, but some as uneducated. Conclusion PMTCT was seen as a community issue in which more than the mother alone can be involved. To support access to PMTCT, especially for rural women, there is need for further innovation and implementation research on involving TBAs in some aspects of PMTCT services

  12. Maternal antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Malawi: maternal and infant outcomes two years after delivery.

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    Marina Giuliano

    Full Text Available BACKGROUND: Optimized preventive strategies are needed to reach the objective of eliminating pediatric AIDS. This study aimed to define the determinants of residual HIV transmission in the context of maternal antiretroviral therapy (ART administration to pregnant women, to assess infant safety of this strategy, and to evaluate its impact on maternal disease. METHODOLOGY/PRINCIPAL FINDINGS: A total of 311 HIV-infected pregnant women were enrolled in Malawi in an observational study and received a nevirapine-based regimen from week 25 of gestation until 6 months after delivery (end of breastfeeding period if their CD4+ count was > 350/mm(3 at baseline (n = 147, or indefinitely if they met the criteria for treatment (n. 164. Mother/child pairs were followed until 2 years after delivery. The Kaplan-Meier method was used to estimate HIV transmission, maternal disease progression, and survival at 24 months. The rate of HIV infant infection was 3.2% [95% confidence intervals (CI 1.0-5.4]. Six of the 8 transmissions occurred among mothers with baseline CD4+ count > 350/mm(3. HIV-free survival of children was 85.8% (95% CI 81.4-90.1. Children born to mothers with baseline CD4+ count < 350/mm(3 were at increased risk of death (hazard ratio 2.6, 95% CI 1.1-6.1. Among women who had stopped treatment the risk of progression to CD4+ count < 350/mm(3 was 20.6% (95% CI 9.2-31.9 by 18 months of drug discontinuation. CONCLUSIONS: HIV transmission in this cohort was rare however, it occurred in a significative proportion among women with high CD4+ counts. Strategies to improve treatment adherence should be implemented to further reduce HIV transmission. Mortality in the uninfected exposed children was the major determinant of HIV-free survival and was associated to maternal disease stage. Given the considerable proportion of women reaching the criteria for treatment within 18 months of drug discontinuation, life-long ART administration to HIV-infected women should

  13. Using electronic readers to monitor progress toward elimination of mother-to-child transmission of HIV and syphilis: An opinion piece.

    Science.gov (United States)

    Wedderburn, Catherine J; Murtagh, Maurine; Toskin, Igor; Peeling, Rosanna W

    2015-06-01

    Electronic readers and smartphones have the potential to standardize the interpretation of rapid diagnostic tests (RDTs) and provide timely surveillance program data. RDTs are widely used for HIV and are being increasingly used for syphilis screening in pregnant women. Following the WHO initiative for the validation of elimination of mother-to-child transmission of HIV and syphilis, there is a need for more extensive testing and data monitoring. However, access to timely and accurate data can be challenging once testing is decentralized as data quality at remote sites is often difficult to verify. Electronic RDT readers can help to ensure quality and allow automated data transmission, creating an opportunity for real-time surveillance to inform control strategies and assess intervention impact. Furthermore, by linking the data to existing supply chain management software, stockouts can be minimized. The present opinion piece looks at the opportunities and challenges of using these tools within national elimination programs. PMID:25983212

  14. Prevention of mother-to-child transmission of HIV: cost-effectiveness of antiretroviral regimens and feeding options in Rwanda.

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    Agnes Binagwaho

    Full Text Available BACKGROUND: Rwanda's National PMTCT program aims to achieve elimination of new HIV infections in children by 2015. In November 2010, Rwanda adopted the WHO 2010 ARV guidelines for PMTCT recommending Option B (HAART for all HIV-positive pregnant women extended throughout breastfeeding and discontinued (short course-HAART only for those not eligible for life treatment. The current study aims to assess the cost-effectiveness of this policy choice. METHODS: Based on a cohort of HIV-infected pregnant women in Rwanda, we modelled the cost-effectiveness of six regimens: dual ARV prophylaxis with either 12 months breastfeeding or replacement feeding; short course HAART (Sc-HAART prophylaxis with either 6 months breastfeeding, 12 months breastfeeding, or 18 months breastfeeding; and Sc-HAART prophylaxis with replacement feeding. Direct costs were modelled based on all inputs in each scenario and related unit costs. Effectiveness was evaluated by measuring HIV-free survival at 18 months. Savings correspond to the lifetime costs of HIV treatment and care avoided as a result of all vertical HIV infections averted. RESULTS: All PMTCT scenarios considered are cost saving compared to "no intervention." Sc-HAART with 12 months breastfeeding or 6 months breastfeeding dominate all other scenarios. Sc-HAART with 12 months breastfeeding allows for more children to be alive and HIV-uninfected by 18 months than Sc-HAART with 6 months breastfeeding for an incremental cost per child alive and uninfected of 11,882 USD. This conclusion is sensitive to changes in the relative risk of mortality by 18 months for exposed HIV-uninfected children on replacement feeding from birth and those who were breastfed for only 6 months compared to those breastfeeding for 12 months or more. CONCLUSION: Our findings support the earlier decision by Rwanda to adopt WHO Option B and could inform alternatives for breastfeeding duration. Local contexts and existing care delivery models should

  15. Disclosure experience to partner and its effect on intention to utilize prevention of mother to child transmission service among HIV positive pregnant women attending antenatal care in Addis Ababa, Ethiopia

    OpenAIRE

    Sendo, Endalew Gemechu; Cherie, Amsale; Erku, Tadese Asfaw

    2013-01-01

    Background Disclosure of HIV status has become an entry criterion for prevention of mother to child transmission programs in resource-constrained countries. However, little has been explored about the prevalence of, barriers to, outcomes and factors associated with HIV status disclosure among HIV positive pregnant women in Ethiopia. Method Cross- sectional study was conducted among 107 pregnant women who were attending antenatal care in public centers from April to June 2011 in Addis Ababa ca...

  16. Tracing defaulters in HIV prevention of mother-to-child transmission programmes through community health workers: results from a rural setting in Zimbabwe

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    Florian Vogt

    2015-10-01

    Full Text Available Introduction: High retention in care is paramount to reduce vertical human immunodeficiency virus (HIV infections in prevention of mother-to-child transmission (PMTCT programmes but remains low in many sub-Saharan African countries. We aimed to assess the effects of community health worker–based defaulter tracing (CHW-DT on retention in care and mother-to-child HIV transmission, an innovative approach that has not been evaluated to date. Methods: We analyzed patient records of 1878 HIV-positive pregnant women and their newborns in a rural PMTCT programme in the Tsholotsho district of Zimbabwe between 2010 and 2013 in a retrospective cohort study. Using binomial regression, we compared vertical HIV transmission rates at six weeks post-partum, and retention rates during the perinatal PMTCT period (at delivery, nevirapine [NVP] initiation at three days post-partum, cotrimoxazole (CTX initiation at six weeks post-partum, and HIV testing at six weeks post-partum before and after the introduction of CHW-DT in the project. Results: Median maternal age was 27 years (inter-quartile range [IQR] 23 to 32 and median CD4 count was 394 cells/µL3 (IQR 257 to 563. The covariate-adjusted rate ratio (aRR for perinatal HIV transmission was 0.72 (95% confidence intervals [95% CI] 0.27 to 1.96, p=0.504, comparing patient outcomes after and before the intervention. Among fully retained patients, 11 (1.9% newborns tested HIV positive. ARRs for retention in care were 1.01 (95% CI 0.96 to 1.06, p=0.730 at delivery; 1.35 (95% CI 1.28 to 1.42, p<0.001 at NVP initiation; 1.78 (95% CI 1.58 to 2.01, p<0.001 at CTX initiation; and 2.54 (95% CI 2.20 to 2.93, p<0.001 at infant HIV testing. Cumulative retention after and before the intervention was 496 (85.7% and 1083 (87.3% until delivery; 480 (82.9% and 1005 (81.0% until NVP initiation; 303 (52.3% and 517 (41.7% until CTX initiation; 272 (47.0% and 427 (34.4% until infant HIV testing; and 172 (29.7% and 405 (32.6% until HIV

  17. Triple-antiretroviral prophylaxis to prevent mother-to-child HIV transmission through breastfeeding--the Kisumu Breastfeeding Study, Kenya: a clinical trial.

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    Timothy K Thomas

    2011-03-01

    Full Text Available BACKGROUND: Effective strategies are needed for the prevention of mother-to-child HIV transmission (PMTCT in resource-limited settings. The Kisumu Breastfeeding Study was a single-arm open label trial conducted between July 2003 and February 2009. The overall aim was to investigate whether a maternal triple-antiretroviral regimen that was designed to maximally suppress viral load in late pregnancy and the first 6 mo of lactation was a safe, well-tolerated, and effective PMTCT intervention. METHODS AND FINDINGS: HIV-infected pregnant women took zidovudine, lamivudine, and either nevirapine or nelfinavir from 34-36 weeks' gestation to 6 mo post partum. Infants received single-dose nevirapine at birth. Women were advised to breastfeed exclusively and wean rapidly just before 6 mo. Using Kaplan-Meier methods we estimated HIV-transmission and death rates from delivery to 24 mo. We compared HIV-transmission rates among subgroups defined by maternal risk factors, including baseline CD4 cell count and viral load. Among 487 live-born, singleton, or first-born infants, cumulative HIV-transmission rates at birth, 6 weeks, and 6, 12, and 24 mo were 2.5%, 4.2%, 5.0%, 5.7%, and 7.0%, respectively. The 24-mo HIV-transmission rates stratified by baseline maternal CD4 cell count <500 and ≥500 cells/mm(3 were 8.4% (95% confidence interval [CI] 5.8%-12.0% and 4.1% (1.8%-8.8%, respectively (p = 0.06; the corresponding rates stratified by baseline maternal viral load <10,000 and ≥10,000 copies/ml were 3.0% (1.1%-7.8% and 8.7% (6.1%-12.3%, respectively (p = 0.01. None of the 12 maternal and 51 infant deaths (including two second-born infants were attributed to antiretrovirals. The cumulative HIV-transmission or death rate at 24 mo was 15.7% (95% CI 12.7%-19.4%. CONCLUSIONS: This trial shows that a maternal triple-antiretroviral regimen from late pregnancy through 6 months of breastfeeding for PMTCT is safe and feasible in a resource-limited setting. These

  18. Impact of Maternal HIV Seroconversion during Pregnancy on Early Mother to Child Transmission of HIV (MTCT Measured at 4-8 Weeks Postpartum in South Africa 2011-2012: A National Population-Based Evaluation.

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    Thu-Ha Dinh

    Full Text Available Mother-to-child transmission of HIV (MTCT depends on the timing of HIV infection. We estimated HIV-seroconversion during pregnancy (HSP after having a HIV-negative result antenatally, and its contribution to early MTCT in South Africa (SA.Between August 2011 and March 2012, we recruited a nationally representative sample of mother-infant pairs with infants aged 4-to-8 weeks from 578 health facilities. Data collection included mother interviews, child health-card reviews, and infant dried-blood-spots sample (iDBS. iDBS were tested for HIV antibodies and HIV-deoxyribonucleic-acid (HIV-DNA. HSP was defined as maternal self-report of an HIV-negative test during this pregnancy, no documented use of antiretroviral drugs and a matched HIV sero-positive iDBS. We used 20 imputations from a uniform distribution for time from reported antenatal HIV-negative result to delivery to estimate time of HSP. Early MTCT was defined based on detection of HIV-DNA in iDBS. Estimates were adjusted for clustering, nonresponse, and weighted by SA's 2011 live-births.Of 9802 mother-infant pairs, 2738 iDBS were HIV sero-positive, including 212 HSP, resulting in a nationally weighted estimate of 3.3% HSP (95% Confidence Interval: 2.8%-3.8%. Median time of HIV-seroconversion was 32.8weeks gestation;28.3% (19.7%- 36.9% estimated to be >36 weeks. Early MTCT was 10.7% for HSP (6.2%-16.8% vs. 2.2% (1.7%-2.8% for mothers with known HIV-positive status. Although they represent 2.2% of all mothers and 6.7% of HIV-infected mothers, HSP accounted for 26% of early MTCT. Multivariable analysis indicated the highest risk for HSP was among women who knew the baby's father was HIV-infected (adjusted-hazard ratio (aHR 4.71; 1.49-14.99, or who had been screened for tuberculosis (aHR 1.82; 1.43-2.32.HSP risk is high and contributes significantly to early MTCT. Identification of HSP by repeat-testing at 32 weeks gestation, during labor, 6 weeks postpartum, in tuberculosis-exposed women, and in

  19. The use of mobile phones to deliver acceptance and commitment therapy in the prevention of mother-child HIV transmission in Nigeria.

    Science.gov (United States)

    Ishola, A G; Chipps, J

    2015-12-01

    The objective of this study was to determine if introducing acceptance and commitment therapy in the prevention of mother to child HIV transmission (PMTCT) programme using weekly mobile phone messages would result in improved mental health status of HIV-positive, pregnant women in Nigeria. We used a Solomon four-group (two intervention and two control groups) randomised design. The study population was 144 randomly selected, HIV-positive pregnant women attending four randomly selected PMTCT centres in Nigeria. The intervention groups were exposed to one session of acceptance and commitment therapy with weekly value-based health messages sent by mobile phone for three months during pregnancy. The control groups received only post-HIV test counselling. A total of 132 participants (33 per site) were enrolled in the study from the two intervention and two control sites. In the pre-tests, the intervention and control groups did not differ significantly with regard to demographics. Evaluation of the pre- and post-tests of the intervention group indicated significantly higher Action and Acceptance Questionnaire (AAQ-II) scores. The introduction of a mobile phone acceptance and commitment therapy programme may result in greater psychological flexibility in women diagnosed with HIV.

  20. Integrating Prevention of Mother to Child HIV Transmission competencies into the nursing curriculum: Methodological lessons from a university-based undergraduate programme.

    Science.gov (United States)

    Mbombo, Nomafrench; Bimerew, Million

    2012-11-14

    South Africa (SA) has the highest number of women infected with HIV and AIDS during pregnancy, which results in more than 70 000 infected babies being born each year AIDS is the major contributor to maternal and child morbidities and mortalities in the country. To combat this, the SA government has developed a national policy to prevent mother-to-child HIV transmission (PMTCT). However, for effective implementation of this policy, there is a dire need for a competent, skilled health worker to render the service. In response to this, the School of Nursing at the University of the Western Cape has integrated PMTCT competencies into the undergraduate Bachelor of Nursing Science curriculum. In this paper, we described teaching and learning approaches used to integrate PMTCT competencies, including the skills laboratory methodology and case-based learning, as well as a portfolio of evidence assessment tool. A quantitative descriptive design was used to analyse data collected from students in regard to assessment of PMTCT competencies achieved. The study used the conceptual framework of Lenburg's competency outcomes and performance assessment model, which focuses on competency development and assessment in a clinical environment. HIV competencies, including PMTCT, should be integrated both theoretically and at service delivery into other nursing and midwifery competencies, including assessment strategies. Provincial policies in provision of antiretrovirals by nurses and midwives become barriers to successful implementation of PMTCT, resulting in limited learning opportunities for students to practice PMTCT competencies. Further research is required to assess an attribute, affect, which is another prong for competencies.

  1. The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review

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    Johri Mira

    2011-02-01

    Full Text Available Abstract Background Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. We reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT of HIV in low- and middle-income countries (LMICs. This article presents syntheses of evidence on the costs, effects and cost-effectiveness of HIV MTCT strategies for LMICs from the published literature and evaluates their implications for policy and future research. Methods Candidate studies were identified through a comprehensive database search including PubMed, Embase, Cochrane Library, and EconLit restricted by language (English or French, date (January 1st, 1994 to January 17th, 2011 and article type (original research. Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion. We searched article bibliographies to identify additional studies. Two authors independently assessed eligibility and extracted data from studies retained for review. Study quality was appraised using a modified BMJ checklist for economic evaluations. Data were synthesised in narrative form. Results We identified 19 articles published in 9 journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks. In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health. Conclusions and Recommendations Interventions to prevent HIV MTCT are compelling on economic

  2. WHO 2010 guidelines for prevention of mother-to-child HIV transmission in Zimbabwe: modeling clinical outcomes in infants and mothers.

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    Andrea L Ciaranello

    Full Text Available BACKGROUND: The Zimbabwean national prevention of mother-to-child HIV transmission (PMTCT program provided primarily single-dose nevirapine (sdNVP from 2002-2009 and is currently replacing sdNVP with more effective antiretroviral (ARV regimens. METHODS: Published HIV and PMTCT models, with local trial and programmatic data, were used to simulate a cohort of HIV-infected, pregnant/breastfeeding women in Zimbabwe (mean age 24.0 years, mean CD4 451 cells/µL. We compared five PMTCT regimens at a fixed level of PMTCT medication uptake: 1 no antenatal ARVs (comparator; 2 sdNVP; 3 WHO 2010 guidelines using "Option A" (zidovudine during pregnancy/infant NVP during breastfeeding for women without advanced HIV disease; lifelong 3-drug antiretroviral therapy (ART for women with advanced disease; 4 WHO "Option B" (ART during pregnancy/breastfeeding without advanced disease; lifelong ART with advanced disease; and 5 "Option B+:" lifelong ART for all pregnant/breastfeeding, HIV-infected women. Pediatric (4-6 week and 18-month infection risk, 2-year survival and maternal (2- and 5-year survival, life expectancy from delivery outcomes were projected. RESULTS: Eighteen-month pediatric infection risks ranged from 25.8% (no antenatal ARVs to 10.9% (Options B/B+. Although maternal short-term outcomes (2- and 5-year survival varied only slightly by regimen, maternal life expectancy was reduced after receipt of sdNVP (13.8 years or Option B (13.9 years compared to no antenatal ARVs (14.0 years, Option A (14.0 years, or Option B+ (14.5 years. CONCLUSIONS: Replacement of sdNVP with currently recommended regimens for PMTCT (WHO Options A, B, or B+ is necessary to reduce infant HIV infection risk in Zimbabwe. The planned transition to Option A may also improve both pediatric and maternal outcomes.

  3. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples

    OpenAIRE

    Anglemyer, Andrew; Rutherford, George W.; Horvath, Tara; Baggaley, Rachel C; Egger, Matthias; Siegfried, Nandi

    2013-01-01

    BACKGROUND Antiretroviral drugs have been shown to reduce risk of mother-to-child transmission of human immunodeficiency virus (HIV) and are also widely used for post-exposure prophylaxis for parenteral and sexual exposures. Sexual transmission may be lower in couples in which one partner is infected with HIV and the other is not and the infected partner is on antiretroviral therapy (ART). OBJECTIVES To determine if ART use in an HIV-infected member of an HIV-discordant couple is ...

  4. Ministry of Health Maps Out Goals for Prevention of Motherto-Child Transmission

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    In a recently circulated document called Implementation Plan (Trial) for Prevention of Mother-to-Child HIV Transmission, the Ministry of Health vowed to step up efforts to cut off mother-tochild transmission and improve maternal and child health.

  5. Utilization of Prevention of Mother-to-Child Transmission of HIV Services and Associated Factors among Antenatal Care Attending Mothers in Sebeta Town, Central Ethiopia

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    Hailu Merga

    2016-01-01

    Full Text Available Background. HIV transmission from mother to child continues to be the major source of HIV infection among children under the age of fifteen. Targeting pregnant women attending antenatal clinics provides a unique opportunity for implementing prevention of mother-to-child transmission (PMTCT programs against HIV infection of newborn babies. This study assessed utilization of PMTCT service of HIV and associated factors among ANC attending mothers. Methods. An institutional based cross-sectional study was conducted from February 20 to March 30, 2015, using exit interviews with 377 ANC attendees using consecutive sampling method. In-depth interviews with service provider were conducted to complement the quantitative data. Data were entered and analysed using EpiData and SPSS, respectively. Results. The prevalence of PMTCT service utilization was 86.9% in this study. Only 8.6% of respondents attended the facility for HCT. After controlling confounders using logistic regression, PMTCT service utilization was associated with age (25–34 of respondents (AOR (95% CI = 0.46 (0.22, 0.97, mother’s occupational status (being merchant AOR (95% CI = 0.31 (0.12, 0.83, government employee AOR (95% CI = 0.05 (0.01, 0.28, student AOR (95% CI = 0.1 (0.01, 0.44, and daily laborer AOR (95% CI = 0.13 (0.05, 0.33, husband’s educational status (lack of formal education (AOR (95% CI = 3.3 (1.1, 9.9, having discussion with husband (AOR (95% CI = 6.1 (2.6, 14.1, partner tested (AOR (95% CI = 8.2 (1.9, 34.46, and being not satisfied with the service (AOR (95% CI = 0.46 (0.2, 0.99. Conclusions. This study revealed that utilization of HIV counseling and testing during antenatal care was high among pregnant women in Sebeta town. It highlights that focusing on improvement of quality and coverage of health services has significant effects on PMTCT service utilization. Effective use or uptake of ARV drug among HIV-positive pregnant women should be further investigated so that

  6. [Maternal-fetal transmission of HIV].

    Science.gov (United States)

    Gillet, J Y; Bongain, A; Monpoux, F; Mariani, R

    1995-02-01

    HIV infection in children is mainly the result of a mother-to-child transmission. The contamination during pregnancy is well known but intrapartum vertical transmission may also occur through ascending infection, blood exchange between mother and child, or direct contact with vaginal or cervical secretions. In addition HIV can be transmitted via breast milk. The reported rates of vertical transmission are highly variable: 14.4% in a European study, 18.3% in a French survey, 20 to 25% in the USA, 35 to 50% in Africa. It is unclear whether such a large variation of the rate of transmission is due to methodological differences or to different distributions of risk factors in the populations. There are some known predictive factors of HIV transmission such as low CD4 cells count, positive p24 antigenaemia and elevated concentrations of virus. The role of other factors is still debated: prematurity, virus (CMV, HTLV-1, HVB, HVC), C section prior labour, rupture of membranes. The prevention of HIV infection in infants is mainly based on contra-indication of pregnancy in infected women, desinfection of the vagina at the beginning of labour, early protection of the newborn by avoiding skin lesions and immediate washing, preventive treatment by zidovudin during pregnancy. PMID:7735451

  7. [Maternal-fetal transmission of HIV].

    Science.gov (United States)

    Gillet, J Y; Bongain, A; Monpoux, F; Mariani, R

    1995-02-01

    HIV infection in children is mainly the result of a mother-to-child transmission. The contamination during pregnancy is well known but intrapartum vertical transmission may also occur through ascending infection, blood exchange between mother and child, or direct contact with vaginal or cervical secretions. In addition HIV can be transmitted via breast milk. The reported rates of vertical transmission are highly variable: 14.4% in a European study, 18.3% in a French survey, 20 to 25% in the USA, 35 to 50% in Africa. It is unclear whether such a large variation of the rate of transmission is due to methodological differences or to different distributions of risk factors in the populations. There are some known predictive factors of HIV transmission such as low CD4 cells count, positive p24 antigenaemia and elevated concentrations of virus. The role of other factors is still debated: prematurity, virus (CMV, HTLV-1, HVB, HVC), C section prior labour, rupture of membranes. The prevention of HIV infection in infants is mainly based on contra-indication of pregnancy in infected women, desinfection of the vagina at the beginning of labour, early protection of the newborn by avoiding skin lesions and immediate washing, preventive treatment by zidovudin during pregnancy.

  8. Antiretroviral treatment response of HIV-infected children after prevention of mother-to-child transmission in West Africa

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    Camille Ndondoki

    2014-06-01

    Full Text Available Introduction: We assessed the rate of treatment failure of HIV-infected children after 12 months on antiretroviral treatment (ART in the Paediatric IeDEA West African Collaboration according to their perinatal exposure to antiretroviral drugs for preventing mother-to-child transmission (PMTCT. Methods: A retrospective cohort study in children younger than five years at ART initiation between 2004 and 2009 was nested within the pWADA cohort, in Bamako-Mali and Abidjan-Côte d’Ivoire. Data on PMTCT exposure were collected through a direct review of children's medical records. The 12-month Kaplan-Meier survival without treatment failure (clinical or immunological was estimated and their baseline factors studied using a Cox model analysis. Clinical failure was defined as the appearance or reappearance of WHO clinical stage 3 or 4 events or any death occurring within the first 12 months of ART. Immunological failure was defined according to the 2006 World Health Organization age-related immunological thresholds for severe immunodeficiency. Results: Among the 1035 eligible children, PMTCT exposure was only documented for 353 children (34.1% and remained unknown for 682 (65.9%. Among children with a documented PMTCT exposure, 73 (20.7% were PMTCT exposed, of whom 61.0% were initiated on a protease inhibitor-based regimen, and 280 (79.3% were PMTCT unexposed. At 12 months on ART, the survival without treatment failure was 40.6% in the PMTCT-exposed group, 25.2% in the unexposed group and 18.5% in the children with unknown exposure status (p=0.002. In univariate analysis, treatment failure was significantly higher in children unexposed (HR 1.4; 95% CI: 1.0–1.9 and with unknown PMTCT exposure (HR 1.5; 95% CI: 1.2–2.1 rather than children PMTCT-exposed (p=0.01. In the adjusted analysis, treatment failure was not significantly associated with PMTCT exposure (p=0.15 but was associated with immunodeficiency (aHR 1.6; 95% CI: 1.4–1.9; p=0.001, AIDS

  9. Community strategies that improve care and retention along the prevention of mother-to-child transmission of HIV cascade: a review

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    Benjamin Ryan Phelps

    2012-07-01

    Full Text Available Introduction: While biomedical innovations have made it possible to prevent the vertical transmission of HIV from mother to child, poor retention along the prevention of mother-to-child transmission (PMTCT cascade continues to limit the impact of programmes, especially in low-resourced settings. In many of the regions with the highest burden of HIV and the greatest number of new paediatric cases, the uptake of facility-based care by pregnant women remains low. In such settings, the continuum of care for pregnant women and other women of reproductive age necessarily relies on the community. There is no recent review capturing effective, promising practices that are community-based and/or employ community-oriented groups to improve outcomes for the prevention of vertical transmission. This review summarizes those studies demonstrating that community-based and community-oriented interventions significantly influence retention and related outcomes along the PMTCT cascade. Methods: Literature on retention within prevention of vertical transmission programmes available on PubMed, Psych Info and MEDLINE was searched and manuscripts reporting on key prevention of vertical transmission outcomes were identified. Short-listed studies that captured significant PMTCT outcome improvements resulting from community-based interventions or facility-based employment of community cohorts (e.g. lay counsellors, community volunteers, etc. were selected for review. Results: The initial search (using terms “HIV” and “PMTCT” yielded 430 articles. These results were further narrowed using terminology relevant to community prevention of vertical transmission strategies addressing retention: “community,” “PMTCT cascade,” “retention,” “loss to follow up” and “early infant diagnosis.” Nine of these reported statistically significant improvements in key prevention of vertical transmission outcomes while meeting other review criteria. Short

  10. The potential role of mother-in-law in prevention of mother-to-child transmission of HIV: a mixed methods study from the Kilimanjaro region, northern Tanzania

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    Leshabari Sebalda

    2011-07-01

    Full Text Available Abstract Background In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT service utilization and adherence to infant feeding guidelines. Methods The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. Results The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Conclusions Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored.

  11. The case for Option B and Optional B+: Ensuring that South Africa’s commitment to eliminating mother-to-child transmission of HIV becomes a reality

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    D Besada

    2012-11-01

    Full Text Available In a previous issue of the Southern African Journal of HIV Medicine, Pillay and Black summarised the trade-offs of the safety of efavirenz use in pregnancy (Pillay P, Black V. Safety, strength and simplicity of efavirenz in pregnancy. Southern African Journal of HIV Medicine 2012;13(1:28-33.. Highlighting the benefits of the World Health Organization’s proposed options for the prevention of mother-to-child transmission (PMTCT of HIV, the authors argued that the South African government should adopt Option B as national PMTCT policy and pilot projects implementing Option B+ as a means of assessing the individual- and population-level effect of the intervention. We echo this call and further propose that the option to remain on lifelong antiretroviral therapy, effectively adopting PMTCT Option B+, be offered to pregnant women following the cessation of breastfeeding, for their own health, following the provision of counselling on associated benefits and risks. Here we highlight the benefits of Options B and B+.

  12. Developing content for a mHealth intervention to promote postpartum retention in prevention of mother-to-child HIV transmission programs and early infant diagnosis of HIV: a qualitative study.

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    Thomas A Odeny

    Full Text Available BACKGROUND: Maternal attendance at postnatal clinic visits and timely diagnosis of infant HIV infection are important steps for prevention of mother-to-child transmission (PMTCT of HIV. We aimed to use theory-informed methods to develop text messages targeted at facilitating these steps. METHODS: We conducted five focus group discussions with health workers and women attending antenatal, postnatal, and PMTCT clinics to explore aspects of women's engagement in postnatal HIV care and infant testing. Discussion topics were informed by constructs of the Health Belief Model (HBM and prior empirical research. Qualitative data were coded and analyzed according to the construct of the HBM to which they related. Themes were extracted and used to draft intervention messages. We carried out two stages of further messaging development: messages were presented in a follow-up focus group in order to develop optimal phrasing in local languages. We then further refined the messages, pretested them in individual cognitive interviews with selected health workers, and finalized the messages for the intervention. RESULTS: Findings indicated that brief, personalized, caring, polite, encouraging, and educational text messages would facilitate women bringing their children to clinic after delivery, suggesting that text messages may serve as an important "cue to action." Participants emphasized that messages should not mention HIV due to fear of HIV testing and disclosure. Participants also noted that text messages could capitalize on women's motivation to attend clinic for childhood immunizations. CONCLUSIONS: Applying a multi-stage content development approach to crafting text messages--informed by behavioral theory--resulted in message content that was consistent across different focus groups. This approach could help answer "why" and "how" text messaging may be a useful tool to support maternal and child health. We are evaluating the effect of these messages on

  13. Current status of medication adherence and infant follow up in the prevention of mother to child HIV transmission programme in Addis Ababa: a cohort study

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    Mirkuzie Alemnesh H

    2011-10-01

    Full Text Available Abstract Background Prevention of mother to child HIV transmission (PMTCT programmes have great potential to achieve virtual elimination of perinatal HIV transmission provided that PMTCT recommendations are properly followed. This study assessed mothers and infants adherence to medication regimen for PMTCT and the proportions of exposed infants who were followed up in the PMTCT programme. Methods A prospective cohort study was conducted among 282 HIV-positive mothers attending 15 health facilities in Addis Ababa, Ethiopia. Descriptive statistics, bivariate and mulitivariate logistic regression analyses were done. Results Of 282 mothers enrolled in the cohort, 232 (82%, 95% CI 77-86% initiated medication during pregnancy, 154 (64% initiated combined zidovudine (ZDV prophylaxis regimen while 78 (33% were initiated lifelong antiretroviral treatment (ART. In total, 171 (60%, 95% CI 55-66% mothers ingested medication during labour. Of the 221 live born infants (including two sets of twins, 191 (87%, 95% CI 81-90% ingested ZDV and single-dose nevirapine (sdNVP at birth. Of the 219 live births (twin births were counted once, 148 (68%, 95% CI 61-73% mother-infant pairs ingested their medication at birth. Medication ingested by mother-infant pairs at birth was significantly and independently associated with place of delivery. Mother-infant pairs attended in health facilities at birth were more likely (OR 6.7 95% CI 2.90-21.65 to ingest their medication than those who were attended at home. Overall, 189 (86%, 95% CI 80-90% infants were brought for first pentavalent vaccine and 115 (52%, 95% CI 45-58% for early infant diagnosis at six-weeks postpartum. Among the infants brought for early diagnosis, 71 (32%, 95% CI 26-39% had documented HIV test results and six (8.4% were HIV positive. Conclusions We found a progressive decline in medication adherence across the perinatal period. There is a big gap between mediation initiated during pregnancy and actually

  14. Integrating Prevention of Mother to Child HIV Transmission competencies into the nursing curriculum: Methodological lessons from a university-based undergraduate programme

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    Nomafrench Mbombo

    2012-11-01

    Full Text Available South Africa (SA has the highest number of women infected with HIV and AIDS during pregnancy, which results in more than 70 000 infected babies being born each year AIDS is the major contributor to maternal and child morbidities and mortalities in the country. To combat this, the SA government has developed a national policy to prevent mother-to-child HIV transmission (PMTCT. However, for effective implementation of this policy, there is a dire need for a competent, skilled health worker to render the service. In response to this, the School of Nursing at the University of the Western Cape has integrated PMTCT competencies into the undergraduate Bachelor of Nursing Science curriculum. In this paper, we describedteaching and learning approaches used to integrate PMTCT competencies, including the skills laboratory methodology and case-based learning, as well as a portfolio of evidence assessment tool. A quantitative descriptive design was used to analyse data collected from students in regard to assessment of PMTCT competencies achieved. The study used the conceptual framework of Lenburg’s competency outcomes and performance assessment model, which focuses on competency development and assessment in a clinical environment. HIV competencies, including PMTCT, should be integrated both theoretically and at service delivery into other nursing and midwifery competencies, including assessment strategies. Provincial policies in provision of antiretrovirals by nurses and midwives become barriers to successful implementation of PMTCT, resulting in limited learning opportunities for students to practice PMTCT competencies. Further research is required to assess an attribute, affect, which is another prong for competencies.

  15. Integrating Prevention of Mother to Child HIV Transmission competencies into the nursing curriculum: Methodological lessons from a university-based undergraduate programme

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    Nomafrench Mbombo

    2012-05-01

    Full Text Available South Africa (SA has the highest number of women infected with HIV and AIDS during pregnancy, which results in more than 70 000 infected babies being born each year AIDS is the major contributor to maternal and child morbidities and mortalities in the country. To combat this, the SA government has developed a national policy to prevent mother-to-child HIV transmission (PMTCT. However, for effective implementation of this policy, there is a dire need for a competent, skilled health worker to render the service. In response to this, the School of Nursing at the University of the Western Cape has integrated PMTCT competencies into the undergraduate Bachelor of Nursing Science curriculum. In this paper, we described teaching and learning approaches used to integrate PMTCT competencies, including the skills laboratory methodology and case-based learning, as well as a portfolio of evidence assessment tool. A quantitative descriptive design was used to analyse data collected from students in regard to assessment of PMTCT competencies achieved. The study used the conceptual framework of Lenburg’s competency outcomes and performance assessment model, which focuses on competency development and assessment in a clinical environment. HIV competencies, including PMTCT, should be integrated both theoretically and at service delivery into other nursing and midwifery competencies, including assessment strategies. Provincial policies in provision of antiretrovirals by nurses and midwives become barriers to successful implementation of PMTCT, resulting in limited learning opportunities for students to practice PMTCT competencies. Further research is required to assess an attribute, affect, which is another prong for competencies.

  16. HIV-1 drug resistance emergence among breastfeeding infants born to HIV-infected mothers during a single-arm trial of triple-antiretroviral prophylaxis for prevention of mother-to-child transmission: a secondary analysis.

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    Clement Zeh

    2011-03-01

    Full Text Available BACKGROUND: Nevirapine and lamivudine given to mothers are transmitted to infants via breastfeeding in quantities sufficient to have biologic effects on the virus; this may lead to an increased risk of a breastfed infant's development of resistance to maternal antiretrovirals. The Kisumu Breastfeeding Study (KiBS, a single-arm open-label prevention of mother-to-child HIV transmission (PMTCT trial, assessed the safety and efficacy of zidovudine, lamivudine, and either nevirapine or nelfinavir given to HIV-infected women from 34 wk gestation through 6 mo of breastfeeding. Here, we present findings from a KiBS trial secondary analysis that evaluated the emergence of maternal ARV-associated resistance among 32 HIV-infected breastfed infants. METHODS AND FINDINGS: All infants in the cohort were tested for HIV infection using DNA PCR at multiple study visits during the 24 mo of the study, and plasma RNA viral load for all HIV-PCR-positive infants was evaluated retrospectively. Specimens from mothers and infants with viral load >1,000 copies/ml were tested for HIV drug resistance mutations. Overall, 32 infants were HIV infected by 24 mo of age, and of this group, 24 (75% infants were HIV infected by 6 mo of age. Of the 24 infants infected by 6 mo, nine were born to mothers on a nelfinavir-based regimen, whereas the remaining 15 were born to mothers on a nevirapine-based regimen. All infants were also given single-dose nevirapine within 48 hours of birth. We detected genotypic resistance mutations in none of eight infants who were HIV-PCR positive by 2 wk of age (specimens from six infants were not amplifiable, for 30% (6/20 at 6 wk, 63% (14/22 positive at 14 wk, and 67% (16/24 at 6 mo post partum. Among the 16 infants with resistance mutations by 6 mo post partum, the common mutations were M184V and K103N, conferring resistance to lamivudine and nevirapine, respectively. Genotypic resistance was detected among 9/9 (100% and 7/15 (47% infected infants

  17. Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: A cross-sectional survey in rural and urban Uganda

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    Bajunirwe Francis

    2005-10-01

    Full Text Available Abstract Background Implementation of programs for the prevention of mother-to-child transmission (PMTCT of HIV faces a variety of barriers and challenges. The assessment of these challenges has generally been conducted in large urban health facilities. As programs expand into rural areas, the potential barriers that may be encountered there also need to be assessed. This study examines potential barriers that might affect the acceptability of interventions for PMTCT in rural and urban settings. Results Four hundred and four women at a large urban hospital and three rural clinics that had recently started implementing PMTCT were interviewed. Level of knowledge of MTCT and preference for rapid HIV testing were equally high in both areas, but rural women had a higher tendency to think that they should consult their husbands before testing, with borderline statistical significance (72% vs. 64% p = 0.09. Health facility-based deliveries were significantly lower among mothers in rural areas compared to those in the urban setting. Overall, significant predictors of willingness to test for HIV were post-primary education (OR = 3.1 95% CI 1.2, 7.7 and knowledge about rapid HIV tests (OR = 1.8, 95% CI 1.01, 3.4. The strongest predictor of willingness to accept an HIV test was the woman's perception that her husband would approve of her testing for HIV. Women who thought their husbands would approve were almost six times more likely to report a willingness to be tested compared to those who thought their husbands would not approve (OR = 5.6, 95% CI 2.8, 11.2. Conclusion Lessons learned in large urban hospitals can be generalized to rural facilities, but the lower proportion of facility-based deliveries in rural areas needs to be addressed. Same-day results are likely to ensure high uptake of HIV testing services but male spousal involvement should be considered, particularly for rural areas. Universal Primary Education will support the success of PMTCT

  18. Results from a rapid national assessment of services for the prevention of mother-to-child transmission of HIV in Côte d'Ivoire

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    Granato, S Adam; Gloyd, Stephen; Robinson, Julia; Dali, Serge A; Ahoba, Irma; Aka, David; Kouyaté, Seydou; Billy, Doroux A; Kalibala, Samuel; Koné, Ahoua

    2016-01-01

    Introduction Loss-to-follow-up (LTFU) in the prevention of mother-to-child HIV transmission (PMTCT) programmes can occur at multiple stages of antenatal and follow-up care. This paper presents findings from a national assessment aimed at identifying major bottlenecks in Côte d'Ivoire's PMTCT cascade, and to distinguish characteristics of high- and low-performing health facilities. Methods This cross-sectional study, based on a nationally representative sample of 30 health facilities in Côte d'Ivoire used multiple data sources (registries, patient charts, patient booklets, interviews) to determine the magnitude of LTFU in PMTCT services. A composite measure of retention – based on child prophylaxis, maternal treatment and infant testing – was used to identify high- and low-performing sites and determine significant differences using Student's t-tests. Results Among 1,741 pregnant women newly recorded as HIV-positive between June 2011 and May 2012, 43% had a CD4 count taken, 77% received appropriate prophylaxis and 70% received prophylaxis intended for their infant. During that time, 1,054 first infant HIV tests were recorded. A conservative rate of adherence to antiretroviral therapy was estimated at 50% (n=219 patient charts). Significant differences between high- and low-performing sites included: duration of time elapsed between HIV testing and CD4 results (29.5 versus 56.3 days, p=0.001); and density (number per 100 first antenatal care visits) of full-time physicians (6.7 versus 1.7, p=0.04), laboratory technicians (2.3 versus 0.7, p=0.046), staff trained in PMTCT (10.7 versus 4.7, p=0.01), and staff performing patient follow-up activities (7.9 versus 2.5, p=0.02). Key informants highlighted staff presence and training, the availability of medical supplies and equipment (i.e., on-site CD4 machine), and the adequacy of infrastructure (i.e., space and ventilation) as perceived key factors positively and negatively impacting retention in care. Conclusions

  19. HIV transmission biology: translation for HIV prevention.

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    Ronen, Keshet; Sharma, Amit; Overbaugh, Julie

    2015-11-01

    Rigorous testing of new HIV-prevention strategies is a time-consuming and expensive undertaking. Thus, making well informed decisions on which candidate-prevention approaches are most likely to provide the most benefit is critical to appropriately prioritizing clinical testing. In the case of biological interventions, the decision to test a given prevention approach in human trials rests largely on evidence of protection in preclinical studies. The ability of preclinical studies to predict efficacy in humans may depend on how well the model recapitulates key biological features of HIV transmission relevant to the question at hand. Here, we review our current understanding of the biology of HIV transmission based on data from animal models, cell culture, and viral sequence analysis from human infection. We summarize studies of the bottleneck in viral transmission; the characteristics of transmitted viruses; the establishment of infection; and the contribution of cell-free and cell-associated virus. We seek to highlight the implications of HIV-transmission biology for development of prevention interventions, and to discuss the limitations of existing preclinical models. PMID:26418086

  20. PREVENTION OF PARENT TO CHILD TRANSMISSION OF HIV : A RETROSPECTIVE STUDY OF 5 YEARS IN A TERTIARY CENTRE , GUNTUR, SOUTH INDIA

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    Potharaju

    2015-02-01

    Full Text Available OBJECTIVE: Mother to child transmission of HIV is a major route of HIV infection in children. The objective of this study is to analyze the response to implementation of PPTCT programme, the response of the spouses of the seropositive antenatal women to undergo HIV testing, mode of delivery and breast feeding practices adopted by the ser o positive postnatal women and the status of infants after delivery at 18 months. METHODS : This retrospective study was done in the Department Of Obstetrics and Gynecology, Guntur Medical College, Guntur, A.P, India and data collected from April 2009 to march 2014, a period of 5 years was studied. PPTCT centre was established in our institution in 2003. The practice in our institution is that all pregnant women attending the Antenatal clinic or Labour Room are counseled for HIV testing, and tested as per NACO guidelines. Babies born to HIV s e ropositive women are followed up to 18 months for confirmatory testing. RESULTS : The number of antenatal women counseled who opted for HIV testing were 99.4% and women who tested seropositive was 1.6 %, 1.3%, 0.9%, 0.84%, 0.6% for the years 2009 - 10, 10 - 11, 11 - 12, 12 - 13, 13 - 14 respectively showing a declining trend in the prevalence of HIV in antenatal women. 94.6% of women attended the post - test counseling . Spouses of ser o positive antenatal women who opted for testing was 52.5% and seropositivity in the spouses tested was 65.87% during the study period. Of the 767 seropositive women who delivered, 542(70.66% had vaginal delivery 225(29.33% had LSCS for obstetric indication. Of the 767 seropositive women who delivered 719(93.7% had live births, 28(3.65% had intrauterine fetal demise and 20(2.6% newborns died in the perinatal period. The number of seropositive women opting for exclusive replacement feeding was 54.4% during the study period April 2009 to March 2014. Confirmatory test for infants was done at 18 months and of the 136 infants tested, 14 were

  1. [Moving from prevention to elimination of mother-to-child transmission of HIV before 2015, an unrealistic objective? Social stakes in Senegal].

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    Desclaux, A; Sow, K; Mbaye, N; Signaté Sy, H

    2012-01-01

    In 2010, international agencies began to promote the elimination of mother-to-child HIV transmission (EMTCT) in 2015 by proposing a new preventive strategy based on the extensive use of antiretrovirals. For a country like Senegal where the epidemic is considered to be concentrated, since prevalence is beyond 1%, and where the prevention program was fully applied to only 7 to 15% of children exposed to HIV, the objective is ambitious. The pharmacological efficacy of antiretrovirals will not be sufficient if the experience of actors in the field about the social aspects and the acceptability of the program to women are not considered. The aim of this article is to describe the social issues on the basis of two studies conducted in the region of Dakar (an exploratory study of the effects of the new prevention strategies and a study of the experience of patients receiving antiretroviral treatment for 10 years). The results reveal the main issues: community prevention showed its limits at the stage of access to the program and test, which suggests the importance of strategies to promote awareness and prevention that are focused on women; retention depends highly on the attitudes of health workers and on the role of peer counselors, but the integration of HIV testing and treatment in reproductive health services is not fully established; ambivalent perceptions of antiretrovirals complicate adherence; and finally, the organization of health services hinders a family approach of prevention. These results are innovative, since most publications on this topic concern southern and east Africa. PMID:23137750

  2. Prevention of Mother-To-Child Transmission of HIV: Cost-Effectiveness of Antiretroviral Regimens and Feeding Options in Rwanda

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    Agnes Binagwaho; Elisabetta Pegurri; Drobac, Peter C.; Placidie Mugwaneza; Stulac, Sara N.; Wagner, Claire M.; Corine Karema; Landry Tsague

    2013-01-01

    BACKGROUND: Rwanda's National PMTCT program aims to achieve elimination of new HIV infections in children by 2015. In November 2010, Rwanda adopted the WHO 2010 ARV guidelines for PMTCT recommending Option B (HAART) for all HIV-positive pregnant women extended throughout breastfeeding and discontinued (short course-HAART) only for those not eligible for life treatment. The current study aims to assess the cost-effectiveness of this policy choice. METHODS: Based on a cohort of HIV-infected pre...

  3. Antenatal HIV-1 RNA load and timing of mother to child transmission; a nested case-control study in a resource poor setting

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    Chirenje Mike Z

    2010-08-01

    Full Text Available Abstract Objective To determine HIV-1 RNA load during the third trimester of pregnancy and evaluate its effect on in utero and intra-partum/postpartum transmissions in a breastfeeding population. Design A nested case-control study within a PMTCT cohort of antiretroviral therapy naive pregnant women and their infants. Methods A case was a mother who transmitted HIV-1 to her infant (transmitter who was matched to one HIV-1 positive but non-transmitting mother (control. Results From a cohort of 691 pregnant women, 177 (25.6% were HIV-1 positive at enrolment and from these 29 (23% transmitted HIV-1 to their infants, 10 and 19 during in utero and intra-partum/postpartum respectively. Twenty-four mothers sero-converted after delivery and three transmitted HIV-1 to their infants. Each unit increase in log10 viral load was associated with a 178 cells/mm3 and 0.2 g/dL decrease in TLC and hemoglobin levels, p = 0.048 and 0.021 respectively, and a 29% increase in the risk of transmission, p = 0.023. Intra-partum/postpartum transmitters had significantly higher mean viral load relative to their matched controls, p = 0.034. Conclusion Antenatal serum HIV-1 RNA load, TLC and hemoglobin levels were significantly associated with vertical transmission but this association was independent of transmission time. This finding supports the rationale for preventive strategies designed to reduce vertical transmission by lowering maternal viral load.

  4. 社区开展孕前孕产期PITC实施HIV母婴阻断效果分析%Effect analysis of community implement of progestation and pregnancy PITC and HIV prevention of mother to child transmission

    Institute of Scientific and Technical Information of China (English)

    梁业琼; 谢满容; 汪一琴

    2015-01-01

    Objective To analyze the effect of prevention of mother to child transmission of active progestation and provider-initiated human immunodeficiency virus (HIV) testing and counseling (PITC) by medical staff in urban-rural integration community, and to investigate comprehensive intervention mode of prevention of mother to child transmission of HIV.Methods PITC was applied in 3042 newlyweds or pregnant couples. Their acknowledge rate of HIV prevention of mother to child transmission, voluntary HIV inspection rate, and changes of acknowledge for prevention HIV propaganda were compared before and after PITC. Effect of PITC for prevention of mother to child transmission in urban-rural integration community was analyzed.Results After implement of PITC, acknowledge rate of HIV prevention of mother to child transmission, voluntary HIV inspection rate, and changes of acknowledge for prevention HIV propaganda in newlyweds or pregnant couples were all significantly improve than those before PITC. Improvement was much obvious in migrant population. Prevention of mother to child transmission was successful after timely referral for positive HIV patients.Conclusion Implement of progestation and pregnancy PITC and mobilization in urban-rural integration community provides precise effect for HIV prevention of mother to child transmission, while its coverage is needed to be expanded.%目的:分析城乡结合社区开展孕前孕产期医务人员主动提供人类免疫缺陷病毒(HIV)检测咨询(PITC)实施母婴阻断的效果,探讨预防HIV母婴传播综合性干预模式。方法对3042名新婚或怀孕夫妇开展PITC并动员配偶参与检测,比较PITC前、后夫妇双方对艾滋病母婴阻断防治的知晓率、自愿接受HIV检测率和对预防艾滋病宣传的认可变化,分析PITC对城乡结合社区实施母婴阻断的效果。结果开展孕前孕产期PITC,新婚或怀孕夫妇双方对艾滋病母婴阻断防治的知晓率、自愿接受HIV检测

  5. Does knowledge about antiretroviral therapy and mother-to-child transmission affect the relationships between HIV status and fertility preferences and contraceptive use? New evidence from Nigeria and Zambia.

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    Bankole, Akinrinola; Biddlecom, Ann E; Dzekedzeke, Kumbutso; Akinyemi, Joshua O; Awolude, Olutosin; Adewole, Isaac F

    2014-09-01

    The increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009-2010 community-based surveys in Nigeria and Zambia, this study explores whether women's knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by women's HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.

  6. Development of Nevirapine Resistance in Children Exposed to the Prevention of Mother-to-Child HIV-1 Transmission Programme in Maputo, Mozambique.

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    Francisco Antunes

    Full Text Available Single-dose nevirapine (sd-NVP has been the main option for prevention of mother-to-child transmission (PMTCT of HIV-1 in low-resource settings. However, sd-NVP can induce the selection of HIV-1 resistant mutations in mothers and infants. In Mozambique, there are limited data regarding the profile of NVP resistance associated mutations (RAM in the context of PMTCT.To assess the prevalence and the factors associated with NVP RAM among children born to HIV-1 infected mothers enrolled in the PMTCT programme adopted in Mozambique.One hundred and fifty seven children aged 6 to 48 weeks were sequentially included (July 2011 to March 2012 at four centres in Maputo. Genotyping of RAM was performed in samples with HIV-1 RNA≥ 100 copies/μL (Viroseq. Sequencing was performed with ABI 3100 (Applied Biosystems. Logistic regression modelling was undertaken to identify the factors associated with NVP RAM.Seventy-nine children had their samples genotyped. Their median age was 7.0 (3-12 months and 92.4% received prophylaxis with sd-NVP at birth plus daily NVP. 35.4% of mothers received antiretrovirals (ARVs for PMTCT. ARV RAM were detected in 43 (54.4% of the children. 45.6% of these children had at least one NVP RAM. The most common mutations associated with NVP resistance were K103N (n = 16 and Y181C (n = 15. NVP RAM was significantly associated with mother exposure to PMTCT (crude odds ratio [OR] 30.3, 95% CI 4.93-186.34 and with mother's CD4 count < 350 cells/mm3 (crude OR 3.08, 95% CI 1.02-9.32. In the multivariable analysis the mother's exposure to PMTCT was the only variable significantly associated with NVP RAM (adjusted OR 48.65, 95% CI 9.33-253.66.We found a high prevalence of NVP RAM among children who were exposed to the drug regimen for PMTCT in Mozambique. The mothers' exposure to PMTCT significantly increased the risk of NVP RAM.

  7. The Role of HIV Replicative Fitness in Perinatal Transmission of HIV

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    Xue-qing Chen; Chang Liu; Xiao-hong Kong

    2011-01-01

    Perinatal transmission of Human immunodeficiency virus(HIV),also called mother-to-child transmission(MTCT),accounts for 90% of infections in infants worldwide and occurs in 30%-45% of children born to untreated HIV-1 infected mothers.Among HIV-1 infected mothers,some viruses are transmitted from mothers to their infants while others are not.The relationship between virologic properties and the pathogenesis caused by HIV-1 remains unclear.Previous studies have demonstrated that one obvious source of selective pressure in the perinatal transmission of HIV-1 is maternal neutralizing antibodies.Recent studies have shown that viruses which are successfully transmitted to the child have growth advantages over those not transmitted,when those two viruses are grown together.Furthermore,the higher fitness is determined by the gp120 protein of the virus envelope.This suggests that the selective transmission of viruses with higher fitness occurred exclusively,regardless of transmission routes.There are many factors contributing to the selective transmission and HIV replicative fitness is an important one that should not be neglected.This review summarizes current knowledge of the role of HIV replicative fitness in HIV MTCT transmission and the determinants of viral fitness upon MTCT.

  8. Integration of prevention of mother-to-child transmission of HIV (PMTCT postpartum services with other HIV care and treatment services within the maternal and child health setting in Zimbabwe, 2012.

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    Katherine Wiegert

    Full Text Available We assessed the integration of PMTCT services during the postpartum period including early infant diagnosis of HIV (EID and adult and pediatric antiretroviral therapy (ART in maternal and child health (MCH facilities in Zimbabwe.From August to December 2012 we conducted a cross-sectional survey of a nationally representative sample of 151 MCH facilities. A questionnaire was used to survey each site about staff training, dried blood spot sample (DBS collection, turnaround time (TAT for test results, PMTCT services, and HIV care and treatment linkages for HIV-infected mothers and children and HIV-exposed infants. Descriptive analyses were used. Of the facilities surveyed, all facilities were trained on DBS collection and 92% responded. Approximately, 99% of responding facilities reported providing DBS collection and a basic HIV-exposed infant service package including EID, extended nevirapine prophylaxis, and use of cotrimoxazole. DBS collection was integrated with immunisations at 83% of facilities, CD4 testing with point-of-care machines was available at 37% of facilities, and ART for both mothers and children was provided at 27% of facilities. More than 80% of facilities reported that DBS test results take >4 weeks to return; TAT did not have a direct association with any specific type of transport, distance to the lab, or intermediate stops for data to travel.Zimbabwe has successfully scaled up and integrated the national EID and PMTCT programs into the existing MCH setting. The long TAT of infant DBS test results and the lack of integrated ART programs in the MCH setting could reduce effectiveness of the national PMTCT and ART programs. Addressing these important gaps will support successful implementation of the 2014 Zimbabwe's PMTCT guidelines under which all HIV-infected pregnant and breastfeeding women will be offered life-long ART and decentralized ART care.

  9. Protecting the unborn -- reducing mother-to-child transmission.

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    Tapper, A

    1998-02-01

    HIV is transmitted to a child during pregnancy, at birth, or through the mother's milk during infancy. Since the beginning of the HIV/AIDS epidemic, 3.8 million children are estimated to have become infected with HIV and 2.7 million have died. More than 9% acquired HIV through their HIV-positive mothers and in 1997, 1600 children were infected daily. Since many women in developing countries do not have access to clean water, it is unsafe for them to bottle feed. As such, HIV-infected women in such settings have been encouraged to breast feed their infants despite the risk of perinatal HIV transmission. The most recent research, however, indicates that 10-25% of fetal/infant HIV infections occur intrauterine, 60-75% during delivery, and 20-40% postpartum. It is estimated that breast feeding increases the risk of infection by 5-40%. These findings have led the principal administrator of the European Union's HIV/AIDS program and other health experts to recommend that children be weaned from breast feeding at 4-6 months, a change from existing breast feeding guidelines. As several trials end in the near future, important results are expected in 1998 on how to prevent perinatal HIV transmission. The ethics of involving pregnant women in Africa and Asia in clinical trials to reduce perinatal HIV transmission and vitamin A supplements and vaginal lavages are discussed.

  10. The Perceived Impact Of The PPTCT Programme On The Management Of Parent To Child HIV And AIDS Transmission A Case Study Of Chikuku Hospital

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    Mashamba Tarashika

    2015-08-01

    Full Text Available ABSTRACT The study was carried out to investigate the perceived impact of the PPTCT programme on the management of parent-to-child HIV and AIDS transmission in Chikuku rural hospital community in Bikita district. A case study was used. A sample of ten expecting couples on Chikuku PPTCT programme and ten expecting mothers who were not on Chikuku PPTCT but attending ANC there participated in the study. Five professional counsellors also participated. Questionnaires and the interviews were used as data collection instruments. The data collected was analysed and interpreted using descriptive statistics and narratives. Tables were used to present the data and each question was analysed. The general findings agree with the reviewed literature as reflected that awareness and knowledge of PPTCT services and knowledge of its benefits was common but there were certain hurdles that need to be overcome in implementing and utilising them effectively. The clarion call is to review and reorganise the existing polices and current approaches in increasing PPTCT service uptake in communities similar to the study area. Recommendations were also made for programme implementers and policy makers in respect of the research findings in order to plan for the future.

  11. Diagnosis of Perinatal Transmission of HIV-1 Infection by HIV DNA PCR

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    Ira Shah

    2004-10-01

    Full Text Available To determine the sensitivity and specificity of HIV DNA PCR (Qualitative at various age groups todetect or rule out HIV infection in infants born to HIV infected mothers. Pediatric and perinatal HIVclinic in a tertiary pediatric hospital.Sixteen infants born to HIV positive mother enrolled in the preventionof mother to child transmission of HIV at our center were tested for HIV infection by HIV DNAPCR at 1.5 months, 3 months, 5.5 months and/or 7 months of age. Their HIV status was confirmedby an HIV ELISA test at 18 months of age by 2 different ELISA kits. Eight patients (50% had anegative HIV DNA PCR whereas 8 patients (50% had a positive DNA PCR of which 6 patients(75% had a false positive HIV DNA PCR and no false negative DNA PCR. Thus, the sensitivity ofHIV DNA PCR was 100% and specificity was 57.1% with a total efficiency of the test being62.5%. The efficiency of HIV DNA PCR at 1.5 months of age was 50%, at 3 months of age42.9%, at 5.5 months of age 60% and at 7 months of age was 100%. HIV DNA PCR has a highsensitivity but low specificity to diagnose HIV infection in infants less than 7 months of age. Hence,the results of the test have to be interpreted with caution in infants born to HIV positive mothers.

  12. Mother-to-child transmission of different HIV-1 subtypes among ARV Naïve infected pregnant women in Nigeria Transmissão materno-fetal de diferentes subtipos de HIV-1 entre gestantes infectadas na Nigéria

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    G.N. Odaibo

    2006-04-01

    Full Text Available The rate of mother-to-child transmission (MTCT of HIV as well as the implications of the circulating multiple subtypes to MTCT in Nigeria are not known. This study was therefore undertaken to determine the differential rates of MTCT of HIV-1 subtypes detected among infected pregnant women before ARV intervention therapy became available in Nigeria. Twenty of the HIV-positive women who signed the informed consent form during pregnancy brought their babies for follow-up testing at age 18-24 months. Plasma samples from both mother and baby were tested for HIV antibody at the Department of Virology, UCH, Ibadan, Nigeria. All positive samples (plasma and peripheral blood mononuclear cells - PBMCs were shipped to the Institute of Tropical Medicine, Antwerp, Belgium, where the subtype of the infecting virus was determined using the HMA technique. Overall, a mother-to-child HIV transmission rate of 45% was found in this cohort. Specifically, 36.4%, 66.7% and 100% of the women infected with HIV-1 CRF02 (IbNg, G and B, respectively, transmitted the virus to their babies. As far as it can be ascertained, this is the first report on the rate of MTCT of HIV in Nigeria. The findings reported in this paper will form a useful reference for assessment of currently available therapeutic intervention of MTCT in the country.A taxa de transmissão materno-fetal (MTCT do HIV bem como as implicações dos múltiplos subtipos circulantes para MTCT na Nigéria não são conhecidos. Este estudo foi realizado para determinar as diferentes taxas de MTCT dos subtipos de HIV-1 detectados entre gestantes infectadas antes que a administração da terapia ARV estivesse disponível na Nigéria. Vinte das mulheres HIV positivas que assinaram o consentimento durante a gravidez trouxeram seus filhos para seguimento na idade de 18-24 meses. Amostras de plasma de ambos, mãe e filho foram testadas para anticorpos HIV no Departamento de Virologia, UCH, Ibadan, Nigéria. Todas as

  13. Assessment of strategies for male involvement in the prevention of mother-to-child transmission of HIV services in Blantyre, Malawi

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    Alinane Linda Nyondo

    2013-12-01

    Full Text Available Background: Despite the documented benefits of prevention of mother-to-child transmission (PMTCT of human immunodeficiency virus (HIV services, the uptake remains low in sub-Saharan Africa. The lack of male involvement (MI may be one of the reasons for this. However, there are limited data on strategies for MI in PMTCT. Objective: The objective of this study was to identify strategies that may promote MI in PMTCT services in antenatal care (ANC services in Blantyre, Malawi. Study design: An exploratory qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC in Blantyre, Malawi. It consisted of six face-to-face key informant interviews (KIIs with healthcare workers and four focus group discussions (FGDs with 18 men and 17 pregnant women attending ANC at SLHC. The FGDs were divided according to sex and age. All FGDs and KIIs were digitally recorded and simultaneously transcribed and translated verbatim into English. Data were analyzed using thematic content analysis. Results: Three major themes with several subcategories emerged. Theme 1 was a gatekeeping strategy with two subcategories: (1 healthcare workers refusing service provision to women accessing antenatal clinic without their partners and (2 women refusing ANC attention in the absence of a partner. Theme 2 comprised extending invitations and had six subcategories: (1 word of mouth, (2 card invites, (3 woman's health passport book invites, (4 telephonic invites, (5 use of influential people, and (6 home visits. Theme 3 was information education and communication, such as health education forums and advertisements. Of all the strategies, an invitation card addressed to the male partner was most preferred by study participants. Conclusions: There are several strategies by which men may be involved in PMTCT. Healthcare workers should offer a pregnant woman all strategies available for MI for her to select the appropriate one. Further research and

  14. Prevention of Mother-to-Child Transmission of HIV data completeness and accuracy assessment in health facilities of the Nkangala District

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    Motlatso G. Mlambo

    2014-08-01

    Full Text Available Background: Even though significant progress has been made in the roll-out and quality of the prevention of mother-to-child transmission of HIV (PMTCT services in South Africa, the quality of patient data recording remains a challenge. Objectives: To assess PMTCT data completeness and accuracy at primary healthcare level to district level in order to assist with the improvement of the PMTCT data recording. Methods: This is a retrospective record review study which involved collecting PMTCT data on indicators which was for the period of August 2009 to January 2010. We conducted baseline facility assessments which included 72 PMTCT sites in one health district, Nkangala. We assessed the data completeness and accuracy of the data values recorded on the seven PMTCT data elements. Results: Data were only complete for less than a quarter of the time for most of the antenatal indicators (0.5% – 44% and for the maternity indicators, data were only complete 11% of the time. Data inaccuracy was a result of recording of data values in the District Health Information System (DHIS which were not within 10% of the data values recorded in the case registers. The results show that data were missing from the case registers, monthly summary sheets and DHIS between 30% and 99% of the time and that data elements had values recorded in the DHIS which were > 10%. Conclusion: There is a need for ongoing training on data recording procedures at all levels. To maintain data quality, healthcare data must be appropriate, organised, timely, available, accurate and complete.

  15. Hematological changes in women and infants exposed to an AZT-containing regimen for prevention of mother-to-child-transmission of HIV in Tanzania.

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    Judith Ziske

    Full Text Available INTRODUCTION: Tanzanian guidelines for prevention of mother-to-child-transmission of HIV (PMTCT recommend an antiretroviral combination regimen involving zidovudine (AZT during pregnancy, single-dosed nevirapine at labor onset, AZT plus Lamivudine (3TC during delivery, and AZT/3TC for 1-4 weeks postpartum. As drug toxicities are a relevant concern, we assessed hematological alterations in AZT-exposed women and their infants. METHODS AND MATERIALS: A cohort of HIV-positive women, either with AZT intake (n = 82, group 1 or without AZT intake (n = 62, group 2 for PMTCT during pregnancy, was established at Kyela District Hospital, Tanzania. The cohort also included the infants of group 1 with an in-utero AZT exposure ≥4 weeks, receiving AZT for 1 week postpartum (n = 41, and infants of group 2 without in-utero AZT exposure, receiving a prolonged 4-week AZT tail (n = 58. Complete blood counts were evaluated during pregnancy, birth, weeks 4-6 and 12. RESULTS: For women of group 1 with antenatal AZT intake, we found a statistically significant decrease in hemoglobin level, red blood cells, white blood cells, granulocytes, as well as an increase in red cell distribution width and platelet count. At delivery, the median red blood cell count was significantly lower and the median platelet count was significantly higher in women of group 1 compared to group 2. At birth, infants from group 1 showed a lower median hemoglobin level and granulocyte count and a higher frequency of anemia and granulocytopenia. At 4-6 weeks postpartum, the mean neutrophil granulocyte count was significantly lower and neutropenia was significantly more frequent in infants of group 2. CONCLUSIONS: AZT exposure during pregnancy as well as after birth resulted in significant hematological alterations for women and their newborns, although these changes were mostly mild and transient in nature. Research involving larger cohorts is needed to further analyze the impact

  16. 综合干预措施对HIV/AIDS孕妇母婴阻断107例的临床分析%107 Cases of HIV-infected Pregnant Patients with Combinative Treatment for Blockade of HIV Mother-to-child Transmission

    Institute of Scientific and Technical Information of China (English)

    陈劲峰; 郭文卫; 钟活麟; 蔡卫平

    2013-01-01

      目的:探讨采用综合措施阻断HIV/AIDS母婴垂直传播的效果.方法:选取2005年1月-2010年12月在笔者所在医院接受综合措施母婴阻断的HIV阳性孕妇107例为研究组,同期在广州市某医院产科的HIV阴性孕妇135例作为对照组.研究组采用HAART、剖宫产及新生儿出生时给予抗病毒药、人工喂养等综合措施进行母婴阻断,监测两组孕妇产前的肝功能、血常规、生化指标.研究组新生儿出生时及18个月龄时进行HIV检测.结果:研究组的107例新生儿出生时及18个月龄时检测HIV抗体均呈阴性.研究组孕妇白细胞、红细胞、血色素、球蛋白、空腹血糖与对照组比较,差异有统计学意义(P0.05).结论:采取孕产期前综合阻断措施,能有效降低HIV母婴垂直传播的发生率.%Objective:To investigate the influence of combinative treatment for blockade of HIV mother-to-child transmission on HIV-infected pregnant patients.Methods:107 pregnant women identified with HIV infected were given combinative treatment for blockade of HIV mother-to-child transmission from Jan 2005 to Dec 2010.Their newborn babies were given anti-viral drug and artificial feeding.135 HIV negative pregnant women were chosen at random in a hospital of Guangzhou city as control group.Results:All the newborns babies were negative to HIV-Ab (ELISA) at the moment they were born and after 18 months.The WBC,RBC,Hb,and GLB were statistic significant differences between study group and control group(P0.05).Conclusion:Combinative treatment could be effective to blockade of HIV mother-to-child transmission.

  17. CHANGING TRENDS OF HIV INFECTION IN PPTCT (PREVENTION OF PARENT TO CHILD TRANSMISSION GOVERNMENT GENERAL HOSPITAL, GUNTUR, ANDHRA PRADESH, SOUTH INDIA, 2002-2013

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    Venkateswara Rao

    2014-09-01

    Full Text Available : INTRODUCTION: The objective of this study is to know the various changing trends in the HIV infection in the antenatal women attending the PPTCT department, Government General Hospital, Guntur, Andhra Pradesh, during 2002 to 2013. METHODS: This is a retrospective study done in Government General Hospital, Guntur, Andhra Pradesh, during 2002 to 2013. The data was collected from the records maintained in the PPTCT department and the changing trends of HIV infection in antenatal women were studied. RESULTS: The prevalence rate of HIV infection in antenatal women decreased from 4.4% to 0.84%. Monthly average number of HIV positive deliveries in our institution varies from 150 to 250 cases. Percentage of caesarian section done was about 20% of cases. More number of cases were from urban than rural areas. Initially the cases were more in low socio-economic status. Young primigravida women around 20 years were more infected. High risk behavior of the husband was mainly responsible for the transmission of the disease. HIV infection was common in the innocent housewife. CONCLUSION: The study concludes that the HIV infection among pregnant women in our institution shows various changing trends and a decreasing incidence due to the effective implementation of the PPTCT programme under the National AIDS control programme started in the year 2002.

  18. Women's preferences regarding infant or maternal antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV during breastfeeding and their views on Option B+ in Dar es Salaam, Tanzania.

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    Matilda Ngarina

    Full Text Available BACKGROUND: The WHO 2010 guidelines for prevention of mother-to-child transmission (PMTCT of HIV recommended prophylactic antiretroviral treatment (ART either for infants (Option A or mothers (Option B during breastfeeding for pregnant women with a CD4 count of >350 cell/µL in low-income countries. In 2012, WHO proposed that all HIV-infected pregnant women should receive triple ART for life (B+ irrespective of CD4 count. Tanzania has recently switched from Option A to B+, with a few centers practicing B. However, more information on the real-life feasibility of these options is needed. This qualitative study explored women's preferences for Option A vs B and their views on Option B+ in Dar es Salaam, Tanzania. METHODS: We conducted four focus group discussions with a total of 27 pregnant women with unknown HIV status, attending reproductive and child health clinics, and 31 in-depth interviews among HIV-infected pregnant and post-delivery women, 17 of whom were also asked about B+. RESULTS: Most participants were in favor of Option B compared to A. The main reasons for choosing Option B were: HIV-associated stigma, fear of drug side-effects on infants and difficult logistics for postnatal drug adherence. Some of the women asked about B+ favored it as they agreed that they would eventually need ART for their own survival. Some were against B+ anticipating loss of motivation after protecting the child, fearing drug side-effects and not feeling ready to embark on lifelong medication. Some were undecided. CONCLUSION: Option B was preferred. Since Tanzania has recently adopted Option B+, women with CD4 counts of >350 cell/µL should be counseled about the possibility to "opt-out" from ART after cessation of breastfeeding. Drug safety and benefits, economic concerns and available resources for laboratory monitoring and evaluation should be addressed during B+ implementation to enhance long-term feasibility and effectiveness.

  19. Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe

    DEFF Research Database (Denmark)

    NN, NN; Boer, K; England, K;

    2010-01-01

    The aim of the study was to examine temporal and geographical patterns of mode of delivery in the European Collaborative Study (ECS), identify factors associated with elective caesarean section (CS) delivery in the highly active antiretroviral therapy (HAART) era and explore associations between ...... mode of delivery and mother-to-child transmission (MTCT)....

  20. Association of HIV transmissions and non-transmission knowledge with negative attitudes to HIV/AIDS

    Institute of Scientific and Technical Information of China (English)

    WEN Yu-feng; WANG Hua-dong; ZHAO Cun-xi; YAO Ying-shui; YE Dong-qing; JIANG Zuo-jun

    2011-01-01

    Background Human immunodeficiency virus/acquired immure deficiency syndrome (HIV/AIDS)-related stigma is an obstacle to the implementation of treatment, care, and support programs for people living with HIV/AIDS. This study explored the association of the HIV knowledge with the attitudes toward HIV/AIDS.Methods A cross-sectional survey was conducted in HIV epidemic rural areas with 5355 participants. Their knowledge and attitudes about HIV/AIDS were assessed, and the associations of HIV transmission and non-transmission knowledge with negative attitudes towards the HIV/AIDS were analyzed.Results Negative attitudes were significantly correlated with the HIV non-transmission knowledge and the correlation was higher than that with HIV transmission knowledge among participants who were male, 20 years old and migrant workers, students and respondents of and above junior high school. However, among those who were female, age 30 and older, illiterate with primary school education, negative attitudes were significantly associated with HIV non-transmission knowledge and the association was lower than that with HIV transmission knowledge.Conclusions HIV transmission knowledge and non-transmission knowledge have different influences on negative attitudes towards HIV/AIDS among different demographic subgroups.

  1. Influence of Improving HIV Prevention of Maternal to Reduce the Wareness Rate of Mother-to-child Transmission%提高孕产妇防控HIV意识对降低HIV母婴传播率的影响

    Institute of Scientific and Technical Information of China (English)

    罗伟炎; 刘丽红; 邹惠英; 李观强; 江白玲; 肖晓霞

    2014-01-01

    目的:提高孕产妇防控HIV意识,降低HIV母婴传播率。方法:将2012年1-12月在深圳市龙岗区人民医院就诊孕产妇中随机抽取400例作为研究对象,采取问卷调查与孕产妇和新生儿病原学检测。结果:400例研究对象对于HIV方面知识掌握程度不是很理想,25.00%的人不了解,主要掌握人群在基本了解阶段190例(47.50%);4例孕产妇HIV检测阳性,孕产妇检测阳性率为1.28%,新生儿检测HIV抗体阳性2例,母婴HIV传播率为50.00%。结论:加强孕产妇防控意识,能有效控制HIV母婴传播率,对控制HIV的发生与流行有十分重要的意义。%Objective:Raising awareness of maternal HIV prevention,to reduce the rates of mother-to-child of HIV.Method:From January 2012 to December 2012 in The People’s Hospital in Longgang District of Shenzhen City,we randomly selected 400 cases for the study,taking the questionnaire and maternal and neonatal pathogen detection.Result:400 cases studied there for HIV mastery of knowledge were not very satisfactory,there were 25.00%of the people do not understand,grasp a basic understanding of the main stage crowd at 190 cases(47.50%).4 cases were HIV-positive pregnant women,pregnant women testing positive rate was 1.28%,newborn testing HIV positive two cases,mother-to-child HIV transmission rate was 50.00%.Conclusion:Strengthen prevention and control of maternal awareness can effectively control the rate of mother-to-child of HIV,the control of HIV incidence and prevalence has a very important significance.

  2. Maternal HIV-1 envelope–specific antibody responses and reduced risk of perinatal transmission

    OpenAIRE

    Permar, Sallie R.; Fong, Youyi; Vandergrift, Nathan; Fouda, Genevieve G.; Gilbert, Peter; Parks, Robert; Jaeger, Frederick H.; Pollara, Justin; Martelli, Amanda; Liebl, Brooke E.; Lloyd, Krissey; Yates, Nicole L.; Overman, R. Glenn; Shen, Xiaoying; Whitaker, Kaylan

    2015-01-01

    Despite the wide availability of antiretroviral drugs, more than 250,000 infants are vertically infected with HIV-1 annually, emphasizing the need for additional interventions to eliminate pediatric HIV-1 infections. Here, we aimed to define humoral immune correlates of risk of mother-to-child transmission (MTCT) of HIV-1, including responses associated with protection in the RV144 vaccine trial. Eighty-three untreated, HIV-1–transmitting mothers and 165 propensity score–mat...

  3. Reducing lost to follow-up in a large clinical trial of prevention of mother-to-child transmission of HIV: The Breastfeeding, Antiretrovirals and Nutrition (BAN) study experience

    Science.gov (United States)

    Sellers, Christopher J; Lee, Hana; Chasela, Charles; Kayira, Dumbani; Soko, Alice; Mofolo, Innocent; Ellington, Sascha; Hudgens, Michael G; Kourtis, Athena P; King, Caroline C; Jamieson, Denise J; van der Horst, Charles

    2014-01-01

    Background/Aims Retaining patients in prevention of mother-to-child transmission of HIV studies can be challenging in resource limited settings, where high lost to follow-up (LTFU) rates have been reported. In this paper, we describe the effectiveness of methods used to encourage retention in the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study and analyze factors associated with LTFU in the study. Methods The BAN clinical trial was designed to evaluate the efficacy of 3 different mother-to-child HIV transmission prevention strategies. Lower than expected participant retention prompted enhanced efforts to reduce LTFU during the conduct of the trial. Following study completion, we employed regression modeling to determine predictors of perfect attendance and variables associated with being LTFU. Results During the study, intensive tracing efforts were initiated after the first 1686 mother-infant pairs had been enrolled, and 327 pairs were missing. Sixty of these pairs were located and had complete data obtained. Among the 683 participants enrolling after initiation of intensive tracing efforts, the LTFU rate was 3.4%. At study's end, 290 (12.2%) of the 2369 mother-infant pairs were LTFU. Among successfully traced missing pairs, relocation was common and three were deceased. Log-binomial regression modeling revealed higher maternal hemoglobin and older maternal age to be significant predictors of perfect attendance. These factors and the presence of food insecurity were also significantly associated with lower rates of LTFU. Conclusions In this large HIV prevention trial, intensive tracing efforts centered on reaching study participants at their homes succeeded in finding a substantial proportion of LTFU participants, and were very effective in preventing further LTFU during the remainder of the trial. The association between food insecurity and lower rates of LTFU is likely related to the study's provision of nutritional support, including a family maize

  4. Transmission of HIV in dialysis centre.

    Science.gov (United States)

    Velandia, M; Fridkin, S K; Cárdenas, V; Boshell, J; Ramirez, G; Bland, L; Iglesias, A; Jarvis, W

    1995-06-01

    In August, 1993, 13 dialysis patients at one dialysis centre in Colombia, South America, were found to be HIV positive, and this prompted an epidemiological investigation. We carried out a cohort study of all dialysis centre patients during January, 1992 to December, 1993 (epidemic period) to determine risk factors for HIV seroconversion. Haemodialysis and medical records were reviewed, dialysis centre staff and surviving patients were interviewed, and dialysis practices were observed. Stored sera from all dialysis centre patients were tested for HIV antibody. 12 (52%) of 23 patients tested positive for HIV antibody by enzyme immunoassay and western blot during the epidemic period. Of the 23 tested, 9 (39%) converted from HIV antibody negative to positive (seroconverters) and 10 (44%) remained HIV negative (seronegatives). The HIV seroconversion rate was higher among patients dialysed at the centre while a new patient, who was HIV seropositive, was dialysed there (90% vs 0%; p dialysis centre reprocessed access needles, dialysers, and bloodlines (60% vs 0%). While 2 of 9 HIV seroconverters had had sex with prostitutes, none had received unscreened blood products or had other HIV risk factors. No surgical or dental procedures were associated with HIV seroconversion. Dialysers were reprocessed separately with 5% formaldehyde and were labelled for use on the same patient. Access needles were reprocessed by soaking them in a common container with a low-level disinfectant, benzalkonium chloride; 4 pairs of needles were placed in one pan creating the potential for cross-contamination or use of one patient's needles on another patient. HIV transmission at the dialysis centre was confirmed. Improperly reprocessed patient-care equipment, most probably access needles, is the likely mechanism of transmission. This outbreak was discovered by accident and similar transmission may be occurring in many other countries where low-level disinfectants are used to sterilise critical

  5. "It is like that, we didn't understand each other": exploring the influence of patient-provider interactions on prevention of mother-to-child transmission of HIV service use in rural Tanzania.

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    Annabelle Gourlay

    Full Text Available Interactions between patients and service providers frequently influence uptake of prevention of mother-to-child transmission (PMTCT HIV services in sub-Saharan Africa, but this process has not been examined in depth. This study explores how patient-provider relations influence PMTCT service use in four government facilities in Kisesa, Tanzania. Qualitative data were collected in 2012 through participatory group activities with community members (3 male, 3 female groups, in-depth interviews with 21 women who delivered recently (16 HIV-positive, 9 health providers, and observations in antenatal clinics. Data were transcribed, translated into English and analysed with NVIVO9 using an adapted theoretical model of patient-centred care. Three themes emerged: decision-making processes, trust, and features of care. There were few examples of shared decision-making, with a power imbalance in favour of providers, although they offered substantial psycho-social support. Unclear communication by providers, and patients not asking questions, resulted in missed services. Omission of pre-HIV test counselling was often noted, influencing women's ability to opt-out of HIV testing. Trust in providers was limited by confidentiality concerns, and some HIV-positive women were anxious about referrals to other facilities after establishing trust in their original provider. Good care was recounted by some women, but many (HIV-positive and negative described disrespectful staff including discrimination of HIV-positive patients and scolding, particularly during delivery; exacerbated by lack of materials (gloves, sheets and associated costs, which frustrated staff. Experienced or anticipated negative staff behaviour influenced adherence to subsequent PMTCT components. Findings revealed a pivotal role for patient-provider relations in PMTCT service use. Disrespectful treatment and lack of informed consent for HIV testing require urgent attention by PMTCT programme

  6. "It is like that, we didn't understand each other": exploring the influence of patient-provider interactions on prevention of mother-to-child transmission of HIV service use in rural Tanzania.

    Science.gov (United States)

    Gourlay, Annabelle; Wringe, Alison; Birdthistle, Isolde; Mshana, Gerry; Michael, Denna; Urassa, Mark

    2014-01-01

    Interactions between patients and service providers frequently influence uptake of prevention of mother-to-child transmission (PMTCT) HIV services in sub-Saharan Africa, but this process has not been examined in depth. This study explores how patient-provider relations influence PMTCT service use in four government facilities in Kisesa, Tanzania. Qualitative data were collected in 2012 through participatory group activities with community members (3 male, 3 female groups), in-depth interviews with 21 women who delivered recently (16 HIV-positive), 9 health providers, and observations in antenatal clinics. Data were transcribed, translated into English and analysed with NVIVO9 using an adapted theoretical model of patient-centred care. Three themes emerged: decision-making processes, trust, and features of care. There were few examples of shared decision-making, with a power imbalance in favour of providers, although they offered substantial psycho-social support. Unclear communication by providers, and patients not asking questions, resulted in missed services. Omission of pre-HIV test counselling was often noted, influencing women's ability to opt-out of HIV testing. Trust in providers was limited by confidentiality concerns, and some HIV-positive women were anxious about referrals to other facilities after establishing trust in their original provider. Good care was recounted by some women, but many (HIV-positive and negative) described disrespectful staff including discrimination of HIV-positive patients and scolding, particularly during delivery; exacerbated by lack of materials (gloves, sheets) and associated costs, which frustrated staff. Experienced or anticipated negative staff behaviour influenced adherence to subsequent PMTCT components. Findings revealed a pivotal role for patient-provider relations in PMTCT service use. Disrespectful treatment and lack of informed consent for HIV testing require urgent attention by PMTCT programme managers. Strategies

  7. Testing the Sexually Abused Child for the HIV Antibody: Issues for the Social Worker.

    Science.gov (United States)

    Gellert, George A.; And Others

    1993-01-01

    Discusses identifying children infected with human immunodeficiency virus (HIV) through sexual abuse. Reviews testing guidelines. Sees social workers contributing to test decision making when perinatal HIV transmissions is possibility, when assailant may be tested, and when parents/legal guardians insist on testing child. Discusses family…

  8. Sex inequality, high transport costs, and exposed clinic location: reasons for loss to follow-up of clients under prevention of mother-to-child HIV transmission in eastern Uganda – a qualitative study

    Directory of Open Access Journals (Sweden)

    Lubega M

    2013-05-01

    Full Text Available Muhamadi Lubega,1–4 Ibrahim A Musenze,3 Gukiina Joshua,2 George Dhafa,2 Rose Badaza,3 Christopher J Bakwesegha,3 Steven J Reynolds41District Health Office, Iganga District Administration, Iganga, Uganda; 2Research Institute, 3School of Graduate Studies and Research, Busoga University, Iganga, Uganda; 4National Institutes of Health/NIAID-ICER American Embassy, Kampala, UgandaBackground: In Iganga, Uganda, 45% of women who tested HIV-positive during antenatal care between 2007 and 2010 were lost to follow-up (LTFU. We explored reasons for LTFU during prevention of mother-to-child transmission (PMTCT from a client perspective in eastern Uganda, where antiretroviral therapy (ART awareness is presumably high.Methods: Seven key informant interviews and 20 in-depth interviews, including both clients who had been retained under PMTCT care and those LTFU during PMTCT were held. Ten focus-group discussions involving a total of 112 participants were also conducted with caretakers/relatives of the PMTCT clients. Content analysis was performed to identify recurrent themes.Results: Our findings indicate that LTFU during PMTCT in eastern Uganda was due to sex inequality, high transport costs to access the services, inadequate posttest counseling, lack of HIV status disclosure, and the isolated/exposed location of the ART clinic, which robs the clients of their privacy.Conclusion: There is a need for approaches that empower women with social capital, knowledge, and skills to influence health-seeking practices. There is also a need to train low-ranking staff and take PMTCT services closer to the clients at the lower-level units to make them affordable and accessible to rural clients. Posttest counseling should be improved to enable PMTCT clients to appreciate the importance of PMTCT services through increasing the number of staff in antenatal care to match the client numbers for improved quality. The counseling should emphasize HIV status disclosure to

  9. Intergenerational transmission of child problem behavior

    NARCIS (Netherlands)

    I. van Meurs (Inge)

    2009-01-01

    textabstractIn the present thesis, the intergenerational transmission of child problem behavior will be investigated. In this introduction, we will explain why it is important to study transmission of problem behavior from parents to their offspring. In addition, we will describe the study design th

  10. 湖南省126例HIV抗体阳性产妇生育新生儿感染状况分析%Effective prevention of HIV-1 mother-to-child transmission: analysis of 126 HIV positive mothers and the infection status of their newborn children in Hunan, China

    Institute of Scientific and Technical Information of China (English)

    李向忠; 贺健梅; 吴让香; 曾侯霖; 陈曦

    2013-01-01

    Objective To study HIV mother-to-child transmission (MTCT) in Hunan province of China and provide evidence for strategies of prevention.Methods The HIV/AIDS MTCT prevention program in Hunan province was launched in 2009.A total of 126 HIV-1 antibody positive pregnant women and their newborn infants were reported in the program during 2010 to 2012.The reported data included the results of mother HIV antibody test,antiviral therapy and the ways of delivery and feeding.The HIV-1 DNA and HIV antibody of the newborn infants were detected.Results Of all 126 HIV-1 antibody positive pregnant women,11 infants were diagnosed of HIV-1 infection.The MTCT incidence was 0% (0/46) in the group with antiviral therapy plus cesarean delivery (C-section birth) while the rate was 40.91% (9/22) in the group without intervention.The MTCT incidence was 7.14% (1/14) in the group with C-section only but without antiviral therapy.Conclusions The precautionary measures such as antiviral therapy and C-section can effectively prevent mother-to-child transmission of HIV.%目的 了解湖南省艾滋病病毒(HIV)母婴传播状况.为制定防治策略提供依据.方法 湖南省于2009年启动预防艾滋病母婴传播项目.采用回顾性调查方法,根据国家妇幼卫生综合信息平台中的“预防艾滋病母婴传播管理信息系统”追踪到湖南省2010-2012年在该系统中上报的126例HIV-1抗体阳性孕妇及其所生126例婴幼儿,收集母亲HIV-1抗体检测、抗病毒治疗和分娩与喂养方式等情况,并对婴幼儿进行HIV-1 DNA和HIV-1抗体检测,明确其HIV感染状况.结果 126例HIV-1抗体阳性孕妇,共生育HIV-1阳性婴幼儿11例.采用孕妇、婴幼儿抗病毒治疗和剖宫产分娩方式为母婴阻断干预措施者,未发生母婴传播,母婴传播发生率为0 (0/46).未进行任何母婴阻断干预者22例,生育9例HIV-1阳性婴幼儿,母婴传播发生率为40.91% (9/22).孕妇和婴幼儿未服药的情况下,采

  11. Estimating the Impact of Plasma HIV-1 RNA Reductions on Heterosexual HIV-1 Transmission Risk

    OpenAIRE

    Lingappa, Jairam R.; Hughes, James P.; Wang, Richard S.; BAETEN, Jared M.; Connie Celum; Gray, Glenda E.; Stevens, Wendy S.; Deborah Donnell; Campbell, Mary S.; Carey Farquhar; Essex, M.; Mullins, James I.; Coombs, Robert W.; Helen Rees; Lawrence Corey

    2010-01-01

    BACKGROUND: The risk of sexual transmission of HIV-1 is strongly associated with the level of HIV-1 RNA in plasma making reduction in HIV-1 plasma levels an important target for HIV-1 prevention interventions. A quantitative understanding of the relationship of plasma HIV-1 RNA and HIV-1 transmission risk could help predict the impact of candidate HIV-1 prevention interventions that operate by reducing plasma HIV-1 levels, such as antiretroviral therapy (ART), therapeutic vaccines, and other ...

  12. Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: an exploratory study

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    Nachega JB

    2016-04-01

    University, Cape Town, South Africa Objective: To examine the acceptability and feasibility of mobile health (mHealth/short message service (SMS and community-based directly observed antiretroviral therapy (cDOT as interventions to improve antiretroviral therapy (ART adherence for preventing mother-to-child human immunodeficiency virus (HIV transmission (PMTCT. Design and methods: A mixed-method approach was used. Two qualitative focus group discussions with HIV-infected pregnant women (n=20 examined the acceptability and feasibility of two ART adherence interventions for PMTCT: 1 SMS text messaging and 2 patient-nominated cDOT supporters. Additionally, 109 HIV-infected, pregnant South African women (18–30 years old receiving PMTCT services under single-tablet antiretroviral therapy regimen during pregnancy and breastfeeding and continuing for life (“Option B+” were interviewed about mobile phone access, SMS use, and potential treatment supporters. Setting: A community primary care clinic in Cape Town, South Africa. Participants: HIV-infected pregnant women. Main outcomes: Acceptability and feasibility of mHealth and cDOT interventions. Results: Among the 109 women interviewed, individual mobile phone access and SMS use were high (>90%, and 88.1% of women were interested in receiving SMS ART adherence support messages such as reminders, motivation, and medication updates. Nearly all women (95% identified at least one person close to them to whom they had disclosed their HIV status and would nominate as a cDOT supporter. Focus group discussions revealed that cDOT supporters and adherence text messages were valued, but some concerns regarding supporter time availability and risk of unintended HIV status disclosure were expressed. Conclusion: mHealth and/or cDOT supporter as interventions to improve ART adherence are feasible in this setting. However, safe HIV status disclosure to treatment supporters and confidentiality of text messaging content about HIV and ART were

  13. HIV rapid testing as a key strategy for prevention of mother-to-child transmission in Brazil Prueba rápida para el HIV como una estrategia para la prevención de la transmisión vertical en Brasil Teste rápido para o HIV como estratégia de prevenção da transmissão vertical no Brasil

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    Valdiléa G Veloso

    2010-10-01

    Full Text Available OBJECTIVE: To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission. METHODS: Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied. RESULTS: HIV prevalence in women was 6.5% (N=1,439 in Porto Alegre and 1.3% (N=3.778 in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%, while in Rio de Janeiro most were tested in the postpartum (67.5%. One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47 and 6 cases in Porto Alegre (6/79. CONCLUSIONS: The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to

  14. Estimating HIV Incidence during Pregnancy and Knowledge of Prevention of Mother-to-Child Transmission with an Ad Hoc Analysis of Potential Cofactors

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    Thomas Obinchemti Egbe

    2016-01-01

    Full Text Available Background. We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. Method. During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT for HIV. Results. The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. Conclusion. The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so.

  15. Control of mother-to-child transmission of infectious diseases in Brazil: progress in HIV/AIDS and failure in congenital syphilis Controle da transmissão vertical de doenças infecciosas no Brasil: avanços na infecção pelo HIV/AIDS e descompasso na sífilis congênita

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    Alberto Novaes Ramos Jr.

    2007-01-01

    Full Text Available In Brazil, syphilis and HIV infection are considered serious public health problems. However, in practice, epidemiological surveillance, prevention measures, and prenatal care seem to be more effective in the control of mother-to-child transmission of the HIV than in the control of transmission of the Treponema pallidum. Here we discuss the differences in surveillance, prenatal care, and care of the newborn. Important differences were identified. It is concluded that there is an urgent need to establish prevention of mother-to-child transmission of syphilis as a public health priority, using an integrated approach including women's health, children's health, primary health care, and STD/AIDS programs on all governmental levels. These issues also need to be discussed with all stakeholders involved. Important aspects related to the problem are the training of public health professionals, as well as the participation of the community. The elimination of congenital syphilis does not require expensive drugs, and diagnostic tools, but a long-term sustainable approach.No Brasil, a infecção pelo Treponema pallidum e pelo vírus da imunodeficiência humana são eventos considerados prioritários. No entanto, apesar das políticas públicas, a resposta em termos das ações de vigilância e prevenção, assistência pré-natal e ao recém-nascido, é diferenciada, parecendo ser mais bem estruturada para a redução da transmissão vertical do HIV do que para a do T. pallidum. No presente artigo, potenciais diferenças são analisadas quanto ao desenvolvimento das ações. Identificou-se que as desigualdades existentes na atenção aos dois problemas apresentam dimensões diferenciadas nas regiões do país. Reconheceu-se a necessária e urgente priorização da sífilis na gravidez, envolvendo áreas técnicas como atenção básica, saúde da mulher, saúde da criança e controle de doenças sexualmente transmissíveis, em todas as esferas de governo

  16. Analysis of HIV early infant diagnosis data to estimate rates of perinatal HIV transmission in Zambia.

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    Kwasi Torpey

    Full Text Available BACKGROUND: Mother-to-child transmission of HIV (MTCT remains the most prevalent source of pediatric HIV infection. Most PMTCT (prevention of mother-to-child transmission of HIV programs have concentrated monitoring and evaluation efforts on process rather than on outcome indicators. In this paper, we review service data from 28,320 children born to HIV-positive mothers to estimate MTCT rates. METHOD: This study analyzed DNA PCR results and PMTCT data from perinatally exposed children zero to 12 months of age from five Zambian provinces between September 2007 and July 2010. RESULTS: The majority of children (58.6% had a PCR test conducted between age six weeks and six months. Exclusive breastfeeding (56.8% was the most frequent feeding method. An estimated 45.9% of mothers were below 30 years old and 93.3% had disclosed their HIV status. In terms of ARV regimen for PMTCT, 32.7% received AZT+single dose NVP (sdNVP, 30.9% received highly active antiretroviral treatment (HAART, 19.6% received sdNVP only and 12.9% received no ARVs. Transmission rates at six weeks when ARVs were received by both mother and baby, mother only, baby only, and none were 5.8%, 10.5%, 15.8% and 21.8% respectively. Transmission rates at six weeks where mother received HAART, AZT+sd NVP, sdNVP, and no intervention were 4.2%, 6.8%, 8.7% and 20.1% respectively. Based on adjusted analysis including ARV exposures and non ARV-related parameters, lower rates of positive PCR results were associated with 1 both mother and infant receiving prophylaxis, 2 children never breastfed and 3 mother being 30 years old or greater. Overall between September 2007 and July 2010, 12.2% of PCR results were HIV positive. Between September 2007 and January 2009, then between February 2009 and July 2010, proportions of positive PCR results were 15.1% and 11% respectively, a significant difference. CONCLUSION: The use of ARV drugs reduces vertical transmission of HIV in a program setting. Non

  17. Treat Jail Detainees' Drug Abuse to Lower HIV Transmission

    Science.gov (United States)

    ... To Lower HIV Transmission Study: Treat Jail Detainees’ Drug Abuse To Lower HIV Transmission Email Facebook Twitter March ... Treatment Research Trends and Statistics Women and Drugs Drugs of Abuse Alcohol Amphetamines Bath Salts Brain and Addiction Club ...

  18. Investigation of interruption of mother-to-child transmission among HIV-infected women%人类免疫缺陷病毒感染母婴传播阻断临床探讨

    Institute of Scientific and Technical Information of China (English)

    李晶; 李征; 郭晓峰; 陈捷谐; 梁丽; 戴卫东

    2015-01-01

    Objective To study the method and effectiveness of interruption of mother-to-child transmis-sion among human immunodeficiency virus (HIV)-infected women. Methods Clinical information of 110 cases of HIV-infected pregnant women who gave birth in the eighth municipal hospital of Guangzhou from June 2009 to June 2012 were retrospectively analyzed. Measures such as antiviral treatment , elective caesarean and artificial feeding were taken to interupt mother-to-child transmission , differences in pregnancy outcomes bewteen CD4 t-lymphocyte count > 200/μL and 200 /μL ( 84 cases ) ] and group 2 [< 200/μL group (26 cases)]. In group 1, the rate of anemia, preterm and postpartum hemorrhage was lower than that of group 2; the rate of low birth weight and FGR was obviously lower than that of group 2. There was statisticsly significantly difference between the two groups. 112 infants were all aged 18 months , among those we regularly followed up 88 cases (78.58%) and no infants were HIV-infected. Conclusion Interruptions of moth-er-to-child transmission of HIV are important measures to control AIDS epidemic among children.%目的:探讨人类免疫缺陷病毒(HIV)感染母婴传播的阻断方法与效果。方法:回顾性分析2009年6月至2012年6月在我院分娩的110例HIV阳性孕妇的临床资料。通过采取抗病毒治疗、选择性剖宫产和人工喂养等措施进行母婴阻断,比较CD4+T 淋巴细胞计数>200个/μL组和<200个/μL组的不同妊娠结局。观察婴儿出生后18个月龄以上HIV抗体情况。结果:(1)110例HIV阳性孕妇实行药物阻断102例,阻断率92.72%,分娩方式选择剖宫产106例,阻断率96.36%,112例新生儿全部实行人工喂养,阻断率100%。(2)CD4+T淋巴计数分为>200个/μL组(84例)和<200个/μL组(26例), CD4+T淋巴细胞计数>200个/μL 组中,贫血、早产和产后出血发生率均低于<200个/μL

  19. 人类免疫缺陷病毒感染母婴传播阻断临床探讨%Investigation of interruption of mother-to-child transmission among HIV-infected women

    Institute of Scientific and Technical Information of China (English)

    李晶; 李征; 郭晓峰; 陈捷谐; 梁丽; 戴卫东

    2015-01-01

    目的:探讨人类免疫缺陷病毒(HIV)感染母婴传播的阻断方法与效果。方法:回顾性分析2009年6月至2012年6月在我院分娩的110例HIV阳性孕妇的临床资料。通过采取抗病毒治疗、选择性剖宫产和人工喂养等措施进行母婴阻断,比较CD4+T 淋巴细胞计数>200个/μL组和<200个/μL组的不同妊娠结局。观察婴儿出生后18个月龄以上HIV抗体情况。结果:(1)110例HIV阳性孕妇实行药物阻断102例,阻断率92.72%,分娩方式选择剖宫产106例,阻断率96.36%,112例新生儿全部实行人工喂养,阻断率100%。(2)CD4+T淋巴计数分为>200个/μL组(84例)和<200个/μL组(26例), CD4+T淋巴细胞计数>200个/μL 组中,贫血、早产和产后出血发生率均低于<200个/μL 组;新生儿低体重儿和 FGR 的发生率明显低于<200个/μL 组,两组对比差异有显著性。(3)112例婴幼儿均已满18个月,定期随访88例,随访率78.58%,随访的88例婴儿HIV抗体均为阴性。结论:人类免疫缺陷病毒(HIV)母婴阻断措施是控制儿童艾滋病流行的重要措施。%Objective To study the method and effectiveness of interruption of mother-to-child transmis-sion among human immunodeficiency virus (HIV)-infected women. Methods Clinical information of 110 cases of HIV-infected pregnant women who gave birth in the eighth municipal hospital of Guangzhou from June 2009 to June 2012 were retrospectively analyzed. Measures such as antiviral treatment , elective caesarean and artificial feeding were taken to interupt mother-to-child transmission , differences in pregnancy outcomes bewteen CD4 t-lymphocyte count > 200/μL and 200 /μL ( 84 cases ) ] and group 2 [< 200/μL group (26 cases)]. In group 1, the rate of anemia, preterm and postpartum hemorrhage was lower than that of group 2; the rate of low birth weight and FGR was obviously lower than

  20. Intrapartum practices to limit vertical transmission of HIV.

    Science.gov (United States)

    du Preez, Antoinette; du Plessis, Engela; Pienaar, Abel

    2006-09-01

    The need to improve health services to HIV-positive women requires a specific focus on limiting mother-to-child transmission. Vertical transmission most often takes place during the intrapartum period; hence, it is essential to alert midwives to what constitutes safe or risky intrapartum practices. Midwives in the southern region of the North West Province of South Africa were surveyed for their knowledge of safe intrapartum practices that can limit vertical transmission of HIV, consequently indicating which intrapartum practices prevail in the region. We used a quantitative survey design and collected data by means of a questionnaire and checklist. A purposeful availability sample of 31 midwives who work in all four hospitals in the province was used and a random sample of 401 obstetric records was audited. Data were analysed by means of frequency analysis, effect sizes and cross-reference. A slight majority of the midwives had sufficient knowledge to distinguish between risky and safe practices. However, safe intrapartum practices are not always carried out and this raises concerns. Accordingly, we formulate general recommendations for nursing education, future research, and midwifery practice. In particular we suggest ways the national Guidelines for Maternity Care in South Africa may be adapted and better implemented to enhance safe intrapartum practices to limit vertical transmission of HIV. PMID:25875244

  1. Study on long-term effect mechanism of prevention of mother-to-child transmission of HIV%预防艾滋病母婴传播项目长效工作机制研究

    Institute of Scientific and Technical Information of China (English)

    宋俊敏; 程锦泉; 石向东; 马汉武; 刘少础; 王竹珍; 陈琳; 杨峥嵘; 张燕; 甘永霞

    2012-01-01

    Objective To systematically investigate the mechanism of Shenzhen Prevention of Mother-to-Child Transmission (PMTCT) Program through integrating the program works into routine responsibilities of health care system and provide basis for developing strategy for other regions. Methods Qualitative and quantitative research methods were adopted. Information on HIV testing and antiretroviral prophylaxis of pregnant women was collected by searching for literature and existing statistics. Group interview method was adopted for the implementation mechanisms of the program. Results The coverage of Shenzhen PMTCT Program was l00%. More than 95% of the pregnant women who came for antenatal care (ANC) and delivery services received HIV testing. More than 90% of the HIV positive women and their babies received antiretroviral prophylaxis. The antenatal care and delivery services were integrated into the mother-child health care system. The follow-ups of the HIV positive mothers and their children were integrated into the follow-up system of CDCs for reported cases of HIV infection. The antiretroviral prophylaxis of HIV positive women were integrated into the antiretroviral treatment system of infectious disease hospitals. Conclusions The integration of PMTCT program into the routine works of multi-sectoral health care institutions can help the establishment of high-quality and long-term effect mechanism of the program.%目的 通过对深圳市预防艾滋病母婴传播项目工作,与卫生系统多部门常规工作相整合的运行机制进行系统的研究,为其他地区提供有益的借鉴.方法 采用定性研究和定量研究.通过文献检索和现有资料收集的方法,了解2008-2010年深圳市孕产妇艾滋病病毒(HIV)抗体检测情况和感染HIV孕妇抗病毒治疗情况.通过小组访谈方法,了解项目运行机制.结果 深圳市预防艾滋病母婴传播项目的覆盖率为100%,孕产妇检测率超过95%,孕妇和分娩

  2. Teaching HIV/AIDS through a Child-to-Child Approach: A Teacher's Perspective

    Science.gov (United States)

    Mwebi, Bosire Monari

    2012-01-01

    This paper draws from a larger study conducted in Kenya, which was a narrative inquiry into a teacher's experiences of teaching the HIV/AIDS curriculum using a child-to-child approach. The two major research questions of this study were: 1) What are the experiences of a teacher teaching the HIV/AIDS curriculum using a child-to-child curriculum…

  3. Barriers to access prevention of mother-to-child transmission for HIV positive women in a well-resourced setting in Vietnam

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    Wright Pamela

    2008-04-01

    Full Text Available Abstract Background According to Vietnamese policy, HIV-infected women should have access at least to HIV testing and Nevirapine prophylaxis, or where available, to adequate counselling, HIV infection staging, ARV prophylaxis, and infant formula. Many studies in high HIV prevalence settings have reported low coverage of PMTCT services, but there have been few reports from low HIV prevalence settings, such as Asian countries. We investigated the access of HIV-infected pregnant women to PMTCT services in the well-resourced setting of the capital city, Hanoi. Methods Fifty-two HIV positive women enrolled in a self-help group in Hanoi were consulted, through in-depth interviews and bi-weekly meetings, about their experiences in accessing PMTCT services. Results Only 44% and 20% of the women had received minimal and comprehensive PMTCT services, respectively. Nine women did not receive any services. Twenty-two women received no counselling. The women reported being limited by lack of knowledge and information due to poor counselling, gaps in PMTCT services, and fear of stigma and discrimination. HIV testing was done too late for optimal interventions and poor quality of care by health staff was frequently mentioned. Conclusion In a setting where PMTCT is available, HIV-infected women and children did not receive adequate care because of barriers to accessing those services. The results suggest key improvements would be improving quality of counselling and making PMTCT guidelines available to health services. Women should receive early HIV testing with adequate counselling, safe care and prophylaxis in a positive atmosphere towards HIV-infected women.

  4. Placental Malaria and Mother-to-Child Transmission of Human Immunodeficiency Virus-1 in Rural Rwanda

    OpenAIRE

    Bulterys, Philip L.; Chao, Ann; Dalai, Sudeb C.; Zink, M. Christine; Dushimimana, Abel; Katzenstein, David; Saah, Alfred J.; Bulterys, Marc

    2011-01-01

    We conducted a nested case-control study of placental malaria (PM) and mother-to-child transmission (MTCT) of human immunodeficiency virus-1 (HIV-1) within a prospective cohort of 627 mother-infant pairs followed from October 1989 until April 1994 in rural Rwanda. Sixty stored placentas were examined for PM and other placental pathology, comparing 20 HIV-infected mother-infant (perinatal transmitter) pairs, 20 HIV-uninfected pairs, and 20 HIV-infected mothers who did not transmit to their inf...

  5. Mother-to-child transmission of HIV: risk factors and missed opportunities for prevention among pregnant women attending health services in Goiânia, Goiás State, Brazil Transmissão vertical do HIV: fatores associados e perdas de oportunidades de intervenção em gestantes atendidas em Goiânia, Goiás, Brasil

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    Marília Dalva Turchi

    2007-01-01

    Full Text Available The objectives of this study were to estimate the risk of vertical HIV transmission and assess the associated factors and missed opportunities for prevention in a cohort of HIV+ pregnant women (1995-2001 treated in Goiânia, Goiás, Brazil, with follow-up of their children until 2005. Three data sources were compared: Information System on Reportable Diseases (SINAN, Information System on HIV+ Pregnant Women and Exposed Children (SISGHIV, and patient clinical charts. The study estimated the vertical transmission rates, factors associated with vertical transmission, and use of antiretroviral therapy. 276 HIV+ women were identified (322 pregnancies, and there were 70 HIV+ children. Overall risk of vertical HIV transmission was 27.8%. The vertical transmission rate was 40.8% in the group without prophylaxis and 1% in the group with adequate prophylaxis, i.e., a 97.5% reduction in transmission risk. Year of delivery, consultation with a specialist, and no history of injecting drug use were factors associated with adequate use of antiretroviral therapy. The study showed an important reduction in the risk of vertical transmission in pregnant women who received adequate therapy, besides identifying missed opportunities for prevention.Os objetivos foram estimar o risco de transmissão vertical do HIV e avaliar fatores associados e perdas de oportunidades de prevenção em coorte de gestantes HIV+ (1995-2001, atendidas em Goiânia, Goiás, Brasil, com seguimento das crianças até 2005. Foi realizada conciliação de três fontes de dados: Sistema de Informação de Agravos de Notificação (SINAN, Sistema de Informação de Gestantes HIV Positivas e Crianças Expostas (SISGHIV e prontuários médicos. Foram estimados os percentuais de transmissão vertical, fatores associados à transmissão vertical e ao uso de terapia anti-retroviral. Foram identificadas 276 mulheres HIV+ (322 gestações e os desfechos foram 70 crianças HIV+. O risco de transmiss

  6. Uptake and outcomes of a prevention-of mother-to-child transmission (PMTCT program in Zomba district, Malawi

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    Gawa Lucy

    2011-06-01

    Full Text Available Abstract Background HIV prevalence among pregnant women in Malawi is 12.6%, and mother-to-child transmission is a major route of transmission. As PMTCT services have expanded in Malawi in recent years, we sought to determine uptake of services, HIV-relevant infant feeding practices and mother-child health outcomes. Methods A matched-cohort study of HIV-infected and HIV-uninfected mothers and their infants at 18-20 months post-partum in Zomba District, Malawi. 360 HIV-infected and 360 HIV-uninfected mothers were identified through registers. 387 mother-child pairs were included in the study. Results 10% of HIV-infected mothers were on HAART before delivery, 27% by 18-20 months post-partum. sd-NVP was taken by 75% of HIV-infected mothers not on HAART, and given to 66% of infants. 18% of HIV-infected mothers followed all current recommended PMTCT options. HIV-infected mothers breastfed fewer months than HIV-uninfected mothers (12 vs.18, respectively; p p Conclusion This study shows low PMTCT program efficiency and effectiveness under routine program conditions in Malawi. HIV-free infant survival may have been influenced by key factors, including underuse of HAART, underuse of sd-NVP, and suboptimal infant feeding practices. Maternal mortality among HIV-infected women demands attention; improved maternal survival is a means to improve infant survival.

  7. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes.

    OpenAIRE

    Medley, Amy; Garcia-Moreno, Claudia; McGill, Scott; Maman, Suzanne

    2004-01-01

    This paper synthesizes the rates, barriers, and outcomes of HIV serostatus disclosure among women in developing countries. We identified 17 studies from peer-reviewed journals and international conference abstracts--15 from sub-Saharan Africa and 2 from south-east Asia--that included information on either the rates, barriers or outcomes of HIV serostatus disclosure among women in developing countries. The rates of disclosure reported in these studies ranged from 16.7% to 86%, with women atten...

  8. HIV Transmission at a Saudi Arabia Hemodialysis Unit

    OpenAIRE

    Mashragi, Faisal; Bernstein, Robert S.; Al-Mazroa, Mohammad; Jaffar A. Al-Tawfiq; Filemban, Sanaa; Assiri, Abdullah; Furukawa, Elaine; Al Hazmi, Mohammad; Alzahrani, Abdullah; Stephens, Gwen; Memish, Ziad A.

    2014-01-01

    Background.  Hemodialysis is associated with increased risk of healthcare-associated infections but considered a low-risk setting for human immunodeficiency virus (HIV) transmission. We investigated 3 hemodialysis unit (HDU) patients with new HIV infections to determine whether transmission was hemodialysis-associated and to correct factors that contributed to transmission. Methods.  Each patient was evaluated for HIV risk factors. Blood samples were tested to determine relatedness of HIV str...

  9. When one can infect two: a reflection on the impact of HIV discordance on child HIV infection

    Directory of Open Access Journals (Sweden)

    Etienne Karita

    2010-05-01

    Full Text Available This is an opinion piece based on data and experience from Rwanda. The authors believe this opinion piece may help improve current programs on prevention of HIV transmission from mother to child in Africa taking into account the prevalence of HIV sero-discordance in couples. The authors recommend that if we want to ensure newborns stay HIV negative, PMTCT protocols should offer a series of HIV tests linked with antenatal visits and the lactation period as well as HIV testing of current sexual partners. Moreover, if the male partner is found to be positive and the woman is negative, programs should provide intensive counseling on the use of condoms. The lives of three individuals have the potential to be changed from HIV testing and counseling. Morally, this cannot be ignored.

  10. Estimating PMTCT's Impact on Heterosexual HIV Transmission: A Mathematical Modeling Analysis.

    Directory of Open Access Journals (Sweden)

    Aditya S Khanna

    Full Text Available Prevention of mother-to-child HIV transmission (PMTCT strategies include combined short-course antiretrovirals during pregnancy (Option A, triple-drug antiretroviral treament (ART during pregnancy and breastfeeding (Option B, or lifelong ART (Option B+. The WHO also recommends ART for HIV treatment and prevention of sexual transmission of HIV. The impact of PMTCT strategies on prevention of sexual HIV transmission of HIV is not known. We estimated the population-level impact of PMTCT interventions on heterosexual HIV transmission in southwestern Uganda and KwaZulu-Natal, South Africa, two regions with different HIV prevalence and fertility rates.We constructed and validated dynamic, stochastic, network-based HIV transmission models for each region. PMTCT Options A, B, and B+ were simulated over ten years under three scenarios: 1 current ART and PMTCT coverage, 2 current ART and high PMTCT coverage, and 3 high ART and PMTCT coverage. We compared adult HIV incidence after ten years of each intervention to Option A (and current ART at current coverage.At current coverage, Options B and B+ reduced heterosexual HIV incidence by about 5% and 15%, respectively, in both countries. With current ART and high PMTCT coverage, Option B+ reduced HIV incidence by 35% in Uganda and 19% in South Africa, while Option B had smaller, but meaningful, reductions. The greatest reductions in HIV incidence were achieved with high ART and PMTCT coverage. In this scenario, all PMTCT strategies yielded similar results.Implementation of Options B/B+ reduces adult HIV incidence, with greater effect (relative to Option A at current levels in Uganda than South Africa. These results are likely driven by Uganda's higher fertility rates.

  11. Moral Agency and the Sexual Transmission of HIV

    Science.gov (United States)

    O'Leary, Ann; Wolitski, Richard J.

    2009-01-01

    Sexual transmission of HIV occurs because an infected person has unprotected sex with a previously uninfected person. The majority of HIV infections are transmitted by individuals who are unaware of their infection, and most persons who are diagnosed with HIV significantly reduce or eliminate risk behaviors once they learn they have HIV. However,…

  12. HLA-G DNA sequence variants and risk of perinatal HIV-1 transmission

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    Shamsa Falah

    2006-10-01

    Full Text Available Abstract Background HLA-G gene is a non-classical MHC class 1 molecule that is highly expressed in the trophoblast at the maternal-fetal interface. In an attempt to elucidate possible immunological mechanisms facilitating protection of infants born to human immunodeficiency virus type (HIV-1 infected mothers, we have been studying genetic variations in the coding and untranslated regions of HLA-G antigen between HIV-1-infected mothers and their infected or uninfected infants. This study investigated whether HLA-G DNA sequence variants are associated with perinatal HIV-1 transmission. Results Genomic DNA samples were obtained from a nested case-control study of 34 mother-child pairs co-enrolled in a cohort of the Perinatal AIDS Collaborative Transmission Study in New York. The samples were from two groups predominantly of African-American and Hispanic origin: In the first group, both mother and child were HIV-1-infected; in the second group, only the mother was infected while the child remained uninfected. Genotyping of HLA-G gene were performed on the extracted DNA from peripheral blood mononuclear cells using PCR based sequencing and restriction fragment-length polymorphism analyses. Among the studied HLA-G exons, dissimilarities in HLA-G DNA sequence variants between the HIV-1 non-transmitting mother child pairs were mostly observed in exon 8-3'-untranslated region at nucleotide positions T3742A, C3743T, G3777C (P = 0.001. Non-transmitting HIV-1 mother child pairs exhibited dissimilarities at nucleotide position C3743T allele with decreased risk of perinatal HIV-1 transmission, compared with HIV-1 transmitting mother-child pairs carrying this allele (odds ratio 0.02 [95% confidence interval 0.00–0.15] P = 0.00001. In addition, heterozygous dissimilarities at nucleotide positions C634G and 714 insT/G in the 5'-upstream regulatory region were observed between the mother child pairs of the HIV-1-non-transmitting group while homozygous

  13. 广西艾滋病母婴传播强化干预效果分析%Analysis of effect of intensive intervention on HIV mother-to-child transmission in Guangxi

    Institute of Scientific and Technical Information of China (English)

    黄越华; 李映; 丘小霞; 谢小花

    2014-01-01

    目的:探讨提高广西预防艾滋病母婴传播服务可及性和有效性的工作模式。方法收集2009年至2013年广西各市县预防艾滋病母婴传播工作月报表、HIV阳性孕产妇个案登记卡,查阅自治区、市、县项目年度督导及工作总结等资料,进行统计分析。结果形成了政府主导,多部门合作,全社会参与的工作氛围,建立目标管理责任制、监督指导和信息上报制度,将预防艾滋病母婴传播工作融入常规妇幼卫生工作中,并与其他项目紧密结合,为HIV阳性孕产妇提供保健、抗病毒治疗、住院分娩等服务;由专人对HIV阳性母亲所生婴儿进行全程强化管理。婚前保健人群、孕产期妇女HIV检测率分别从2009年的80.14%和83.07%上升到2013年的99.97%和99.86%;HIV阳性产妇及其所生婴儿应用抗病毒药物的比例分别从2009年的56.68%和77.78%上升到2013年的94.60%和97.69%;母婴传播率控制在5%以下。结论实施攻坚工程使广西预防艾滋病母婴传播各项措施得到了有效落实,目标人群HIV筛查率、HIV阳性孕产妇及其所生婴儿抗病毒药物用药率逐年上升。%Objective To explore the working pattern to enhance the accessibility and validity of service on prevention of mother-to-child transmission of HIV/AIDS in Guangxi. Methods Monthly summary report of PMTCT program and individual information cards of HIV-infected pregnant woman among the cities and counties of Guangxi from 2009 to 2013 were collected and the project supervision and working annual summaries of autonomous region, cities and counties were consulted and analyzed. Results We fostered the aura in multiple sections coordination and all society participation under Government-Guiding. The target management responsibility system, supervision guiding and information submission system were built and the work on PMTCT was integrated into routine maternity and child hygiene, We made

  14. Analysis of effect of intensive intervention on HIV mother-to-child transmission in Guangxi%广西艾滋病母婴传播强化干预效果分析

    Institute of Scientific and Technical Information of China (English)

    黄越华; 李映; 丘小霞; 谢小花

    2014-01-01

    Objective To explore the working pattern to enhance the accessibility and validity of service on prevention of mother-to-child transmission of HIV/AIDS in Guangxi. Methods Monthly summary report of PMTCT program and individual information cards of HIV-infected pregnant woman among the cities and counties of Guangxi from 2009 to 2013 were collected and the project supervision and working annual summaries of autonomous region, cities and counties were consulted and analyzed. Results We fostered the aura in multiple sections coordination and all society participation under Government-Guiding. The target management responsibility system, supervision guiding and information submission system were built and the work on PMTCT was integrated into routine maternity and child hygiene, We made further efforts to improve the cooperation with other programs in order to offer the health care, antiviral treatment, hospital delivery and other services for the HIV-positive maternal. The professionals reinforced the management of HIV-positive babies for their mothers during the whole course. The HIV detection rates of pre-marital health care people and maternal women rose from 80.14% and 83.07% in 2009 to 99.97% and 99.86% in 2013.respectively. And then the proportions of HIV-infected pregnant women and the proportions of children born to HIV-infected pregnant women who took antiretroviral(ARV) drugs rose from 56.68% and 77.78% to 94.60% and 97.69% .respectively.The rate of MTCT was controlled under 5% . Conclusion The crucial project program provides the effective implementation measures on prevention MTCT of HIV in Guangxi. Each index of HIV screening, antiviral medication usage rate of target populations increases year by year.%目的:探讨提高广西预防艾滋病母婴传播服务可及性和有效性的工作模式。方法收集2009年至2013年广西各市县预防艾滋病母婴传播工作月报表、HIV阳性孕产妇个案登记卡,查阅自治区、市、县项

  15. What does high and low have to do with it? Performance classification to identify health system factors associated with effective prevention of mother-to-child transmission of HIV delivery in Mozambique

    Directory of Open Access Journals (Sweden)

    Sarah Gimbel

    2014-03-01

    Full Text Available Introduction: Efforts to implement and take to scale highly efficacious, low-cost interventions to prevent mother-to-child HIV transmission (pMTCT have been a cornerstone of reproductive health services in sub-Saharan Africa for over a decade. Yet efforts to increase access and utilization of these services remain far from optimal. This study developed and applied an approach to systematically classify pMTCT performance to identify modifiable health system factors associated with pMTCT performance which may be replicated in other pMTCT systems. Methods: Facility-level performance measures were collected at 30 sites over a 12-month period and reviewed for consistency. Five combinations of three indicators (1. HIV testing; 2. CD4 testing; 3. antiretroviral prophylaxis and combined antiretroviral therapy initiation were compared including a composite of all three, a combination of 1. and 3., and each individually. Approaches were visually assessed to describe facility performance, focusing on rank order consistency across high, medium and low categories. Modifiable and non-modifiable factors were ascertained at each site and ranking process was reviewed to estimate association with facility performance through unadjusted Chi-square tests and logistic regression. After describing factors associated with high versus low performing pMTCT clinics, the effect of inclusion of the 10 middle performers was assessed. Results: The indicator most consistently associated with the reference composite indicator (HIV testing, antiretroviral prophylaxis and combined antiretroviral therapy was the single measure of antiretroviral prophylaxis and combined antiretroviral therapy. Lower performing pMTCT clinics ranked consistently low across measurement strategies; high and middle performing clinics demonstrated more variability. Association between clinic characteristics and high pMTCT performance varied markedly across ranking strategies. Using the reference

  16. What does high and low have to do with it? Performance classification to identify health system factors associated with effective prevention of mother-to-child transmission of HIV delivery in Mozambique

    Science.gov (United States)

    Gimbel, Sarah; Voss, Joachim; Rustagi, Alison; Mercer, Mary Anne; Zierler, Brenda; Gloyd, Stephen; Coutinho, Maria de Joana; Cuembelo, Maria de Fatima; Sherr, Kenneth

    2014-01-01

    Introduction Efforts to implement and take to scale highly efficacious, low-cost interventions to prevent mother-to-child HIV transmission (pMTCT) have been a cornerstone of reproductive health services in sub-Saharan Africa for over a decade. Yet efforts to increase access and utilization of these services remain far from optimal. This study developed and applied an approach to systematically classify pMTCT performance to identify modifiable health system factors associated with pMTCT performance which may be replicated in other pMTCT systems. Methods Facility-level performance measures were collected at 30 sites over a 12-month period and reviewed for consistency. Five combinations of three indicators (1. HIV testing; 2. CD4 testing; 3. antiretroviral prophylaxis and combined antiretroviral therapy initiation) were compared including a composite of all three, a combination of 1. and 3., and each individually. Approaches were visually assessed to describe facility performance, focusing on rank order consistency across high, medium and low categories. Modifiable and non-modifiable factors were ascertained at each site and ranking process was reviewed to estimate association with facility performance through unadjusted Chi-square tests and logistic regression. After describing factors associated with high versus low performing pMTCT clinics, the effect of inclusion of the 10 middle performers was assessed. Results The indicator most consistently associated with the reference composite indicator (HIV testing, antiretroviral prophylaxis and combined antiretroviral therapy) was the single measure of antiretroviral prophylaxis and combined antiretroviral therapy. Lower performing pMTCT clinics ranked consistently low across measurement strategies; high and middle performing clinics demonstrated more variability. Association between clinic characteristics and high pMTCT performance varied markedly across ranking strategies. Using the reference composite indicator, larger

  17. Performance of HIV Prevention of Mother-To-Child Transmission Programs in Sub-Saharan Africa: Longitudinal Assessment of 64 Nevirapine-Based Programs Implemented in 25 Countries, 2000-2011.

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    Joël Ladner

    Full Text Available To evaluate the performance and to identify predictive factors of performance in prevention of mother-to-child HIV transmission programs (PMTCT in sub-Saharan African countries.From 2000 to 2011, PMTCT programs included in the Viramune Donation Programme (VDP were prospectively followed. Each institution included in the VDP provided data on program implementation, type of management institution, number of PMTCT sites, key programs outputs (HIV counseling and testing, NVP regimens received by mothers and newborns. Nevirapine Coverage Ratio (NCR, defined as the number of women who should have received nevirapine (observed HIV prevalence x number of women in antenatal care, was used to measure performance. Included programs were followed every six months through progress reports.A total of 64 programs in 25 sub-Saharan African countries were included. The mean program follow-up was 48.0 months (SD = 24.5; 20,084,490 women attended in antenatal clinics were included. The overall mean NCR was 0.52 (SD = 0.25, with an increase from 0.37 to 0.57 between the first and last progress reports (p<.0001; NCR increased by 3.26% per year-program. Between the first and the last report, the number of women counseled and tested increased from 64.3% to 86.0% (p<.0001, the number of women post-counseled from 87.5% to 91.3% (p = 0.08. After mixed linear regression analysis, type of responsible institution, number of women attended in ANC, and program initiation in 2005-2006 were significant predictive factors associated with the NCR. The effect of the time period increased from earlier to later periods.A longitudinal assessment of large PMTCT programs shows that scaling-up of programs was increased in sub-Saharan African countries. The PMTCT coverage increased throughout the study period, especially after 2006. Performance may be better for programs with a small or medium number of women attended in ANC. Identification of factors that predict PMTCT program

  18. HIV Transmission in a State Prison System, 1988–2005

    OpenAIRE

    Krishna Jafa; Peter McElroy; Lisa Fitzpatrick; Borkowf, Craig B.; Robin Macgowan; Andrew Margolis; Ken Robbins; Ae Saekhou Youngpairoj; Dale Stratford; Alan Greenberg; Jennifer Taussig; R Luke Shouse; Madeleine Lamarre; Eleanor McLellan-Lemal; Walid Heneine

    2009-01-01

    INTRODUCTION: HIV prevalence among state prison inmates in the United States is more than five times higher than among nonincarcerated persons, but HIV transmission within U.S. prisons is sparsely documented. We investigated 88 HIV seroconversions reported from 1988-2005 among male Georgia prison inmates. METHODS: We analyzed medical and administrative data to describe seroconverters' HIV testing histories and performed a case-crossover analysis of their risks before and after HIV diagnosis. ...

  19. Maternal HIV-1 envelope–specific antibody responses and reduced risk of perinatal transmission

    Science.gov (United States)

    Permar, Sallie R.; Fong, Youyi; Vandergrift, Nathan; Fouda, Genevieve G.; Gilbert, Peter; Parks, Robert; Jaeger, Frederick H.; Pollara, Justin; Martelli, Amanda; Liebl, Brooke E.; Lloyd, Krissey; Yates, Nicole L.; Overman, R. Glenn; Shen, Xiaoying; Whitaker, Kaylan; Chen, Haiyan; Pritchett, Jamie; Solomon, Erika; Friberg, Emma; Marshall, Dawn J.; Whitesides, John F.; Gurley, Thaddeus C.; Von Holle, Tarra; Martinez, David R.; Cai, Fangping; Kumar, Amit; Xia, Shi-Mao; Lu, Xiaozhi; Louzao, Raul; Wilkes, Samantha; Datta, Saheli; Sarzotti-Kelsoe, Marcella; Liao, Hua-Xin; Ferrari, Guido; Alam, S. Munir; Montefiori, David C.; Denny, Thomas N.; Moody, M. Anthony; Tomaras, Georgia D.; Gao, Feng; Haynes, Barton F.

    2015-01-01

    Despite the wide availability of antiretroviral drugs, more than 250,000 infants are vertically infected with HIV-1 annually, emphasizing the need for additional interventions to eliminate pediatric HIV-1 infections. Here, we aimed to define humoral immune correlates of risk of mother-to-child transmission (MTCT) of HIV-1, including responses associated with protection in the RV144 vaccine trial. Eighty-three untreated, HIV-1–transmitting mothers and 165 propensity score–matched nontransmitting mothers were selected from the Women and Infants Transmission Study (WITS) of US nonbreastfeeding, HIV-1–infected mothers. In a multivariable logistic regression model, the magnitude of the maternal IgG responses specific for the third variable loop (V3) of the HIV-1 envelope was predictive of a reduced risk of MTCT. Neutralizing Ab responses against easy-to-neutralize (tier 1) HIV-1 strains also predicted a reduced risk of peripartum transmission in secondary analyses. Moreover, recombinant maternal V3–specific IgG mAbs mediated neutralization of autologous HIV-1 isolates. Thus, common V3-specific Ab responses in maternal plasma predicted a reduced risk of MTCT and mediated autologous virus neutralization, suggesting that boosting these maternal Ab responses may further reduce HIV-1 MTCT. PMID:26053661

  20. Yours faithfully -- prevention of parent to child transmission (PPTCT).

    Science.gov (United States)

    Ray, Sabyasachi; Basak, Subhadeep; Konar, Hiralal

    2011-07-01

    The objective of this study is to find out the reasons behind drop out of the mothers from the prevention of parent to child transmission (PPTCT) programme, thereby going undiagnosed of their HIV serostatus. A retrospective 6-year study was undertaken among mothers attending antenatal clinic and the unbooked cases delivering at the medical college. The percentage of mothers taking pretest counselling was 95.19; 94.09 per cent agreed to have their blood tested among those who had registered at the antenatal clinic only. Of them, 33 were found to be seropositive, 12 being found in 2009 alone. But the daily average of unbooked cases delivering at this institution was 16.42 out of 28. And a huge number (58.9%) were unregistered ie, unknown HIV serostatus deliveries were taken place during this 6-year of study (2004-2009). By this study we have found out that our ignorance, work pressure and patients' lack of knowledge, fear of so called 'HIV-AIDS', social stigmas are creating the big gaps in PPTCT programme and thus made it unsuccessful. PMID:22315838

  1. Probability of HIV Transmission During Acute Infection in Rakai, Uganda

    OpenAIRE

    Pinkerton, Steven D.

    2007-01-01

    Accurate estimates of the probability of HIV transmission during various stages of infection are needed to inform epidemiological models. Very limited information is available about the probability of transmission during acute HIV infection. We conducted a secondary analysis of published data from the Rakai, Uganda seroconversion study. Mathematical and computer-based models were used to quantify the per-act and per-partnership transmission probabilities during acute and chronic HIV infection...

  2. Attitudes and beliefs about mental illness among church-based lay health workers: experience from a prevention of mother-to-child HIV transmission trial in Nigeria

    OpenAIRE

    Iheanacho, Theddeus; Kapadia, Daniel; Ezeanolue, Chinenye O.; Osuji, Alice A.; Ogidi, Amaka G.; Ike, Anulika; Patel, Dina; Stefanovics, Elina; Rosenheck, Robert; Obiefune, Michael; Echezona E Ezeanolue

    2015-01-01

    Common mental disorders are prevalent in Nigeria. Due to stigma and a limited number of trained specialists, only 10% of adults with mental illness in Nigeria receive any care. The Healthy Beginning Initiative is a community-based maternal/child health program that includes screening for perinatal depression and was implemented by lay, volunteer, church-based health advisors (CHAs). The aim of the study was to assess the beliefs and attitudes about mental illness among the CHAs. The study use...

  3. 凉山地区预防艾滋病母婴传播相关资源整合的分析%Analysis of financial resources on prevention of mother-to-child transmission of HIV in Liangshan

    Institute of Scientific and Technical Information of China (English)

    王爱玲; 王临虹; 布的尔波; 苏穗青; 边绍勇; 彭竟; 王潇滟

    2012-01-01

    Objective To explore the feasibility and effectiveness of prevention of mother-to-child transmission ( PMTCT ) of HIV with integrated health resources in Liangshan by analyzing the present financial supports for women and child health care related with preventing AIDS spread. Methods The expenses for delivery of HIV infected women were investigated with quantitative survey, and qualitative methods of in-depth interviews and group discussion were used to understand the funds for PMTCT and support of other related health resources as well as their integration and utilization. Results The fund supports of PMTCT were central financial transfer payment and C-MAP program. Related supports of PMTCT included new rural cooperative medical system, program for reduction of mortality of pregnant and lying-in women and elimination of neonatal tetanus, allowance for hospital delivery of rural pregnant women and civil medical assistance. For the expenses for hospital delivery of HIV infected women in the county, 57. 12% were from PMTCT program, 34. 21% were from new rural cooperative medical system, 5. 22% were from program for reduction of mortality of pregnant and lying-in women and elimination of neonatal tetanus and the rest 3.45% were paid by themselves. Conclusion The detection of HIV and expenses for hospital delivery of pregnant women are financially supported by PMTCT program and related programs and policies for maternal and child health, but the support and focus on service links such as premarital care, antenatal care, puerperium health care and child health care are insufficient. It is suggested that present resources should be allocated reasonably in poverty-stricken areas and minority areas and close attention should be paid to puerperium health care and child health care. Meanwhile, the follow-up of pregnant women and infected children and investment on human and material resources should be strengthened.%目的 通过收集四川省凉山地区与预防艾滋病

  4. Estimating the impact of plasma HIV-1 RNA reductions on heterosexual HIV-1 transmission risk.

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    Jairam R Lingappa

    Full Text Available BACKGROUND: The risk of sexual transmission of HIV-1 is strongly associated with the level of HIV-1 RNA in plasma making reduction in HIV-1 plasma levels an important target for HIV-1 prevention interventions. A quantitative understanding of the relationship of plasma HIV-1 RNA and HIV-1 transmission risk could help predict the impact of candidate HIV-1 prevention interventions that operate by reducing plasma HIV-1 levels, such as antiretroviral therapy (ART, therapeutic vaccines, and other non-ART interventions. METHODOLOGY/PRINCIPAL FINDINGS: We use prospective data collected from 2004 to 2008 in East and Southern African HIV-1 serodiscordant couples to model the relationship of plasma HIV-1 RNA levels and heterosexual transmission risk with confirmation of HIV-1 transmission events by HIV-1 sequencing. The model is based on follow-up of 3381 HIV-1 serodiscordant couples over 5017 person-years encompassing 108 genetically-linked HIV-1 transmission events. HIV-1 transmission risk was 2.27 per 100 person-years with a log-linear relationship to log(10 plasma HIV-1 RNA. The model predicts that a decrease in average plasma HIV-1 RNA of 0.74 log(10 copies/mL (95% CI 0.60 to 0.97 reduces heterosexual transmission risk by 50%, regardless of the average starting plasma HIV-1 level in the population and independent of other HIV-1-related population characteristics. In a simulated population with a similar plasma HIV-1 RNA distribution the model estimates that 90% of overall HIV-1 infections averted by a 0.74 copies/mL reduction in plasma HIV-1 RNA could be achieved by targeting this reduction to the 58% of the cohort with plasma HIV-1 levels ≥4 log(10 copies/mL. CONCLUSIONS/SIGNIFICANCE: This log-linear model of plasma HIV-1 levels and risk of sexual HIV-1 transmission may help estimate the impact on HIV-1 transmission and infections averted from candidate interventions that reduce plasma HIV-1 RNA levels.

  5. Cell-free (RNA and cell-associated (DNA HIV-1 and postnatal transmission through breastfeeding.

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    James Ndirangu

    Full Text Available INTRODUCTION: Transmission through breastfeeding remains important for mother-to-child transmission (MTCT in resource-limited settings. We quantify the relationship between cell-free (RNA and cell-associated (DNA shedding of HIV-1 virus in breastmilk and the risk of postnatal HIV-1 transmission in the first 6 months postpartum. MATERIALS AND METHODS: Thirty-six HIV-positive mothers who transmitted HIV-1 by breastfeeding were matched to 36 non-transmitting HIV-1 infected mothers in a case-control study nested in a cohort of HIV-infected women. RNA and DNA were quantified in the same breastmilk sample taken at 6 weeks and 6 months. Cox regression analysis assessed the association between cell-free and cell-associated virus levels and risk of postnatal HIV-1 transmission. RESULTS: There were higher median levels of cell-free than cell-associated HIV-1 virus (per ml in breastmilk at 6 weeks and 6 months. Multivariably, adjusting for antenatal CD4 count and maternal plasma viral load, at 6 weeks, each 10-fold increase in cell-free or cell-associated levels (per ml was significantly associated with HIV-1 transmission but stronger for cell-associated than cell-free levels [2.47 (95% CI 1.33-4.59 vs. aHR 1.52 (95% CI, 1.17-1.96, respectively]. At 6 months, cell-free and cell-associated levels (per ml in breastmilk remained significantly associated with HIV-1 transmission but was stronger for cell-free than cell-associated levels [aHR 2.53 (95% CI 1.64-3.92 vs. 1.73 (95% CI 0.94-3.19, respectively]. CONCLUSIONS: The findings suggest that cell-associated virus level (per ml is more important for early postpartum HIV-1 transmission (at 6 weeks than cell-free virus. As cell-associated virus levels have been consistently detected in breastmilk despite antiretroviral therapy, this highlights a potential challenge for resource-limited settings to achieve the UNAIDS goal for 2015 of eliminating vertical transmission. More studies would further knowledge on

  6. Clinical study of the effects and time of interventions to prevent HIV mother-to-child transmission%HIV感染孕妇母婴传播的阻断效果及时机的临床研究

    Institute of Scientific and Technical Information of China (English)

    周敏; 陈竹; 曾义岚; 何克静; 黄海霞

    2015-01-01

    目的:探讨妊娠合并HIV感染孕妇的母婴阻断效果及阻断时机。方法将2010年1月至2013年6月本院收治的126例妊娠合并HIV感染孕妇,按照开始抗反转录病毒治疗的时间,分为孕期治疗组、产前治疗组及未治疗组。并将孕期治疗组分为早中孕治疗组和晚孕治疗组。所有患者均给予三联高效抗反转录病毒药物治疗(HAART),同时采取安全分娩及人工喂养等综合干预措施。观察各组的不良妊娠结局、新生儿不良结局及母婴阻断效果。结果孕期治疗组的不良妊娠结局发生率(3.95%,3/74)显著低于产前治疗组(20.00%,8/45)及未治疗组(42.86%,3/7),差异均具有统计学意义(χ2=14.448,P <0.05)。孕期治疗组的新生儿不良结局发生率(9.46%,7/74)显著低于产前治疗组(22.22%,10/45)及未治疗组(50%,3/6),差异具有统计学意义(χ2=8.742, P <0.05)。对82例存活婴儿完成随访,孕期治疗组无1例婴儿感染HIV,产前治疗组的婴儿HIV感染率(9.68%,3/31)显著低于未治疗组(33.33%,1/3),差异具有统计学意义(χ2=9.235,P <0.05)。早中孕治疗组的不良妊娠结局发生率、新生儿不良结局发生率及婴儿感染HIV率与晚孕治疗组相比,差异均无统计学意义(P>0.05)。结论妊娠合并HIV感染的患者,其妊娠结局及新生儿预后与患者开始HAART的时间密切相关,孕期采用HAART治疗者显著优于产前治疗者和未治疗者,且HAART对胎儿的生长发育未见明显不良影响。%Objective To investigate the effects and time of interventions to prevent HIV motherto- child transmission. Methods Total of 126 pregnant women infected with HIV from January 2010 to June 2013 in our hospital were divided into three groups according to the time of antiretroviral therapy, including pregnancy-treated group, prenatal-treated group and un-treated group

  7. HIV感染孕妇母婴传播的阻断效果及时机的临床研究%Clinical study of the effects and time of interventions to prevent HIV mother-to-child transmission

    Institute of Scientific and Technical Information of China (English)

    周敏; 陈竹; 曾义岚; 何克静; 黄海霞

    2015-01-01

    Objective To investigate the effects and time of interventions to prevent HIV motherto- child transmission. Methods Total of 126 pregnant women infected with HIV from January 2010 to June 2013 in our hospital were divided into three groups according to the time of antiretroviral therapy, including pregnancy-treated group, prenatal-treated group and un-treated group. Moreover, pregnancy-treated group was divided into early-pregnancy-treated group and late-pregnancy-treated group. All patients were given triple highly active antiretroviral therapy (HAART), safety delivery, artificial feeding and other integrated intervention measures. Adverse pregnancy outcomes, newborn’s adverse outcomes and effects of motherinfant block were analyzed, respectively. Results The rate of adverse pregnancy outcomes in pregnancytreated group (3.95%, 3/74) was significantly lower than prenatal-treated group (20.00%, 8/45) and un-treated group (42.86%, 3/7) (χ2 = 14.448, P < 0.05). The rate of newborn’s adverse outcomes in pregnancy-treated group (20.00%, 8/45) was also significantly lower than prenatal-treated group (22.22%, 10/45) and un-treated group (50.00%, 3/6) (χ2 = 8.742, P < 0.05). Among 82 cases of survived infants followed-up, no HIV infection in pregnancy-treated group. While, the infection rate of infants in prenatal-treated group (9.68%, 3/31) was evidently lower than un-treated group (33.33%, 1/3) (χ2 = 9.235, P < 0.05). Furthermore, there was no significant differences in the rate of adverse pregnancy outcomes, newborn’s adverse outcomes and motherto- child transmission in early-pregnancy-treated group and late-pregnancy-treated group. Conclusions Pregnancy outcomes and newborn’s prognosis in HIV-infected mother treated during pregnancy were better than those prenatal-treated or un-treated, which are closely related to the time of starting HAART. HAART seems to have not obvious side effects on newborn’s growth and development.%目的:探讨妊娠合并HIV

  8. Antiretroviral treatment, viral load of mothers & perinatal HIV transmission in Mumbai, India

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    Swati P Ahir

    2013-01-01

    Full Text Available Background & objectives: Mother-to-child transmission (MTCT is the most significant route of HIV transmission in children below the age of 15 yr. In India, perinatal HIV transmission, even after treatment, accounts for 5.4 per cent of HIV cases. The present study was conducted to evaluate the efficacy of anti-retro viral therapy (ART or prophylactic treatment (PT to control maternal viral load in HIV positive women, and its effect on vertical HIV transmission to their infants. Methods: A total of 58 HIV positive women were enrolled at the time of delivery and their plasma samples were obtained within 24 h of delivery for estimation of viral load. Viral load analysis was completed in 38 women. Infants received single dose nevirapine within 2 h of birth and zidovudine for 6 wk. At the end of 18 month follow up, HIV positive or negative status was available in 28 infants. Results: Results revealed undetectable levels of viral load in 58.3 per cent of women with ART compared to 30.7 per cent of women with PT. No women on ART had viral load more than 10,000 copies/ml, whereas seven (26.9%, P=0.07 women receiving PT had this viral load. Median CD4 count of women on PT (483 cells/μl was high compared to the women on ART (289 cells/ μl. At the end of 18 months follow up, only two children were HIV positive, whose mothers were on PT. One had in utero transmission; infection detected within 48 h of delivery, while the other child was infected post partum as HIV was detected at six months follow up. Interpretation & conclusions: Women who received a single dose of nevirapine during delivery had higher levels of viral load than women on ART. Combination drug therapy for pregnant women is now a standard of care in most of the western countries; use of nevirapine monotherapy at the time of delivery in our settings is not effective in controlling viral load. This highlights initiation of ART in pregnant women to control their viral load and thus to inhibit

  9. Comparison of anti-retroviral therapy treatment strategies in prevention of mother-to-child transmission in a teaching hospital in Ethiopia

    OpenAIRE

    Kumela K; Amenu D; Chelkeba L

    2015-01-01

    Background: More than 90% of Human immunodeficiency virus (HIV) infection in children is acquired due to mother-to-child transmission, which is spreading during pregnancy, delivery or breastfeeding. Objective: To determine the effectiveness of highly active antiretroviral and short course antiretroviral regimens in prevention of mother-to-child transmission of HIV and associated factors Jimma University Specialized Hospital (JUSH). Method: A hospital based retrospective cohort study w...

  10. The virus stops with me: HIV-infected Ugandans' motivations in preventing HIV transmission.

    Science.gov (United States)

    King, Rachel; Lifshay, Julie; Nakayiwa, Sylvia; Katuntu, David; Lindkvist, Pille; Bunnell, Rebecca

    2009-02-01

    Few Positive Prevention interventions have been implemented in Africa; however, greater attention is now being paid to interventions that include messages of personal responsibility or altruism that may motivate HIV-infected individuals towards HIV prevention behaviors in Africa. We conducted 47 in-depth interviews in 2004 with HIV-infected men and women purposefully sampled to represent a range of sexual activities among clients of an AIDS support organization in Uganda. Qualitative interviews were selected from a cross-sectional survey of 1092 HIV-infected men and women. Clients were interviewed about their concerns around sexual HIV transmission, feelings of responsibility and reasons for these feelings, as well as about the challenges and consequences of actions to prevent HIV transmission. The reasons they provided for their sense of prevention responsibility revolved around ethical and practical themes. Responsibility toward sexual partners was linked to the belief that conscious transmission of HIV equals murder, would cause physical and emotional harm, and would leave children orphaned. The primary reason specific to preventing HIV transmission to unborn children was the perception that they are 'innocent'. Most participants felt that HIV-infected individuals held a greater responsibility for preventing HIV transmission than did HIV-uninfected individuals. Respondents reported that their sense of responsibility lead them to reduce HIV transmission risk, encourage partner testing, disclose HIV test results, and assume an HIV/AIDS educator role. Challenges to HIV preventive behavior and altruistic intentions included: sexual desire; inconsistent condom use, especially in long term relationships; myths around condom use; fear of disclosure; gender-power dynamics; and social and financial pressure. Our finding that altruism played an important role in motivating preventive behaviors among HIV-infected persons in Uganda supports the inclusion of altruistic

  11. A post-partum single-dose TDF/FTC tail does not prevent the selection of NNRTI resistance in women receiving pre-partum ZDV and intrapartum single-dose nevirapine to prevent mother-to- child HIV-1 transmission.

    Science.gov (United States)

    Samuel, Reshmi; Paredes, Roger; Parboosing, Raveen; Moodley, Pravi; Singh, Lavanya; Naidoo, Anneta; Gordon, Michelle

    2015-10-01

    Although the rates of vertical transmission of HIV in the developing world have improved to around 3% in countries like South Africa, resistance to antiretrovirals (ARV) used in Prevention of Mother-to-Child transmission (pMTCT) strategies may thwart such outcomes and affect the efficacy of future ARV regimens in mothers and children. This study conducted in Durban, South Africa, between 2010 and 2013 found a high rate of nevirapine (NVP) resistance among women receiving Zidovudine (AZT) from 14 weeks gestation, single dose nevirapine (sd NVP) at the onset of labor and a single dose of coformulated Tenofovir/Emtricitabine (TDF/FTC) postpartum. Using Sanger sequencing, high and intermediate levels of nevirapine (NVP) resistance were detected in 15/44 (34%) and in 1/44 (2%) of women tested, respectively. Most subjects selected the K103N mutation (22% (10/45) of all patients and 66% (10/15) of those with high-level NVP resistance). Such rate of NVP resistance is comparable to studies where only sd NVP was used. In conclusion, a post-partum single-dose TDF/FTC tail does not prevent the selection of NNRTI resistance in women receiving pre-partum ZDV and intrapartum sd NVP to prevent mother-to-child HIV-1 transmission. PMID:25940687

  12. HIV transmission in a state prison system, 1988-2005.

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    Krishna Jafa

    Full Text Available INTRODUCTION: HIV prevalence among state prison inmates in the United States is more than five times higher than among nonincarcerated persons, but HIV transmission within U.S. prisons is sparsely documented. We investigated 88 HIV seroconversions reported from 1988-2005 among male Georgia prison inmates. METHODS: We analyzed medical and administrative data to describe seroconverters' HIV testing histories and performed a case-crossover analysis of their risks before and after HIV diagnosis. We sequenced the gag, env, and pol genes of seroconverters' HIV strains to identify genetically-related HIV transmission clusters and antiretroviral resistance. We combined risk, genetic, and administrative data to describe prison HIV transmission networks. RESULTS: Forty-one (47% seroconverters were diagnosed with HIV from July 2003-June 2005 when voluntary annual testing was offered. Seroconverters were less likely to report sex (OR [odds ratio] = 0.02, 95% CI [confidence interval]: 0-0.10 and tattooing (OR = 0.03, 95% CI: <0.01-0.20 in prison after their HIV diagnosis than before. Of 67 seroconverters' specimens tested, 33 (49% fell into one of 10 genetically-related clusters; of these, 25 (76% reported sex in prison before their HIV diagnosis. The HIV strains of 8 (61% of 13 antiretroviral-naïve and 21 (40% of 52 antiretroviral-treated seroconverters were antiretroviral-resistant. DISCUSSION: Half of all HIV seroconversions were identified when routine voluntary testing was offered, and seroconverters reduced their risks following their diagnosis. Most genetically-related seroconverters reported sex in prison, suggesting HIV transmission through sexual networks. Resistance testing before initiating antiretroviral therapy is important for newly-diagnosed inmates.

  13. Impact of being informed of HIV sero-status on the utilization of mother-to-child HIV transmission prevention services before or after pregnancy%妊娠前后获知HIV感染对预防母婴传播干预措施利用的影响

    Institute of Scientific and Technical Information of China (English)

    王芳; 方利文; 王临虹; 王前; 王潇滟; 乔亚萍

    2010-01-01

    目的 探讨妇女妊娠前后获知HIV感染对预防母婴传播(PMTCT)干预措施利用的影响.方法 前瞻性调查了2005-2009年河南、广西、云南、新疆四省(自治区)确认HIV感染的孕产妇5552例,5894人次妊娠,了解其社会人口学特征(将调查对象分为15~、25~、35~49岁3个年龄段),以及确认感染的时期、妊娠结局、艾滋病抗病毒药物应用等PMTCT干预措施的实施.采用单因素和非条件logistic多因素回归模型对HIV感染孕产妇实施PMTCT干预措施的影响因素进行分析.结果 HIV感染孕产妇84.5%(4979/5894)年龄在35岁以下,56.0%(3108/5552)为汉族,85.1%(4727/5552)为农民或无业,86.8%(4815/5552)为初中或以下文化程度,31.2%(1836/5894)的感染孕产妇在妊娠前已知HIV感染.31.7%(1869/5894)的HIV感染孕产妇选择人工终止妊娠,妊娠前已知感染者终止妊娠的比例高达43.8%(805/1836).80.0%(3046/3808)分娩的HIV感染孕产妇应用抗病毒药物,92.3%(883/957)的妊娠前已知感染者应用抗病毒药物,远高于当次妊娠才明确感染者[75.9%(2163/2851);x2=120.39,P<0.05].多变量分析结果显示,妊娠前已知感染较妊娠前未知感染(OR=3.91,95%CI:3.03~5.05)、15~岁年龄段较35~49岁年龄段(OR=0.75,95%CI:0.57~0.98)的HIV感染孕产妇抗病毒药物应用比例较高.结论 妊娠前已知HIV感染有利于感染孕产妇尽早接受抗病毒药物应用等预防母婴传播的干预措施.%Objective To explore the impact of being informed of HIV infection before or after pregnancy on the prevention of mother-to-child transmission (PMTCT) HIV interventions uptake. Methods From 2005 to 2009, a tatal of 5552 HIV-infected pregnant women and their 5894 pregnancies in Henan,Guangxi,Yunnan and Xinjiang province were investigated using the method of a cohort study. The socialdemographic characters ( the objects were divided three age groups 15 -, 25 -, 35 - 49 ), the period identified to be HIV positive

  14. Mother-to-Child Transmission of Chagas Disease in El Salvador.

    Science.gov (United States)

    Sasagawa, Emi; Aiga, Hirotsugu; Corado Soriano, Edith Yanira; Cuyuch Marroquín, Blanca Leticia; Hernández Ramírez, Marta Alicia; Guevara de Aguilar, Ana Vilma; Romero Chévez, José Eduardo; Ramos Hernández, Hector Manuel; Cedillos, Rafael Antonio; Misago, Chizuru; Kita, Kiyoshi

    2015-08-01

    To estimate the incidence (any mother to child) and rate (from seropositive mother to child) of mother-to-child transmission of Trypanosoma cruzi, a serological census was conducted, targeting pregnant women and infants born to seropositive mothers, in four municipalities of El Salvador. Of 943 pregnant women, 36 (3.8%) were seropositive for T. cruzi. Of 36, 32 proceeded to serological tests of their infants when they became 6-8 months of age. Six infants seropositive at the age of 6-8 months further proceeded to second-stage serological test at the age of 9-16 months. As the result, one infant was congenitally infected. Thus, serological tests at the age of 6-8 months produced five false positives. To ensure earlier effective medication only for true positives, identification of seropositive infants at the age of 9-16 months is crucial. Incidence and rate of mother-to-child transmission were 0.14 (per 100 person-years) and 4.0%, respectively. Estimated number of children infected through mother-to-child transmission in El Salvador (170 per year) was much higher than that of human immunodeficiency virus (HIV; seven per year). It is recommended that serological testing for T. cruzi be integrated into those for HIV and syphilis as part of antenatal care package.

  15. Invitation cards during pregnancy enhance male partner involvement in prevention of mother to child transmission (PMTCT of human immunodeficiency virus (HIV in Blantyre, Malawi: a randomized controlled open label trial.

    Directory of Open Access Journals (Sweden)

    Alinane Linda Nyondo

    Full Text Available Male involvement (MI is vital for the uptake of Prevention of Mother to Child Transmission (PMTCT of Human Immunodeficiency Virus (HIV interventions. Partner notification (PN is among the strategies identified for MI in PMTCT services. The purpose of this randomized controlled trial was to evaluate the efficacy of an invitation card to the male partners as a strategy for MI in PMTCT services by comparing the proportion of pregnant women that were accompanied by their partners between the intervention and the non-intervention study groups.Pregnant women attending antenatal care without a male partner at South Lunzu and Mpemba health centres in Blantyre, Malawi, were enrolled in the study from June to December 2013. In an intention-to-treat analysis, we compared all participants that were randomized in the invitation card group with the standard of care (SoC group. Risk ratios (RR with 95% confidence intervals (CI were computed to assess the efficacy of the invitation card.Of the 462 randomized women, 65/230 (28.26% of the women in the invitation card group reported to the antenatal care clinic with their partners compared to 44/232 (18.97% women in the SoC group. In an unadjusted intention-to-treat analysis women in the invitation card group were 50% more likely to be accompanied by their male partners than those in the SoC group RR: 1.49 (95% CI: 1.06-2.09; p = 0.02. Our random effects analysis showed that there was no clustering by site of recruitment with an inter cluster correlation coefficient (ICC of 1.98 x 10(-3, (95% CI: 1.78 x10(-7 - 0.96 x 10(-1; p =0.403.An invitation card significantly increased the proportion of women who were accompanied by their male partners for the PMTCT services. An invitation card is a feasible strategy for MI in PMTCT.

  16. Effects of HIV status notification on reducing the risk of sexual transmission of HIV in China

    Institute of Scientific and Technical Information of China (English)

    Bao Yugang; Jing Jun; Zhang Yanhui; Li Huasheng; Feng Liangui; Ning Zhen; Tan Hongzhuan

    2014-01-01

    Background The risk of HIV sexual transmission is much higher among people unaware of their HIV status than among those aware.Only a few studies have indicated that the incidence of unsafe sex can be reduced when people know their HIV status.This study was to investigate this effect in China.Methods A cohort study consisting of two surveys was conducted at two different times among a group of people living with HIV/AIDS,whose status was newly diagnosed with HIV via sexual contact,in Shanghai,Chongqing,and Kunming.The first survey was conducted among 823 people tested positive for HIV before notifying them of the HIV status.The second survey was conducted among 650 HIV-positive people at six months following the first survey (after notification of HIV status).The scope of survey covered unsafe sex practices,number of unsafe sexual partners,and frequency of unsafe sexual behaviors over the prior six months.Unsafe sex is defined as unprotected anal or vaginal sex with partners who are HIV positive or whose HIV status is unknown.Results The proportion of unsafe sex was reduced by about 85% after HIV status notification.The risk of HIV sexual transmission was 15 times higher among persons unaware of their HIV status than among those aware.Approximately 95% of new sexually transmitted HIV infections stemmed from 56% of the infected persons unaware of their HIV status in China.Conclusion Timely HIV status notification has the potential to significantly reduce unsafe sex among HIV-infected persons and reduce the risk for HIV transmission via unsafe sex.

  17. Contraceptive methods and risk of HIV acquisition or female-to-male transmission.

    Science.gov (United States)

    Haddad, Lisa B; Polis, Chelsea B; Sheth, Anandi N; Brown, Jennifer; Kourtis, Athena P; King, Caroline; Chakraborty, Rana; Ofotokun, Igho

    2014-12-01

    Effective family planning with modern contraception is an important intervention to prevent unintended pregnancies which also provides personal, familial, and societal benefits. Contraception is also the most cost-effective strategy to reduce the burden of mother-to-child HIV transmission for women living with HIV who wish to prevent pregnancy. There are concerns, however, that certain contraceptive methods, in particular the injectable contraceptive depot medroxyprogesterone acetate (DMPA), may increase a woman's risk of acquiring HIV or transmitting it to uninfected males. These concerns, if confirmed, could potentially have large public health implications. This paper briefly reviews the literature on use of contraception among women living with HIV or at high risk of HIV infection. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) recommendations place no restrictions on the use of hormonal contraceptive methods by women with or at high risk of HIV infection, although a clarification recommends that, given uncertainty in the current literature, women at high risk of HIV who choose progestogen-only injectable contraceptives should be informed that it may or may not increase their risk of HIV acquisition and should also be informed about and have access to HIV preventive measures, including male or female condoms.

  18. Group Intervention to Reduce HIV Transmission Risk Behavior Among Persons Living With HIV/AIDS

    Science.gov (United States)

    Kalichman, Seth C.; Rompa, David; Cage, Marjorie

    2005-01-01

    Results of a randomized controlled trial show that a behavioral intervention grounded in social cognitive theory reduces unprotected sexual behaviors among men and women living with HIV infection, with the greatest reductions in HIV transmission risk behaviors occurring with non-HIV-positive sex partners. In this article, the authors describe the…

  19. Mucosal transmission of HIV-1: first stop dendritic cells.

    Science.gov (United States)

    Wilkinson, John; Cunningham, Anthony L

    2006-12-01

    Worldwide the heterosexual route is the prevalent mode of transmission of HIV, increasing the demand for measures that block the sexual spread of HIV infection. Vaccines designed to prevent mucosal transmission of HIV should be considered a component of vaccine strategies against HIV (in addition to cytotoxic T cells required for clearance and to prevent viral dissemination) and include antibodies, which are capable of blocking HIV entry at mucosal epithelial barriers, and prevent initial infection of target cells in the mucosa. However, in the interim and in the absence of an effective vaccine, the development of microbicides, topical preparations that block the early steps of HIV infection and transmission, may represent a more viable alternative to condom use in many HIV infected regions of the world especially by empowering women. To date there has been some success with antiviral antibodies applied as a microbicide capable of preventing SIV infection in macaques and reports of vaccines capable of preventing intravaginal and intrarectal inoculated SIV. However, for such success in humans a much greater understanding of the mechanisms involved in the very early stages of mucosal transmission in HIV infection are required. These may lead to additional strategies to inactivate or inhibit viral uptake and replication before a potentially life threatening acute infection develops. Such measures will lead to the development of effective microbicides and vaccines that will diminish the global spread of HIV. PMID:17168831

  20. EFFECT OF HIV PREVENTION AND TREATMENT PROGRAM ON HIV AND HCV TRANSMISSION AND HIV MORTALITY AT AN INDONESIAN NARCOTIC PRISON.

    Science.gov (United States)

    Nelwan, Erni J; Indrati, Agnes K; Isa, Ahmad; Triani, Nurlita; Alam, Nisaa Nur; Herlan, Maria S; Husen, Wahid; Pohan, Herdiman T; Alisjahbana, Bachti; Meheus, Andre; Van Crevel, Reinout; van der Ven, Andre Jam

    2015-09-01

    Validated data regarding HIV-transmission in prisons in developing countries is scarce. We examined sexual and injecting drug use behavior and HIV and HCV transmission in an Indonesian narcotic prison during the implementation of an HIV prevention and treatment program during 2004-2007 when the Banceuy Narcotic Prison in Indonesia conducted an HIV transmission prevention program to provide 1) HIV education, 2) voluntary HIV testing and counseling, 3) condom supply, 4) prevention of rape and sexual violence, 5) antiretroviral treatment for HIV-positive prisoners and 6) methadone maintenance treatment. During a first survey that was conducted between 2007 and 2009, new prisoners entered Banceuy Narcotics Prison were voluntary tested for HIV and HCV-infection after written informed consent was obtained. Information regarding sexual and injecting risk behavior and physical status were also recorded at admission to the prison. Participants who tested negative for both HIV and HCV during the first survey were included in a second survey conducted during 2008-2011. During both surveys, data on mortality among HIV-seropositive patients were also recorded. All HIV-seropositive participants receive treatment for HIV. HIV/ AIDS-related deaths decreased: 43% in 2006, 18% in 2007, 9% in 2008 and 0% in 2009. No HIV and HCV seroconversion inside Banceuy Narcotic Prison were found after a median of 23 months imprisonment (maximum follow-up: 38 months). Total of 484.8 person-years observation was done. Participants reported HIV transmission risk-behavior in Banceuy Prison during the second survey was low. After implementation of HIV prevention and treatment program, no new HIV or HCV cases were detected and HIV-related mortality decreased. PMID:26863859

  1. Counselling services in prevention of mother-to-child transmission (PMTCT) in Delhi, India: an assessment through a modified version of UNICEF-PPTCT tool.

    Science.gov (United States)

    Kumar, Arvind; Singh, Bir; Kusuma, Yadlapalli S

    2015-03-01

    The study aims to assess the counselling services provided to prevent mother to child transmission of HIV (PMTCT) under the Indian programme of prevention of parent-to-child transmission of HIV (PPTCT). Five hospitals in Delhi providing PMTCT services were randomly selected. A total of 201 post-test counselled women were interviewed using a modified version of the UNICEF-PPTCT evaluation tool. Knowledge about HIV transmission from mother-to-child was low. Post-test counselling mainly helped in increasing the knowledge of HIV transmission; yet 20%-30% of the clients missed this opportunity. Discussion on window period, other sexually transmitted diseases and danger signs of pregnancy were grossly neglected. The PMTCT services during the antenatal period are feasible and agreeable to be provided; however, certain aspects, like lack of privacy, confidentiality of HIV status of the client, counsellor's 'hurried' attitude, communication skills and discriminant behaviour towards HIV-positive clients, and disinterest of clients in the counselling, remain as gaps. These issues may be addressed through refresher training to counsellors with an emphasis on social and behaviour change communication strategies. Addressing attitudinal aspects of the counsellors towards HIV positives is crucial to improve the quality of the services to prevent mother-to-child transmission of HIV.

  2. Counselling services in prevention of mother-to-child transmission (PMTCT) in Delhi, India: an assessment through a modified version of UNICEF-PPTCT tool.

    Science.gov (United States)

    Kumar, Arvind; Singh, Bir; Kusuma, Yadlapalli S

    2015-03-01

    The study aims to assess the counselling services provided to prevent mother to child transmission of HIV (PMTCT) under the Indian programme of prevention of parent-to-child transmission of HIV (PPTCT). Five hospitals in Delhi providing PMTCT services were randomly selected. A total of 201 post-test counselled women were interviewed using a modified version of the UNICEF-PPTCT evaluation tool. Knowledge about HIV transmission from mother-to-child was low. Post-test counselling mainly helped in increasing the knowledge of HIV transmission; yet 20%-30% of the clients missed this opportunity. Discussion on window period, other sexually transmitted diseases and danger signs of pregnancy were grossly neglected. The PMTCT services during the antenatal period are feasible and agreeable to be provided; however, certain aspects, like lack of privacy, confidentiality of HIV status of the client, counsellor's 'hurried' attitude, communication skills and discriminant behaviour towards HIV-positive clients, and disinterest of clients in the counselling, remain as gaps. These issues may be addressed through refresher training to counsellors with an emphasis on social and behaviour change communication strategies. Addressing attitudinal aspects of the counsellors towards HIV positives is crucial to improve the quality of the services to prevent mother-to-child transmission of HIV. PMID:25700918

  3. HIV-1 transmission linkage in an HIV-1 prevention clinical trial

    Energy Technology Data Exchange (ETDEWEB)

    Leitner, Thomas [Los Alamos National Laboratory; Campbell, Mary S [UNIV OF WASHINGTON; Mullins, James I [UNIV OF WASHINGTON; Hughes, James P [UNIV OF WASHINGTON; Wong, Kim G [UNIV OF WASHINGTON; Raugi, Dana N [UNIV OF WASHINGTON; Scrensen, Stefanie [UNIV OF WASHINGTON

    2009-01-01

    HIV-1 sequencing has been used extensively in epidemiologic and forensic studies to investigate patterns of HIV-1 transmission. However, the criteria for establishing genetic linkage between HIV-1 strains in HIV-1 prevention trials have not been formalized. The Partners in Prevention HSV/HIV Transmission Study (ClinicaITrials.gov NCT00194519) enrolled 3408 HIV-1 serodiscordant heterosexual African couples to determine the efficacy of genital herpes suppression with acyclovir in reducing HIV-1 transmission. The trial analysis required laboratory confirmation of HIV-1 linkage between enrolled partners in couples in which seroconversion occurred. Here we describe the process and results from HIV-1 sequencing studies used to perform transmission linkage determination in this clinical trial. Consensus Sanger sequencing of env (C2-V3-C3) and gag (p17-p24) genes was performed on plasma HIV-1 RNA from both partners within 3 months of seroconversion; env single molecule or pyrosequencing was also performed in some cases. For linkage, we required monophyletic clustering between HIV-1 sequences in the transmitting and seroconverting partners, and developed a Bayesian algorithm using genetic distances to evaluate the posterior probability of linkage of participants sequences. Adjudicators classified transmissions as linked, unlinked, or indeterminate. Among 151 seroconversion events, we found 108 (71.5%) linked, 40 (26.5%) unlinked, and 3 (2.0%) to have indeterminate transmissions. Nine (8.3%) were linked by consensus gag sequencing only and 8 (7.4%) required deep sequencing of env. In this first use of HIV-1 sequencing to establish endpoints in a large clinical trial, more than one-fourth of transmissions were unlinked to the enrolled partner, illustrating the relevance of these methods in the design of future HIV-1 prevention trials in serodiscordant couples. A hierarchy of sequencing techniques, analysis methods, and expert adjudication contributed to the linkage

  4. Prevention of vertical transmission of HIV in Denmark

    DEFF Research Database (Denmark)

    Rasmussen, M.B.; Rasmussen, J.B.; Nielsen, V.R.;

    2008-01-01

    was to describe vertical transmission of HIV in Denmark after the introduction of ART. MATERIALS AND METHODS: The study was a retrospective study of all HIV-infected women who gave birth in Denmark between 1 January 2000 and 31 May 2005 and their children. RESULTS: 83 HIV-infected women gave birth to 96 children...... during the study period. In 79% of the cases, the woman knew her HIV status at the beginning of her pregnancy. The median CD4 count before delivery was 447 x 10(6)/l, and in 76% of the cases the HIV-RNA was Caesarean section. None of the children were...... breastfed. None of the children were infected during pregnancy, delivery or after birth. During the same period of time, 8 children were diagnosed with HIV in Denmark; they were born to mothers whose HIV infection was not diagnosed during pregnancy or delivery and therefore preventive treatment...

  5. Grappling with HIV transmission risks: narratives of rural women in eastern Kenya living with HIV.

    Science.gov (United States)

    Kako, Peninnah M; Stevens, Patricia E; Karani, Anna K; Mkandawire-Valhmu, Lucy; Banda, Anne

    2012-01-01

    As people live longer and more productively with HIV infection, issues of agency in reducing HIV risk are particularly important for HIV-infected women living in high prevalence, underresourced countries such as Kenya. Because of their gendered lives, in that being masculine is associated with dominance and being feminine is associated with passiveness, women in rural Kenya must cope with continued HIV transmission risk even after knowing they are infected with HIV. In this narrative interview study, informed by theories of gender and postcolonial feminism, we examined personal accounts of HIV risk and risk reduction of 20 rural women in eastern Kenya who were living with HIV. From our analysis of the women's narratives, two major themes emerged: gender-based obstacles even in the context of a known HIV diagnosis, and struggles with economic pressures amid HIV risks. Implications for policy, programs, and research are discussed. PMID:22137546

  6. Linking anthropological analysis and epidemiological evidence: formulating a narrative of HIV transmission in Acholiland of northern Uganda.

    Science.gov (United States)

    Westerhaus, M

    2007-08-01

    For twenty years, a region of northern Uganda known as Acholiland has been heavily affected by war, leading to the formation of internally displaced people's camps, rape, transactional sex and child abductions. While it is clear that the war has had onerous consequences for the health of the Acholi people, the specific impact of the war on HIV transmission remains unclear, as the epidemiological evidence presents an ambiguous picture of HIV prevalence patterns. Other than a few non-governmental organization reports, very little qualitative data exists about the impact of HIV on the Acholi population. Attempting to formulate a clearer narrative of HIV transmission in Acholiland, this paper jointly analyses the historical and political context of the Acholi people and the war, the epidemiologic evidence of HIV prevalence patterns, and the ethnographic perspectives of Acholi healthcare workers and patients living with HIV/AIDS. Juxtaposing these sources of information allows for the emergence of a rich understanding of HIV in Acholiland. It is argued that three specific forms of violence--physical, symbolic and structural--create vulnerability to HIV infection in Acholiland, although to variable degrees dependent on location. The ethnographic evidence presented regarding HIV's impact on Acholiland suggests that an incorporation of historical, political, cultural and social factors must form the backbone of efforts both to understand HIV transmission and design strategies for curbing the epidemic in war settings.

  7. Vertical human immunodeficiency virus type 1 - HIV-1 -transmission - a review

    Directory of Open Access Journals (Sweden)

    Vera Bongertz

    2001-01-01

    Full Text Available Several factors appear to affect vertical HIV-1 transmission, dependent mainly on characteristics of the mother (extent of immunodeficiency, co-infections, risk behaviour, nutritional status, immune response, genetical make-up, but also of the virus (phenotype, tropism and, possibly, of the child (genetical make-up. This complex situation is compounded by the fact that the virus may have the whole gestation period, apart from variable periods between membrane rupture and birth and the breast-feeding period, to pass from the mother to the infant. It seems probable that an extensive interplay of all factors occurs, and that some factors may be more important during specific periods and other factors in other periods. Factors predominant in protection against in utero transmission may be less important for peri-natal transmission, and probably quite different from those that predominantly affect transmission by mothers milk. For instance, cytotoxic T lymphocytes will probably be unable to exert any effect during breast-feeding, while neutralizing antibodies will be unable to protect transmission by HIV transmitted through infected cells. Furthermore, some responses may be capable of controlling transmission of determined virus types, while being inadequate for controlling others. As occurence of mixed infections and recombination of HIV-1 types is a known fact, it does not appear possible to prevent vertical HIV-1 transmission by reinforcing just one of the factors, and probably a general strategy including all known factors must be used. Recent reports have brought information on vertical HIV-1 transmission in a variety of research fields, which will have to be considered in conjunction as background for specific studies.

  8. HIV screening during pregnancy and the prevention of mother-to-child HIV vertical transmission%人类免疫缺陷病毒感染孕期筛查及母婴垂直传播的预防

    Institute of Scientific and Technical Information of China (English)

    孙丽洲; 陈炳兰

    2010-01-01

    人类免疫缺陷病毒(HIV)的母婴垂直传播是儿童感染HIV的主要原因.母婴垂直传播可发生于3个关键时期:孕期、产时及产后哺乳过程.孕期筛查出HIV阳性孕妇,并采取综合阻断措施--抗逆转录病毒药物应用、选择性剖宫产和人工喂养等,对于有效降低HIV母婴垂直传播具有重要意义.

  9. Ending the Epidemic of Heterosexual HIV Transmission Among African Americans

    Science.gov (United States)

    Adimora, Adaora A.; Schoenbach, Victor J.; Floris-Moore, Michelle A.

    2014-01-01

    This article examines factors responsible for the stark racial disparities in HIV infection in the U.S. and the now concentrated epidemic among African Americans. Sexual network patterns characterized by concurrency and mixing among different subpopulations, together with high rates of other sexually transmitted infections, facilitate dissemination of HIV among African Americans. The social and economic environment in which many African Americans live shapes sexual network patterns and increases personal infection risk almost independently of personal behavior. The African American HIV epidemic constitutes a national crisis whose successful resolution will require modifying the social and economic systems, structures, and processes that facilitate HIV transmission in this population. PMID:19840704

  10. Emergence of minor drug-resistant HIV-1 variants after triple antiretroviral prophylaxis for prevention of vertical HIV-1 transmission.

    Directory of Open Access Journals (Sweden)

    Andrea Hauser

    Full Text Available BACKGROUND: WHO-guidelines for prevention of mother-to-child transmission of HIV-1 in resource-limited settings recommend complex maternal antiretroviral prophylaxis comprising antenatal zidovudine (AZT, nevirapine single-dose (NVP-SD at labor onset and AZT/lamivudine (3TC during labor and one week postpartum. Data on resistance development selected by this regimen is not available. We therefore analyzed the emergence of minor drug-resistant HIV-1 variants in Tanzanian women following complex prophylaxis. METHOD: 1395 pregnant women were tested for HIV-1 at Kyela District Hospital, Tanzania. 87/202 HIV-positive women started complex prophylaxis. Blood samples were collected before start of prophylaxis, at birth and 1-2, 4-6 and 12-16 weeks postpartum. Allele-specific real-time PCR assays specific for HIV-1 subtypes A, C and D were developed and applied on samples of mothers and their vertically infected infants to quantify key resistance mutations of AZT (K70R/T215Y/T215F, NVP (K103N/Y181C and 3TC (M184V at detection limits of <1%. RESULTS: 50/87 HIV-infected women having started complex prophylaxis were eligible for the study. All women took AZT with a median duration of 53 days (IQR 39-64; all women ingested NVP-SD, 86% took 3TC. HIV-1 resistance mutations were detected in 20/50 (40% women, of which 70% displayed minority species. Variants with AZT-resistance mutations were found in 11/50 (22%, NVP-resistant variants in 9/50 (18% and 3TC-resistant variants in 4/50 women (8%. Three women harbored resistant HIV-1 against more than one drug. 49/50 infants, including the seven vertically HIV-infected were breastfed, 3/7 infants exhibited drug-resistant virus. CONCLUSION: Complex prophylaxis resulted in lower levels of NVP-selected resistance as compared to NVP-SD, but AZT-resistant HIV-1 emerged in a substantial proportion of women. Starting AZT in pregnancy week 14 instead of 28 as recommended by the current WHO-guidelines may further increase

  11. Surveillance of mother-to-child HIV transmission: socioeconomic and health care coverage indicators Vigilância da transmissão vertical do HIV: indicadores socioeconômicos e de cobertura de atenção à saúde

    Directory of Open Access Journals (Sweden)

    Christovam Barcellos

    2009-12-01

    TODOS: Estudo ecológico tendo como unidade de análise as áreas de abrangência de unidades básicas de saúde em Porto Alegre, RS, em 2003. Foram utilizados Sistema de Informações Geográficas e ferramentas de análise espacial para calcular indicadores de cobertura da atenção básica à saúde, condições socioeconômicas e prevalência de nascidos vivos expostos ao HIV durante a gravidez e perinatal. Os dados analisados foram obtidos em sistemas de informação nacionais. A associação entre os diferentes indicadores foi avaliada por meio de teste não-paramétrico de Spearman. RESULTADOS: Observou-se associação entre infecção pelo HIV em gestantes com taxas de natalidade (r=0,22, p<0,01 e falta de assistência pré-natal (r=0,15, p<0,05. As maiores taxas de infecção por HIV em gestantes foram verificadas em áreas com piores condições socioeconômicas e dificuldades de acesso a serviços de saúde (r=0,28, p<0,01. No entanto, a relação observada entre a maior freqüência de assistência pré-natal entre gestantes HIV positivas e maior cobertura vacinal nas áreas (r=0,35, p<0,01 indica a capacidade de detecção precoce da infecção pelo HIV em áreas com melhores serviços de atenção básica. CONCLUSÕES: A pobreza urbana representa um forte condicionante da transmissão vertical do HIV mas a atuação de serviços de vigilância em saúde articulados com a atenção básica podem vencer essa tendência.

  12. HIV-1 transmission during early antiretroviral therapy: evaluation of two HIV-1 transmission events in the HPTN 052 prevention study.

    Directory of Open Access Journals (Sweden)

    Li-Hua Ping

    Full Text Available In the HPTN 052 study, transmission between HIV-discordant couples was reduced by 96% when the HIV-infected partner received suppressive antiretroviral therapy (ART. We examined two transmission events where the newly infected partner was diagnosed after the HIV-infected partner (index initiated therapy. We evaluated the sequence complexity of the viral populations and antibody reactivity in the newly infected partner to estimate the dates of transmission to the newly infected partners. In both cases, transmission most likely occurred significantly before HIV-1 diagnosis of the newly infected partner, and either just before the initiation of therapy or before viral replication was adequately suppressed by therapy of the index. This study further strengthens the conclusion about the efficacy of blocking transmission by treating the infected partner of discordant couples. However, this study does not rule out the potential for HIV-1 transmission to occur shortly after initiation of ART, and this should be recognized when antiretroviral therapy is used for HIV-1 prevention.

  13. 驻马店市2001-2009年预防艾滋病母婴传播干预工作分析%Analysis of prevention of mother-to-child transmission of HIV(PMTCT) work in Zhnmadian city,2001-2009

    Institute of Scientific and Technical Information of China (English)

    王复昆; 聂勇; 刘建; 侯振华; 焦秀珍; 李召文

    2009-01-01

    Objective To analyze the current status of maternal HIV infection, mother to child transmission,and the work accomplishments in preventing mother-to-child transmission of HIV (PMTCT). Methods During October,2001 to May,2009,HIV voluntary consultation and examination were carried out in 339 866 pregnant women in the urban areas, while 594 pregnant women who tested positive were intervened, and interventions were also conducted among 326 babies who were born to HIV positive mothers, incluidng HIV immune body examination on the babies when they were 12 months and 18 months old. Results A total of 594 pregnant women were found HIV positive, with the positive rate of 0.17% (594/339 866). And the rate was declining year by year. The highest rate was 0.47% (37/7837) in 2002, and the lowest rate was 0.12% (86/73 343) in 2008. Of the 594 positive pregnant women,228(38.38%) terminated pregnancy voluntarily,43 (7.24%) kept on pregnancy and 317 (53.37%) parturients. Of 326 babies born by the 317 parturients, 317 survived. 298 received curbing intervention for mother to child transmission(PMTCT), the ratio was 94.01% (298/317). Of 224 babies who were 18 months old, 221 accepted examination, and 7 HIV positive. The maternal infant transmission rate after intervention was 3.17% (7/221). Conclusion Through the prevention of mother-to-child transmission of HIV, the HIV infection status in the pregnant women can be timely observed, which can effectively decrease the level of mother-to-child transmission of HIV.%目的 分析驻马店市开展预防艾滋病母婴传播干预工作以来,孕产妇人群中艾滋病病毒(HIV)感染情况和母婴传播情况及工作成效.方法 2001年10月-2009年5月,在全市孕产妇人群开展HIV自愿咨询与检测,共检测339 866名孕产妇;对检测过程中发现的594例HIV抗体阳性孕产妇进行综合干预,对其分娩的326名婴儿实施干预措施并在满12个月和18个月进行HIV抗体检测.结果 检测发现594例HIV

  14. Child-mother attachments in the face of grandparent HIV.

    Science.gov (United States)

    Ward, Mary J; Carlson, Elizabeth A; Lester, Patricia; Beckwith, Leila; Sigman, Marian; Rotheram-Borus, Mary Jane

    2016-10-01

    Child-mother attachment, as observed in the Strange Situation (SSP), was assessed in 61 families affected by HIV and 18 neighborhood comparison families not affected by HIV, but of similar ethnicity and socioeconomic status. Children were aged one to three years at the assessment. Secure attachment was significantly less likely among children in the HIV-affected group than among comparison group children (36% versus 67%). The most common pattern of attachment in the HIV-affected group was disorganized/disoriented, observed in 41% of children (versus 22% of comparison children). Children from families that included a surviving grandparent with HIV showed disorganized attachments more often than children whose grandparents died (53% versus 36%). Child attachment classifications were not associated with families' participation in a family-based, cognitive-behavioral HIV intervention. These results document the inter-generational impact of young mothers' who were growing up with an HIV-infected parent. These findings suggest that families affected by HIV may benefit from interventions that address attachment issues. PMID:27434834

  15. How ready are our health systems to implement prevention of mother to child transmission Option B+?

    Directory of Open Access Journals (Sweden)

    Palesa Nkomo

    2015-04-01

    Full Text Available In January 2015, the South African National Department of Health released new consolidated guidelines for the prevention of mother to child transmission (PMTCT of HIV, in line with the World Health Organization’s (WHO PMTCT Option B+. Implementing these guidelines should make it possible to eliminate mother to child transmission (MTCT of HIV and improve long-term maternal and infant outcomes. The present article summarises the key recommendations of the 2015 guidelines and highlights current gaps that hinder optimal implementation; these include late antenatal booking (as a result of poor staff attitudes towards ‘early bookers’ and foreigners, unsuitable clinic hours, lack of transport to facilities, quota systems being applied to antenatal clients and clinic staff shortages; poor compliance with rapid HIV testing protocols; weak referral systems with inadequate follow-up; inadequate numbers of laboratory staff to handle HIV-related monitoring procedures and return of results to the correct facility; and inadequate supply chain management, leading to interrupted supplies of antiretroviral drugs. Additionally, recommendations are proposed on how to address these gaps. There is a need to evaluate the implementation of the 2015 guidelines and proactively communicate with ground-level implementers to identify operational bottlenecks, test solutions to these bottlenecks, and develop realistic implementation plans.

  16. Creating an African HIV clinical research and prevention trials network: HIV prevalence, incidence and transmission.

    Directory of Open Access Journals (Sweden)

    Anatoli Kamali

    Full Text Available HIV epidemiology informs prevention trial design and program planning. Nine clinical research centers (CRC in sub-Saharan Africa conducted HIV observational epidemiology studies in populations at risk for HIV infection as part of an HIV prevention and vaccine trial network. Annual HIV incidence ranged from below 2% to above 10% and varied by CRC and risk group, with rates above 5% observed in Zambian men in an HIV-discordant relationship, Ugandan men from Lake Victoria fishing communities, men who have sex with men, and several cohorts of women. HIV incidence tended to fall after the first three months in the study and over calendar time. Among suspected transmission pairs, 28% of HIV infections were not from the reported partner. Volunteers with high incidence were successfully identified and enrolled into large scale cohort studies. Over a quarter of new cases in couples acquired infection from persons other than the suspected transmitting partner.

  17. HIV-exposed infants on follow up at a PMTCT clinic: risk of HIV transmission and its predictors in north-west Ethiopia

    Directory of Open Access Journals (Sweden)

    K Negesse

    2012-11-01

    Full Text Available Background: The HIV pandemic created an enormous challenge to the survival of mankind worldwide. Vertical HIV transmission from mother to child accounts for more than 90% of pediatric AIDS. Prevention of mother-to-child transmission (PMTCT programs are provided for dual benefits, i.e. prevention of HIV transmission from mother to child and enrolment of infected pregnant women and their families into antiretroviral treatment. The availability and use of short-course antiretroviral (ARV prophylaxis, a safe and well-tolerated regimen, can contribute significantly to PMTCT during childbirth. This study assessed risk and predictors of HIV transmission among HIV-exposed infants on follow up at a PMTCT clinic of a referral hospital. Methods: Institution-based retrospective follow-up study was carried out on all records of HIV-exposed infants enrolled between September 2005 and July 2011 at Gondar University Hospital PMTCT clinic. Secondary data were collected using a structured data extraction format prepared in English by a trained nurse working at the PMTCT clinic. Data were then entered in to EPI INFO Version 3.5.1 statistical software and analyzed by SPSS version 16.0. Both bivariate and multivariate analyses were carried out to identify variables that had association with vertical HIV transmission. Results: A total of 509 records were included in the analysis. The median age of infants at enrolment to follow up was 6 weeks (IQR=2 weeks. A total of 51 (10% infants were infected with HIV. Late enrolment to the exposed infant follow-up clinic (AOR=2.89, 95% CI: 1.35, 6.21, rural residence (AOR=5.05, 95% CI: 2.34, 10.9, delivery at home (AOR=2.82, 95% CI: 1.2, 6.64, absence of maternal PMTCT intervention (AOR=5.02, 95% CI: 2.43, 10.4 and mixed infant feeding practices (AOR=4.18, 95% CI: 1.59, 10.99 were significantly and independently associated with maternal-to-child HIV transmission. Conclusion: There is a high risk of MTCT of HIV among exposed

  18. Role of semen in HIV-1 transmission: inhibitor or facilitator?

    Science.gov (United States)

    Doncel, Gustavo F; Joseph, Theresa; Thurman, Andrea R

    2011-03-01

    Sexual transmission of human immunodeficiency virus type 1 (HIV-1) accounts for 60-90% of new infections, especially in developing countries. During male-to-female transmission, the virus is typically deposited in the vagina as cell-free and cell-associated virions carried by semen. But semen is more than just a carrier for HIV-1. Evidence from in vitro and in vivo studies supports both inhibitory and enhancing effects. Intrinsic antiviral activity mediated by cationic antimicrobial peptides, cytotoxicity, and blockage of HIV-dendritic cell interactions are seminal plasma properties that inhibit HIV-1 infection. On the contrary, neutralization of vaginal acidic pH, enhanced virus-target cell attachment by seminal amyloid fibrils, opsonization by complement fragments, and electrostatic interactions are factors that facilitate HIV-1 infection. The end result, i.e., inhibition or enhancement of HIV mucosal infection, in vivo, likely depends on the summation of all these biological effects. More research is needed, especially in animal models, to dissect the role of these factors and establish their relevance in HIV-1 transmission.

  19. Characterization of HIV Transmission in South-East Austria.

    Science.gov (United States)

    Hoenigl, Martin; Chaillon, Antoine; Kessler, Harald H; Haas, Bernhard; Stelzl, Evelyn; Weninger, Karin; Little, Susan J; Mehta, Sanjay R

    2016-01-01

    To gain deeper insight into the epidemiology of HIV-1 transmission in South-East Austria we performed a retrospective analysis of 259 HIV-1 partial pol sequences obtained from unique individuals newly diagnosed with HIV infection in South-East Austria from 2008 through 2014. After quality filtering, putative transmission linkages were inferred when two sequences were ≤1.5% genetically different. Multiple linkages were resolved into putative transmission clusters. Further phylogenetic analyses were performed using BEAST v1.8.1. Finally, we investigated putative links between the 259 sequences from South-East Austria and all publicly available HIV polymerase sequences in the Los Alamos National Laboratory HIV sequence database. We found that 45.6% (118/259) of the sampled sequences were genetically linked with at least one other sequence from South-East Austria forming putative transmission clusters. Clustering individuals were more likely to be men who have sex with men (MSM; pAustria had at least one putative inferred linkage with sequences from a total of 69 other countries. In conclusion, analysis of HIV-1 sequences from newly diagnosed individuals residing in South-East Austria revealed a high degree of national and international clustering mainly within MSM. Interestingly, we found that a high number of heterosexual males clustered within MSM networks, suggesting either linkage between risk groups or misrepresentation of sexual risk behaviors by subjects.

  20. [Prevalence of Hepatitis C virus infection in pregnant women and mother-child transmission in Ouagadougou, Burkina Faso].

    Science.gov (United States)

    Serme, A K; Ilboudo, P D; Samandoulgou, A; Simpore, J; Bougouma, A; Sombie, A R

    2006-05-01

    The aim of our study was to estimate the prevalence of Hepatitis C virus (HCV) among pregnant women and the rate of mother-child transmission. Over one month (April 26 to May 25, 2002) blood samples of 200 pregnant women who gave birth at the maternity of the university hospital and Gounguin center medical of Ouagadougou were tested for anti-HVC antibodies (Ac HCV) and anti HIV antibodies (Ac HIV). Infants born to mother tested positive for Ac HCV and their mother were tested for HCV-RNA. The prevalence of HCV (positive Ac HCV and HCV-RNA) was 2% in pregnant women (4/200). One case of mother-child transmission was found. The virus transmitted was 2a (A/C) genotype. The mother had a high titre of HCV-ARN, was co-infected by HIV and had had history of blood transfusion, excision and tattoo of the gums. PMID:16821441

  1. 珠海市香洲区2008-2013年孕产妇艾滋病感染及母婴阻断分析%Analysis of the Maternal HIV Infection and Prevention of Mother-to-child Transmission of Zhuhai Xiangzhou District During 2008-2013

    Institute of Scientific and Technical Information of China (English)

    赵慧贞; 程黎; 戚小兵; 梁晓红; 陈强

    2014-01-01

    Objective To analyze the maternal HIV infection and prevention of mother-to-child transmission (PMTCT) of Zhuhai Xianzhou District during 2008-2013. Methods The PMTCT given to 22 cases of admitted HIV positive pregnant women during 2008-2013 was analyzed. Results Of the 22 cases of HIV positive pregnant women, there was 1 case of termination of pregnancy, 21 cases of delivery;16 cases of babies were older than 18 months, 3 cases of babies under 18 months, 2 cases were lost to follow up; 16 cases had successful PMTCT, the PMTCT success rate was 100%. Conclusion Comprehensive PMTCT given to HIV posi-tive pregnant women can effectively reduce the incidence of HIV in children.%目的:分析珠海市香洲区2008要2013年孕产妇艾滋病感染及母婴阻断情况。方法对2008要2013年收治的22例HIV阳性孕产妇及所生婴儿母婴阻断情况进行分析。结果HIV阳性孕妇22例中1例终止妊娠,21例分娩,满18个月婴儿16例,未满18个月婴儿3例,失访2例,母婴阻断成功16例,母婴阻断成功率为100%。结论对HIV阳性孕妇进行综合母婴阻断,能有效降低儿童HIV发生。

  2. Migrant workers: a risk factor for hiv transmission

    International Nuclear Information System (INIS)

    Background: HIV continues to be a threat in both developed and developing countries. Pakistan has entered concentrated epidemic from low epidemic stage. The prevalence of HIV is more in at risk population particularly intravenous drug users (IDUs). Studies are required to find out other risk factors contributing to spread of the disease in the general population in order to prevent the spread of disease among general population. Methods: A cross-sectional study was carried out on patients reporting for HIV testing at National HIV/STI Referral Lab, National AIDS Control Program (NACP) from January to December 2011. Results: A total of 345 patients reported to the lab during the study period. The detailed histories of 271 patients were available out of which 131 (48.3%) patients were found to be positive for HIV. Minimum age of patient with HIV was 2 years while maximum age was 64 years. HIV affected those more significantly who had visited abroad (p=0.000) or were IDUs (p=0.000). Extramarital sexual activity, blood transfusion, or any surgical procedure in the past was not found to be significant (p=0.574, p=0.243, p=0.252 respectively). Most of the affected males were drivers (16, 12.2%) by profession. Among them 9 had visited gulf countries and 4 of them were deported from the gulf countries having HIV. Conclusion: Migrant workers are a risk factor for HIV transmission. Policy may be developed to focus on this population who continues to spread HIV among their spouses and children as a result of unawareness about their HIV status and its modes of transmission. (author)

  3. Effect evaluation on intervention of mother to child transmission of HIV/AIDS in Hezhou City,2006 -2012%2006-2012年贺州市预防艾滋病母婴传播干预措施状况分析

    Institute of Scientific and Technical Information of China (English)

    刘丽芬; 张远旺; 赵彦成; 梁静; 王前

    2015-01-01

    目的:了解贺州市孕产期艾滋病抗体检测、感染孕产妇及感染孕产妇母子抗艾滋病病毒药物应用与检测状况及变化趋势。方法利用国家预防艾滋病母婴传播管理信息网络直报系统,收集和整理贺州市2006—2012年孕产期艾滋病抗体、CD +4 T 淋巴细胞、病毒载量等检测信息、HIV 感染孕产妇孕期、产时以及所生儿童应用抗逆转录病毒药物等相关信息。对相关数据进行描述性分析和年度趋势变化分析。结果2006—2012年贺州市共有130743例孕产妇接受艾滋病抗体检测,其中孕产妇 HIV 抗体检测率从2006年的88.68%上升至2012年的99.96%。7年中,贺州市共发现230例 HIV 感染孕产妇。2006—2012年分别有67.86%、70.59%、82.05%、82.14%、97.30%、100%和100%的感染孕产妇应用了抗病毒药物,并呈逐年上升趋势(χ2=6.30,P <0.05),感染产妇孕28周前(含28周)开始应用三联方案比例也呈逐年上升趋势;感染产妇所生婴儿抗逆转录病毒药物应用比例自2010年均达到100%。结论孕期抗体检测比例仍有待进一步提高。尽管感染孕产妇及所生婴儿抗病毒药物应用比例逐年上升,但感染产妇在孕早期抗病毒药物应用比例比较低,需要进一步提高孕早期抗体检测比例及感染产妇在孕早期抗病毒药物应用比例,从而减少母婴传播的风险。%Objective To learn the status and trends of HIV-antibody testing and the application of antiretroviral drugs during pregnant women in Hezhou.Methods Depending on management information system of prevention of mother-to-child transmission of HIV (PMTCT)information network and reporting system,information including HIV testing during pregnancy and delivery,antiretroviral drugs application in HIV-infected pregnant women and their infants,HIV co-infec-tion,HIV status among HIV infected pregnant women’s spouse

  4. Genital ulcers and transmission of HIV among couples in Zimbabwe.

    Science.gov (United States)

    Latif, A S; Katzenstein, D A; Bassett, M T; Houston, S; Emmanuel, J C; Marowa, E

    1989-08-01

    Seventy-five married men found to be positive for HIV-1 in Harare, Zimbabwe, were interviewed in order to define behaviours associated with acquisition of infection and to determine factors associated with transmission of infection to their wives. The majority of infected men reported sexual intercourse with multiple heterosexual partners and female prostitutes, and gave a history of sexually transmitted diseases (STDs). All subjects denied homosexual activity and parenteral drug abuse. Serological testing of the wives of seropositive men showed that 45 (60%) were HIV-antibody-positive. Wives of men with AIDS and AIDS-related complex (ARC) and wives of men who gave a history of genital ulcer disease were more likely to be seropositive. The study demonstrates that HIV-1 infection in Zimbabwe occurs through heterosexual intercourse and is associated with other STDs. In addition, the study shows that male to female transmission of HIV-1 is facilitated by the presence of genital ulcers in infected men.

  5. Suspected dog bite associated HIV horizontal transmission in Swaziland

    OpenAIRE

    Ganizani Mlawanda

    2013-01-01

    Background: Dog bites may lead to transmission of bacteria and viruses over and above tetanus and rabies. Theoretically human immunodeficiency virus (HIV), Hepatitis B and Hepatitis C may be transmitted after dog bites where transfer of blood from one victim to another occur in clinical practice HIV, Hepatitis B and Hepatitis C are not considered when making treatment decisions, nor adequate patient history taken to consider all potential risks after dog bites in succession.Objective: To pres...

  6. Determinantes de la transmisión vertical del VIH en Cataluña (1997-2001: ¿es posible su eliminación? Determinants of HIV mother-to-child transmission in Catalonia, Spain [1997-2001]: is it possible to eliminate it?

    Directory of Open Access Journals (Sweden)

    F. Ramos

    2003-07-01

    Full Text Available Objetivos: Identificar y describir los factores que han hecho posible la existencia de nuevas infecciones de VIH por transmisión vertical desde la implementación del tratamiento antirretroviral en la gestante seropositiva (1997-2001 en Cataluña. Métodos: Revisión sistemática de casos identificados en servicios de pediatría de todos los hospitales de Cataluña. Resultados: Se identificaron 28 casos de infección pediátrica por VIH: 9, 9, 8, 2 y 0 por año de nacimiento de 1997 a 2001, respectivamente. De 16 madres con diagnóstico de infección por VIH conocido antes o durante el embarazo, 9 realizaron profilaxis antirretroviral durante éste (5 con buena adhesión, uno desconocido y el resto con mala adhesión y 7 no realizaron profilaxis (6 por rechazo y uno no se conoce. De 12 diagnosticadas después del parto, 5 fueron embarazos no controlados y el resto poco o bien controlados. De estos últimos, en 6 no se practicó serología para VIH y en uno fue negativa en el primer trimestre. Conclusiones: La transmisión vertical del VIH en Cataluña ha disminuido en los últimos años, pero se han producido infecciones por la mala implementación en algún caso de las medidas preventivas conocidas. Debería ofrecerse la prueba diagnóstica para VIH a toda gestante no sólo en el primer trimestre de embarazo sino también al final, si se sospecha exposición al virus, y en caso de gestaciones no controladas hay que usar pruebas diagnósticas de lectura rápida en la sala de partos.Objectives: To identify and describe the factors that have led to new cases of HIV infection through mother-to-child transmission since the introduction of antiretroviral therapy in HIV-seropositive pregnant women (1997-2001 in Catalonia. Methods: Systematic review of cases identified in the pediatric services of all the hospitals in Catalonia. Results: Twenty-eight cases of pediatric HIV infection were identified: 9, 9, 8, 2 and 0 per year of birth from 1997 to 2001

  7. Integration of HIV in child survival platforms: a novel programmatic pathway towards the 90–90–90 targets

    Directory of Open Access Journals (Sweden)

    Dick D Chamla

    2015-12-01

    Full Text Available Introduction: Integration of HIV into child survival platforms is an evolving territory with multiple connotations. Most literature on integration of HIV into other health services focuses on adults; however promising practices for children are emerging. These include the Double Dividend (DD framework, a new programming approach with dual goal of improving paediatric HIV care and child survival. In this commentary, the authors discuss why integrating HIV testing, treatment and care into child survival platforms is important, as well as its potential to advance progress towards global targets that call for, by 2020, 90% of children living with HIV to know their status, 90% of those diagnosed to be on treatment and 90% of those on treatment to be virally suppressed (90–90–90. Discussion: Integration is critical in improving health outcomes and efficiency gains. In children, integration of HIV in programmes such as immunization and nutrition has been associated with an increased uptake of HIV infant testing. Integration is increasingly recognized as a case-finding strategy for children missed from prevention of mother-to-child transmission programmes and as a platform for diffusing emerging technologies such as point-of-care diagnostics. These support progress towards the 90–90–90 targets by providing a pathway for early identification of HIV-infected children with co-morbidities, prompt initiation of treatment and improved survival. There are various promising practices that have demonstrated HIV outcomes; however, few have documented the benefits of integration on child survival interventions. The DD framework is well positioned to address the bidirectional impacts for both programmes. Conclusions: Integration provides an important programmatic pathway for accelerated progress towards the 90–90–90 targets. Despite this encouraging information, there are still challenges to be addressed in order to maximize the benefits of integration.

  8. Analysis on the influencing factors of utilization of interventional measures in the course of prevention of HIV mother-to-child transmission%预防HIV母婴传播干预措施利用的影响因素分析

    Institute of Scientific and Technical Information of China (English)

    宋丽萍; 耿文奎; 蓝文展; 黄丽华; 苏晶; 李芳; 董文逸; 范玉珍

    2012-01-01

    目的:了解欠发达地区HIV母婴传播干预措施利用状况及其影响因素,为更好制订预防HIV母婴传播措施提供依据.方法:采用回顾性队列研究的方法,采用自行设计的问卷进行面对面问卷调查,收集社会人口学特征、HIV确认时间,抗逆转录病毒药物应用情况及开始应用时间等.结果:1045例HIV感染的孕产妇27.3% (285/1 045)是在妊娠前获知HIV感染;89.4% (934/1 045)选择分娩,抗病毒药物的应用率为84.5% (789/934).多因素分析结果显示高中或以上文化程度的HIV感染孕产妇抗病毒药物应用率(80.5%)高于初中或以下文化程度的孕产妇(86.8%),其OR值为1.587.月收入800~1 000元的HIV感染的孕产妇抗病毒药物应用率高于家庭月收入≤800元,其OR值为0.024.妊娠前获知HIV感染的孕产妇抗病毒药物应用率高于妊娠后获知HIV感染的孕产妇,其OR值为1.602.结论:文化程度高、家庭经济状况好、妊娠前获知HIV感染状况有利于HIV感染孕产妇尽早接受抗病毒药物等HIV母婴传播干预措施的利用.%Objective: To understand the utilization and influencing factors of interventional measures of human immunodeficiency virus (HIV) mother - to - child transmission in underdeveloped areas, provide a basis for making measures to prevent HTV mother - to - child transmission. Methods: A retrospective cohort study was conducted, a self - designed questionnaire was used for face - to - face investigation; socio - demographic characteristics, confirmation time of HIV, the application of antiretroviral drugs, and the start time were collected. Results: Among 1 045 pregnant women with HIV infection, 285 women (27. 3% ) were found with HIV infection before pregnancy; 934 women (89. 4% ) chose delivery, the application rate of antiviral drugs was 84. 5% (789/934) . The results of multivariate regression analysis showed that the application rate of antiviral drugs among HIV - infected

  9. The prevention strategy study of mother-to-child HIV transmission in different epidemic areas:the evidence based on economic evaluation%艾滋病不同流行区防治母婴传播的策略研究:基于卫生经济学评价的证据

    Institute of Scientific and Technical Information of China (English)

    贾琳; 岳一姬; 赵旭晖; 贾文霄

    2016-01-01

    Objective Through analyzing the published article to investigate cost-effectiveness,cost-benefit and cost-utility evidence of mother-to-child transmission of HIV/AIDS in low and middle income countries. Methods Reviewed published during the year of 1994-1995 on low and middle income countries to pre-vent mother-to-child transmission of HIV economics evaluation through analyzing cost-effectiveness cost-benefit and cost-utility of the different countries,extracted and integratied the data.Results 13 article fo-cuses on the cost-effectiveness,3 articles reserched the cost-utillity,9 articles reserched the cost-effective-ness and cost-utillity.Conclusion In low and middle-income countries,the best prevention measure of mother-to-child transmission with HIV cost-effectbest interventions is voluntary counseling and testing (VCT)HIV-NET012/ACTG076 used in Mexico pregnant women.The best intervention of cost-uility ACTG076 28 weeks+HIVNET012+hiv-positive children of antiretroviral therapy (art)used in South Af-rica′s use pregnant women.The use of drugs is the best intervention measures for the cost-effectiveness and cost-utility,and preferably used in the 1 w postpartum.%目的:通过综合分析已发表的文献,探讨低收入和中等收入国家预防艾滋病母婴传播的成本-效果、成本-效用与成本-效益。方法回顾1994年-2015年期间已发表的有关低收入和中等收入国家预防艾滋病母婴传播经济学评价的文献,分析各国的成本-效果、成本-效用和成本-效益,对其数据进行提取、整合。结果13篇文献关注的是成本-效果,3篇文献研究的是成本-效用,9篇文献既研究了成本-效果又研究了成本-效用。结论在低、中等收入国家,预防艾滋病病毒母婴传播成本-效果最好的干预措施是孕妇自愿咨询检测(VCT)和短期口服抗逆转录病毒治疗方案(HIVNET012)/齐多夫定与抗逆转录病毒药物合用的治疗方案(ACTG076

  10. Relationship characteristics and HIV transmission risk in same-sex male couples in HIV serodiscordant relationships.

    Science.gov (United States)

    Starks, Tyrel J; Gamarel, Kristi E; Johnson, Mallory O

    2014-01-01

    Unprotected anal intercourse (UAI) remains a main risk factor for HIV among men who have sex with men (MSM) and this is of particular concern for partners of HIV serodiscordant status. However, HIV transmission risk has been demonstrated to vary by the sexual position adopted among partners. Guided by interdependence theory, this study examined how relational factors were differentially associated with risk taking (HIV-positive/insertive and HIV-negative/receptive) and strategic positioning (HIV-positive/receptive and HIV-negative/insertive) UAI within serodiscordant same-sex male couples. HIV-positive men and their HIV-negative partners (n couples = 91; n individuals = 182) simultaneously but independently completed computerized questionnaires and HIV-positive men had blood drawn for viral load. A minority of couples (30 %) engaged in risk taking and/or strategic positioning unprotected anal sex. Results of multinomial logistic regression indicated that HIV-negative partners' levels of relationship commitment were positively associated with the odds of engaging in strategic positioning sexual behaviors. For HIV-negative partners, reports of relationship intimacy, and sexual satisfaction were negatively associated with odds of reporting risk taking behavior. In contrast, HIV-positive partners' reported sexual satisfaction was positively associated with odds of engaging in risk taking behavior. Findings suggested that aspects of relational quality may be differentially associated with sexual decision making for same-sex male couples in serodiscordant relationships. Study findings lend support for the incorporation of discussions of HIV risk reduction strategies, enhancing communication between partners, and support for general relationship functioning in HIV care.

  11. 2006-2012年贺州市预防艾滋病母婴传播干预措施状况分析%Effect evaluation on intervention of mother to child transmission of HIV/AIDS in Hezhou City,2006 -2012

    Institute of Scientific and Technical Information of China (English)

    刘丽芬; 张远旺; 赵彦成; 梁静; 王前

    2015-01-01

    Objective To learn the status and trends of HIV-antibody testing and the application of antiretroviral drugs during pregnant women in Hezhou.Methods Depending on management information system of prevention of mother-to-child transmission of HIV (PMTCT)information network and reporting system,information including HIV testing during pregnancy and delivery,antiretroviral drugs application in HIV-infected pregnant women and their infants,HIV co-infec-tion,HIV status among HIV infected pregnant women’s spouse were collected from 2006 to 2012 in Hezhou.The rate or ra-tio was described and the difference of HIV testing and ARVs taking among the mother-child pairs was tested by Chi-square. Results From 2006 to 2012,a total of 130 743 cases of pregnant women received HIV antibody testing,of which HIV tes-ting ratio of each year were raised from 88.68% to 99.96%.In those 7 years,230 pregnant women were positive in Hezhou, and ratio of ARVs application among HIV infected pregnant women were 70.59%,82.05%,67.86%,82.14%, 97.30% and 100%,respectively,which showed increasing year by year (χ2 =6.30,P <0.05).The ratio of women who accepted triple ARV regimen before 28 weeks of gestation (28 weeks)was also raised from 2006 to 2012.For the in-fants of these women,the ratio of receiving drugs reached 100% since 2010.Conclusion The proportion of HIV-testing during pregnancy still needs improvement.Although the proportion of the HIV-infected pregnant women and their infants who received antiviral drugs increased year by year,the proportion is relatively lower in the early pregnancy,we should improve the early pregnancy antibody testing and antiviral drugs application,thereby reducing the risk of HIV mother to child trans-mission.%目的:了解贺州市孕产期艾滋病抗体检测、感染孕产妇及感染孕产妇母子抗艾滋病病毒药物应用与检测状况及变化趋势。方法利用国家预防艾滋病母婴传播管理信息网络直报系统,收

  12. Effect of the one-child policy on influenza transmission in China: a stochastic transmission model.

    Directory of Open Access Journals (Sweden)

    Fengchen Liu

    Full Text Available BACKGROUND: China's one-child-per-couple policy, introduced in 1979, led to profound demographic changes for nearly a quarter of the world's population. Several decades later, the consequences include decreased fertility rates, population aging, decreased household sizes, changes in family structure, and imbalanced sex ratios. The epidemiology of communicable diseases may have been affected by these changes since the transmission dynamics of infectious diseases depend on demographic characteristics of the population. Of particular interest is influenza because China and Southeast Asia lie at the center of a global transmission network of influenza. Moreover, changes in household structure may affect influenza transmission. Is it possible that the pronounced demographic changes that have occurred in China have affected influenza transmission? METHODS AND FINDINGS: To address this question, we developed a continuous-time, stochastic, individual-based simulation model for influenza transmission. With this model, we simulated 30 years of influenza transmission and compared influenza transmission rates in populations with and without the one-child policy control. We found that the average annual attack rate is reduced by 6.08% (SD 2.21% in the presence of the one-child policy compared to a population in which no demographic changes occurred. There was no discernible difference in the secondary attack rate, -0.15% (SD 1.85%, between the populations with and without a one-child policy. We also forecasted influenza transmission over a ten-year time period in a population with a two-child policy under a hypothesis that a two-child-per-couple policy will be carried out in 2015, and found a negligible difference in the average annual attack rate compared to the population with the one-child policy. CONCLUSIONS: This study found that the average annual attack rate is slightly lowered in a population with a one-child policy, which may have resulted from a

  13. 76 FR 58517 - Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

    Science.gov (United States)

    2011-09-21

    ... Transmission of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV... Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and... Draft Guideline provides evidence-based recommendations for reducing unexpected transmission of HIV,...

  14. Human Herpesviruses as Copathogens of HIV Infection, Their Role in HIV Transmission, and Disease Progression.

    Science.gov (United States)

    Munawwar, Arshi; Singh, Sarman

    2016-01-01

    Of eight human herpesviruses (HHVs), often, only herpes simplex virus types 1 (HSV-1) and 2 (HSV-2) find mention in medical literature as both of these viruses are commonly associated with genital lesions and oral ulcers, commonly known as cold sores. However, role of human herpesviruses as copathogens and in aggravation and in the transmission of other human diseases, especially the Acquired immunodeficiency syndrome (HIV/AIDS) has only very recently been recognized. Therefore, screening and treating subclinical HHV infections may offer slowing of HIV infection, disease progression, and its transmission. Beside HSV-1 and HSV-2, HHV-3 a causative agent of herpes zoster remained one of the first manifestations of HIV disease before the era of highly active antiretroviral therapy (HAART). HHV-5 also known as human Cytomegalovirus infection remains a significant risk factor for HIV-associated mortality and morbidity even in HAART era. It is proposed that Cytomegalovirus viremia could be a better predictor of HIV disease progression than CD4+ T-lymphocyte count. The role of HHV-4 or Epstein-Burr virus and HHV-6, HHV-7, and HHV-8 is still being investigated in HIV disease progression. This review provides insight into the current understanding about these 8 HHVs, their co-pathogenesis, and role in HIV/AIDS disease progression. The review also covers recent literature in favor and against administering anti-HHV treatment along with HAART for slower AIDS progression and interrupted sexual transmission. PMID:27013807

  15. Preventing HIV transmission in chinese internal migrants: A behavioral approach

    NARCIS (Netherlands)

    X. Liu (Xiaona); V. Erasmus (Vicky); X. Sun (Xinying); R. Cai (Rui); Y. Shi (Yuhui); J.H. Richardus (Jan Hendrik)

    2014-01-01

    textabstractThis study is a step towards a behavioral intervention to prevent HIV transmission among Chinese internal migrants. To explore important and changeable determinants of condom use and inspect effective and feasible methods to increase condom use for the target population, we conducted a t

  16. Are you HIV invincible? A probabilistic study of discordant couples in the context of HIV transmission.

    Directory of Open Access Journals (Sweden)

    Georgiy Bobashev

    Full Text Available A number of factors have been identified that are related to sexual and injecting HIV transmission. We developed a probabilistic mathematical model to put these factors together and interpret risks in the context of individual behavior among injecting drug-using (IDU couples in St. Petersburg, Russia. Some HIV-discordant couples have unprotected sex and sometimes inject drugs together but stay discordant for a long time, while some individuals acquire HIV on the first encounter. We considered existing estimates of HIV transmission risks through injecting and sexual contacts to develop a predictive survival model for an individual who is exposed to HIV through intimate relationships. We computed simulated survival curves for a number of behavioral scenarios and discussed sources of simulated uncertainty. We then applied the model to a longitudinal study of HIV-discordant couples and validated the model's forecast. Although individual prediction of seroconversion time appeared impossible, the ability to rank behavioral patterns in terms of HIV risk and to estimate the probability of survival HIV-free will be important to educators and counselors.

  17. 我国部分地区2005-2007年艾滋病母婴传播水平变化趋势%The change trend of mother-to-child transmission rate of HIV-1 during 2005 -2007 in some areas of China

    Institute of Scientific and Technical Information of China (English)

    王临虹; 方利文; 王前; 蒋岩; 莫云; 孙定勇; 张伟; 张燕

    2009-01-01

    Objective To explore the change trend of mother-to-child-transmission (MTCT) of HIV-1 in some areas in China. Methods The investigation was conducted in 15 counties or districts of 4 provinces in China with relatively high HIV prevalence from January 2005 to June 2009. The data on the death and HIV-status of the babies born to HIV-positive mothers from January 2005 -December 2007 in research sites were collected through 18-month following up after they were born. Results During the time that the research was conducted, there were 644 babies born to HIV-positive mothers who were followed up for 18 months. At the end of 18 months, full data were collected from 550 babies,44 babies were lost to follow-up and 50 babies died. Among 550 babies who were followed up for 18 months, 53 babies were confirmed as HIV positive. The rate of MTCT of HIV-1 was 13. 19% (24/182), 8.90% (17/191) and 6.78 % (12/177) in 2005,2006,2007 respectively, which showed a descending trend yearly ( X~2=4.23, P< 0.05). Adjusted by the death data of the HIV-exposed children,it was found that during 2005-2007 the rate of MTCT of HIV-1 was 16.74%, 12.98%, 9.52% respectively, which was also descending year by year ( X~2=4.69, P<0.05 ). Conclusion Long-terns, effective prevention of mother-to-child-transmission of HIV (PMTCT) could reduce the level of MTCT of HIV-1 year-by-year. In addition, using death data of HIV-exposed children to adjust the level of MTCT of HIV-1 is valuable to grade the effect of PMTCT.%目的 了解我国部分艾滋病高发地区艾滋病母婴传播水甲变化趋势.方法 自2005年1月至2009年6月在我国艾滋病相对高发的15个县(区)开展相关调查研究,对2005年1月至2007年12月期间人类免疫缺陷病毒(HIV)感染产妇分娩所生婴幼儿进行追踪随访至产后18个月,收集的儿童死亡及确定HIV感染等相关资料.结果 调查研究期间,研究地区HIV感染孕产妇所生满18月龄儿童共644名.其中,随访至满18

  18. Tetherin restricts productive HIV-1 cell-to-cell transmission.

    Directory of Open Access Journals (Sweden)

    Nicoletta Casartelli

    Full Text Available The IFN-inducible antiviral protein tetherin (or BST-2/CD317/HM1.24 impairs release of mature HIV-1 particles from infected cells. HIV-1 Vpu antagonizes the effect of tetherin. The fate of virions trapped at the cell surface remains poorly understood. Here, we asked whether tetherin impairs HIV cell-to-cell transmission, a major means of viral spread. Tetherin-positive or -negative cells, infected with wild-type or DeltaVpu HIV, were used as donor cells and cocultivated with target lymphocytes. We show that tetherin inhibits productive cell-to-cell transmission of DeltaVpu to targets and impairs that of WT HIV. Tetherin accumulates with Gag at the contact zone between infected and target cells, but does not prevent the formation of virological synapses. In the presence of tetherin, viruses are then mostly transferred to targets as abnormally large patches. These viral aggregates do not efficiently promote infection after transfer, because they accumulate at the surface of target cells and are impaired in their fusion capacities. Tetherin, by imprinting virions in donor cells, is the first example of a surface restriction factor limiting viral cell-to-cell spread.

  19. A case of emmonsiosis in an HIV-infected child

    Directory of Open Access Journals (Sweden)

    Harsha Lochan

    2015-04-01

    Full Text Available Opportunistic fungal infections can cause significant morbidity and mortality in immunocompromised patients. We describe a paediatric case of an unusual disseminated fungal infection. A three-year-old HIV-infected child with severe immunosuppression (CD4+ T-cell count 12 × 106 /L was admitted to hospital with pneumonia, gastroenteritis and herpes gingivostomatitis. Despite antibacterial and antiviral therapy, he experienced high fevers and developed an erythematous maculopapular rash and abdominal tenderness. The child’s condition progressively worsened during the admission. A thermally dimorphic fungus was cultured from bone marrow and identified as an Emmonsia species on DNA sequencing. The patient made a good recovery on amphotericin B deoxycholate and antiretroviral therapy. Itraconazole was continued for a minimum of 12 months, allowing for immune reconstitution to occur. This case is the first documented description of disseminated disease caused by a novel Emmonsia species in an HIV-infected child in South Africa.

  20. The Transmission Dynamics of Human Immunodeficiency Virus (HIV)

    Science.gov (United States)

    May, R. M.; Anderson, R. M.

    1988-10-01

    The paper first reviews data on HIV infections and AIDS disease among homosexual men, heterosexuals, intravenous (IV) drug abusers and children born to infected mothers, in both developed and developing countries. We survey such information as is currently available about the distribution of incubation times that elapse between HIV infection and the appearance of AIDS, about the fraction of those infected with HIV who eventually go on to develop AIDS, about time-dependent patterns of infectiousness and about distributions of rates of acquiring new sexual or needle-sharing partners. With this information, models for the transmission dynamics of HIV are developed, beginning with deliberately oversimplified models and progressing - on the basis of the understanding thus gained - to more complex ones. Where possible, estimates of the model's parameters are derived from the epidemiological data, and predictions are compared with observed trends. We also combine these epidemiological models with demographic considerations to assess the effects that heterosexually-transmitted HIV/AIDS may eventually have on rates of population growth, on age profiles and on associated economic and social indicators, in African and other countries. The degree to which sexual or other habits must change to bring the `basic reproductive rate', R_0, of HIV infections below unity is discussed. We conclude by outlining some research needs, both in the refinement and development of models and in the collection of epidemiological data.

  1. Performance of the prevention of parent to child transmission program: A decadal trend from rural Maharashtra, India

    OpenAIRE

    Mohite, R. V.; Mohite, V. R.

    2016-01-01

    Background: Human immunodeficiency virus (HIV) infection is widely spread across the state of Maharashtra with high prevalence among antenatal women. Aims: To assess the effectiveness of prevention of parent to child transmission (PPTCT) services in rural Tertiary Health Care Centre of Western Maharashtra, India and to address the weaknesses in functioning of PPTCT services. Materials and Methods: A cross-sectional study was conducted at Integrated Counselling and Testing Centre (ICTC) of a r...

  2. Episodic sexual transmission of HIV revealed by molecular phylodynamics.

    Directory of Open Access Journals (Sweden)

    Fraser Lewis

    2008-03-01

    Full Text Available BACKGROUND: The structure of sexual contact networks plays a key role in the epidemiology of sexually transmitted infections, and their reconstruction from interview data has provided valuable insights into the spread of infection. For HIV, the long period of infectivity has made the interpretation of contact networks more difficult, and major discrepancies have been observed between the contact network and the transmission network revealed by viral phylogenetics. The high rate of HIV evolution in principle allows for detailed reconstruction of links between virus from different individuals, but often sampling has been too sparse to describe the structure of the transmission network. The aim of this study was to analyze a high-density sample of an HIV-infected population using recently developed techniques in phylogenetics to infer the short-term dynamics of the epidemic among men who have sex with men (MSM. METHODS AND FINDINGS: Sequences of the protease and reverse transcriptase coding regions from 2,126 patients, predominantly MSM, from London were compared: 402 of these showed a close match to at least one other subtype B sequence. Nine large clusters were identified on the basis of genetic distance; all were confirmed by Bayesian Monte Carlo Markov chain (MCMC phylogenetic analysis. Overall, 25% of individuals with a close match with one sequence are linked to 10 or more others. Dated phylogenies of the clusters using a relaxed clock indicated that 65% of the transmissions within clusters took place between 1995 and 2000, and 25% occurred within 6 mo after infection. The likelihood that not all members of the clusters have been identified renders the latter observation conservative. CONCLUSIONS: Reconstruction of the HIV transmission network using a dated phylogeny approach has revealed the HIV epidemic among MSM in London to have been episodic, with evidence of multiple clusters of transmissions dating to the late 1990s, a period when HIV

  3. Efficiency of HAART in the prevention of mother to children HIV-1 transmission at Saint Camille medical centre in Burkina Faso, West Africa

    Institute of Scientific and Technical Information of China (English)

    Laure Stella Ghoma Linguissi; Remy Moret; Jean Baptiste Nikiema; Jacques Simpore; Cyrille Bisseye; Tani Sagna; Bolni Marius Nagalo; Djeneba Ouermi; Florencia W Djigma; Salvatore Pignatelli; Joseph D Sia; Virginio Pietra

    2012-01-01

    Objective: To evaluate efficiency of HAART in the prevention of mother to child HIV transmission. Methods: A longitudinal study was conducted on 1 300 women attending the antenatal service at Saint Camille Medical Centre from September 2010 to July 2011. The HIV status of mothers was determined by rapid tests and ELISA. Discordant results were confirmed by real-time PCR. PCR was used to determine HIV status of children born from HIV-positive mothers. Results: Among 1 300 pregnant women tested for HIV, 378 were seropositive. Mothers were predominantly housewives (69.7%), and their mean age was (28.32±0.15) years. The overall prevalence of HIV transmission from mother to child was 4.8% (18/378). This prevalence differed significantly from 0.0% (0/114) to 6.8% (18/264) in children born from mothers under HAART and those with mothers under New Prophylactic Protocol (AZT + 3TC + NVP), respectively (P<0.01). Children’s mortality rate during the medical follow up was 1.3% (5/378). Among 16 women with HIV dubious status by ELISA, the Real Time PCR confirmed 2/16 (12.5%) as HIV positive. Conclusions: The protocol of prevention of mother to children HIV transmission (PMTCT) is effective. The rate of HIV vertical transmission is significantly reduced. Early diagnosis determined by PCR of children born from HIV- positive mother is necessary and recommended in the context of PMTCT in Burkina Faso. We also found that PCR is an effective tool to confirm HIV status in pregnant women.

  4. Mathematical models for therapeutic approaches to control HIV disease transmission

    CERN Document Server

    Roy, Priti Kumar

    2015-01-01

    The book discusses different therapeutic approaches based on different mathematical models to control the HIV/AIDS disease transmission. It uses clinical data, collected from different cited sources, to formulate the deterministic as well as stochastic mathematical models of HIV/AIDS. It provides complementary approaches, from deterministic and stochastic points of view, to optimal control strategy with perfect drug adherence and also tries to seek viewpoints of the same issue from different angles with various mathematical models to computer simulations. The book presents essential methods and techniques for students who are interested in designing epidemiological models on HIV/AIDS. It also guides research scientists, working in the periphery of mathematical modeling, and helps them to explore a hypothetical method by examining its consequences in the form of a mathematical modelling and making some scientific predictions. The model equations, mathematical analysis and several numerical simulations that are...

  5. Thoughts, Attitudes, and Feelings of HIV-Positive MSM Associated with High Transmission-Risk Sex

    Science.gov (United States)

    Skinta, Matthew D.; Murphy, Jessie L.; Paul, Jay P.; Schwarcz, Sandra K.; Dilley, James W.

    2012-01-01

    This study presents survey data collected from a sample of HIV-positive men (N = 182) who had high transmission-risk sex, defined as unprotected anal intercourse with a man whose HIV-status was negative or unknown, in the previous 6 months. Despite the tremendous changes in HIV treatment and their impact on people living with HIV, little recent…

  6. Modeling HIV transmission and AIDS in the united states

    CERN Document Server

    Hethcote, Herbert W

    1992-01-01

    The disease that came to be called acquired immunodeficiency syndrome (AIDS) was first identified in the summer of 1981. By that time, nearly 100,000 persons in the United States may have been infected with human immunodeficiency virus (HIV). By the time the routes of transmission were clearly identified and HIV was established as the cause of AIDS in 1983, over 300,000 people may have been infected. That number has continued to increase, with approximately 1,000,000 Americans believed to be infected in 1991. The epidemic is of great public health concern because HlV is infectious, causes severe morbidity and death in most if not all of those infected, and often occurs in relatively young persons. In addition, the cost of medical care for a person with HIV disease is high, and the medical care needs of HIV-infected persons place a severe burden on the medical care systems in many areas. Understanding and controlling the HIV epidemic is a particularly difficult challenge. The long and variable period between H...

  7. HIV-1 envelope, integrins and co-receptor use in mucosal transmission of HIV

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    Cicala Claudia

    2010-01-01

    Full Text Available Abstract It is well established that HIV-1 infection typically involves an interaction between the viral envelope protein gp120/41 and the CD4 molecule followed by a second interaction with a chemokine receptor, usually CCR5 or CXCR4. In the early stages of an HIV-1 infection CCR5 using viruses (R5 viruses predominate. In some viral subtypes there is a propensity to switch to CXCR4 usage (X4 viruses. The receptor switch occurs in ~ 40% of the infected individuals and is associated with faster disease progression. This holds for subtypes B and D, but occurs less frequently in subtypes A and C. There are several hypotheses to explain the preferential transmission of R5 viruses and the mechanisms that lead to switching of co-receptor usage; however, there is no definitive explanation for either. One important consideration regarding transmission is that signaling by R5 gp120 may facilitate transmission of R5 viruses by inducing a permissive environment for HIV replication. In the case of sexual transmission, infection by HIV requires the virus to breach the mucosal barrier to gain access to the immune cell targets that it infects; however, the immediate events that follow HIV exposure at genital mucosal sites are not well understood. Upon transmission, the HIV quasispecies that is replicating in an infected donor contracts through a “genetic bottleneck”, and often infection results from a single infectious event. Many details surrounding this initial infection remain unresolved. In mucosal tissues, CD4+ T cells express high levels of CCR5, and a subset of these CD4+/CCR5high cells express the integrin α4β7, the gut homing receptor. CD4+/CCR5high/ α4β7high T cells are highly susceptible to infection by HIV-1 and are ideal targets for an efficient productive infection at the point of transmission. In this context we have demonstrated that the HIV-1 envelope protein gp120 binds to α4β7 on CD4+ T cells. On CD4+/CCR5high/ α4β7high T cells,

  8. Gender inequality and HIV transmission: a global analysis

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    Eugene T Richardson

    2014-06-01

    Full Text Available Introduction: The HIV pandemic disproportionately impacts young women. Worldwide, young women aged 15–24 are infected with HIV at rates twice that of young men, and young women alone account for nearly a quarter of all new HIV infections. The incommensurate HIV incidence in young – often poor – women underscores how social and economic inequalities shape the HIV epidemic. Confluent social forces, including political and gender violence, poverty, racism, and sexism impede equal access to therapies and effective care, but most of all constrain the agency of women. Methods: HIV prevalence data was compiled from the 2010 UNAIDS Global Report. Gender inequality was assessed using the 2011 United Nations Human Development Report Gender Inequality Index (GII. Logistic regression models were created with predominant mode of transmission (heterosexual vs. MSM/IDU as the dependent variable and GII, Muslim vs. non-Muslim, Democracy Index, male circumcision rate, log gross national income (GNI per capita at purchasing power parity (PPP, and region as independent variables. Results and discussion: There is a significant correlation between having a predominantly heterosexual epidemic and high gender inequality across all models. There is not a significant association between whether a country is predominantly Muslim, has a high/low GNI at PPP, has a high/low circumcision rate, and its primary mode of transmission. In addition, there are only three countries that have had a generalized epidemic in the past but no longer have one: Cambodia, Honduras, and Eritrea. GII data are available only for Cambodia and Honduras, and these countries showed a 37 and 34% improvement, respectively, in their Gender Inequality Indices between 1995 and 2011. During the same period, both countries reduced their HIV prevalence below the 1% threshold of a generalized epidemic. This represents limited but compelling evidence that improvements in gender inequality can lead to

  9. Model Construction of Organizational Characteristic and Work Characteristic toward Role of the Midwife in Measures Prevention Mother To Child Transmission (PMTCT on Independence Pregnant HIV/AIDS in Makassar

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    Pesta Corry Sihotang

    2016-05-01

    Full Text Available The research problem namely: 1 is the organization characteristic Affect toward the role of midwife on PMTCT; 2 is the characteristic Affect work toward the role of midwife on PMTCT; 3 is characteristic Affect the organization toward the independence of pregnant in HIV/AIDS; 4 is the work characteristic Affect toward the independence of pregnant in HIV/AIDS; and 5 is the role of midwife on PMTCTC Affect toward the independence of pregnant in HIV/AIDS. This research aims to analysis the Affect of organization and work characteristics toward the role of midwife on PMTCT, to analysis the Affect of organization and work characteristics toward the independence of pregnant in HIV/AIDS, and to analysis the Affect of the role of midwife on PMTCT toward the independence of pregnant in HIV/AIDS. Kind of research is quantitative with inferential approach with the design of correlational research. Reviews These applied research in Several Community Health Center at Makassar City. Population and sample amount as 180 of midwifes from 35 Community Health Center take in multistage random sampling. Data analysis through SEM analysis with computer program AMOS 20. The result of the research found that the organization characteristic have positive and insignificant toward the role of midwife on PMTCT. That mean the reward system, training and development, and leadership have applied but the insignificant contribution to the role of midwife on PMTCT. The work characteristic have positive and significant toward the role of midwife on PMTCT. That mean the performance goal and feedback have applied and give a significant contribution to the role of midwife on PMTCT. The organization characteristic have positive and significant toward the independence of pregnant in HIV/AIDS. That mean the reward system, training and development, and leadership have applied and have significant contribution to the independence of pregnant in HIV/AIDS. The work characteristic have

  10. Engagement of non-government organisations and community care workers in collaborative TB/HIV activities including prevention of mother to child transmission in South Africa: Opportunities and challenges

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    Uwimana Jeannine

    2012-08-01

    Full Text Available Abstract Background The implementation of collaborative TB/HIV activities may help to mitigate the impact of the dual epidemic on patients and communities. Such implementation requires integrated interventions across facilities and levels of government, and with communities. Engaging Community Care Workers (CCWs in the delivery of integrated TB/HIV services may enhance universal coverage and treatment outcomes, and address human resource needs in sub-Saharan Africa. Methods Using pre-intervention research in Sisonke district, KwaZulu-Natal, South Africa as a case study, we report on three study objectives: (1 to determine the extent of the engagement of NGOs and CCWs in the implementation of collaborative TB/HIV including PMTCT; (2 to identify constraints related to provision of TB/HIV/PMTCT integrated care at community level; and (3 to explore ways of enhancing the engagement of CCWs to provide integrated TB/HIV/PMTCT services. Our mixed method study included facility and NGO audits, a household survey (n = 3867, 33 key informant interviews with provincial, district, facility, and NGO managers, and six CCW and patient focus group discussions. Results Most contracted NGOs were providing TB or HIV support and care with little support for PMTCT. Only 11% of facilities’ TB and HIV patients needing care and support at the community level were receiving support from CCWs. Only 2% of pregnant women reported being counseled by CCWs on infant feeding options and HIV testing. Most facilities (83% did not have any structural linkage with NGOs. Major constraints identified were system-related: structural, organizational and managerial constraints; inadequate CCW training and supervision; limited scope of CCW practice; inadequate funding; and inconsistency in supplies and equipment. Individual and community factors, such as lack of disclosure, stigma related to HIV, and cultural beliefs were also identified as constraints. Conclusions NGO

  11. Explanations for Child Sexual Abuse Given by Convicted Offenders in Malawi: No Evidence for "HIV Cleansing"

    Science.gov (United States)

    Mtibo, Charles; Kennedy, Neil; Umar, Eric

    2011-01-01

    Objective: A commonly cited, but unproven reason given for the rise in reported cases of child sexual abuse in Sub-Saharan Africa is the "HIV cleansing myth"--the belief that an HIV infected individual can be cured by having sex with a child virgin. The purpose of this study was to explore in Malawi the reasons given by convicted sex offenders for…

  12. Seksuel transmission af hepatitis C-virus hos hiv-inficerede maend

    DEFF Research Database (Denmark)

    Peters, Lars; Weis, Nina M; Lindhardt, Bjarne Orskov

    2006-01-01

    Infections with the hepatitis C virus (HCV) occur primarily through percutaneous transmission, while sexual transmission seems to be rare. Recently, in some European cities, an increasing incidence of sexually transmitted HCV infection among HIV-infected homosexual males has been reported. We...... describe four cases of acute HCV infection among HIV-infected homosexual males, where sexual transmission was likely. Udgivelsesdato: 2006-Oct-16...

  13. Impact of community-based interventions on HIV knowledge, attitudes, and transmission

    OpenAIRE

    Salam, Rehana A; Haroon, Sarah; Ahmed, Hashim H; Das, Jai K; Bhutta, Zulfiqar A

    2014-01-01

    In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported. Community-based interventions (CBIs) for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk, or already infected with, HIV. This paper evaluates the impact of CBIs on HIV knowledge, attitudes, and transmission. We included 39 studies on educational activities, counseling sessions, home visits, mentoring, w...

  14. Critical Review: Mechanisms of HIV Transmission in Depo-Provera Users: The Likely Role of Hypoestrogenism.

    Science.gov (United States)

    Hickey, Martha; Marino, Jennifer L; Tachedjian, Gilda

    2016-01-01

    Almost half of new HIV infections worldwide occur in women, and vaginal intercourse is the most common mode of transmission. Accumulating evidence suggests that depot medroxyprogesterone acetate may increase HIV transmission, but little is known about the underlying mechanisms. We propose that hypoestrogenism in depot medroxyprogesterone acetate may contribute to increased HIV transmission. We present supportive evidence and propose potential interventions to prevent or treat vaginal hypoestrogenism using vaginal estrogens. PMID:26761267

  15. A study on the effectiveness of prevention of mother-to-child HIV, syphilis, and hepatitis B transmission among pregnant women in Dehong prefecture, Yunnan province, China from 2011 to 2013%云南省德宏州2011-2013年预防艾滋病、梅毒和乙型肝炎母婴传播效果研究

    Institute of Scientific and Technical Information of China (English)

    单多; 王娟; 孙江平; 段松; 郭云松

    2014-01-01

    Objective To demonstrate the effectiveness of prevention of mother-to-child HIV, syphilis, and hepatitis B transmission among pregnant women in Dehong prefecture , Yunnan province,China from 2011 to 2013.Methods Data were collected mainly from the continuous HIV surveillance system and prevention of mother-to-child transmission ( PMTCT ) reporting system of Dehong prefecture , and supplemented by annual reported data on HIV , syphilis, and hepatitis B PMTCT to know the general demographic characteristics , HIV testing and counseling service , PMTCT service, and other medical services.Data were presented as absolute numbers and proportions.Results From 2011 to 2013,the number of pregnant women participating in HIV ,syphilis,and hepatitis B testing in Dehong prefecture increased and the HIV testing rates were 99.2%( 18 694/18 854 ) , 99.9%( 22 047/22 060 ) and 99.9%( 21 751/21 756),the syphilis testing rates were 56.0%(10 550/18 854),99.6%(21 980/22 060) and 99.9%(21 751/21 756),and the hepatitis B testing rates were 60.2%(11 358/18 854),99.6%(21 974/22 060) and 99.9%(21 751/21 756).From 2011 to 2013, the HIV positive rates were 0.87%(327/37 787), 0.82%(319/38 817) and 0.85%(315/37 261),the syphilis positive rates were 0.05%(10/18 520), 0.12%(43/36 817) and 0.11%(40/35 888),the hepatitis B positive rates were 2.46%(456/18 520), 2.23%(794/35 547) and 2.14%(739/34 468),respectively.The rates of HIV-positive pregnant women giving birth in hospitals were 99.2%(128/129),100.0%(141/141) and 100.0%(141/141).From 2011 to 2013,the proportions of HIV-positive pregnant women receiving antiretroviral therapy were 99.2%(128/129),99.3%(140/141) and 99.3%(140/141),respectively.And the treatment rate of syphilis-positive pregnant women were 71%(5/7),89%(16/18) and 97%(32/33).The rates of hepatitis B immunoglobulin injection among new-borns of hepatitis B-positive pregnant women were 92.9%(263/283),99.7%(612/614) and 99.4%(629/633).The estimated rates of mother-to-child transmission

  16. HIV transmission and related risk factors among serodiscordant couples in Liuzhou, China.

    Science.gov (United States)

    Zhang, Yu-Jing; Feng, Xian-Xiang; Fan, Yin-Guang; Jiang, Zhi-Yu; Zhong, Xiang-Hai; Li, Ming-Qiang; Ye, Dong-Qing

    2015-04-01

    To evaluate the incidence and risk factors for human immunodeficiency virus (HIV) seroconversion of HIV-negative partners among HIV-discordant couples in Liuzhou, China, 1854 eligible HIV-serodiscordant couples were retrospectively identified through the HIV epidemiology and follow-up database from January 1, 1996 to June 30, 2013. Cox proportional-hazards model was used to examine risk factors related to HIV seroconversion of negative partners. Finally, 125 HIV seroconversion occurred over 4963.5 person-years, resulting in an overall HIV incidence of 2.52/100 person-years. HIV-positive partners with the last CD4 counts of 350 cells/ul or more were significantly protected against HIV seroconversion compared with those CD4 counts of less than 200 cells/ul (aHR = 0.46, 95% CI: 0.27-0.81, P HIV-positive wives (aHR: 1.96, 95% CI: 1.27-3.02, P HIV-positive partners who did not receive ART before their HIV-negative partners' seroconversion (aHR: 2.22, 95% CI, 1.41-3.51, P HIV seroconversion. HIV-negative partners remain high risk of HIV infection in Liuzhou city. Comprehensive package of HIV prevention services should contribute to reduction in HIV transmission of discordant couples.

  17. Child Care Providers' Use of HIV/AIDS Information Resources: Links to Professional Background Variables and Feelings about Caring for an HIV-Infected Child.

    Science.gov (United States)

    Coleman, Mick; Toledo, Carlos; Wallinga, Charlotte

    2002-01-01

    Examined child caregivers' use of various HIV/AIDS information resources in relation to professional background and attitudes. Found that providers' education level, child care experience, and the age group for which they were responsible correlated with use of newspaper/magazine articles, pamphlets, and educational workshops. Use of…

  18. Molecular epidemiology of HIV-1 transmission in a cohort of HIV-1 concordant heterosexual couples from Dakar, Senegal.

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    Wim Jennes

    Full Text Available BACKGROUND: A large number of HIV-1 infections in Africa occur in married couples. The predominant direction of intracouple transmission and the principal external origins of infection remain important issues of debate. METHODS: We investigated HIV-1 transmission in 46 HIV-1 concordant positive couples from Dakar, Senegal. Intracouple transmission was confirmed by maximum-likelihood phylogenetic analysis and pairwise distance comparisons of HIV-1 env gp41 sequences from both partners. Standardized interview data were used to deduce the direction as well as the external sources of the intracouple transmissions. RESULTS: Conservative molecular analyses showed linked viruses in 34 (74% couples, unlinked viruses in 6 (13% couples, and indeterminate results for 6 (13% couples. The interview data corresponded completely with the molecular analyses: all linked couples reported internal transmission and all unlinked couples reported external sources of infection. The majority of linked couples (93% reported the husband as internal source of infection. These husbands most frequently (82% reported an occasional sexual relationship as external source of infection. Pairwise comparisons of the CD4 count, antiretroviral therapy status, and the proportion of gp41 ambiguous base pairs within transmission pairs correlated with the reported order of infection events. CONCLUSIONS: In this suburban Senegalese population, a majority of HIV-1 concordant couples showed linked HIV-1 transmission with the husband as likely index partner. Our data emphasize the risk of married women for acquiring HIV-1 as a result of the occasional sexual relationships of their husbands.

  19. Estimating the timing of mother-to-child transmission of the human immunodeficiency virus type 1 using a viral molecular evolution model.

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    Antoine Chaillon

    Full Text Available BACKGROUND: Mother-to-child transmission (MTCT is responsible for most pediatric HIV-1 infections worldwide. It can occur during pregnancy, labor, or breastfeeding. Numerous studies have used coalescent and molecular clock methods to understand the epidemic history of HIV-1, but the timing of vertical transmission has not been studied using these methods. Taking advantage of the constant accumulation of HIV genetic variation over time and using longitudinally sampled viral sequences, we used a coalescent approach to investigate the timing of MTCT. MATERIALS AND METHODS: Six-hundred and twenty-two clonal env sequences from the RNA and DNA viral population were longitudinally sampled from nine HIV-1 infected mother-and-child pairs [range: 277-1034 days]. For each transmission pair, timing of MTCT was determined using a coalescent-based model within a Bayesian statistical framework. Results were compared with available estimates of MTCT timing obtained with the classic biomedical approach based on serial HIV DNA detection by PCR assays. RESULTS: Four children were infected during pregnancy, whereas the remaining five children were infected at time of delivery. For eight out of nine pairs, results were consistent with the transmission periods assessed by standard PCR-based assay. The discordance in the remaining case was likely confused by co-infection, with simultaneous introduction of multiple maternal viral variants at the time of delivery. CONCLUSIONS: The study provided the opportunity to validate the Bayesian coalescent approach that determines the timing of MTCT of HIV-1. It illustrates the power of population genetics approaches to reliably estimate the timing of transmission events and deepens our knowledge about the dynamics of viral evolution in HIV-infected children, accounting for the complexity of multiple transmission events.

  20. Understanding HIV Transmission Risk Behavior Among HIV-Infected South Africans Receiving Antiretroviral Therapy: An Information—Motivation—Behavioral Skills Model Analysis

    OpenAIRE

    Kiene, Susan M.; Fisher, William A.; Shuper, Paul A.; Cornman, Deborah H.; CHRISTIE, Sarah; MacDonald, Susan; Pillay, Sandy; Mahlase, Gethwana; Jeffrey D. Fisher

    2013-01-01

    The current study applied the Information—Motivation—Behavioral Skills (IMB) model (J. D. Fisher & Fisher, 1992; W. A. Fisher & Fisher, 1993) to identify factors associated with HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy (ART), a population of considerable significance for curtailing, or maintaining, South Africa’s generalized HIV epidemic. HIV prevention information, HIV prevention motivation, HIV prevention behavioral skills, and HIV tr...

  1. Prevention of mother-to-child transmission: experience of a Portuguese centre

    Directory of Open Access Journals (Sweden)

    Carmela Piñeiro

    2014-11-01

    Full Text Available Introduction: HIV infection during pregnancy still raises controversial issues. Combined antiretroviral therapy (cART has been successful in reducing mother-to-child transmission (MTCT. Routine screening in pregnancy and in pre-conception consultation proved to be one of the best methods able to get this treatment on time. We review our experience with pregnant patients with HIV infection. Materials and Methods: Retrospective and descriptive study. Data obtained from HIV-infected pregnant women from 1999 to 2012 with delivery and subsequent infectious diseases follow-up at our hospital. Results: We evaluated 136 patients (169 pregnancies, with a total of 147 living newborns (2 twin pregnancies and 1 stillbirth. Median age at pregnancy was 30 (SD 5.7 years. Four patients were HIV-2 infected and one HIV-1+2 infected. 26 (19.1% women were HCV co-infected and 6 (4.4% HBV co-infected; 1 patient has HCV and HBV co-infection. Sexual risk for HIV acquisition was determined in 102 (75% patients and 31 (22.8% were intravenous drug users. 33/136 (24.2% women were diagnosed on routine screening in pregnancy, 4 during delivery and 2 immediately after delivery. 36 (26.4% patients had an AIDS-defining entity before pregnancy and no new opportunistic infections were diagnosed. ART was used in 157 (92.9% pregnancies and 15 (9.5% of them were treated only with NRTIs. At the time of delivery 86/144 (59.7% patients had undetectable viral load (VL (25 patients without VL determined, 91.7% of those on ART. 119 (70.4% had a TCD4 cell count above 200 cells/mm3. MTCT occurred in 3/147 cases (2%: in one mother HIV-1 infection was diagnosed three weeks before delivery, other immediately after delivery and the third woman started cART (2NRTI+1PI/r in the second trimester of pregnancy, always adherent and without secondary effects, VL at delivery was 50 copies/mL and elective C-section was performed. Conclusions: The fact that 24% of patients were diagnosed during pregnancy

  2. Injection drug use and HIV/AIDS transmission in China

    Institute of Scientific and Technical Information of China (English)

    Tian; Xin; CHU; Judith; A; LEVY

    2005-01-01

    After nearly three decades of being virtually drug free, use of heroin and other illicit drugs has re-emerged in China as a major public health problem. One result is that drug abuse, particularly heroin injection, has come to play a predominant role in fueling China's AIDS epidemic. The first outbreak of HIV among China's IDUs was reported in the border area of Yunnan province between China and Myanmar where drug trafficking is heavy. Since then drug-related HIV has spread to all 31 provinces, autonomous regions and municipalities. This paper provides an overview to HIV/AIDS transmission through injection drug use in China. It begins with a brief history of the illicit drug trade in China, followed by a discussion of the emergence of drug related AIDS, and a profile of drug users and their sexual partners who have contracted the virus or who are vulnerable to infection. It ends by summarizing three national strategies being used by China to address both drug use and AIDS as major health threats.

  3. Knowledge of AIDS and HIV transmission among drug users in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Clair Scott

    2011-02-01

    Full Text Available Abstract Background Proper knowledge of HIV transmission is not enough for people to adopt protective behaviors, but deficits in this information may increase HIV/AIDS vulnerability. Objective To assess drug users' knowledge of HIV/AIDS and the possible association between knowledge and HIV testing. Methods A Cross-sectional study conducted in 2006/7 with a convenience sample of 295 illicit drug users in Rio de Janeiro, assessing knowledge on AIDS/HIV transmission and its relationship with HIV testing. Information from 108 randomly selected drug users who received an educational intervention using cards illustrating situations potentially associated with HIV transmission were assessed using Multidimensional Scaling (MDS. Results Almost 40% of drug users reported having never used condoms and more than 60% reported not using condoms under the influence of substances. Most drug users (80.6% correctly answered that condoms make sex safer, but incorrect beliefs are still common (e.g. nearly 44% believed HIV can be transmitted through saliva and 55% reported that HIV infection can be transmitted by sharing toothbrushes, with significant differences between drug users who had and who had not been tested for HIV. MDS showed queries on vaginal/anal sex and sharing syringes/needles were classified in the same set as effective modes of HIV transmission. The event that was further away from this core of properly perceived risks referred to blood donation, perceived as risky. Other items were found to be dispersed, suggesting inchoate beliefs on transmission modes. Conclusions Drug users have an increased HIV infection vulnerability compared to the general population, this specific population expressed relevant doubts about HIV transmission, as well as high levels of risky behavior. Moreover, the findings suggest that possessing inaccurate HIV/AIDS knowledge may be a barrier to timely HIV testing. Interventions should be tailored to such specific

  4. 2004-2013年云南省德宏州预防艾滋病母婴传播的卫生经济学评价%A study on the health economic evaluations of prevention of mother-to-child HIV transmission in Dehong prefecture, Yunnan province, China from 2004 to 2013

    Institute of Scientific and Technical Information of China (English)

    单多; 王娟; 段松; 郭云松; 唐树萍; 杨跃诚; 叶润华; 薛珲; 张广

    2015-01-01

    目的 对2004-2013年云南省德宏州预防艾滋病母婴传播工作进行卫生经济学评价.方法 根据德宏州实施艾滋病母婴阻断历年资料记录及当地防治艾滋病委员会办公室历年开展预防艾滋病母婴传播的资源投入、物资分配、经费下拨等资料估算成本数据,通过德宏州CDC历年的项目监测数据和预防艾滋病母婴传播工作报表数据计算相关效果指标,运用成本效果和成本效用分析方法,对母婴阻断工作进行卫生经济学评价.结果 2004-2013年期间,共对283 980名孕产妇进行了HIV检测,发现HIV阳性孕产妇2059例,阳性率为0.73%.2004-2013年各年总成本经贴现后为1 422.7万元,每发现1例HIV阳性孕产妇成本为0.42万元.由于实施艾滋病母婴阻断工作,分别有325名婴儿和26名成年人避免了HIV感染,成本效果比(CER)为4.05万元/例;实施该项工作所获得的质量调整生命年(QALY)为8 911.5,每获得1个QALY的成本为0.16万元.将母乳喂养和人工喂养进行比较发现,若全部实施母乳喂养,CER为4.28万元/例,每获得1个QALY所需成本为0.22万元.结论 通过成本效果和成本效用分析,提示德宏州艾滋病母婴阻断工作的实施具有经济学价值,建议持续加大投入,继续加强德宏州预防艾滋病母婴传播工作.%Objective To conduct health economic evaluation of the prevention of mother-to-child HIV among pregnant women in Dehong prefecture,Yunnan province,China from 2004 to 2013.Methods Data on cost were collected mainly from the annual prevention of mother-to-child transmission (PMTCT) reporting system of Dehong prefecture,and supplemented by HIV PMTCT-related resource allocation data from local health bureau.Effectiveness indexes were from local continuous HIV surveillance system and annual reported data.Cost-effectiveness and cost-utility analysis were used to conduct the health economic evaluation.Results From 2004 to 2013,283 980 pregnant women

  5. Baseline survey of pregnant women 's knowledge of treat-ment to prevent mother-to-child human immuno-deficien-cy virus transmission in a resource limited setting

    Institute of Scientific and Technical Information of China (English)

    Stephen Onwere; Obioha Okoro; Bright Chigbu; Chuks Kamanu; Christian Aluka; Paul Feyi-Wa-boso

    2008-01-01

    Despite continuing advances in scientific knowledge about treatments to prevent mother-to-child (MTCT)of the human immune deficiency virus (HIV),there is a paucity of data on pregnant women's knowledge of treat-ments to prevent MTCT of HIV in Aba,South Eastern Nigeria.We investigated pregnant women's knowledge of the availability of treatments to prevent MTCT of HIV in the low resourced setting of Aba town in South Eastern Nigeria.A descriptive study involving 100 consecutive and consenting patients at the antenatal clinic of Abia State University Teaching Hospital (ABSUTH),Aba,South Eastern Nigeria over the period 1st November, 2007 to 30th November,2007.Using a structured questionnaire,the respondents'sociodemographic data were obtained as well as their knowledge of the availability of treatments to prevent mother to child HIV transmission in pregnant women and self-reported data on their having ever tested for HIV.Knowledge regarding availability of treatment to prevent mother to child transmission of HIV was good as 95% of the respondents were aware that such treatment was available.Knowledge that treatment is available to help someone infected by HIV to live longer was also good as 96% of the respondents were aware of the availability of such treatment.Seventy one percent of the respondents had ever tested for HIV.The levels of knowledge regarding the availability of treatment to prevent mother to child HIV transmission and to help someone infected with HIV are good.Thus, utilization of anti-retroviral prophylaxis amongst HIV infected pregnant women in this community would be ex-pected to be high if the drugs were available.This will reduce the impact of HIV,especially in children.

  6. Assessing the impact of homelessness on HIV/AIDS transmission dynamics

    Directory of Open Access Journals (Sweden)

    C.P. Bhunu

    2015-12-01

    Full Text Available Care for the people living with HIV/AIDS is more than the provision of antiretroviral therapy. The effects of homelessness on HIV/AIDS transmission are captured through a mathematical model. The mathematical model is rigorously analyzed. The disease-free equilibrium is globally asymptotically stable when the reproduction number is less than unity. Results from the analysis of the reproduction number suggests that homelessness enhances both HIV transmission and progression to the AIDS stage. This is further supported by numerical simulations which show that some elements of homelessness (lack of entertainment enhances HIV/AIDS transmission.

  7. Impact of HIV co-infection on the evolution and transmission of multidrug-resistant tuberculosis.

    Science.gov (United States)

    Eldholm, Vegard; Rieux, Adrien; Monteserin, Johana; Lopez, Julia Montana; Palmero, Domingo; Lopez, Beatriz; Ritacco, Viviana; Didelot, Xavier; Balloux, Francois

    2016-01-01

    The tuberculosis (TB) epidemic is fueled by a parallel Human Immunodeficiency Virus (HIV) epidemic, but it remains unclear to what extent the HIV epidemic has been a driver for drug resistance in Mycobacterium tuberculosis (Mtb). Here we assess the impact of HIV co-infection on the emergence of resistance and transmission of Mtb in the largest outbreak of multidrug-resistant TB in South America to date. By combining Bayesian evolutionary analyses and the reconstruction of transmission networks utilizing a new model optimized for TB, we find that HIV co-infection does not significantly affect the transmissibility or the mutation rate of Mtb within patients and was not associated with increased emergence of resistance within patients. Our results indicate that the HIV epidemic serves as an amplifier of TB outbreaks by providing a reservoir of susceptible hosts, but that HIV co-infection is not a direct driver for the emergence and transmission of resistant strains. PMID:27502557

  8. Hormonal Contraceptive Use Among HIV-Positive Women and HIV Transmission Risk to Male Partners, Zambia, 1994–2012

    Science.gov (United States)

    Wall, Kristin M.; Kilembe, William; Vwalika, Bellington; Ravindhran, Preeti; Khu, Naw Htee; Brill, Ilene; Chomba, Elwyn; Johnson, Brent A.; Haddad, Lisa B.; Tichacek, Amanda; Allen, Susan

    2016-01-01

    Background. Evidence on the association between female-to-male human immunodeficiency virus (HIV) transmission risk and hormonal contraception is sparse and conflicting. Methods. Heterosexual HIV-discordant couples from Lusaka, Zambia, were followed longitudinally at 3 month-intervals from 1994 to 2012. The impact of hormonal contraception on time to HIV transmission from HIV-positive women to their HIV-negative male partners (M−F+) was evaluated. Results. Among 1601 M−F+ couples, 171 genetically linked HIV transmissions occurred in men over 3216 couple-years (5.3 transmissions/100 couple-years; 95% confidence interval [CI], 4.5–6.2). In multivariable Cox models, neither injectable (adjusted hazard ratio [aHR], 0.6; 95% CI, .4–1.2), oral contraceptive pill (aHR, 0.8; 95% CI, .3–2.1), nor implant (aHR, 0.8; 95% CI, .5–1.4) use was associated with HIV transmission, relative to nonhormonal methods, after controlling for the man's age at baseline and time-varying measures of pregnancy, self-reported unprotected sex with the study partner, sperm present on a vaginal swab wet mount, genital inflammation of either partner, genital ulceration of the man, and first follow-up interval. Sensitivity analyses, including marginal structural modeling and controlling for viral load and fertility intentions available in a subset of couples, led to similar conclusions. Conclusions. Our findings suggest null associations between hormonal contraception and risk of female-to-male HIV transmission. We support efforts to increase the contraceptive method mix for all women, regardless of HIV serostatus, along with reinforced condom counseling for HIV-serodiscordant couples. PMID:27462093

  9. Regulatory T cells diminish transmission of HIV from Dendritic cells to conventional CD4+ T cells

    OpenAIRE

    Maria Eugenia Moreno-Fernandez; Joedicke, Jara J; Claire Anne Chougnet

    2014-01-01

    Formation of immunological synapses between dendritic cells (DC) and conventional CD4+ T cells (Tcon) is critical for productive immune responses. However, when DCs are HIV-infected such synapses are critical to establish HIV infection. As regulatory T cells (Treg) control DC-Tcon interactions, we inquired whether Treg might interfere with DC to Tcon HIV transmission. We developed a model, using monocyte-derived DC infected with R5-HIV, and cultured with Tcon in the presence or absence of a...

  10. 我国西部某两个区县预防艾滋病母婴传播随访现状及影响因素研究%Study on follow-up status and its influence factors in HIV prevention on mother-to-child transmission

    Institute of Scientific and Technical Information of China (English)

    王芳; 王爱玲; 王前; 王潇滟; 苏穗青; 肖年; 王伟人; 金曦

    2013-01-01

    Objective To understand the current follow-up status for HIV positive pregnant women and their chil-dren in HIV prevention of mother-to-child transmission (PMTCT),and explore the main obstacles and possible influence factors for target population in western China.Methods A prospective survey was used to collect data on HIV infected preg-nant women and their exposed children in one district in Chongqing and one county in Guizhou from 2005 to 2012,based on the routine comprehensive HIV PMTCT interventions.Results The rate of Loss to Follow-up (LFU)among pregnant women who were confirmed to be HIV infected and their children was high in the two study sites,cumulated to 33.8% (25 /74).LFU mainly occurred during the phase from confirmation to delivery and from delivery to 6 -8 weeks postpartum.The number and rate of LFU were 7 (5.6%)and 16 (23.9%),respectively.Among those LFU,the proportions of being repor-ted in or before 2010 (69.6%),not receiving post-test counseling (30.4%)and living outside study sites (39.1%)were significantly higher than those not LFU (P <0.01).There was no differences in age,occupations,level of educations,mar-riage status,previous pregnancy history,infection route,stage of receiving ANC and PMTCT services between LFU and un-LFU.Conclusion The two stages from HIV positive result confirmation to delivery and from delivery to the first visit at the 6th-8th week after delivery are critical to reduce the rate of LFU.The further research about service delivery impact on LFU should be carried out as soon as possible.%目的了解我国西部地区 HIV 感染孕产妇及所生儿童随访现状,发现主要问题及可能的需方影响因素。方法采用前瞻性调查方法,对2005-2012年我国重庆市、贵州省的两个区县发现的所有 HIV 感染孕产妇及所生儿童进行社会人口学、接受服务情况等调查。结果研究地区 HIV 感染孕产妇及所生儿童失访率较高,累计达33.8%(25/74),失访主要

  11. Fatores protetores e de risco envolvidos na transmissão vertical do HIV-1 Protective and risk factors related to vertical transmission of the HIV-1

    Directory of Open Access Journals (Sweden)

    Rosângela P. Gianvecchio

    2005-04-01

    Full Text Available Este estudo avalia os fatores maternos e fetais envolvidos na transmissão vertical do HIV-1 em 47 pares de mãe e filho. As variáveis comportamentais, demográficas e obstétricas foram obtidas mediante entrevista; os dados referentes ao parto e ao recém-nascido, dos prontuários das maternidades. Durante o terceiro trimestre de gestação foi realizada a contagem da carga viral materna e dos linfócitos T CD4+. A média de idade foi de 25 anos e 23,4% das gestantes eram primigestas, e o fator comportamental mais prevalente foi não usar preservativos. Dentre as gestantes, 48,9% tinham células CD4+ superior a 500 células/mm³ e 93,6% se enquadravam na categoria clínica A; 95,7% submeteram-se à profilaxia com zidovudina durante a gestação ou no parto, a qual foi ministrada a todos os recém-nascidos; 50,0% delas foram submetidas à cesárea eletiva. Apesar de expostas a vários fatores de risco e protetores, nenhuma criança tornou-se infectada. A transmissão vertical resulta de um desequilíbrio entre os fatores, com predomínio dos de risco sobre os protetores.This study aimed to evaluate maternal and fetal factors related to vertical transmission of HIV-1. Participants included 47 mother-child pairs. Behavioral, demographic, and obstetric data were obtained through interviews. Data related to delivery and newborns were collected from registries in the maternity hospitals. During the third trimester of pregnancy, CD4+ T lymphocytes and maternal viral load were measured. Mean age of the mothers was 25 years and 23.4% of the pregnant women were primigravidae. The most prevalent behavioral factor was lack of condom use. 48.9% of the women presented a CD4+ count greater than 500 cells/ mm³, and 93.6% belonged to clinical category A. 95.7% of the women received zidovudine prophylaxis during pregnancy or childbirth, and the medication was also administered to all the neonates. 50.0% of patients were submitted to elective cesareans. Despite

  12. Medical Ethic Problem of Intervention to Prevent Mother-to-child Transmission in HIV Infected Pregnant Women%HIV感染孕妇母婴传播阻断的医学伦理学思考

    Institute of Scientific and Technical Information of China (English)

    王笑犁

    2010-01-01

    探讨艾滋病母婴传播概况以及我国 HIV 感染母婴传播阻断的现行方式,并思考由此而带来的伦理学问题.在艾滋病尚不能临床治愈并且有可能垂直传播给下一代、我国卫生资源短缺的前提下,日益增多的HIV感染孕妇是选择终止妊娠还是其他的母婴阻断措施问题,带来了尖锐的伦理学冲突,已不再是一个简单的临床决策问题,其背后的医学伦理学问题值得深思.

  13. Strategies to prevent HIV transmission to serodiscordant couples

    Directory of Open Access Journals (Sweden)

    Ronaldo Campos Hallal

    2015-09-01

    Full Text Available ABSTRACTIntroduction:The use antiretroviral reduces the sexual transmission of HIV, expanding interventions for serodiscordant couples.Objective:This article aims to review the use of antiretroviral and other prevention interventions among serodiscordant couples and to analyze its use in Brazil.Methods:A retrospective review was performed through the MEDLINE database and bases included in the Biblioteca Virtual em Saúde.Results:The articles recovered exhibit four main strategies: (1 condom; (2 reduction of risks in sexual practices; (3 use of antiretrovirals, particularly early initiation of antiretroviral therapy (TASP and pre-exposure prophylaxis (PrEP; (4 risk reduction in reproduction.Discussion:TASP is highly effective in reducing sexual transmission, PrEP was tested in serodiscordant couples and both reduce the sexual transmission risk in different sexual practices, enabling individualized prevention strategies.Conclusions:When used in combination, antiretrovirals and sexual practices with condoms offer greater efficacy than any single strategy. The combined use of new and old strategies allows us to build a prevention policy for all.

  14. HIV-associated (non-thymic) intrathoracic lymphoepithelial cyst in a child

    Energy Technology Data Exchange (ETDEWEB)

    Brudnicki, A.R.; Moser, J. [Dept. of Radiology, Westchester County Medical Center, Valhalla, NY (United States); Levin, T.L. [Dept. of Radiology, Weiler Hospital, Albert Einstein College of Medicine, Bronx, NY (United States); Slim, M.S. [Dept. of Pediatric Surgery, Westchester County Medical Center, Valhalla, NY (United States); Amin, N. [Dept. of Pediatrics, Westchester County Medical Center, Valhalla, NY (United States)

    2001-08-01

    An unusual case of a juxtabronchial lymphoepithelial cyst in an HIV-positive child with post-obstructive pneumonia is presented. The pathogenesis and similarity with parotid lymphoepithelial cysts is discussed. (orig.)

  15. Anxiety/Stress among Mothers Living with HIV: Effects on Parenting Skills & Child Outcomes

    OpenAIRE

    Murphy, Debra A.; Marelich, William D.; Armistead, Lisa; Herbeck, Diane M.; Payne, Diana L.

    2010-01-01

    Parental HIV infection has been associated with negative outcomes for children, and parenting skills appear to be one mechanism operating in that association. The present study focuses on the relations between maternal stress, parenting, and child functioning among families where the mother is living with HIV. Sixty-nine mothers with at least one child between 6 and 12 years old completed questionnaires at the baseline assessment of an intervention designed to facilitate maternal disclosure o...

  16. A modified mathematical model for HIV transmission, AIDS and intervention strategies in Ireland

    OpenAIRE

    Dunne, Mary T

    1995-01-01

    The aim of this project was to modify transmission models previously developed to describe HIV transmission in Ireland through more precise estimates of parameters delineating sexual and needle sharing behaviour and AIDS related mortality, with a view to examining the extent of spread from IVDUs to the general heterosexual population. To provide predictions on HIV transmission and AIDS cases up to the year 2010 and to examine the sensitivity of the predictions to changes in the key parameters...

  17. No SEVI-mediated enhancement of rectal HIV-1 transmission of HIV-1 in two humanized mouse cohorts.

    Science.gov (United States)

    Van Dis, Erik S; Moore, Tyler C; Lavender, Kerry J; Messer, Ronald J; Keppler, Oliver T; Verheyen, Jens; Dittmer, Ulf; Hasenkrug, Kim J

    2016-01-15

    Amyloid fibrils from semen-derived peptide (SEVI) enhance HIV-1 infectivity in vitro but the ability of SEVI to mediate enhancement of HIV infection in vivo has not been tested. In this study we used immunodeficient mice reconstituted with human immune systems to test for in vivo enhancement of HIV-1 transmission. This mouse model supports mucosal transmission of HIV-1 via the intrarectal route leading to productive infection. In separate experiments with humanized mouse cohorts reconstituted with two different donor immune systems, high dose HIV-1JR-CSF that had been incubated with SEVI amyloid fibrils at physiologically relevant concentrations did not show an increased incidence of infection compared to controls. In addition, SEVI failed to enhance rectal transmission with a reduced concentration of HIV-1. Although we confirmed potent SEVI-mediated enhancement of HIV infectivity in vitro, this model showed no evidence that it plays a role in the much more complex situation of in vivo transmission. PMID:26609939

  18. Substance Abuse and Medication Adherence Among HIV-Positive Women with Histories of Child Sexual Abuse

    OpenAIRE

    Liu, Honghu; Longshore, Doug; Williams, John K.; Rivkin, Inna; Loeb, Tamra; Warda, Umme S.; Carmona, Jennifer; Wyatt, Gail

    2006-01-01

    Substance abuse increases the risks for infections and impairs medication adherence among HIV/AIDS patients. However, little is known about the characteristics of substance abuse and its impact on medication adherence among HIV-positive women with a history of child sexual abuse (CSA). In the present study, 148 HIV-positive women with a history of CSA completed a structured interview assessing CSA severity, psychological status, substance abuse, medication adherence, and sexual decision-makin...

  19. [Prospects of using miramistin for individual prevention of sexual HIV transmission].

    Science.gov (United States)

    Krivorutchenko, Iu L; Andronovskaia, I B

    2013-03-01

    For more than 20 years cationic surfactant Miramistin has been used in Russia and Ukraine as an antiseptic mean for individual prophylaxis of venereal diseases and for the treatment of genitourinary tract and other systems infections. Complete inhibition of HIV-1 activity in vitro by Miramistin in concentrations higher than 0.0075%, has been demonstrated, that allows to consider this detergent as a potent first-generation vaginal microbicide for the prevention of HIV transmission. Higher anti-HIV effect of Miramistin than of nonoxynol-9 and low local toxicity show good prospects of using Miramistin for individual prevention of HIV transmission. PMID:24605621

  20. Prevention of mother to child transmission lay counsellors: Are they adequately trained?

    Directory of Open Access Journals (Sweden)

    Catherine H. Thurling

    2012-05-01

    Full Text Available South Africa’s high prevalence of human immunodeficiency virus (HIV infected women requires a comprehensive health care approach to pregnancy because of the added risk of their HIV status. As a result of the shortage of health care workers in South Africa, lay counsellors play important roles in the prevention of mother to child transmission of HIV (PMTCT.There is no standardization of training of lay counsellors in South Africa, and training varies in length depending on the training organisation.The study aimed to investigate the training of lay counsellors by analysing their training curricula and interviewing lay counsellors about their perceptions of their training.A two phase research method was applied. Phase one documented an analysis of the training curricula. Phase two was semi-structured interviews with the participants. Purposive sampling was undertaken for this study. The total sample size was 13 people, with a final sample of 9 participants, determined at the point of data saturation.The research was qualitative, descriptive and contextual in design. The curricula analysed had different styles of delivery, and the approaches to learning and courses varied, resulting in inconsistent training outcomes. A need for supervision and mentorship in the working environment was also noted.The training of lay counsellors needs to be adapted to meet the extended roles that they are playing in PMTCT. The standardization of training programmes, and the incorporation of a system of mentorship in the work environment, would ensure that the lay counsellors are adequately prepared for their role in PMTCT.

  1. Tetherin does not significantly restrict dendritic cell-mediated HIV-1 transmission and its expression is upregulated by newly synthesized HIV-1 Nef

    Directory of Open Access Journals (Sweden)

    Wu Li

    2011-04-01

    Full Text Available Abstract Background Dendritic cells (DCs are among the first cells to encounter HIV-1 and play important roles in viral transmission and pathogenesis. Immature DCs allow productive HIV-1 replication and long-term viral dissemination. The pro-inflammatory factor lipopolysaccharide (LPS induces DC maturation and enhances the efficiency of DC-mediated HIV-1 transmission. Type I interferon (IFN partially inhibits HIV-1 replication and cell-cell transmission in CD4+ T cells and macrophages. Tetherin is a type I IFN-inducible restriction factor that blocks HIV-1 release and modulates CD4+ T cell-mediated cell-to-cell transmission of HIV-1. However, the role of type I IFN and tetherin in HIV-1 infection of DCs and DC-mediated viral transmission remains unknown. Results We demonstrated that IFN-alpha (IFNα-induced mature DCs restricted HIV-1 replication and trans-infection of CD4+ T cells. Tetherin expression in monocyte-derived immature DCs was undetectable or very low. High levels of tetherin were transiently expressed in LPS- and IFNα-induced mature DCs, while HIV-1 localized into distinct patches in these DCs. Knockdown of induced tetherin in LPS- or IFNα-matured DCs modestly enhanced HIV-1 transmission to CD4+ T cells, but had no significant effect on wild-type HIV-1 replication in mature DCs. Intriguingly, we found that HIV-1 replication in immature DCs induced significant tetherin expression in a Nef-dependent manner. Conclusions The restriction of HIV-1 replication and transmission in IFNα-induced mature DCs indicates a potent anti-HIV-1 response; however, high levels of tetherin induced in mature DCs cannot significantly restrict wild-type HIV-1 release and DC-mediated HIV-1 transmission. Nef-dependent tetherin induction in HIV-1-infected immature DCs suggests an innate immune response of DCs to HIV-1 infection.

  2. Intergenerational Transmission of Attachment in Father-Child Dyads: The Case of Single Parenthood

    Science.gov (United States)

    Bernier, Annie; Miljkovitch, Raphaele

    2009-01-01

    Researchers have repeatedly found that intergenerational transmission of attachment is more robust in mother-child dyads than it is in father-child dyads. They have proposed several explanations for the inconsistent father-child findings, including the use of the strange situation procedure, the young age of the children, and the fact that fathers…

  3. Gender inequality and HIV transmission: a global analysis

    OpenAIRE

    Eugene T Richardson; Collins, Sean E.; Tiffany Kung; Jones, James H; Khai Hoan Tram; Victoria L Boggiano; Linda-Gail Bekker; Zolopa, Andrew R.

    2014-01-01

    Introduction: The HIV pandemic disproportionately impacts young women. Worldwide, young women aged 15–24 are infected with HIV at rates twice that of young men, and young women alone account for nearly a quarter of all new HIV infections. The incommensurate HIV incidence in young – often poor – women underscores how social and economic inequalities shape the HIV epidemic. Confluent social forces, including political and gender violence, poverty, racism, and sexism impede equal access to thera...

  4. Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents

    Science.gov (United States)

    Safren, Steven A; Hughes, James P; Mimiaga, Matthew J; Moore, Ayana T; Friedman, Ruth Khalili; Srithanaviboonchai, Kriengkrai; Limbada, Mohammed; Williamson, Brian D; Elharrar, Vanessa; Cummings, Vanessa; Magidson, Jessica F; Gaydos, Charlotte A; Celentano, David D; Mayer, Kenneth H

    2016-01-01

    Introduction Successful global treatment as prevention (TasP) requires identifying HIV-positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI) acquisition among sexually active HIV-positive individuals in care from three representative global settings. Methods HIV-positive individuals (n=749), including heterosexual men, heterosexual women and men who have sex with men (MSM) in HIV care, were recruited from Chiang Mai (Thailand), Rio De Janeiro (Brazil) and Lusaka (Zambia). Participants were assessed on HIV and STI sexual transmission risk variables, psychosocial characteristics and bacterial STIs at enrolment and quarterly for 12 months (covering 15 months). Estimated numbers of HIV transmissions per person were calculated using reported numbers of partners and sex acts together with estimates of HIV transmissibility, accounting for ART treatment and condom use. Results An estimated 3.81 (standard error, (SE)=0.63) HIV transmissions occurred for every 100 participants over the 15 months, which decreased over time. The highest rate was 19.50 (SE=1.68) for every 100 MSM in Brazil. In a multivariable model, country×risk group interactions emerged: in Brazil, MSM had 2.85 (95% CI=1.45, 4.25, p<0.0001) more estimated transmissions than heterosexual men and 3.37 (95% CI=2.01, 4.74, p<0.0001) more than heterosexual women over the 15 months. For MSM and heterosexual women, the combined 12-month STI incidence rate for the sample was 22.4% (95% CI=18.1%, 27.3%; incidence deemed negligible in heterosexual men). In the multivariable model, MSM had 12.3 times greater odds (95% CI=4.44, 33.98) of acquiring an STI than women, but this was not significant in Brazil. Higher alcohol use on the Alcohol Use Disorders Identification Test (OR=1.04, 95% CI=1.01, 1.08) was also significantly associated

  5. Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents

    Directory of Open Access Journals (Sweden)

    Steven A Safren

    2016-09-01

    Full Text Available Introduction: Successful global treatment as prevention (TasP requires identifying HIV-positive individuals at high risk for transmitting HIV, and having impact via potential infections averted. This study estimated the frequency and predictors of numbers of HIV transmissions and bacterial sexually transmitted infection (STI acquisition among sexually active HIV-positive individuals in care from three representative global settings. Methods: HIV-positive individuals (n=749, including heterosexual men, heterosexual women and men who have sex with men (MSM in HIV care, were recruited from Chiang Mai (Thailand, Rio De Janeiro (Brazil and Lusaka (Zambia. Participants were assessed on HIV and STI sexual transmission risk variables, psychosocial characteristics and bacterial STIs at enrolment and quarterly for 12 months (covering 15 months. Estimated numbers of HIV transmissions per person were calculated using reported numbers of partners and sex acts together with estimates of HIV transmissibility, accounting for ART treatment and condom use. Results: An estimated 3.81 (standard error, (SE=0.63 HIV transmissions occurred for every 100 participants over the 15 months, which decreased over time. The highest rate was 19.50 (SE=1.68 for every 100 MSM in Brazil. In a multivariable model, country×risk group interactions emerged: in Brazil, MSM had 2.85 (95% CI=1.45, 4.25, p<0.0001 more estimated transmissions than heterosexual men and 3.37 (95% CI=2.01, 4.74, p<0.0001 more than heterosexual women over the 15 months. For MSM and heterosexual women, the combined 12-month STI incidence rate for the sample was 22.4% (95% CI=18.1%, 27.3%; incidence deemed negligible in heterosexual men. In the multivariable model, MSM had 12.3 times greater odds (95% CI=4.44, 33.98 of acquiring an STI than women, but this was not significant in Brazil. Higher alcohol use on the Alcohol Use Disorders Identification Test (OR=1.04, 95% CI=1.01, 1.08 was also significantly

  6. HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA

    Directory of Open Access Journals (Sweden)

    Seth C Kalichman

    2015-08-01

    Full Text Available Introduction: Antiretroviral therapy (ART improves the health of people living with HIV and has the potential to reduce HIV infectiousness, thereby preventing HIV transmission. However, the success of ART for HIV prevention hinges on sustained ART adherence and avoiding sexually transmitted infections (STI. Objectives: To determine the sexual behaviours and HIV transmission risks of individuals with suppressed and unsuppressed HIV replication (i.e., viral load. Methods: Assessed HIV sexual transmission risks among individuals with clinically determined suppressed and unsuppressed HIV. Participants were 760 men and 280 women living with HIV in Atlanta, GA, USA, who completed behavioural assessments, 28-daily prospective sexual behaviour diaries, one-month prospective unannounced pill counts for ART adherence, urine screening for illicit drug use and medical record chart abstraction for HIV viral load. Results: Individuals with unsuppressed HIV demonstrated a constellation of behavioural risks for transmitting HIV to uninfected sex partners that included symptoms of STI and substance use. In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma. Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners. Conclusions: Implementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART.

  7. HIV transmission law in the age of treatment-as-prevention.

    Science.gov (United States)

    Haire, Bridget; Kaldor, John

    2015-12-01

    Evidence that treating people with HIV early in infection prevents transmission to sexual partners has reframed HIV prevention paradigms. The resulting emphasis on HIV testing as part of prevention strategies has rekindled the debate as to whether laws that criminalise HIV transmission are counterproductive to the human rights-based public health response. It also raises normative questions about what constitutes 'safe(r) sex' if a person with HIV has undetectable viral load, which has significant implications for sexual practice and health promotion. This paper discusses a recent high-profile Australian case where HIV transmission or exposure has been prosecuted, and considers how the interpretation of law in these instances impacts on HIV prevention paradigms. In addition, we consider the implications of an evolving medical understanding of HIV transmission, and particularly the ability to determine infectiousness through viral load tests, for laws that relate to HIV exposure (as distinct from transmission) offences. We conclude that defensible laws must relate to appreciable risk. Given the evidence that the transmissibility of HIV is reduced to negligible level where viral load is suppressed, this needs to be recognised in the framing, implementation and enforcement of the law. In addition, normative concepts of 'safe(r) sex' need to be expanded to include sex that is 'protected' by means of the positive person being virally suppressed. In jurisdictions where use of a condom has previously mitigated the duty of the person with HIV to disclose to a partner, this might logically also apply to sex that is 'protected' by undetectable viral load.

  8. Trends in attitudes toward people living with HIV, homophobia, and HIV transmission knowledge in Quebec, Canada (1996, 2002, and 2010).

    Science.gov (United States)

    Adrien, Alix; Beaulieu, Marianne; Leaune, Viviane; Perron, Michèle; Dassa, Clément

    2013-01-01

    People living with HIV (PWHIV) face negative attitudes that isolate and discourage them from accessing services. Understanding negative attitudes and the social environment can lead to more effective health promotion strategies and programs. However, a scale to measure attitudes has been lacking. We developed and validated attitudes toward PWHIV Scale to examine trends in attitudes toward PWHIV in Quebec in 1996, 2002, and 2010. We also examined the relationship between negative attitudes toward PWHIV, homophobia, and knowledge about HIV transmission. The scale included 16 items and had a five-factor structure: F1 (fear of being infected), F2 (fear of contact with PWHIV), F3 (prejudicial beliefs toward groups at high risk of HIV), F4 (tolerance regarding sexual mores and behaviors), and F5 (social support for PWHIV). The validity and reliability of the scale were assessed and found to be high. Overall, Quebecers had positive attitudes toward PWHIV, with more negative attitudes observed in subgroups defined as male, ≥50 years of age, homophobia, and below-average knowledge about HIV transmission. Scores were stable between 1996 and 2002, and increased in 2010. Negative attitudes were correlated with higher levels of homophobia and lesser knowledge about HIV transmission. The lowest scores for each factor were observed in the same subgroups that had low overall scores on the Attitudes Scale. The findings from this study can be used to intensify interventions that promote compassion for PWHIV, address attitudes toward homosexuality, and encourage greater knowledge about the transmission of HIV in these subgroups.

  9. Pregnancy and delivery outcomes of HIV infected women in Switzerland 2003-2008

    OpenAIRE

    Aebi-Popp, Karoline; Lapaire, Olav; Glass, Tracy R; Vilén, Louise; Rudin, Christoph; Elzi, Luigia; Battegay, Mannel; Keiser, Olivia; de Tejada, Begona Martinez; Hoesli, Irene M.

    2010-01-01

    Rates of vertical HIV transmission between mother and child are low, allowing many HIV positive women to have children with near impunity. In this study, data from the Swiss Mother and Child HIV Cohort Study were used to describe maternal characteristics and their association with pregnancy outcomes in HIV positive women.

  10. HIV-1 transmission within marriage in rural Uganda: a longitudinal study.

    Directory of Open Access Journals (Sweden)

    Samuel Biraro

    Full Text Available BACKGROUND: Early initiation of antiretroviral therapy reduces risk of transmission to the uninfected partner in HIV discordant couples, but there are relatively little observational data on HIV transmission within couples from non-trial settings. The aims of this paper are to estimate HIV incidence among HIV discordant couples using longstanding observational data from a rural Ugandan population and to identify factors associated with HIV transmission within couples, including the role of HSV-2 infection. METHODS: Using existing data collected at population-wide annual serological and behavioural surveys in a rural district in southwest Uganda between 1989 and 2007, HIV discordant partners were identified. Stored serum samples were tested for HSV-2 serostatus using the Kalon ELISA test. HIV seroconversion rates and factors association with HIV seroconversion were analysed using Poisson regression. RESULTS: HIV status of both partners was known in 2465 couples and of these 259 (10.5% were HIV serodiscordant. At enrollment, HSV-2 prevalence was 87.3% in HIV positive partners and 71.5% in HIV negative partners. Of the 259 discordant couples, 62 converted to HIV (seroconversion rate 7.11/100 PYAR, 95%CI; 5.54, 9.11 with the rate decreasing from 10.89 in 1990-1994 to 4.32 in 2005-2007. Factors independently associated with HIV seroconversion were female sex, non-Muslim religion, greater age difference (man older than woman by more than 15 years, higher viral load in the positive partner and earlier calendar period. HSV-2 was not independently associated with HIV acquisition (HR 1.62, 95%CI; 0.57, 4.55 or transmission (HR 0.61, 95%CI; 0.24, 1.57. No transmissions occurred in the 29 couples where the index partner was on ART during follow up (872 person-years on ART. DISCUSSION: HIV negative partners in serodiscordant couples have a high incidence of HIV if the index partner is not on antiretroviral therapy and should be provided with interventions

  11. 76 FR 72417 - Public Health Service Guideline for Reducing Transmission of Human Immunodeficiency Virus (HIV...

    Science.gov (United States)

    2011-11-23

    ... Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) through Solid Organ Transplantation'' (76 FR 58517). Written and electronic comments were to be received on or before November 21, 2011... Transmission of Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), and Hepatitis C Virus...

  12. Mutz-3-derived Langerhans cells are a model to study HIV-1 transmission and potential inhibitors

    NARCIS (Netherlands)

    de Jong, Marein A. W. P.; de Witte, Lot; Santegoets, Saskia J. A. M.; Fluitsma, Donna; Taylor, Maureen E.; de Gruijl, Tanja D.; Geijtenbeek, Teunis B. H.

    2010-01-01

    Sexual transmission is the primary route of HIV-1 infection, and DC subsets are thought to be involved in viral dissemination to T cells. In the genital mucosa, two main subsets of DCs are present: epithelial LCs capture and degrade HIV-1 through C-type lectin Langerin, whereas subepithelial DCs exp

  13. HIV Transmission Patterns Among Immigrant Latinos Illuminated by the Integration of Phylogenetic and Migration Data.

    Science.gov (United States)

    Dennis, Ann M; Hué, Stéphane; Pasquale, Dana; Napravnik, Sonia; Sebastian, Joseph; Miller, William C; Eron, Joseph J

    2015-10-01

    Latinos represent a growing proportion of HIV cases in North Carolina (NC). Understanding how immigrants are involved in local HIV transmission is important to guide interventions. We used phylogenetics to characterize Latino involvement in local HIV transmission chains. Transmission clusters were identified from maximum-likelihood phylogenies constructed with HIV pol sequences from 177 Latinos and 1,496 non-Latinos receiving care in NC. Highly supported clusters involving one or more Latinos were characterized. Migration data were obtained from interviews and chart review. Factors associated with cluster membership were identified using log-binomial regression. Most Latinos were male (76%), immigrants (83%), and had HIV-1B (99%). Immigrants were more likely to report heterosexual risk (67% vs. 23%) than U.S.-born Latinos (p Immigrant and U.S.-born Latinos were equally likely to be in clusters, but immigrants were more likely to be in clusters with another Latino (78% vs. 29%; p = 0.02). Cluster composition by ethnicity and risk behavior varied by cluster size; larger clusters contained fewer immigrants and more men who have sex with men (MSM). Factors associated with immigrant membership in local transmission clusters included age immigrate with HIV infection, many immigrants are involved in transmission networks after arrival, particularly MSM. HIV testing and prevention interventions must consider this heterogeneity and may be better targeted by integrating phylogenetic analyses. PMID:26214548

  14. Application of a case–control study design to investigate genotypic signatures of HIV-1 transmission

    OpenAIRE

    Mota Talia M; Murray John M; Center Rob J; Purcell Damian F J; McCaw James M

    2012-01-01

    Abstract Background The characterization of HIV-1 transmission strains may inform the design of an effective vaccine. Shorter variable loops with fewer predicted glycosites have been suggested as signatures enriched in envelope sequences derived during acute HIV-1 infection. Specifically, a transmission-linked lack of glycosites within the V1 and V2 loops of gp120 provides greater access to an α4β7 binding motif, which promotes the establishment of infection. Also, a histidine at position 12 ...

  15. Mucosal HIV-1 transmission and prevention strategies in BLT humanized mice

    OpenAIRE

    Denton, Paul W.; Garcia, J. Victor

    2012-01-01

    Clinical trials testing microbicides and related biomedical interventions to block HIV transmissions have produced contradictory results and to date it is unclear why. Further elucidation of the molecular basis of mucosal HIV transmission and extensive pharmacokinetic and pharmacodynamic analyses are essential to implementing effective prevention strategies. Animal models are of critical importance to this effort and bone marrow-liver-thymus (or BLT) humanized mice have recently emerged as a ...

  16. Could low dead-space syringes really reduce HIV transmission to low levels?

    Science.gov (United States)

    Vickerman, P; Martin, N K; Hickman, M

    2013-01-01

    Studies published by Zule and colleagues have suggested that use of low dead-space syringes (LDSS) instead of high dead-space syringes (HDSS) by injecting drug users (IDUs) could dramatically reduce HIV transmission. However, evidence is limited because experiments have considered a small range of syringe types and have been unable to reliably estimate the efficacy of using LDSS for reducing HIV transmission. We critically appraise available evidence to determine whether using LDSS is likely to dramatically reduce HIV transmission. We systematically review the literature on the dead-space volume of syringes and estimate the factor difference in blood volume transferred from sharing LDSS or HDSS. Existing data on the relationship between host viral load and HIV transmission risk is used to evaluate the likely efficacy of using LDSS instead of HDSS. An HIV transmission model is used to make conservative impact projections for switching to using LDSS, and explore the implications of heterogeneity in IDU transmission risk and syringe preferences. Although highly variable, reviewed studies suggest that HDSS have on average 10 times the dead-space volume of LDSS and could result in 6/54/489 times more blood being transferred after 0/1/2 water rinses. Assuming a conservative 2-fold increase in HIV transmission risk per 10-fold increase in infected blood inoculum, HDSS use could be associated with a mean 1.7/3.6/6.5-fold increase in transmission risk compared to LDSS for 0/1/2 rinses. However, even for a low efficacy estimate, modelling suggests that partially transferring to LDSS use from using HDSS could dramatically reduce HIV prevalence (generally >33% if LDSS use is 50%), but impact will depend on IDU behavioural heterogeneity and syringe preference. Indirect evidence suggests that encouraging HDSS users to use LDSS could be a powerful HIV prevention strategy. There is an urgent need to evaluate the real life effectiveness of this strategy.

  17. Transmission of single and multiple viral variants in primary HIV-1 subtype C infection.

    Directory of Open Access Journals (Sweden)

    Vladimir Novitsky

    Full Text Available To address whether sequences of viral gag and env quasispecies collected during the early post-acute period can be utilized to determine multiplicity of transmitted HIV's, recently developed approaches for analysis of viral evolution in acute HIV-1 infection [1,2] were applied. Specifically, phylogenetic reconstruction, inter- and intra-patient distribution of maximum and mean genetic distances, analysis of Poisson fitness, shape of highlighter plots, recombination analysis, and estimation of time to the most recent common ancestor (tMRCA were utilized for resolving multiplicity of HIV-1 transmission in a set of viral quasispecies collected within 50 days post-seroconversion (p/s in 25 HIV-infected individuals with estimated time of seroconversion. The decision on multiplicity of HIV infection was made based on the model's fit with, or failure to explain, the observed extent of viral sequence heterogeneity. The initial analysis was based on phylogeny, inter-patient distribution of maximum and mean distances, and Poisson fitness, and was able to resolve multiplicity of HIV transmission in 20 of 25 (80% cases. Additional analysis involved distribution of individual viral distances, highlighter plots, recombination analysis, and estimation of tMRCA, and resolved 4 of the 5 remaining cases. Overall, transmission of a single viral variant was identified in 16 of 25 (64% cases, and transmission of multiple variants was evident in 8 of 25 (32% cases. In one case multiplicity of HIV-1 transmission could not be determined. In primary HIV-1 subtype C infection, samples collected within 50 days p/s and analyzed by a single-genome amplification/sequencing technique can provide reliable identification of transmission multiplicity in 24 of 25 (96% cases. Observed transmission frequency of a single viral variant and multiple viral variants were within the ranges of 64% to 68%, and 32% to 36%, respectively.

  18. HIV transmission by seronegative blood components: report of 2 probable cases.

    Science.gov (United States)

    Isarangkura, P; Mahaphan, W; Chiewsilp, P; Chuansumrit, A; Hathirat, P

    1993-01-01

    HIV seroconversion was reported in 2 haemophiliacs after having corrective orthopaedic surgery. They received solvent-detergent/heat-treated factor VIII concentrate, HIV-seronegative cryoprecipitate and fresh frozen plasma during the course of surgery. HIV seroconversion was found on days 31 and 71 after surgery. It is highly probable that the infections were acquired by transfusions of seronegative blood components. In countries with a relatively low prevalence of HIV infection, transmission of HIV by transfusion of derivatives of seronegative blood is occasionally reported as a rare complication of blood transfusion [1-3]. In Thailand the prevalence of HIV infection and the incidence of new infections in the general population and in blood donors has recently increased dramatically (fig. 1) [4-5]. As a result of these components prepared from HIV-seronegative blood donations pose a significant hazard to recipients because of the risk of viraemia during the 'window period' of HIV infection. Here we report HIV infection in 2 haemophilia patients treated with HIV-seronegative (using Fujirebio agglutination or second-generation Abbott ELISA) cryoprecipitate and fresh frozen plasma in 1991, prepared locally from single-unit donations. All donors were voluntary. Anti-HIV was tested in every unit of donor blood before processing to blood components. Although not proven, it is highly probable that the infections were acquired by transfusions of seronegative blood components.

  19. Knowledge of HIV transmission and condom use among HIV-positive heterosexual men and women in Guatemala

    Directory of Open Access Journals (Sweden)

    Delgado Hurtado Juan J

    2011-12-01

    Full Text Available Abstract Background The prevalence of HIV/AIDS in Guatemala among the general population is 0.79%, and 94% of transmission is directly related to sexual contact. Studies have been conducted on high- prevalence HIV-positive populations (men who have sex with men, commercial sex workers and prisoners. Heterosexual transmission has gained importance in the epidemic in Central America. To our knowledge, no study addressing knowledge of mechanisms of HIV transmission and condom use has been done on HIV-positive heterosexual men and women. Methods A closed-ended structured interview that addressed knowledge of mechanisms of HIV transmission and condom use was conducted on 283 heterosexual HIV-positive men (54.8% and women (45.2% outpatients who attend the Roosevelt Hospital's Clinic of Infectious Diseases in Guatemala City. Differences between selected characteristics were examined for significance using the Chi-square test. A multiple logistic regression was done to determine socio-demographic variables associated with inconsistent condom use. Results Of the interviewed persons, 68.5% were either living with a partner or married, and 94.3% were currently using antiretroviral therapy. Most respondents knew the mechanisms of transmission of HIV. 81.7% and 87.3% reported always using a condom with their regular and casual sexual partner in the past year, respectively. There was no statistically difference in condom use according to the patient's formal education, gender, type of partner (regular or casualor number of sexual partners. According to the interviewees, 72% of sexual partners in the past year were either HIV negative or of an unknown serostatus. Potentially, these HIV-negative persons are at risk of contracting the virus. Among the main reasons given for not using a condom were: "my partner did not want to use a condom"; and "the condom irritates or makes my partner uncomfortable". Conclusions Since no socio-demographic or sexual behavior

  20. Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy

    DEFF Research Database (Denmark)

    Rodger, Alison J; Cambiano, Valentina; Bruun, Tina;

    2016-01-01

    of within-couple HIV transmission (heterosexual and men who have sex with men [MSM]) during periods of sex without condoms and when the HIV-positive partner had HIV-1 RNA load less than 200 copies/mL. DESIGN, SETTING, AND PARTICIPANTS: The prospective, observational PARTNER (Partners of People on ART-A New...... Evaluation of the Risks) study was conducted at 75 clinical sites in 14 European countries and enrolled 1166 HIV serodifferent couples (HIV-positive partner taking suppressive ART) who reported condomless sex (September 2010 to May 2014). Eligibility criteria for inclusion of couple-years of follow-up were...... condomless sex and HIV-1 RNA load less than 200 copies/mL. Anonymized phylogenetic analysis compared couples' HIV-1 polymerase and envelope sequences if an HIV-negative partner became infected to determine phylogenetically linked transmissions. EXPOSURES: Condomless sexual activity with an HIV...

  1. Human Milk Galectin-3 Binding Protein and Breastfeeding-Associated HIV Transmission

    Science.gov (United States)

    Chan, Christina S.; Kim, Hae-Young; Autran, Chloe; Kim, Jae H.; Sinkala, Moses; Kankasa, Chipepo; Mwiya, Mwiya; Thea, Donald M.; Aldrovandi, Grace M.; Kuhn, Louise; Bode, Lars

    2013-01-01

    Analysis of milk from 247 HIV-infected Zambian mothers showed that Galectin-3 Binding Protein (Gal3BP) concentrations were significantly higher among HIV-infected mothers who transmitted HIV through breastfeeding (6.51±2.12 ug/mL) than among non-transmitters but were also correlated with higher milk and plasma HIV RNA copies/ml and lower CD4+ cell counts. The association between Gal3BP and postnatal transmission was attenuated after adjustment for milk and plasma HIV load and CD4+ cell counts. This suggests that although milk Gal3BP is a marker of advanced maternal disease, it does not independently modify transmission risk. PMID:23899964

  2. The Drafting and Submission of an HIV/AIDS Policy Draft for a Native American Child Welfare Agency.

    Science.gov (United States)

    Holzemer, Daniel Pete

    An Indian child welfare agency realized the need for an HIV/AIDS policy when a diabetic child possibly exposed to the HIV virus was placed in one of the agency's licensed foster homes. A focus-group interview process was selected for policy development because this method appeared to parallel the Native American cultural approach toward consensus…

  3. Chlamydia trachomatis Infection of Endocervical Epithelial Cells Enhances Early HIV Transmission Events.

    Science.gov (United States)

    Buckner, Lyndsey R; Amedee, Angela M; Albritton, Hannah L; Kozlowski, Pamela A; Lacour, Nedra; McGowin, Chris L; Schust, Danny J; Quayle, Alison J

    2016-01-01

    Chlamydia trachomatis causes a predominantly asymptomatic, but generally inflammatory, genital infection that is associated with an increased risk for HIV acquisition. Endocervical epithelial cells provide the major niche for this obligate intracellular bacterium in women, and the endocervix is also a tissue in which HIV transmission can occur. The mechanism by which CT infection enhances HIV susceptibility at this site, however, is not well understood. Utilizing the A2EN immortalized endocervical epithelial cell line grown on cell culture inserts, we evaluated the direct role that CT-infected epithelial cells play in facilitating HIV transmission events. We determined that CT infection significantly enhanced the apical-to-basolateral migration of cell-associated, but not cell-free, HIVBaL, a CCR5-tropic strain of virus, across the endocervical epithelial barrier. We also established that basolateral supernatants from CT-infected A2EN cells significantly enhanced HIV replication in peripheral mononuclear cells and a CCR5+ T cell line. These results suggest that CT infection of endocervical epithelial cells could facilitate both HIV crossing the mucosal barrier and subsequent infection or replication in underlying target cells. Our studies provide a mechanism by which this common STI could potentially promote the establishment of founder virus populations and the maintenance of local HIV reservoirs in the endocervix. Development of an HIV/STI co-infection model also provides a tool to further explore the role of other sexually transmitted infections in enhancing HIV acquisition.

  4. HIV transmission as a result of drug market violence: a case report

    Directory of Open Access Journals (Sweden)

    Kerr Thomas

    2008-07-01

    Full Text Available Abstract While unprotected sexual intercourse and the use of contaminated injection equipment account for the majority of HIV infections worldwide, other routes of HIV transmission have received less attention. We report on a case of HIV transmission attributable to illicit drug market violence involving a participant in a prospective cohort study of injection drug users. Data from a qualitative interview was used in addition to questionnaire data and nursing records to document an episode of violence which likely resulted in this individual acquiring HIV infection. The case report demonstrates that the dangers of drug market violence go beyond the immediate physical trauma associated with violent altercations to include the possibility for infectious disease transmission. The case highlights the need to consider antiretroviral post-exposure prophylaxis in cases of drug market violence presenting to the emergency room, as well strategies to reduce violence associated with street-based drug markets.

  5. A new approach to prevent HIV transmission: Project Protect intervention for recently infected individuals

    Science.gov (United States)

    Vasylyeva, T.I.; Friedman, S.R.; Smyrnov, P.; Bondarenko, K.

    2015-01-01

    Past research suggests that as many as 50% of onward human immunodeficiency virus (HIV) transmissions occur during acute and recent HIV infection. It is clearly important to develop interventions which focus on this highly infectious stage of HIV infection to prevent further transmission in the risk networks of acutely and recently infected individuals. Project Protect tries to find recently and acutely infected individuals and prevents HIV transmission in their risk networks. Participants are recruited by community health outreach workers at community-based HIV testing sites and drug users’ community venues, by coupon referrals and through referrals from AIDS clinics. When a network with acute/recent infection is identified, network members are interviewed about their risky behaviors, network information is collected, and blood is drawn for HIV testing. Participants are also educated and given prevention materials (condoms, syringes, educational materials); HIV-infected participants are referred to AIDS clinics and are assisted with access to care. Community alerts about elevated risk of HIV transmission are distributed within the risk networks of recently infected. Overall, 342 people were recruited to the project and screened for acute/recent HIV infection. Only six index cases of recent infection (2.3% of all people screened) were found through primary screening at voluntary counseling and testing (VCT) sites, but six cases of recent infection were found through contact tracing of these recently infected participants (7% of network members who came to the interview). Combining screening at VCT sites and contact tracing the number of recently infected people we located as compared to VCT screening alone. No adverse events were encountered. These first results provide evidence for the theory behind the intervention, i.e., in the risk networks of recently infected people there are other people with recent HIV infection and they can be successfully located

  6. Sexual behavior, risk perception, and HIV transmission can respond to HIV antiviral drugs and vaccines through multiple pathways.

    Science.gov (United States)

    Tully, Stephen; Cojocaru, Monica; Bauch, Chris T

    2015-01-01

    There has been growing use of highly active antiretroviral treatment (HAART) for HIV and significant progress in developing prophylactic HIV vaccines. The simplest theories of counterproductive behavioral responses to such interventions tend to focus on single feedback mechanisms: for instance, HAART optimism makes infection less scary and thus promotes risky sexual behavior. Here, we develop an agent based, age-structured model of HIV transmission, risk perception, and partner selection in a core group to explore behavioral responses to interventions. We find that interventions can activate not one, but several feedback mechanisms that could potentially influence decision-making and HIV prevalence. In the model, HAART increases the attractiveness of unprotected sex, but it also increases perceived risk of infection and, on longer timescales, causes demographic impacts that partially counteract HAART optimism. Both HAART and vaccination usually lead to lower rates of unprotected sex on the whole, but intervention effectiveness depends strongly on whether individuals over- or under-estimate intervention coverage. Age-specific effects cause sexual behavior and HIV prevalence to change in opposite ways in old and young age groups. For complex infections like HIV-where interventions influence transmission, demography, sexual behavior and risk perception-we conclude that evaluations of behavioral responses should consider multiple feedback mechanisms. PMID:26507957

  7. Sexual behavior, risk perception, and HIV transmission can respond to HIV antiviral drugs and vaccines through multiple pathways.

    Science.gov (United States)

    Tully, Stephen; Cojocaru, Monica; Bauch, Chris T

    2015-10-28

    There has been growing use of highly active antiretroviral treatment (HAART) for HIV and significant progress in developing prophylactic HIV vaccines. The simplest theories of counterproductive behavioral responses to such interventions tend to focus on single feedback mechanisms: for instance, HAART optimism makes infection less scary and thus promotes risky sexual behavior. Here, we develop an agent based, age-structured model of HIV transmission, risk perception, and partner selection in a core group to explore behavioral responses to interventions. We find that interventions can activate not one, but several feedback mechanisms that could potentially influence decision-making and HIV prevalence. In the model, HAART increases the attractiveness of unprotected sex, but it also increases perceived risk of infection and, on longer timescales, causes demographic impacts that partially counteract HAART optimism. Both HAART and vaccination usually lead to lower rates of unprotected sex on the whole, but intervention effectiveness depends strongly on whether individuals over- or under-estimate intervention coverage. Age-specific effects cause sexual behavior and HIV prevalence to change in opposite ways in old and young age groups. For complex infections like HIV-where interventions influence transmission, demography, sexual behavior and risk perception-we conclude that evaluations of behavioral responses should consider multiple feedback mechanisms.

  8. Analysis of Social and Genetic Factors Influencing Heterosexual Transmission of HIV within Serodiscordant Couples in the Henan Cohort.

    Directory of Open Access Journals (Sweden)

    Qian Zhu

    Full Text Available There is considerable variability between individuals in susceptibility to infection by human immunodeficiency virus (HIV. Many social, clinical and genetic factors are known to contribute to the likelihood of HIV transmission, but there is little consensus on the relative importance and potential interaction of these factors. Additionally, recent studies of several variants in chemokine receptors have identified alleles that may be predictive of HIV transmission and disease progression; however the strengths and directions of the associations of these genetic markers with HIV transmission have markedly varied between studies. To better identify factors that predict HIV transmission in a Chinese population, 180 cohabiting serodiscordant couples were enrolled for study by the Henan Center for Disease Prevention and Control, and transmission and progression of HIV infection were regularly measured. We found that anti-retroviral therapy, education level, and condom use were the most significant factors in determining likelihood of HIV transmission in this study. We also assessed ten variants in three genes (CXCL12, CCR2, and CCR5 that have been shown to influence HIV transmission. We found two tightly linked variants in CCR2 and CCR5, rs1799864 and rs1800024, have a significant positive association with transmission as recessive models (OR>10, P value=0.011. Mixed effects models showed that these genetic variants both retained significance when assessed with either treatment or condom use. These markers of transmission susceptibility may therefore serve to help stratify individuals by risk for HIV transmission.

  9. HIV transmission in the dental setting and the HIV-infected oral health care professional: workshop 1C.

    LENUS (Irish Health Repository)

    Flint, S R

    2011-04-01

    This workshop addressed two important issues: first, the global evidence of HIV transmission from health care provider to patient and from patient to health care provider in the general health care environment and the dental practice setting; second, in the era of highly active antiretroviral therapy, whether oral health care professionals living with HIV pose a risk of transmission to their patients and whether standard infection control is adequate to protect both the patient and the oral health care professional in dental practice. The workshop culminated in a general discussion and the formulation of a consensus statement from the participating delegates, representing more than 30 countries, on the criteria under which an HIV-infected oral health care professional might practice dentistry without putting patients at risk. This consensus statement, the Beijing Declaration, was agreed nem con.

  10. Sex, condoms, gender roles, and HIV transmission knowledge among adolescents in León, Nicaragua: implications for HIV prevention.

    Science.gov (United States)

    Manji, A; Peña, R; Dubrow, R

    2007-09-01

    There are few peer-reviewed studies of HIV/AIDS-related knowledge, attitudes, beliefs and practices among adolescents in Central America. A population-based cross-sectional survey was conducted among 246 adolescents in León, Nicaragua, where there is reason for concern about a rise in HIV infections. In many respects, León adolescents were typical of those in other Latin American countries, with a mixture of correct and incorrect knowledge about transmission of HIV and sexually transmitted infections, a higher proportion of males than females reporting having had sex or using condoms, and inconsistent condom use. While some sexual attitudes conformed to the ideology of machismo, others did not, providing an opening for prevention interventions. Some dimensions of HIV/AIDS stigma were high, and most adolescents disapproved of same-sex sexual behaviour. Intervention against homosexuality-related stigma is particularly urgent because a concentrated HIV epidemic may be emerging in Nicaragua among men who have sex with men. Personal religious beliefs did not appear to pose a barrier to condom use. In a multivariate model, being out of school was a significant correlate of having had sex and of insufficient HIV/AIDS-related knowledge. Accordingly, HIV prevention interventions must reach adolescents both in and out of school. A multi-component approach to prevention is needed, including programmes based in schools, communities, the mass media and health facilities.

  11. Transmission of HIV in sexual networks in sub-Saharan Africa and Europe

    Science.gov (United States)

    van de Vijver, David A. M. C.; Prosperi, Mattia C. F.; Ramasco, José J.

    2013-09-01

    We are reviewing the literature regarding sexual networks and HIV transmission in sub-Saharan Africa and Europe. On Likoma Island in Malawi, a sexual network was reconstructed using a sociometric survey in which individuals named their sexual partners. The sexual network identified one giant component including half of all sexually active individuals. More than 25% of respondents were linked through independent chains of sexual relations. HIV was more common in the sparser regions of the network due to over-representation of groups with higher HIV prevalence. A study from KwaZulu-Natal in South-Africa collected egocentric data about sexual partners and found that new infections in women in a particular area was associated with the number of life-time partners in men. Data about sexual networks and HIV transmission are not reported in Europe. It is, however, found that the annual number of sexual partners follows a scale-free network. Phylogenetic studies that determine genetic relatedness between HIV isolates obtained from infected individuals, found that patients in the early stages of infections explain a high number of new infections. In conclusion, the limited information that is available suggest that sexual networks play a role in spread of HIV. Obtaining more information about sexual networks can be of benefit for modeling studies on HIV transmission and prevention.

  12. Impact of HIV co-infection on the evolution and transmission of multidrug-resistant tuberculosis

    Science.gov (United States)

    Eldholm, Vegard; Rieux, Adrien; Monteserin, Johana; Lopez, Julia Montana; Palmero, Domingo; Lopez, Beatriz; Ritacco, Viviana; Didelot, Xavier; Balloux, Francois

    2016-01-01

    The tuberculosis (TB) epidemic is fueled by a parallel Human Immunodeficiency Virus (HIV) epidemic, but it remains unclear to what extent the HIV epidemic has been a driver for drug resistance in Mycobacterium tuberculosis (Mtb). Here we assess the impact of HIV co-infection on the emergence of resistance and transmission of Mtb in the largest outbreak of multidrug-resistant TB in South America to date. By combining Bayesian evolutionary analyses and the reconstruction of transmission networks utilizing a new model optimized for TB, we find that HIV co-infection does not significantly affect the transmissibility or the mutation rate of Mtb within patients and was not associated with increased emergence of resistance within patients. Our results indicate that the HIV epidemic serves as an amplifier of TB outbreaks by providing a reservoir of susceptible hosts, but that HIV co-infection is not a direct driver for the emergence and transmission of resistant strains. DOI: http://dx.doi.org/10.7554/eLife.16644.001 PMID:27502557

  13. Knowledge of HIV serodiscordance, transmission, and prevention among couples in Durban, South Africa.

    Directory of Open Access Journals (Sweden)

    William Kilembe

    Full Text Available Couples' voluntary HIV counseling and testing (CVCT significantly decreases HIV transmission within couples, the largest risk group in sub-Saharan Africa, but it is not currently offered in most HIV testing facilities. To roll out such an intervention, understanding locale-specific knowledge barriers is critical. In this study, we measured knowledge of HIV serodiscordance, transmission, and prevention before and after receipt of CVCT services in Durban.Pre- and post-CVCT knowledge surveys were administered to a selection of individuals seeking CVCT services.Changes in knowledge scores were assessed with McNemar Chi-square tests for balanced data and generalized estimating equation methods for unbalanced data.The survey included 317 heterosexual black couples (634 individuals who were primarily Zulu (87%, unemployed (47%, and had at least a secondary level education (78%. 28% of couples proved to be discordant. Only 30% of individuals thought serodiscordance between couples was possible pre-CVCT compared to 95% post-CVCT. One-third thought there was at least one benefit of CVCT pre-CVCT, increasing to 96% post-CVCT. Overall, there were positive changes in knowledge about HIV transmission and prevention. However, many respondents thought all HIV positive mothers give birth to babies with AIDS (64% pre-CVCT, 59% post-CVCT and that male circumcision does not protect negative men against HIV (70% pre-CVCT, 67% post-CVCT.CVCT was well received and was followed by improvements in understanding of discordance, the benefits of joint testing, and HIV transmission. Country-level health messaging would benefit from targeting gaps in knowledge about serodiscordance, vertical transmission, and male circumcision.

  14. Human immunodeficiency virus-associated disruption of mucosal barriers and its role in HIV transmission and pathogenesis of HIV/AIDS disease.

    Science.gov (United States)

    Tugizov, Sharof

    2016-01-01

    Oral, intestinal and genital mucosal epithelia have a barrier function to prevent paracellular penetration by viral, bacterial and other pathogens, including human immunodeficiency virus (HIV). HIV can overcome these barriers by disrupting the tight and adherens junctions of mucosal epithelia. HIV-associated disruption of epithelial junctions may also facilitate paracellular penetration and dissemination of other viral pathogens. This review focuses on possible molecular mechanisms of HIV-associated disruption of mucosal epithelial junctions and its role in HIV transmission and pathogenesis of HIV and acquired immune deficiency syndrome (AIDS). PMID:27583187

  15. Under-two child mortality according to maternal HIV status in Rwanda: assessing outcomes within the National PMTCT Program

    OpenAIRE

    Mugwaneza, Placidie; Umutoni, Nadine Wa Shema; Ruton, Hinda; Rukundo, Alphonse; Lyambabaje, Alexandre; Bizimana, Jean de Dieu; Tsague, Landry; Wagner, Claire M.; Nyankesha, Elévanie; Muita, Jane; Mutabazi, Vincent; Nyemazi, Jean Pierre; Nsanzimana, Sabin; Karema, Corine; Binagwaho, Agnes

    2011-01-01

    Introduction We sought to compare risk of death among children aged under-2 years born to HIV positive mother (HIV-exposed) and to HIV negative mother (HIV non-exposed), and identify determinants of under-2 mortality among the two groups in Rwanda. Methods In a stratified, two-stage cluster sampling design, we selected mother-child pairs using national Antenatal Care (ANC) registers. Household interview with each mother was conducted to capture socio-demographic data and information related t...

  16. Diminished transmission of drug resistant HIV-1 variants with reduced replication capacity in a human transmission model

    OpenAIRE

    Pingen, Marieke; Sarrami-Forooshani, Ramin; Wensing, Annemarie MJ; van Ham, Petra; Drewniak, Agata; Boucher, Charles Ab; Geijtenbeek, Teunis BH; Nijhuis, Monique

    2014-01-01

    Background Different patterns of drug resistance are observed in treated and therapy naïve HIV-1 infected populations. Especially the NRTI-related M184I/V variants, which are among the most frequently encountered mutations in treated patients, are underrepresented in the antiretroviral naïve population. M184I/V mutations are known to have a profound effect on viral replication and tend to revert over time in the new host. However it is debated whether a diminished transmission efficacy of HIV...

  17. The combination of phylogenetic analysis with epidemiological and serological data to track HIV-1 transmission in a sexual transmission case.

    Directory of Open Access Journals (Sweden)

    Min Chen

    Full Text Available To investigate the linkage of HIV transmission from a man to a woman through unprotected sexual contact without disclosing his HIV-positive status.Combined with epidemiological information and serological tests, phylogenetic analysis was used to test the a priori hypothesis of HIV transmission from the man to the woman. Control subjects, infected with HIV through heterosexual intercourse, from the same location were also sampled. Phylogenetic analyses were performed using the consensus gag, pol and env sequences obtained from blood samples of the man, the woman and the local control subjects. The env quasispecies of the man, the woman, and two controls were also obtained using single genome amplification and sequencing (SGA/S to explore the paraphyletic relationship by phylogenetic analysis.Epidemiological information and serological tests indicated that the man was infected with HIV-1 earlier than the woman. Phylogenetic analyses of the consensus sequences showed a monophyletic cluster for the man and woman in all three genomic regions. Furthermore, gag sequences of the man and woman shared a unique recombination pattern from subtype B and C, which was different from those of CRF07_BC or CRF08_BC observed in the local samples. These indicated that the viral sequences from the two subjects display a high level of similarity. Further, viral quasispecies from the man exhibited a paraphyletic relationship with those from the woman in the Bayesian and maximum-likelihood (ML phylogenetic trees of the env region, which supported the transmission direction from the man to the woman.In the context of epidemiological and serological evidence, the results of phylogenetic analyses support the transmission from the man to the woman.

  18. Genetic analysis reveals the complex structure of HIV-1 transmission within defined risk groups

    OpenAIRE

    HUE,S; Pillay, D; Clewley, J. P.; Pybus, O. G.

    2005-01-01

    We explored the epidemic history of HIV-1 subtype B in the United Kingdom using statistical methods that infer the population history of pathogens from sampled gene sequence data. Phylogenetic analysis of HIV-1 pol gene sequences from Britain showed at least six large transmission chains, indicating a genetically variable, but epidemiologically homogeneous, epidemic among men having sex with men. Through coalescent-based analysis we showed that these chains arose through separa...

  19. Anxiety Specific Pathways to HIV Sexual Transmission Risk Behavior among Young Gay and Bisexual Men

    OpenAIRE

    O’Cleirigh, Conall; Traeger, Lara; Mayer, Kenneth H.; Magidson, Jessica F.; Steven A Safren

    2013-01-01

    This study evaluated whether specific anxiety disorders increased the likelihood of sexual transmission risk behavior (TRB) in younger (ages 20–29) versus older (ages 30+) HIV positive gay and bisexual men. Participants completed screening measures for Posttraumatic Stress Disorder (PTSD), Social Phobia, and Panic Disorder, and an assessment of recent TRB Moderated regression analyses indicated that PTSD was associated with greater risk of TRB in younger but not older men, independent of HIV ...

  20. The importance of addressing gender inequality in efforts to end vertical transmission of HIV

    Directory of Open Access Journals (Sweden)

    Dean Peacock

    2012-07-01

    Full Text Available Issues: The recently launched “Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive” sets forth ambitious targets that will require more widespread implementation of comprehensive prevention of vertical HIV transmission (PMTCT programmes. As PMTCT policymakers and implementers work toward these new goals, increased attention must be paid to the role that gender inequality plays in limiting PMTCT programmatic progress. Description: A growing body of evidence suggests that gender inequality, including gender-based violence, is a key obstacle to better outcomes related to all four components of a comprehensive PMTCT programme. Gender inequality affects the ability of women and girls to protect themselves from HIV, prevent unintended pregnancies and access and continue to use HIV prevention, care and treatment services. Lessons Learned: In light of this evidence, global health donors and international bodies increasingly recognize that it is critical to address the gender disparities that put women and children at increased risk of HIV and impede their access to care. The current policy environment provides unprecedented opportunities for PMTCT implementers to integrate efforts to address gender inequality with efforts to expand access to clinical interventions for preventing vertical HIV transmission. Effective community- and facility-based strategies to transform harmful gender norms and mitigate the impacts of gender inequality on HIV-related outcomes are emerging. PMTCT programmes must embrace these strategies and expand beyond the traditional focus of delivering ARV prophylaxis to pregnant women living with HIV. Without greater implementation of comprehensive, gender transformative PMTCT programmes, elimination of vertical transmission of HIV will remain elusive.

  1. Mortality following snake bite envenomation by Bitis arietans in an HIV positive child: A case report.

    Science.gov (United States)

    Firth, Gregory B; Street, Matthew; Ramguthy, Yammesh; Doedens, Linda

    2016-07-01

    Snake bites occur commonly in the rural areas of South Africa. Hospitals where snake bites are uncommon should always have protocols on standby in the event of such cases presenting. This is the first reported case documenting the effect of human immunodeficiency virus (HIV) on snake bite in South African children.A case report and review of relevant information about the case was undertaken.We present a case of a 1-year-old child referred from a peripheral hospital following a snake bite to the left upper limb with a compartment syndrome and features of cytotoxic envenomation. The patient presented late with a wide area of necrotic skin on the arm requiring extensive debridement. The underlying muscle was not necrotic. Polyvalent antivenom (South African Institute of Medical Research Polyvalent Snakebite Antiserum) administration was delayed by 4 days after the snake bite. The patient was also diagnosed with HIV and a persistent thrombocytopenia possibly due to both HIV infection and the snake bite venom. Lower respiratory tract infections with subsequent overwhelming sepsis ultimately resulted in the child's death.The case highlights the challenge of treating a snake bite in a young child with HIV and the detrimental outcome of delayed treatment. A protocol is essential in the management of snake bites in all hospitals.Level IV, Case report.This case highlights the interaction of snake bite envenomation and HIV infection on thrombocytopenia. PMID:27399076

  2. Seroprevalence of human immunodeficiency virus among antenatal patients and incidence of mother- to- child transmission using single dose nevirapine: a cohort study in Maharashtra

    Directory of Open Access Journals (Sweden)

    Sonal A. Bhuyar

    2015-10-01

    Full Text Available Background: Objective was to study the seroprevalence of human immunodeficiency virus (HIV in antenatal patients and to find out the incidence of mother to child transmission (MTCT using single dose nevirapine (sdNVP to mother- baby pairs in labour. Methods: This prospective study was conducted in the department of Obstetrics and Gynecology, Dr. PDMMC, Amravati, Maharashtra from February 2010 to May 2015. All pregnant women attending the antenatal clinic were subjected to pretest counseling and HIV testing after informed consent. The HIV +ve pregnant patients who opted for delivery at our hospital were included in the study. sdNVP was administered to mother- baby pairs according to NACO guidelines. Babies of these patients were followed up to 18 months of age for HIV testing. Results: 12077 antenatal patients underwent pretest counseling. 11957 antenatal patients were tested for HIV of which 28 were detected positive. Therefore, the seroprevalence in this study was found to be 0.23%. 23 patients delivered at our hospital during the study period and babies of 2 patients tested positive for HIV. Hence the incidence of MTCT was found to be 9.5% in our study. Conclusions: Universal screening of pregnant patients for HIV and judicious use of PPTCT regimens can significantly reduce MTCT of HIV and prevalence of pediatric HIV infection. Single dose nevirapine use over last few years has successfully reduced MTCT, but our aim should be to reduce it further with more effective ART regimens for the seropositive antenatal patients and their babies. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1436-1441

  3. HIV Infection and Children: A Medical Overview.

    Science.gov (United States)

    Anderson, Virginia

    1998-01-01

    Updates a 10-year medical overview on HIV/AIDS written for a Child Welfare League of America publication. Covers HIV transmission, diagnosis and treatment of HIV in infants, maternal treatment and testing, and advances and challenges, including new drug therapies. Concludes with recommendations on systems of care for affected families. (EV)

  4. High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission.

    Directory of Open Access Journals (Sweden)

    Louise Kuhn

    Full Text Available BACKGROUND: Empirical data showing the clear benefits of exclusive breastfeeding (EBF for HIV prevention are needed to encourage implementation of lactation support programs for HIV-infected women in low resource settings among whom replacement feeding is unsafe. We conducted a prospective, observational study in Lusaka, Zambia, to test the hypothesis that EBF is associated with a lower risk of postnatal HIV transmission than non-EBF. METHODS AND RESULTS: As part of a randomized trial of early weaning, 958 HIV-infected women and their infants were recruited and all were encouraged to breastfeed exclusively to 4 months. Single-dose nevirapine was provided to prevent transmission. Regular samples were collected from infants to 24 months of age and tested by PCR. Detailed measurements of actual feeding behaviors were collected to examine, in an observational analysis, associations between feeding practices and postnatal HIV transmission. Uptake of EBF was high with 84% of women reporting only EBF cumulatively to 4 months. Post-natal HIV transmission before 4 months was significantly lower (p = 0.004 among EBF (0.040 95% CI: 0.024-0.055 than non-EBF infants (0.102 95% CI: 0.047-0.157; time-dependent Relative Hazard (RH of transmission due to non-EBF = 3.48 (95% CI: 1.71-7.08. There were no significant differences in the severity of disease between EBF and non-EBF mothers and the association remained significant (RH = 2.68 95% CI: 1.28-5.62 after adjusting for maternal CD4 count, plasma viral load, syphilis screening results and low birth weight. CONCLUSIONS: Non-EBF more than doubles the risk of early postnatal HIV transmission. Programs to support EBF should be expanded universally in low resource settings. EBF is an affordable, feasible, acceptable, safe and sustainable practice that also reduces HIV transmission providing HIV-infected women with a means to protect their children's lives. TRIAL REGISTRATION: ClinicalTrials.gov NCT00310726.

  5. HIV-1 transmission during early infection in men who have sex with men: a phylodynamic analysis.

    Directory of Open Access Journals (Sweden)

    Erik M Volz

    2013-12-01

    Full Text Available BACKGROUND: Conventional epidemiological surveillance of infectious diseases is focused on characterization of incident infections and estimation of the number of prevalent infections. Advances in methods for the analysis of the population-level genetic variation of viruses can potentially provide information about donors, not just recipients, of infection. Genetic sequences from many viruses are increasingly abundant, especially HIV, which is routinely sequenced for surveillance of drug resistance mutations. We conducted a phylodynamic analysis of HIV genetic sequence data and surveillance data from a US population of men who have sex with men (MSM and estimated incidence and transmission rates by stage of infection. METHODS AND FINDINGS: We analyzed 662 HIV-1 subtype B sequences collected between October 14, 2004, and February 24, 2012, from MSM in the Detroit metropolitan area, Michigan. These sequences were cross-referenced with a database of 30,200 patients diagnosed with HIV infection in the state of Michigan, which includes clinical information that is informative about the recency of infection at the time of diagnosis. These data were analyzed using recently developed population genetic methods that have enabled the estimation of transmission rates from the population-level genetic diversity of the virus. We found that genetic data are highly informative about HIV donors in ways that standard surveillance data are not. Genetic data are especially informative about the stage of infection of donors at the point of transmission. We estimate that 44.7% (95% CI, 42.2%-46.4% of transmissions occur during the first year of infection. CONCLUSIONS: In this study, almost half of transmissions occurred within the first year of HIV infection in MSM. Our conclusions may be sensitive to un-modeled intra-host evolutionary dynamics, un-modeled sexual risk behavior, and uncertainty in the stage of infected hosts at the time of sampling. The intensity of

  6. HIV status awareness, partnership dissolution and HIV transmission in generalized epidemics.

    Directory of Open Access Journals (Sweden)

    Georges Reniers

    Full Text Available OBJECTIVES: HIV status aware couples with at least one HIV positive partner are characterized by high separation and divorce rates. This phenomenon is often described as a corollary of couples HIV Testing and Counseling (HTC that ought to be minimized. In this contribution, we demonstrate the implications of partnership dissolution in serodiscordant couples for the propagation of HIV. METHODS: We develop a compartmental model to study epidemic outcomes of elevated partnership dissolution rates in serodiscordant couples and parameterize it with estimates from population-based data (Rakai, Uganda. RESULTS: Via its effect on partnership dissolution, every percentage point increase in HIV status awareness reduces HIV incidence in monogamous populations by 0.27 percent for women and 0.63 percent for men. These effects are even larger when the assumption of monogamy can be relaxed, but are moderated by other behavior changes (e.g., increased condom use in HIV status aware serodiscordant partnerships. When these behavior changes are taken into account, each percentage point increase in HIV status awareness reduces HIV incidence by 0.13 and 0.32 percent for women and men, respectively (assuming monogamy. The partnership dissolution effect exists because it decreases the fraction of serodiscordant couples in the population and prolongs the time that individuals spend outside partnerships. CONCLUSION: Our model predicts that elevated partnership dissolution rates in HIV status aware serodiscordant couples reduce the spread of HIV. As a consequence, the full impact of couples HTC for HIV prevention is probably larger than recognized to date. Particularly high partnership dissolution rates in female positive serodiscordant couples contribute to the gender imbalance in HIV infections.

  7. The Intergeneratonal Transmission of Parental Schooling and Child Development

    DEFF Research Database (Denmark)

    Bingley, Paul; Christensen, Kaare; Jensen, Vibeke Myrup

    Understanding the causal relation between mothers and fathers schooling and child development is important to create polices raising schooling level. We use unique Danish administrative data with information on identical twins and their children to estimate the causal effect of parental schooling...... that endowments counts for a substantial part of the correlation between parents' schooling on the devel-opment of the child. Father's schooling increases children's length of schooling, but decreases 9th grade academic achievement. Mother's schooling increases short run outcomes and the probability of high...... on both short-run and long-run outcomes. By applying within twin fixed effect techniques we are able to take heritable endowments transmitted from parent to child into account and as an important reference point to the general population we do a parallel study on a sample of same sex DZ twins. We find...

  8. The Intergenerational Transmission of Parental Schooling and Child Development

    DEFF Research Database (Denmark)

    Bingley, Paul; Christensen, Kaare; Jensen, Vibeke Myrup

    Understanding the causal relationship between parental schooling and child development is important to create polices raising schooling level. We use unique Danish administrative data with information on identical twins to estimate the effect of parental schooling on short-run and long-run outcomes....... By applying within twin fixed effect techniques we are able to take heritable endowments transmitted from parent to child into account. We find OLS to be consistently upward biased due to endowments. Further, paternal schooling has no causal effect on infant and early childhood health but increases children...

  9. Occupational HIV Transmission Among Male Adult Film Performers - Multiple States, 2014.

    Science.gov (United States)

    Wilken, Jason A; Ried, Christopher; Rickett, Pristeen; Arno, Janet N; Mendez, Yesenia; Harrison, Robert J; Wohlfeiler, Dan; Bauer, Heidi M; Joyce, M Patricia; Switzer, William M; Heneine, Walid; Shankar, Anupama; Mark, Karen E

    2016-02-12

    In 2014, the California Department of Public Health was notified by a local health department of a diagnosis of acute human immunodeficiency virus (HIV) infection* and rectal gonorrhea in a male adult film industry performer, aged 25 years (patient A). Patient A had a 6-day history of rash, fever, and sore throat suggestive of acute retroviral syndrome at the time of examination. He was informed of his positive HIV and gonorrhea test results 6 days after his examination. Patient A had a negative HIV-1 RNA qualitative nucleic acid amplification test (NAAT)(†) 10 days before symptom onset. This investigation found that during the 22 days between the negative NAAT and being informed of his positive HIV test results, two different production companies directed patient A to have condomless sex with a total of 12 male performers. Patient A also provided contact information for five male non-work-related sexual partners during the month before and after his symptom onset. Patient A had additional partners during this time period for which no locating information was provided. Neither patient A nor any of his interviewed sexual partners reported taking HIV preexposure prophylaxis (PrEP). Contact tracing and phylogenetic analysis of HIV sequences amplified from pretreatment plasma revealed that a non-work-related partner likely infected patient A, and that patient A likely subsequently infected both a coworker during the second film production and a non-work-related partner during the interval between his negative test and receipt of his positive HIV results. Adult film performers and production companies, medical providers, and all persons at risk for HIV should be aware that testing alone is not sufficient to prevent HIV transmission. Condom use provides additional protection from HIV and sexually transmitted infections (STIs). Performers and all persons at risk for HIV infection in their professional and personal lives should discuss the use of PrEP with their medical

  10. Antiretroviral interventions to reduce mother-to-child transmission of human immunodeficiency virus: challenges for health systems, communities and society.

    OpenAIRE

    Baggaley, R; Van Praag, E.

    2000-01-01

    This paper examines the ethical, economic and social issues that should be considered when antiretroviral interventions are being planned to reduce mother-to-child transmission of the human immunodeficiency virus. Interventions aiming to reduce mother-to-child transmission should be concerned with the rights of both the child and the mother. Women should not be seen as vectors of transmission but as people entitled to adequate health care and social services in their own right. For women acce...

  11. Vertikal smitte med hiv i Danmark

    DEFF Research Database (Denmark)

    Kvinesdal, Birgit Bak; Valerius, Niels Henrik; Herlin, Troels;

    2002-01-01

    INTRODUCTION: Vertical transmission of HIV can be reduced if the pregnant woman and new born child receive antiretroviral treatment. Delivery by caesarean section and avoidance of breast feeding further reduce vertical transmission. The aim of this study was to describe the treatment of HIV......-positive pregnant women in Denmark and the risk of vertical transmission. MATERIAL AND METHODS: We retrospectively describe the risk of vertical transmission of HIV among HIV-positive women giving birth in Denmark during the period, mid-1994 to February 2000. RESULTS: Fifty children were born. One mother gave birth...... mothers was the HIV-infection known until the time of delivery or later. Transmission of HIV did not occur in the 34 mother-child pairs who received antepartum and intrapartum antiretroviral treatment, who had a caesarean delivery, who did not breast-feed, and whose children were given postpartum...

  12. Dynamic mathematical models of HIV/AIDS transmission in China

    Institute of Scientific and Technical Information of China (English)

    WANG Jun-jie; Kathleen Heather Reilly; LUO Jing; ZANG Chun-peng; WANG Ning

    2010-01-01

    @@ Social, cultural, and political aspects of the disease may alter the dynamics of infection.In the early 1980s, China's first outbreak of HIV was found in intravenous drug users (IDUs) and in the mid-1990s,there was a concentrated outbreak in individuals who were donors and recipients of illegal blood donations.

  13. Medidas contraceptivas e de proteção da transmissão do HIV por mulheres com HIV/Aids Contraceptive measures and HIV transmission protection among women with HIV/AIDS

    Directory of Open Access Journals (Sweden)

    Marli T Gimeniz Galvão

    2004-04-01

    Full Text Available OBJETIVO: Atualmente, entre as mulheres, a relação sexual é a forma de transmissão que mais tem contribuído para a feminização da epidemia de HIV/Aids. Na busca constante de se estabelecer padrões mais adequados de orientação para saúde, investigou-se o uso de medidas contraceptivas, que também sirvam de proteção da transmissão do HIV, entre mulheres portadoras de HIV/Aids. MÉTODOS: Estudo exploratório desenvolvido em um serviço público ambulatorial de um hospital universitário, referência aos portadores de HIV/Aids da região centro-sul do Estado de São Paulo, no período de cinco meses (2000 a 2001. Foram estudadas 73 mulheres portadoras da infecção pelo HIV, ou com Aids. Os dados foram obtidos por meio de um formulário que investigava a caracterização sociodemográfica, as formas de anticoncepção utilizada e a situação sorológica do parceiro sexual. Os dados foram analisados descritivamente e os conteúdos das respostas abertas, agrupados em temas. Foi aplicado o teste exato de Fisher para análise de algumas variáveis, em nível de 5%. Para a análise de conteúdo utilizou-se a proposta de Bardin. RESULTADOS: A maioria das mulheres estava em fase de vida reprodutiva, eram casadas e foram contaminadas quase exclusivamente por meio da relação heterossexual. Entre elas, 35,4% referiam parceiro sexual discordante quanto à sorologia anti-HIV, e 13,7% utilizavam formas inadequadas de anticoncepção que também não protegiam da transmissão do HIV. CONCLUSÕES: Os resultados alertam para a necessidade de ações educativas continuadas quanto a experiências sexuais mais seguras entre portadoras de HIV/Aids, para que elas possam discutir com seus parceiros outras formas de exercerem sua sexualidade, sendo capazes de estabelecer opção contraceptiva mais consciente, de maneira a zelar pela sua saúde, do parceiro e até do concepto.OBJECTIVE: Sexual intercourse is currently the route of transmission among women

  14. HIV and HCV: from Co-infection to Epidemiology, Transmission,Pathogenesis, and Treatment

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Human immunodeficiency virus (HIV) is the infectious agent causing acquired immunodeficiency syndrome (AIDS), a deadliest scourge of human society. Hepatitis C virus (HCV) is a major causative agent of chronic liver disease and infects an estimated 170 million people worldwide,resulting in a serious public health burden. Due to shared routes of transmission, co-infection with HIV and HCV has become common among individuals who had high risks of blood exposures. Among hemophiliacs the co-infection rate accounts for 85%; while among injection drug users (IDU) the rate can be as high as 90%. HIV can accelerate the progression of HCV-related liver disease, particularly when immunodeficiency has developed. Although the effect of HCV on HIV infection is controversial,most studies showed an increase in mortality due to liver disease. HCV may act as a direct cofactor to fasten the progression of AIDS and decrease the tolerance of highly active antiretroviral therapy(HARRT). Conversely, HAART-related hepatotoxicity may enhance the progression of liver fibrosis.Due to above complications, co-infection with HCV and HIV-1 has imposed a critical challenge in the management of these patients. In this review, we focus on the epidemiology and transmission of HIV and HCV, the impact of the two viruses on each other, and their treatment.

  15. Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries.

    Science.gov (United States)

    Raj, Anita; Boehmer, Ulrike

    2013-04-01

    This study was designed to assess associations between national rates of girl child marriage and national rates of HIV and maternal and child health (MCH) concerns, using national indicator data from 2009 United Nations reports. Current analyses were limited to the N = 97 nations (of 188 nations) for which girl child marriage data were available. Regression analyses adjusted for development and world region demonstrate that nations with higher rates of girl child marriage are significantly more likely to contend with higher rates of maternal and infant mortality and nonutilization of maternal health services, but not HIV.

  16. HIV sero-conversion during late pregnancy – when to retest

    Directory of Open Access Journals (Sweden)

    Emma Kalk

    2013-06-01

    Full Text Available The South African National Prevention of Mother-to-Child Transmission of HIV programme has resulted in significant reductions in vertical transmission, but new infant HIV infections continue to occur. We present two cases of HIV seroconversion during late pregnancy, demonstrating the limitations of the current programme. These could be mitigated by expanding the programme to include maternal testing at delivery and at immunisation clinic visits as we pursue the elimination of mother-to-child transmission.

  17. Systematic review of HIV transmission between heterosexual serodiscordant couples where the HIV-positive partner is fully suppressed on antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Mona R Loutfy

    Full Text Available BACKGROUND: The risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART is debated. This study aims to systematically review observational studies and randomized controlled trials (RCTs, evaluating rates of sexual HIV transmission between heterosexual serodiscordant couples when the HIV-positive partner has full suppression on cART. METHODS AND FINDINGS: We searched major bibliographic databases to November 2012 for relevant observational studies and RCTs without language restrictions. Conference proceedings, key journals and bibliographies were also searched. Studies reporting HIV transmission rates, cART histories and viral loads of the HIV-positive partners were included. Two reviewers extracted methodologic characteristics and outcomes. Of 20,252 citations, 3 studies met all eligibility criteria with confirmed full virologic suppression in the HIV-positive partner. We included 3 additional studies (2 cohort studies, 1 RCT that did not confirm viral suppression in the HIV-positive partner at transmission in a secondary meta-analysis. Methodologic quality was reasonable. The rate of transmission in the 3 studies confirming virologic suppression was 0 per 100 person-years (95% CI = 0-0.05, with low heterogeneity (I(2 = 0%. When we included the 3 studies that did not confirm virologic suppression, the rate of transmission was 0.14 per 100 person-years (95%CI = 0.04-0.31 (I(2 = 0%. In a sensitivity analysis including all 6 studies, the rate of transmission was 0 per 100 person-years (95%CI = 0-0.01 after omitting all transmissions with known detectable or unconfirmed viral loads, as full suppression in these cases was unlikely. Limitations included lack of data on same-sex couples, type of sexual intercourse (vaginal vs. anal, direction of HIV transmission, exact viral load at the time of transmission, sexually

  18. Application of a case–control study design to investigate genotypic signatures of HIV-1 transmission

    Directory of Open Access Journals (Sweden)

    Mota Talia M

    2012-06-01

    Full Text Available Abstract Background The characterization of HIV-1 transmission strains may inform the design of an effective vaccine. Shorter variable loops with fewer predicted glycosites have been suggested as signatures enriched in envelope sequences derived during acute HIV-1 infection. Specifically, a transmission-linked lack of glycosites within the V1 and V2 loops of gp120 provides greater access to an α4β7 binding motif, which promotes the establishment of infection. Also, a histidine at position 12 in the leader sequence of Env has been described as a transmission signature that is selected against during chronic infection. The purpose of this study is to measure the association of the presence of an α4β7 binding motif, the number of N-linked glycosites, the length of the variable loops, and the prevalence of histidine at position 12 with HIV-1 transmission. A case–control study design was used to measure the prevalence of these variables between subtype B and C transmission sequences and frequency-matched randomly-selected sequences derived from chronically infected controls. Results Subtype B transmission strains had shorter V3 regions than chronic strains (p = 0.031; subtype C transmission strains had shorter V1 loops than chronic strains (p = 0.047; subtype B transmission strains had more V3 loop glycosites (p = 0.024 than chronic strains. Further investigation showed that these statistically significant results were unlikely to be biologically meaningful. Also, there was no difference observed in the prevalence of a histidine at position 12 among transmission strains and controls of either subtype. Conclusions Although a genetic bottleneck is observed after HIV-1 transmission, our results indicate that summary characteristics of Env hypothesised to be important in transmission are not divergent between transmission and chronic strains of either subtype. The success of a transmission strain to initiate infection may be a random

  19. Child characteristics and parental educational expectations: evidence for transmission with transaction.

    Science.gov (United States)

    Briley, Daniel A; Harden, K Paige; Tucker-Drob, Elliot M

    2014-12-01

    Parents' expectations for their children's ultimate educational attainment have been hypothesized to play an instrumental role in socializing academically relevant child behaviors, beliefs, and abilities. In addition to social transmission of educationally relevant values from parents to children, parental expectations and child characteristics may transact bidirectionally. We explore this hypothesis using both longitudinal and genetically informative twin data from the Early Childhood Longitudinal Study-Birth and Kindergarten cohorts. Our behavior genetic results indicate that parental expectations partly reflect child genetic variation, even as early as 4 years of age. Two classes of child characteristics were hypothesized to contribute to these child-to-parent effects: behavioral tendencies (approaches toward learning and problem behaviors) and achievement (math and reading). Using behavior genetic models, we find within-twin-pair associations between these child characteristics and parental expectations. Using longitudinal cross-lagged models, we find that initial variation in child characteristics predicts future educational expectations above and beyond previous educational expectations. These results are consistent with transactional frameworks in which parent-to-child and child-to-parent effects co-occur. PMID:25285965

  20. The study of the effect of the project of mother-to-child transmission in Yibin Cuiping%宜宾市翠屏区预防艾滋病母婴传播工作效果分析

    Institute of Scientific and Technical Information of China (English)

    田华

    2012-01-01

    To evaluate the project of mother-to-child transmission(PMTCT) prevention services among Human Immunodeficiency Virus ( HIV ) infected mothers in Cuiping, and improve some implement measures. Methods The pregnant women (infected with HIV from January 2008 to January 2011) were enrolled in the project of mother-to-child transmission (PMTCT)prevention and intervention. Results Among the antibodies to HIV of the 33906 pregnant women, 15 cases were positive; The infection rate is 0.04%. We have adopted the intervention theropy on HIV infectors through progressive stages and have got favorable results. Conclusion The project of mother-to-child transmission (PMTCT) prevention for pregnant women and neo-nates infected with HIV can effective block the matemal-infant transmission of HIV.%目的 评估翠屏区预防艾滋病母婴传播项目工作成效,探索并改进实施方案.方法 2008~2011年对孕产妇进行艾滋病抗体检测,把艾滋病抗体检测阳性的孕产妇纳入预防艾滋病母婴传播项目进行干预.结果 对33906例孕妇进行了艾滋病抗体检测,查出艾滋病病毒感染者15例,感染率为0.04%,均在不同阶段进行了干预治疗,取得了良好效果.结论 通过预防艾滋病母婴传播项目工作的开展,对艾滋病病毒感染孕产妇及其所生婴儿进行干预,对预防艾滋病母婴传播起到有效的阻断作用.

  1. Nosocomial HIV-transmission in an outpatient clinic detected by epidemiologicaland phylogenetic analyses

    DEFF Research Database (Denmark)

    Katzenstein, T.L.; Jørgensen, L.B.; H, Permin;

    1999-01-01

    OBJECTIVE: To determine if a case of HIV-infection in a patient (GP) with common variable immunodeficiency, and with no knownrisk factors for HIV-infection, could be due to horizontal nosocomial transmission. METHODS: For determination of time oftransmission stored serum-samples from GP were.......9% respectively. In addition, GP harboured HIV RNA with a foscarnet resistance mutation further lendingsupport to virus from the foscarnet-treated FDL being the source of the infection. Interestingly, GP experienced increases inimmunoglobulin production after contracting the HIV-infection, and decreases after...... antiretroviral-induced viral suppression. Aclinical procedure which, under stressful conditions, could lead to breaches in infection control measures was identified. The source ofthe infection was most likely a contaminated multidose vial. CONCLUSION: Through epidemiological and phylogenetic analyses acase...

  2. Knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Onibokun Adenike

    2007-10-01

    Full Text Available Abstract Background Mother-to-Child Transmission (MTCT of HIV remains the main mode of acquisition of HIV in children. Transmission of HIV may occur during pregnancy, delivery or breastfeeding. Studies have shown that some specific interventions help to reduce the transmission of the virus to the baby. In order to target safe, rational and effective intervention to reduce MTCT of HIV, it is necessary to ensure that the nurse/midwife has knowledge of the strategies for the prevention of vertical transmission of HIV. Method The cross-sectional design was utilized to determine the knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria. The study sample consisted of 155 nurse/midwives drawn from three selected hospitals through stratified random sampling method. Official permission was obtained from the institutions and consent from participants. Data was collected through the use of a self administered questionnaire. Information sought included respondents' demographic characteristics, knowledge about and behaviour of prevention of vertical transmission as well as factors influencing behaviour. Results Findings revealed that nurse/midwives had moderate level of knowledge with mean score of 51.4%. The mean score on behaviour was 52.5%, major factors that influence behaviour in these settings were mainly fear of getting infected, irregular supply of resources like gloves, goggles, sharp boxes, and water supply was not regular also. Hypotheses tested revealed that there is a positive relationship between knowledge and behaviour (r = 0.583, p = 0.00. Knowledge level of nurse/midwives who had educational exposure was not different from those who did not (t = 1.439, p = 0.152. There was a significant difference in the knowledge of nurse/midwives who had experience in managing pregnant women living with HIV/AIDS and those who did not (t = 2.142, p = 0.03. Also, there was a significant

  3. What is the benefit of the biomedical and behavioral interventions in preventing HIV transmission?

    Directory of Open Access Journals (Sweden)

    Ricardo Kuchenbecker

    2015-09-01

    Full Text Available ABSTRACTIntroduction:Scientific evidence supports the sinergy between biomedical and behavioral interventions aimed at preventing the transmission of HIV as a strategy to eradicate AIDS.Objective:To characterize comparatively the benefits from biomedical and behavioral interventions to prevent HIV transmission.Methods:Narrative review. We performed a comparative analysis of the benefits of studied interventions by means of estimating the number needed to treat (NNT. Evaluated interventions: counseling activities for behavior change to prevent exposure to HIV; antiretroviral pre-exposure prophylaxis (PrEP and antiretroviral post-exposure prophylasis (PEP for HIV and treatment of serodiscordant couples as a strategy for prevention of HIV transmission (TasP.Results:counseling interventions and TasP have smaller NNTs, equal to, respectively, 11 (95%CI 9 - 18 at 12 months and 34 (95%CI 23 - 54 in 42 months comparatively to PrEP interventions, that resulted in 41 (95%CI 28 - 67 individuals receiving antiretrovirals in order to prevent one case of HIV infection at 36 months for men and serodiscordant couples. PEP interventions are associated with protective effects estimated at 81%. Lack of trials evaluating PEP prevents estimate of NNT.Conclusion:The estimate of the NNT can be a helpful parameter in the comparison between the effectiveness of different behavioral and biomedical HIV prevention strategies. Studies evaluating the benefit and safety of combined behavioral and biomedical interventions are needed, especially considering the attributable fraction of each component. Integration of behavioral and biomedical interventions is required to achieve complete suppression of the virus, and thus reducing viral replication, infectivity and the number of cases.

  4. Reasons for loss to follow-up among mothers registered in a prevention-of-mother-to-child transmission program in rural Malawi.

    Science.gov (United States)

    Bwirire, L D; Fitzgerald, M; Zachariah, R; Chikafa, V; Massaquoi, M; Moens, M; Kamoto, K; Schouten, E J

    2008-12-01

    This study was conducted to identify reasons for a high and progressive loss to follow-up among HIV-positive mothers within a prevention-of-mother-to-child HIV transmission (PMTCT) program in a rural district hospital in Malawi. Three focus group discussions were conducted among a total of 25 antenatal and post-natal mothers as well as nurse midwives (median age 39 years, range 22-55 years). The main reasons for loss to follow-up included: (1) not being prepared for HIV testing and its implications before the antenatal clinic (ANC) visit; (2) fear of stigma, discrimination, household conflict and even divorce on disclosure of HIV status; (3) lack of support from husbands who do not want to undergo HIV testing; (4) the feeling that one is obliged to rely on artificial feeding, which is associated with social and cultural taboos; (5) long waiting times at the ANC; and (6) inability to afford transport costs related to the long distances to the hospital. This study reveals a number of community- and provider-related operational and cultural barriers hindering the overall acceptability of PMTCT that need to be addressed urgently. Mothers attending antenatal services need to be better informed and supported, at both community and health-provider level.

  5. Positive parenting for positive parents: HIV/AIDS, poverty, caregiver depression, child behavior and parenting in South Africa

    OpenAIRE

    Lachman, J.; Cluver, L; Boyes, M.; Kuo, C.; Casale, M.

    2013-01-01

    Families affected by HIV/AIDS in the developing world experience higher risks of psychosocial problems than non-affected families. Positive parenting behavior may buffer against the negative impact of child AIDS-orphanhood and caregiver AIDS-sickness on child wellbeing. Although there is substantial literature regarding the predictors of parenting behavior in Western populations, there is insufficient evidence on HIV/AIDS as a risk factor for poor parenting in low- and middle-income countries...

  6. Recent Infection, Sexually Transmitted Infections and Transmission Clusters Frequently Observed Among Persons Newly-Diagnosed with HIV in San Francisco

    Science.gov (United States)

    Truong, Hong-Ha M.; Pipkin, Sharon; O’Keefe, Kara J.; Louie, Brian; Liegler, Teri; McFarland, Willi; Grant, Robert M.; Bernstein, Kyle; Scheer, Susan

    2015-01-01

    There were 1,311 newly-diagnosed HIV cases in San Francisco between 2005 and 2011 that were linked to care at publicly-funded facilities and had viral sequences available for analysis. Of the 214 cases characterized as recently-infected with HIV at time of diagnosis, 25% had a recent sexually transmitted infection (STI) diagnosis (vs. 10% among longer-standing HIV infections, p<0.001) and 57% were part of a phylogenetic transmission cluster (vs. 42% among longer-standing HIV infection, p<0.001). The association observed between recent HIV infection and having a STI diagnosis during the interval overlapping likely HIV acquisition points to potential opportunities to interrupt HIV transmission. PMID:25967271

  7. Child-street migration among HIV-affected families in Kenya: a mediation analysis from cross-sectional data

    Science.gov (United States)

    Goodman, Michael L.; Mutambudzi, Miriam S.; Gitari, Stanley; Keiser, Philip H.; Seidel, Sarah E.

    2016-01-01

    ABSTRACT Within Kenya, an estimated quarter of a million children live on the streets, and 1.8 million children are orphaned. In this study, we analyze how HIV contributes to the phenomenon of child-street migration. We interviewed a random community sample of caregiving women (n = 1974) in Meru County, Kenya, using a structured questionnaire in summer 2015. Items included reported HIV prevalence of respondent and her partner, social support, overall health, school enrollment of biologically related children and whether the respondent has a child currently living on the streets. Controlling for alcohol use, education, wealth, age and household size, we found a positive-graded association between the number of partners living with HIV and the probability that a child lives on the street. There was little difference in the odds of a child living on the street between maternally affected and paternally affected households. Lower maternal social support, overall health and school enrollment of biologically related children mediated 14% of the association between HIV-affected households and reporting child-street migration. Street-migration of children is strongly associated with household HIV, but the small percentage of mediated effect presents a greater need to focus on interactions between household and community factors in the context of HIV. Programs and policies responding to these findings will involve targeting parents and children in HIV-affected households, and coordinate care between clinical providers, social service providers and schools. PMID:27392012

  8. The Prevalence of Different Human Immunodeficiency Virus Transmission Routes and Knowledge about AIDS in Infected People with HIV in Sirjan

    OpenAIRE

    Mahin Behzadpour; Narges Khanjani

    2012-01-01

    Background & Objective: The immune system of Patients with Acquired Immune Deficiency Syndrome (AIDS) is weekend because of Human immunodeficiency virus (HIV) infection, and they become vulnerable to several opportunistic and non-opportunistic pathogens and different carcinomas. IV drug abuse, sexual contact, occupational transmission, blood transfusion and maternal-fetal transmission are well known transmission routes for HIV infection. This study was under taken to investigate the prevalenc...

  9. Visualization of HIV-1 interactions with penile and foreskin epithelia: clues for female-to-male HIV transmission.

    Science.gov (United States)

    Dinh, Minh H; Anderson, Meegan R; McRaven, Michael D; Cianci, Gianguido C; McCoombe, Scott G; Kelley, Z L; Gioia, Casey J; Fought, Angela J; Rademaker, Alfred W; Veazey, Ronald S; Hope, Thomas J

    2015-03-01

    To gain insight into female-to-male HIV sexual transmission and how male circumcision protects against this mode of transmission, we visualized HIV-1 interactions with foreskin and penile tissues in ex vivo tissue culture and in vivo rhesus macaque models utilizing epifluorescent microscopy. 12 foreskin and 14 cadaveric penile specimens were cultured with R5-tropic photoactivatable (PA)-GFP HIV-1 for 4 or 24 hours. Tissue cryosections were immunofluorescently imaged for epithelial and immune cell markers. Images were analyzed for total virions, proportion of penetrators, depth of virion penetration, as well as immune cell counts and depths in the tissue. We visualized individual PA virions breaching penile epithelial surfaces in the explant and macaque model. Using kernel density estimated probabilities of localizing a virion or immune cell at certain tissue depths revealed that interactions between virions and cells were more likely to occur in the inner foreskin or glans penis (from local or cadaveric donors, respectively). Using statistical models to account for repeated measures and zero-inflated datasets, we found no difference in total virions visualized at 4 hours between inner and outer foreskins from local donors. At 24 hours, there were more virions in inner as compared to outer foreskin (0.0495 +/- 0.0154 and 0.0171 +/- 0.0038 virions/image, p = 0.001). In the cadaveric specimens, we observed more virions in inner foreskin (0.0507 +/- 0.0079 virions/image) than glans tissue (0.0167 +/- 0.0033 virions/image, pimage, p = 0.099) and to significantly greater mean depths (29.162 +/- 3.908 vs. 12.466 +/- 2.985 μm). Our in vivo macaque model confirmed that virions can breach penile squamous epithelia in a living model. In summary, these results suggest that the inner foreskin and glans epithelia may be important sites for HIV transmission in uncircumcised men.

  10. At Risk: The Relationship between Experiences of Child Sexual Abuse and Women's HIV Status in Papua New Guinea

    Science.gov (United States)

    Lewis, Ione R.

    2012-01-01

    Child sexual abuse in Papua New Guinea is a human rights issue as well as an indicator of HIV risk in women. This study aimed to develop knowledge about the link between violence experienced by women and their HIV status. The study used a mixed method approach to collect quantitative and qualitative data through structured interviews with a sample…

  11. Mode of delivery and the risk of vertical HIV transmission%分娩方式与艾滋病母婴传播

    Institute of Scientific and Technical Information of China (English)

    张璐; 王临虹; 方利文

    2012-01-01

    艾滋病病毒(HIV)可通过母亲妊娠分娩传播给新生儿,即艾滋病的母婴传播.艾滋病母婴传播可发生在妊娠、分娩和哺乳的各个过程,但在分娩前后的传播比例最高.分娩过程中产科因素对艾滋病母婴传播风险的影响,特别是不同分娩方式是否会影响艾滋病母婴传播风险,既往一直争议不断.近年来由于抗病毒药物特别是高效抗反转录病毒疗法和人工喂养,已将母婴传播的风险下降到一个较低的水平,越来越多的研究者已不再倾向将分娩方式选择作为减少艾滋病母婴传播的主要干预措施.%HIV could be transmitted from mother to child by pregnancy and delivery, which is called vertical HIV transmission. Vertical transmission can occur during pregnancy, childbirth and breast-feeding, but most occurred during labor and delivery or early postpartum period. For many years it has been contentious whether obstetric factors during labor and delivery would affect the risk of transmission, especially different modes of delivery. In recent years, risk of vertical HIV transmission has been reduced to a lower level owing to antiviral drugs, especially highly active antiretroviral therapy (HAART) and artificial feeding. Then more and more researchers questioned the need to reduce vertical transmission by selection of mode of delivery.

  12. Prevalence of Child and Adult Sexual Abuse and Risk Taking Practices Among HIV Serodiscordant African-American Couples

    OpenAIRE

    el-Bassel, N; Wingood, G; Wyatt, GE; III, JJB; Pequegnat, W; Landis, JR; Bellamy, S.; Gilbert, L; Remien, RH; Witte, S; Wu, E; DiClemente, R; Myers, H.; Jemmott, LS; Metzger, D

    2010-01-01

    This study reports the prevalence of child (CSA) and adult (ASA) sexual abuse among 535 African American HIV serodiscordant couples from four major United State cities, and its relationship to personal and couple related vulnerabilities and HIV risk factors. As part of a randomized, clinical trial, CSA and ASA histories were obtained through face-to-face interviews. Results indicate that HIV positive women were significantly more likely to report one kind of abuse (32.32%), either before or s...

  13. An ethical analysis of opt-out HIV screening for pregnant women.

    Science.gov (United States)

    Wocial, Lucia D; Cox, Elaine G

    2013-07-01

    Critical advances in prevention of mother-to-child-transmission (MTCT) of the HIV in the perinatal period have changed practice recommendations for HIV screening for pregnant women. Using case studies we illustrate the ethical complexities and implications of opt-out HIV testing for pregnant women. Despite the potential for compromised informed consent, an opt-out HIV screening approach is ethically defensible.

  14. 深圳市宝安区预防与控制HIV/AIDS母婴传播的研究%Study on control of HIV/AIDS mother-to child transmission among pregnant women in Baoan District,Shenzhen City

    Institute of Scientific and Technical Information of China (English)

    刘益民; 刘利共

    2004-01-01

    目的了解深圳市孕产妇艾滋病病毒(HIV)感染情况,探索阻断艾滋病(AIDS)母婴传播的方法.方法采取政府行为,建立监测网络,对全部首次做孕期检查的孕产妇免费进行HIV检测及规范化的干预措施.结果 2002年、2003年的监测率分别为95.09%、95.12%;孕产妇HIV感染率分别为0.002%、0.009%.通过健康教育干预,孕产妇AIDS预防知识知晓率从项目实施前的28.5%~58.6%上升到实施后的85.6%~100.0%(P< 0.001%).结论深圳市孕产妇的HIV感染率远低于云南等省,但有逐年升高的趋势;建立监测网络,免费对首次孕期检查的孕产妇做HIV检测并实施预防性干预,以阻断HIV垂直传播的方法是成功可行的.

  15. Molecular epidemiology identifies HIV transmission networks associated with younger age and heterosexual exposure among Korean individuals.

    Science.gov (United States)

    Chin, Bum Sik; Chaillon, Antoine; Mehta, Sanjay R; Wertheim, Joel O; Kim, Gayeon; Shin, Hyoung-Shik; Smith, Davey M

    2016-10-01

    To evaluate if HIV transmission networks could be elucidated from data collected in a short time frame, 131 HIV-1 pol sequences were analyzed which were generated from treatment-naïve Korean individuals who were sequentially identified over 1 year. A transmission linkage was inferred when there was a genetic distance <1.5% and a total of 16 clusters, involving 39/131 (29.8%), were identified. Younger age and heterosexual exposure were independently related with clustering in the inferred network, which demonstrated that molecular epidemiology with currently generated data (i.e., drug resistance genotypes) can be used to identify local transmission networks, even over a short timeframe. J. Med. Virol. 88:1832-1835, 2016. © 2016 Wiley Periodicals, Inc. PMID:26990771

  16. Heterosexual transmission of HIV and related risk factors among serodiscordant couples in Henan province, China

    Institute of Scientific and Technical Information of China (English)

    WANG Lan; WANG Lu; M.Kumi Smith; LI Li-ming; MING Shuai; L(U) Jun; CAO Wei-hua

    2013-01-01

    Background HIV transmission between discordant couples has become an important source of new infections in China.To describe the seroconversion rate among serodiscordant couples and to identify salient behavioral and clinical risk factors including ART that affect heterosexual HIV transmission risk among couples in rural China.Methods Longitudinal follow-up of an open cohort of HIV serodiscordant couples took place between 2007 and 2011 in Zhumadian,a city in southern Henan province in China,where blood plasma selling in 1990s led to a regional HIV epidemic.Annual follow-up included separate face-to-face interviews of husbands and wives,and HIV antibody testing for non-index partners.Cox proportional-hazard modeling was used to assess the relationship between HIV seroconversion and covariates of interest.Results By the end of 2011,4499 HIV serodiscordant couples had been enrolled in at least two follow-up interviews; 100 non-index partners seroconverted during the entire observation period for an incidence rate of 0.82 per 100 person-years (95% CI:0.66-0.99).The incidence rates by the end of 2008,2009,and 2010 were 2.14,1.51,and 0.90 per 100 personyears respectively.Always using condoms in the past year of sex,gender of the index partner,frequency of sex,and ART exposure were all significant predictors of HIV seroconversion in the negative spouse.ART was highly protective against seroconversion whether the index partner was actively receiving treatment at the last follow-up (RR=0.05,95% CI,0.01-0.16) or if the index partner had ever received ART (RR=0.01,95% CI,0.00,0.12).The risk of seroconversion in the nonindex spouse also decreased the longer the duration of the index partner's exposure to ART.Conclusions ART exposure and always using condom were highly protective against HIV semconversion in the negative spouse.HIV incidence in serodiscordant couples has been decreasing over time,associated with ART treatment time within 7 years in the index partner

  17. Social media use and HIV transmission risk behavior among ethnically diverse HIV-positive gay men: results of an online study in three U.S. states.

    Science.gov (United States)

    Hirshfield, Sabina; Grov, Christian; Parsons, Jeffrey T; Anderson, Ian; Chiasson, Mary Ann

    2015-10-01

    Though Black and Hispanic men who have sex with men (MSM) are at an increased risk for HIV, few HIV risk reduction interventions that target HIV-positive MSM, and even fewer that use technology, have been designed to target these groups. Despite similar rates of social media and technology use across racial/ethnic groups, online engagement of minority MSM for HIV prevention efforts is low. Since minority MSM tend to have less representation in online HIV prevention studies, the goals of this online anonymous study of HIV-positive gay-identified men were to test the feasibility of conducting targeted recruitment by race/ethnicity and sexual orientation, to assess technology and social media use, and to assess global HIV transmission risk. In 2011, an anonymous online survey was conducted among 463 members of an HIV-positive personals website. Emails were sent to a subset of HIV-positive male members who self-identified as gay. While 57 % were White, substantial proportions of participants were Black (20 %) or Hispanic (18 %). Median age was 46 (range 18-79). Men who reported using 3 or more websites or apps to meet sex partners were significantly more likely to report anal intercourse (AOR 4.43, p social media use, and sexual risk among a diverse sample of HIV-positive gay men. Efficacy trials of technology-based HIV prevention interventions targeting high-risk minority HIV-positive MSM are warranted. PMID:26179596

  18. Selecting HIV infection prevention interventions in the mature HIV epidemic in Malawi using the mode of transmission model

    Directory of Open Access Journals (Sweden)

    Maleta Kenneth

    2010-08-01

    Full Text Available Abstract Background Malawi is reassessing its HIV prevention strategy in the light of a limited reduction in the epidemic. No community based incidence studies have been carried out in Malawi, so estimates of where new infections are occurring require the use of mathematical models and knowledge of the size and sexual behaviour of different groups. The results can help to choose where HIV prevention interventions are most needed. Methods The UNAIDS Mode of Transmission model was populated with Malawi data and estimates of incident cases calculated for each exposure group. Scenarios of single and multiple interventions of varying success were used to identify those interventions most likely to reduce incident cases. Results The groups accounting for most new infections were the low-risk heterosexual group - the discordant couples (37% and those who had casual sex and their partners (a further 16% and 27% respectively of new cases. Circumcision, condoms with casual sex and bar girls and improved STI treatment had limited effect in reducing incident cases, while condom use with discordant couples, abstinence and a zero-grazing campaign had major effects. The combination of a successful strategy to eliminate multiple concurrent partners and a successful strategy to eliminate all infections between discordant couples would reduce incident cases by 99%. Conclusions A revitalised HIV prevention strategy will need to include interventions which tackle the two modes of transmission now found to be so important in Malawi - concurrency and discordancy.

  19. Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the "HIV Treatment as Prevention" experience in a Canadian setting.

    Directory of Open Access Journals (Sweden)

    Julio S G Montaner

    Full Text Available BACKGROUND: There has been renewed call for the global expansion of highly active antiretroviral therapy (HAART under the framework of HIV treatment as prevention (TasP. However, population-level sustainability of this strategy has not been characterized. METHODS: We used population-level longitudinal data from province-wide registries including plasma viral load, CD4 count, drug resistance, HAART use, HIV diagnoses, AIDS incidence, and HIV-related mortality. We fitted two Poisson regression models over the study period, to relate estimated HIV incidence and the number of individuals on HAART and the percentage of virologically suppressed individuals. RESULTS: HAART coverage, median pre-HAART CD4 count, and HAART adherence increased over time and were associated with increasing virological suppression and decreasing drug resistance. AIDS incidence decreased from 6.9 to 1.4 per 100,000 population (80% decrease, p = 0.0330 and HIV-related mortality decreased from 6.5 to 1.3 per 100,000 population (80% decrease, p = 0.0115. New HIV diagnoses declined from 702 to 238 cases (66% decrease; p = 0.0004 with a consequent estimated decline in HIV incident cases from 632 to 368 cases per year (42% decrease; p = 0.0003. Finally, our models suggested that for each increase of 100 individuals on HAART, the estimated HIV incidence decreased 1.2% and for every 1% increase in the number of individuals suppressed on HAART, the estimated HIV incidence also decreased by 1%. CONCLUSIONS: Our results show that HAART expansion between 1996 and 2012 in BC was associated with a sustained and profound population-level decrease in morbidity, mortality and HIV transmission. Our findings support the long-term effectiveness and sustainability of HIV treatment as prevention within an adequately resourced environment with no financial barriers to diagnosis, medical care or antiretroviral drugs. The 2013 Consolidated World Health Organization Antiretroviral

  20. THE MANAGEMENT OF HIV INFECTION IN PREGNANCY

    Directory of Open Access Journals (Sweden)

    Clara Marcaelia Valerian

    2013-02-01

    Full Text Available The Human Immunodeficiency Virus (HIV is a RNA retrovirus which causes the clinical disease termed the acquired immunodeficiency syndrome (AIDS. Mother-to-child transmission is the main source of spreading HIV infection to the child with frequency is as high as 25-30%. This may occurred because of the intrapartum maternal blood exposure, infected genital tract secretions and during breastfeeding. The right combination of ARV treatment and elective section caesarean delivery has been proved to reduce the mother-to-child transmission of HIV infection prevalence and preventing obstetric complications significantly. Consultation and follow up with specialists is highly recommended.

  1. Factors enhancing utilization of and adherence to prevention of mother-to-child transmission (PMTCT) service in an urban setting in Kenya.

    Science.gov (United States)

    Murithi, Lydia Karuta; Masho, Saba W; Vanderbilt, Allison A

    2015-04-01

    Despite expansive scale-up of prevention of mother-to-child transmission (PMTCT) of HIV services in Kenya over the last decade, Kenya remains one of the countries contributing to high numbers of children living with HIV globally and is among the 22 PMTCT global plan priority countries. Using structured and in-depth interviews this study examined enabling factors that enhance utilization of and adherence to PMTCT services in an urban setting in Kenya. HIV-positive birthmothers (N = 55) whose infants were HIV-negative at the time of the study completed a structured interview and a subset (n = 15) participated in in-depth interviews. The majority of the mothers (98 %) delivered at a health facility and 91 % exclusively breastfed. Further, 91 % attended clinic appointments regularly and 69.1 % strictly adhered to prescribed medication dosage and schedules. However, 18 % had not disclosed their HIV status to anybody, 27 % did not use condom during sex, 95 % did not participate in AIDS support groups and 53 % of their male partners were not involved in PMTCT. Four key themes facilitating PMTCT success emerged from the qualitative data: supportive counseling, striving for motherhood, assurance of confidentiality; and confirmation, affirmation and admiration. HIV/AIDS related stigma and gender imbalances create many missed opportunities for HIV-positive mothers to reach out for support from family and community, apply acquired knowledge and access more affordable care. To be successful, PMTCT programs should be aware of these factors and ensure that mothers are provided with culturally competent care. PMID:25381562

  2. Toxoplasmic encephalitis in an HIV infected pregnant woman: successful outcome for both mother and child

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    Susie Andries Nogueira

    2002-08-01

    Full Text Available This report describes a case of Toxoplasma encephalitis during pregnancy of an HIV infected woman who was severely immunosuppressed (CD4: 17 cells/mm3, had a high viral load (RNA PCR:230,000 copies/ml, was treated with sulfadiazine, pyrimethamine and folinic acid for toxoplasmosis and was being treated with highly potent antiretroviral drugs (AZT, 3TC and nelfinavir for HIV infection. The newborn was born through an elective C-section, received six weeks of AZT according to the 076 protocol and was clinically normal at birth. Subsequently he had two RNA PCR negatives for HIV, seroreverted and had no clinical or laboratory evidence of congenital toxoplasmosis. Despite the concerns of the use of these combined therapies on the foetus during pregnancy, their efficacy illustrates that keeping the mother alive and in good health is an important strategy to protect the unborn child from acquiring these two infections.

  3. Assessing transmissibility of HIV-1 drug resistance mutations from treated and from drug-naive individuals

    Science.gov (United States)

    Winand, Raf; Theys, Kristof; Eusébio, Mónica; Aerts, Jan; Camacho, Ricardo J.; Gomes, Perpetua; Suchard, Marc A.; Vandamme, Anne-Mieke; Abecasis, Ana B.

    2015-01-01

    Objectives: Surveillance drug resistance mutations (SDRMs) in drug-naive patients are typically used to survey HIV-1-transmitted drug resistance (TDR). We test here how SDRMs in patients failing treatment, the original source of TDR, contribute to assessing TDR, transmissibility and transmission source of SDRMs. Design: This is a retrospective observational study analyzing a Portuguese cohort of HIV-1-infected patients. Methods: The prevalence of SDRMs to protease inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) in drug-naive and treatment-failing patients was measured for 3554 HIV-1 subtype B patients. Transmission ratio (prevalence in drug-naive/prevalence in treatment-failing patients), average viral load and robust linear regression with outlier detection (prevalence in drug-naive versus in treatment-failing patients) were analyzed and used to interpret transmissibility. Results: Prevalence of SDRMs in drug-naive and treatment-failing patients were linearly correlated, but some SDRMs were classified as outliers – above (PRO: D30N, N88D/S, L90 M, RT: G190A/S/E) or below (RT: M184I/V) expectations. The normalized regression slope was 0.073 for protease inhibitors, 0.084 for NRTIs and 0.116 for NNRTIs. Differences between SDRMs transmission ratios were not associated with differences in viral loads. Conclusion: The significant linear correlation between prevalence of SDRMs in drug-naive and in treatment-failing patients indicates that the prevalence in treatment-failing patients can be useful to predict levels of TDR. The slope is a cohort-dependent estimate of rate of TDR per drug class and outlier detection reveals comparative persistence of SDRMs. Outlier SDRMs with higher transmissibility are more persistent and more likely to have been acquired from drug-naive patients. Those with lower transmissibility have faster reversion dynamics after transmission and are associated with

  4. Systemic administration of antiretrovirals prior to exposure prevents rectal and intravenous HIV-1 transmission in humanized BLT mice.

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    Paul W Denton

    Full Text Available Successful antiretroviral pre-exposure prophylaxis (PrEP for mucosal and intravenous HIV-1 transmission could reduce new infections among targeted high-risk populations including discordant couples, injection drug users, high-risk women and men who have sex with men. Targeted antiretroviral PrEP could be particularly effective at slowing the spread of HIV-1 if a single antiretroviral combination were found to be broadly protective across multiple routes of transmission. Therefore, we designed our in vivo preclinical study to systematically investigate whether rectal and intravenous HIV-1 transmission can be blocked by antiretrovirals administered systemically prior to HIV-1 exposure. We performed these studies using a highly relevant in vivo model of mucosal HIV-1 transmission, humanized Bone marrow/Liver/Thymus mice (BLT. BLT mice are susceptible to HIV-1 infection via three major physiological routes of viral transmission: vaginal, rectal and intravenous. Our results show that BLT mice given systemic antiretroviral PrEP are efficiently protected from HIV-1 infection regardless of the route of exposure. Specifically, systemic antiretroviral PrEP with emtricitabine and tenofovir disoproxil fumarate prevented both rectal (Chi square = 8.6, df = 1, p = 0.003 and intravenous (Chi square = 13, df = 1, p = 0.0003 HIV-1 transmission. Our results indicate that antiretroviral PrEP has the potential to be broadly effective at preventing new rectal or intravenous HIV transmissions in targeted high risk individuals. These in vivo preclinical findings provide strong experimental evidence supporting the potential clinical implementation of antiretroviral based pre-exposure prophylactic measures to prevent the spread of HIV/AIDS.

  5. Strategies to prevent HIV transmission among heterosexual African-American women

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    Peters Ronald J

    2005-03-01

    Full Text Available Abstract Background African-American women are disproportionately affected by HIV, accounting for 60% of all cases among women in the United States. Although their race is not a precursor for HIV, the socioeconomic and cultural disparities associated with being African American may increase their risk of infection. Prior research has shown that interventions designed to reduce HIV infection among African-American women must address the life demands and social problems they encounter. The present study used a qualitative exploratory design to elicit information about strategies to prevent HIV transmission among young, low-income African-American women. Methods Twenty five low income African American women, ages 18–29, participated in five focus groups of five women each conducted at a housing project in Houston, Texas, a large demographically diverse metropolitan area that is regarded as one of the HIV/AIDS epicenters in the United States. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. Results The participants revealed that they had most frequently placed themselves at risk for HIV infection through drugs and drinking and they also reported drug and alcohol use as important barriers to practicing safer sex. The women also reported that the need for money and having sex for money to buy food or drugs had placed them at risk for HIV transmission. About one-third of the participants stated that a barrier to their practicing safe sex was their belief that there was no risk based on their being in a monogamous relationship and feeling no need to use protection, but later learning that their mate was unfaithful. Other reasons given were lack of concern, being unprepared, partner's refusal to use a condom, and lack of money to buy condoms. Finally, the women stated that they were motivated to practice safe sex because of fear of contracting sexually transmitted diseases and HIV, desire not to become pregnant, and

  6. Strategies to prevent HIV transmission among heterosexual African-American women.

    Science.gov (United States)

    Essien, E James; Meshack, Angela F; Peters, Ronald J; Ogungbade, Go; Osemene, Nora I

    2005-03-17

    BACKGROUND: African-American women are disproportionately affected by HIV, accounting for 60% of all cases among women in the United States. Although their race is not a precursor for HIV, the socioeconomic and cultural disparities associated with being African American may increase their risk of infection. Prior research has shown that interventions designed to reduce HIV infection among African-American women must address the life demands and social problems they encounter. The present study used a qualitative exploratory design to elicit information about strategies to prevent HIV transmission among young, low-income African-American women. METHODS: Twenty five low income African American women, ages 18-29, participated in five focus groups of five women each conducted at a housing project in Houston, Texas, a large demographically diverse metropolitan area that is regarded as one of the HIV/AIDS epicenters in the United States. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. RESULTS: The participants revealed that they had most frequently placed themselves at risk for HIV infection through drugs and drinking and they also reported drug and alcohol use as important barriers to practicing safer sex. The women also reported that the need for money and having sex for money to buy food or drugs had placed them at risk for HIV transmission. About one-third of the participants stated that a barrier to their practicing safe sex was their belief that there was no risk based on their being in a monogamous relationship and feeling no need to use protection, but later learning that their mate was unfaithful. Other reasons given were lack of concern, being unprepared, partner's refusal to use a condom, and lack of money to buy condoms. Finally, the women stated that they were motivated to practice safe sex because of fear of contracting sexually transmitted diseases and HIV, desire not to become pregnant, and personal experience with

  7. Expanding the role of community mobilization to accelerate progress towards ending vertical transmission of HIV in Uganda: the Networks model

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    Kate Iorpenda

    2012-07-01

    Full Text Available Introduction: Efforts to prevent vertical transmission of HIV have gained momentum globally since the launch of the “Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive”, reflecting the growing consensus that we now have low-cost, efficacious interventions that promise to end vertical transmission of HIV. Uganda is one of the 22 focus countries in the global plan and one of the 10 countries with the highest need for prevention of vertical transmission globally. In the context of current shortfalls in the prevention of vertical HIV transmission, this paper presents the results of the Networks project, a community mobilisation model implemented by the International HIV/AIDS Alliance in Uganda, and draws out the theoretical foundations and promising community mobilization practices relevant to prevention of vertical transmission. Methods: A retrospective review of the Network project's activities, documentation and evaluation was performed. Results: The Networks project, through community mobilisation and greater involvement of people living with HIV, reached an estimated 1.3 million people with at least one health service. By clustering 750 groups of people living with HIV into larger coalitions, the project supported existing groups to amalgamate their collective strengths and skills in outreach, referral and literacy activities; and improved reach and coverage of HIV services through strengthened linkages with healthcare facilities. Our analysis of the Networks model shows that it could contribute to the prevention of vertical transmission of HIV as a replicable and sustainable community mobilisation approach. In particular, the Networks model increased the uptake of decentralized interventions for preventing vertical transmission through community referrals; promoted male involvement through peer sensitisation; and linked communities to advocacy channels for advancing maternal

  8. HIV-1 Diversity, Transmission Dynamics and Primary Drug Resistance in Angola

    Science.gov (United States)

    Bártolo, Inês; Zakovic, Suzana; Martin, Francisco; Palladino, Claudia; Carvalho, Patrícia; Camacho, Ricardo; Thamm, Sven; Clemente, Sofia; Taveira, Nuno

    2014-01-01

    Objectives To assess HIV-1 diversity, transmission dynamics and prevalence of transmitted drug resistance (TDR) in Angola, five years after ART scale-up. Methods Population sequencing of the pol gene was performed on 139 plasma samples collected in 2009 from drug-naive HIV-1 infected individuals living in Luanda. HIV-1 subtypes were determined using phylogenetic analysis. Drug resistance mutations were identified using the Calibrated Population Resistance Tool (CPR). Transmission networks were determined using phylogenetic analysis of all Angolan sequences present in the databases. Evolutionary trends were determined by comparison with a similar survey performed in 2001. Results 47.1% of the viruses were pure subtypes (all except B), 47.1% were recombinants and 5.8% were untypable. The prevalence of subtype A decreased significantly from 2001 to 2009 (40.0% to 10.8%, P = 0.0019) while the prevalence of unique recombinant forms (URFs) increased>2-fold (40.0% to 83.1%, P<0.0001). The most frequent URFs comprised untypable sequences with subtypes H (U/H, n = 7, 10.8%), A (U/A, n = 6, 9.2%) and G (G/U, n = 4, 6.2%). Newly identified U/H recombinants formed a highly supported monophyletic cluster suggesting a local and common origin. TDR mutation K103N was found in one (0.7%) patient (1.6% in 2001). Out of the 364 sequences sampled for transmission network analysis, 130 (35.7%) were part of a transmission network. Forty eight transmission clusters were identified; the majority (56.3%) comprised sequences sampled in 2008–2010 in Luanda which is consistent with a locally fuelled epidemic. Very low genetic distance was found in 27 transmission pairs sampled in the same year, suggesting recent transmission events. Conclusions Transmission of drug resistant strains was still negligible in Luanda in 2009, five years after the scale-up of ART. The dominance of small and recent transmission clusters and the emergence of new URFs are consistent with a rising

  9. HIV-1 diversity, transmission dynamics and primary drug resistance in Angola.

    Directory of Open Access Journals (Sweden)

    Inês Bártolo

    Full Text Available OBJECTIVES: To assess HIV-1 diversity, transmission dynamics and prevalence of transmitted drug resistance (TDR in Angola, five years after ART scale-up. METHODS: Population sequencing of the pol gene was performed on 139 plasma samples collected in 2009 from drug-naive HIV-1 infected individuals living in Luanda. HIV-1 subtypes were determined using phylogenetic analysis. Drug resistance mutations were identified using the Calibrated Population Resistance Tool (CPR. Transmission networks were determined using phylogenetic analysis of all Angolan sequences present in the databases. Evolutionary trends were determined by comparison with a similar survey performed in 2001. RESULTS: 47.1% of the viruses were pure subtypes (all except B, 47.1% were recombinants and 5.8% were untypable. The prevalence of subtype A decreased significantly from 2001 to 2009 (40.0% to 10.8%, P = 0.0019 while the prevalence of unique recombinant forms (URFs increased > 2-fold (40.0% to 83.1%, P < 0.0001. The most frequent URFs comprised untypable sequences with subtypes H (U/H, n = 7, 10.8%, A (U/A, n = 6, 9.2% and G (G/U, n = 4, 6.2%. Newly identified U/H recombinants formed a highly supported monophyletic cluster suggesting a local and common origin. TDR mutation K103N was found in one (0.7% patient (1.6% in 2001. Out of the 364 sequences sampled for transmission network analysis, 130 (35.7% were part of a transmission network. Forty eight transmission clusters were identified; the majority (56.3% comprised sequences sampled in 2008-2010 in Luanda which is consistent with a locally fuelled epidemic. Very low genetic distance was found in 27 transmission pairs sampled in the same year, suggesting recent transmission events. CONCLUSIONS: Transmission of drug resistant strains was still negligible in Luanda in 2009, five years after the scale-up of ART. The dominance of small and recent transmission clusters and the emergence of new URFs are consistent with a rising HIV-1

  10. Informed recruitment in partner studies of HIV transmission: an ethical issue in couples research

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    Gordon Elisa J

    2009-08-01

    Full Text Available Abstract Background Much attention has been devoted to ethical issues related to randomized controlled trials for HIV treatment and prevention. However, there has been less discussion of ethical issues surrounding families involved in observational studies of HIV transmission. This paper describes the process of ethical deliberation about how best to obtain informed consent from sex partners of injection drug users (IDUs tested for HIV, within a recent HIV study in Eastern Europe. The study aimed to assess the amount of HIV serodiscordance among IDUs and their sexual partners, identify barriers to harm reduction, and explore ways to optimize intervention programs. Including IDUs, either HIV-positive or at high risk for HIV, and their sexual partners would help to gain a more complete understanding of barriers to and opportunities for intervention. Discussion This paper focuses on the ethical dilemma regarding informed recruitment: whether researchers should disclose to sexual partners of IDUs that they were recruited because their partner injects drugs (i.e., their heightened risk for HIV. Disclosing risks to partners upholds the ethical value of respect for persons through informed consent. However, disclosure compromises the IDU's confidentiality, and potentially, the scientific validity of the research. Following a brief literature review, we summarize the researchers' systematic evaluation of this issue from ethical, scientific, and logistical perspectives. While the cultural context may be somewhat unique to Eastern Europe and Central Asia, the issues raised and solutions proposed here inform epidemiological research designs and their underlying ethical tensions. Summary We present ethical arguments in favor of disclosure, discuss how cultural context shapes the ethical issues, and recommend refinement of guidance for couples research of communicable diseases to assist investigators encountering these ethical issues in the future.

  11. Scale up use of family planning services to prevent maternal transmission of HIV among discordant couples: a cross-sectional study within a resource-limited setting

    Directory of Open Access Journals (Sweden)

    Kuete M

    2016-10-01

    Full Text Available Martin Kuete,1,2 HongFang Yuan,1 Aude Laure Tchoua Kemayou,2 Emmanuel Ancel Songo,2 Fan Yang,1 XiuLan Ma,1 ChengLiang Xiong,1 HuiPing Zhang1 1Obstetrics and Gynecology, Reproductive Center, Family Planning and Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 2Main Maternity of Obstetrics and Gynecology, Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon Background: Integration of family planning services (FPS into human immunodeficiency virus (HIV care for HIV-infected women is an important aspect of the global prevention of mother-to-child transmission (PMTCT strategy. We assessed the integration of FPS into routine care of HIV-infected mothers by evaluating the uptake and barriers of contraception and PMTCT services. Methods: We conducted an interventional study using the interrupted time series approach in the health care facilities located in Yaounde, Cameroon. First, structured questionnaires related to family planning use, PMTCT services use, and infection risk of the sexual partner were administered to the first trimester pregnant women who were HIV infected and living with uninfected partners. Second, 2 weeks before the delivery date, the women were interviewed according to the prior counseling interventions received, in order to assess their behavior on FPS, antiretroviral therapy (ART use, delivery option, and infant nourishment to be adopted. P-values below 0.05 were considered statistically significant in the statistical analyses. Results: Of 94 HIV-infected women, 69% were stable couples. Only 13% of women had attended FPS before conception. Although the vast majority were knowledgeable about modern and traditional contraception methods, only 19% had experienced effective contraceptive methods. However, 66% preferred condom use, 45% having three children still expressed a desire to conceive, while 44% reported

  12. HIV transmission in the adult film industry--Los Angeles, California, 2004.

    Science.gov (United States)

    2005-09-23

    In April 2004, the Los Angeles County Department of Health Services (LACDHS) received reports of work-related exposure to human immunodeficiency virus (HIV) in the heterosexual segment of the adult film industry in California. This report summarizes an investigation by LACDHS into four work-related HIV-transmission cases among adult film industry workers. The investigation was initiated April 20, 2004, and joined by the California Department of Industrial Relations, Division of Occupational Safety and Health (Cal/OSHA) on April 21, 2004, and by CDC on May 18, 2004. This investigation identified important and remediable gaps in the prevention of HIV and other sexually transmitted diseases (STDs) in the adult film industry. PMID:16177683

  13. Knowledge about transmission and prevention of HIV/AIDS among th e high risk groups (HRG population of Ahmedabad city.

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    Dr. Puwar Bhavna T

    2015-01-01

    Full Text Available Abstract Background HIV epidemic in India is concentrated in populations with high-risk behaviour. So if knowledge about HIV/AIDS transmission and prevention among these people is improved, then it may help in controlling the epidemic. Objectives 1 .To assess knowledge about HIV/AIDS transmission among different HRGs population. 2 . To assess knowledge about myths related to HIV/AIDS among different HRGs population. 3 . To assess knowledge about HIV/AIDS prevention among different HRGs population. Methodology A Cross sectional study was conducted amongst 3125 HRGs (high risk groups comprising of IDUs (Injectable Drug Users, Female Sex workers (FSWs, MSMs(Male having Sex with Males and Single Male Migrants(SMMs of Ahmedabad during April - July 2010. Results Mean age of the study population was 28.69± 8.2 yrs .About 85% HRGs knew about HIV and 76% about AIDS. Knowledge about HIV/AIDS transmission was highest for sexual route among HRGs and same was poor for all routes among MSMs. Regarding myths surrounding the disease, correct information was found among more than half for sharing clothes and bathroom and living/eating together and in 81% for hand shake and 34% for mosquito bite .About half of HRGs knew about all major modes of prevention. Conclusions Good knowledge about transmission and prevention of HIV/AIDS among HRGs is essential to change the high risk behaviour so in this context extensive work needs to be done among HRGs specially MSMs

  14. Linearity and Nonlinearity in HIV/STI Transmission: Implications for the Evaluation of Sexual Risk Reduction Interventions

    Science.gov (United States)

    Pinkerton, Steven D.; Chesson, Harrell W.; Crosby, Richard A.; Layde, Peter M.

    2011-01-01

    A mathematical model of HIV/sexually transmitted infections (STI) transmission was used to examine how linearity or nonlinearity in the relationship between the number of unprotected sex acts (or the number of sex partners) and the risk of acquiring HIV or a highly infectious STI (such as gonorrhea or chlamydia) affects the utility of sexual…

  15. Looking upstream to prevent HIV transmission: can interventions with sex workers alter the course of HIV epidemics in Africa as they did in Asia?

    NARCIS (Netherlands)

    Steen, R. van der; Hontelez, J.A.; Veraart, A.; White, R.G.; Vlas, S.J. de

    2014-01-01

    BACKGROUND: High rates of partner change in 'upstream' sex work networks have long been recognized to drive 'downstream' transmission of sexually transmitted infections (STIs). We used a stochastic microsimulation model (STDSIM) to explore such transmission dynamics in a generalized African HIV epid

  16. An Agent-Based Epidemic Simulation of Social Behaviors Affecting HIV Transmission among Taiwanese Homosexuals

    OpenAIRE

    Chung-Yuan Huang

    2015-01-01

    Computational simulations are currently used to identify epidemic dynamics, to test potential prevention and intervention strategies, and to study the effects of social behaviors on HIV transmission. The author describes an agent-based epidemic simulation model of a network of individuals who participate in high-risk sexual practices, using number of partners, condom usage, and relationship length to distinguish between high- and low-risk populations. Two new concepts—free links and fixed lin...

  17. Linking Syndemic Stress and Behavioral Indicators of Main Partner HIV Transmission Risk in Gay Male Couples.

    Science.gov (United States)

    Starks, Tyrel J; Tuck, Andrew N; Millar, Brett M; Parsons, Jeffrey T

    2016-02-01

    The purpose of the current study was to examine whether syndemic stress in partnered gay men might undermine communication processes essential to the utilization of negotiated safety and other harm reduction strategies that rely on partners' HIV status disclosure. Participants included 100 gay male couples (N = 200 individuals) living in the U.S., who responded to an online survey. Participants completed measures of five syndemic factors (depression, poly-drug use, childhood sexual abuse, intimate partner violence, and sexual compulsivity). They also reported on whether condoms were used during first intercourse together and the timing of first condomless anal intercourse (CAI) relative to HIV disclosure in their relationship. Results of binary logistic regression analyses supported the hypothesis that the sum of partners' syndemic stress was negatively associated with condom use at first intercourse and with HIV disclosure prior to first CAI. Syndemic stress may contribute to HIV transmission risk between main partners in part because it accelerates the progression to CAI and interferes with communication processes central to harm reduction strategies utilized by gay men in relationships. Implications for prevention strategies and couples interventions, such as couples HIV counseling and testing, that facilitate communication skill-building, are discussed.

  18. My intention was a child but I was very afraid: fertility intentions and HIV risk perceptions among HIV-serodiscordant couples experiencing pregnancy in Kenya.

    Science.gov (United States)

    Ngure, Kenneth; Baeten, Jared M; Mugo, Nelly; Curran, Kathryn; Vusha, Sophie; Heffron, Renee; Celum, Connie; Shell-Duncan, Bettina

    2014-01-01

    We sought to understand fertility intentions and HIV risk considerations among Kenyan HIV-serodiscordant couples who became pregnant during a prospective study. We conducted individual in-depth interviews (n = 36) and focus group discussions (n = 4) and performed qualitative data analysis and interpretation using an inductive approach. Although most of the couples were aware of the risk of horizontal and vertical HIV transmission, almost all couples reported that they had intended to become pregnant and that the desire for children superseded HIV risk considerations. Motivations for pregnancy were numerous and complex: satisfying desired family size, desire for biological children, maintaining stability of the union, and sociocultural pressures. Couples desired strategies to reduce HIV risk during conception, but expressed hesitation toward assisted reproductive technologies as unnatural. HIV prevention programs should therefore address conception desires and counsel about coordinated periconception risk-reduction strategies.

  19. The Road Less Travelled: Exploring Gay and Bisexual Men's Explanations of 'Uncommon' Routes of HIV Transmission.

    Science.gov (United States)

    Callander, Denton; Prestage, Garrett; Ellard, Jeanne; Triffitt, Kathy; Brown, Graham; Down, Ian

    2016-10-01

    Although there are practices other than condomless anal intercourse that may result in HIV transmission among gay and bisexual men, very little is known about these 'uncommon' transmission explanations. To address this topic, the free text survey responses from 465 HIV positive gay men in Australia were thematically analysed; 123 participants offered uncommon explanations for their seroconversion. Men described several sexual acts they believed led to infection, categorised as adventurous sex (e.g., fisting) and foreplay (e.g., oral sex). Participants also identified mediating factors associated with their seroconversion, either internal (e.g., cum/pre-cum) or external (e.g., sores, illness) to sex. Finally, contextual forces associated with infection were also explored, namely physical spaces (e.g., sex on premises venues) or mental states (e.g., depression). While some uncommon explanations are unlikely to have resulted in HIV transmission, these accounts reveal the diverse and intersecting ways that men attempt to make sense of their seroconversion.

  20. Visualization of HIV-1 interactions with penile and foreskin epithelia: clues for female-to-male HIV transmission.

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    Minh H Dinh

    2015-03-01

    Full Text Available To gain insight into female-to-male HIV sexual transmission and how male circumcision protects against this mode of transmission, we visualized HIV-1 interactions with foreskin and penile tissues in ex vivo tissue culture and in vivo rhesus macaque models utilizing epifluorescent microscopy. 12 foreskin and 14 cadaveric penile specimens were cultured with R5-tropic photoactivatable (PA-GFP HIV-1 for 4 or 24 hours. Tissue cryosections were immunofluorescently imaged for epithelial and immune cell markers. Images were analyzed for total virions, proportion of penetrators, depth of virion penetration, as well as immune cell counts and depths in the tissue. We visualized individual PA virions breaching penile epithelial surfaces in the explant and macaque model. Using kernel density estimated probabilities of localizing a virion or immune cell at certain tissue depths revealed that interactions between virions and cells were more likely to occur in the inner foreskin or glans penis (from local or cadaveric donors, respectively. Using statistical models to account for repeated measures and zero-inflated datasets, we found no difference in total virions visualized at 4 hours between inner and outer foreskins from local donors. At 24 hours, there were more virions in inner as compared to outer foreskin (0.0495 +/- 0.0154 and 0.0171 +/- 0.0038 virions/image, p = 0.001. In the cadaveric specimens, we observed more virions in inner foreskin (0.0507 +/- 0.0079 virions/image than glans tissue (0.0167 +/- 0.0033 virions/image, p<0.001, but a greater proportion was seen penetrating uncircumcised glans tissue (0.0458 +/- 0.0188 vs. 0.0151 +/- 0.0100 virions/image, p = 0.099 and to significantly greater mean depths (29.162 +/- 3.908 vs. 12.466 +/- 2.985 μm. Our in vivo macaque model confirmed that virions can breach penile squamous epithelia in a living model. In summary, these results suggest that the inner foreskin and glans epithelia may be important sites

  1. Transmission of HIV drug resistance in antiretroviral treatment-naive HIV-infected individuals%未治疗艾滋病患者中HIV耐药株的传播研究

    Institute of Scientific and Technical Information of China (English)

    李扬; 邢辉

    2016-01-01

    HIV病毒通过血液、性和母婴多种途径扩散传播,感染者数量持续增长,抗病毒药物的应用虽然大大抑制了病毒的复制,但药物使用过程中由于产生了耐药突变,使治疗效果降低。而且耐药株已传播至未接受抗病毒治疗的人群中,本文综述了近几年全球发现的耐药传播株在不同地域和高危人群中的分布和耐药株发生传播的影响因素。%Human immunodeficiency virus ( HIV) is commonly transmitted through blood transfu-sion, sexual contact and mother-to-child transmission. The number of patients with HIV infection has kept growing in the last three decades. Although the wide application of antiretroviral therapy ( ART) has effec-tively suppressed the replication of HIV, the emergence of drug resistant mutants compromises the efficacy of ART. What is worse is that there has been transmission of drug resistance strains in ART-naïve HIV-infected individuals. This review describes the distribution of transmitted drug resistance strains in different regions and high risk population as well as the factors associated with the transmission in recent years.

  2. Venue-Based Networks May Underpin HCV Transmissions amongst HIV-Infected Gay and Bisexual Men

    Science.gov (United States)

    Bradshaw, Daniel; Raghwani, Jayna; Jacka, Brendan; Sacks-Davis, Rachel; Lamoury, Francois; Down, Ian; Prestage, Garrett; Applegate, Tanya L.; Hellard, Margaret; Sasadeusz, Joe; Dore, Gregory J.; Pybus, Oliver G.; Matthews, Gail V.; Danta, Mark

    2016-01-01

    Background This study aimed to investigate the potential influence of venue-based networks on HCV transmission in HIV-positive gay and bisexual men (GBM). Methods This was a prospectively recruited cohort of HIV-infected GBM with recently-acquired HCV infection resident in Melbourne and Sydney. Clinical and demographic data were collected together with blood samples for HCV sequencing. Phylogenies were inferred and clusters of individuals infected with HCV with genetic sequence homology were identified. Venues used for sourcing sexual partners were identified; sourcing partners from the same venue was considered a potential social link. Using the Jaccard similarity coefficient, associations were identified between the network of sites where men sourced sex partners and transmission relationships as defined by phylogenetic clustering. Results Forty individuals were recruited, of whom 62.5% were considered to have sexually- and 37.5% IDU-acquired HCV. Venue use was consistent with men being members of a more sexually adventurous gay community subculture. Six phylogenetically-determined pairs or clusters were identified, comprising fifteen (15/28, 53.6%) individuals. Participants belonging to phylogenetic clusters were observed within the same networks. There was a significant correlation between the network and phylogenetic clustering when both cities were considered simultaneously (p = 0.005), raising the possibility that social connections may be important for HCV transmissions. Conclusions Venue-based network elicitation is a promising approach for elucidating HCV transmissions amongst HIV-infected GBM. Public health approaches targeting individuals and venues prominent within networks may reduce onward HCV transmission. PMID:27584149

  3. Consequences of Missed Opportunities for HIV Testing during Pregnancy and Delayed Diagnosis for Mexican Women, Children and Male Partners

    OpenAIRE

    Tamil Kendall

    2014-01-01

    INTRODUCTION: HIV testing during pregnancy permits prevention of vertical (mother-to-child) transmission and provides an opportunity for women living with HIV to access treatment for their own health. In 2001, Mexico's National HIV Action Plan committed to universal offer of HIV testing to pregnant women, but in 2011, only 45.6% of women who attended antenatal care (ANC) were tested for HIV. The study objective was to document the consequences of missed opportunities for HIV testing and couns...

  4. [Sexuality and risk for sexual transmission of HIV among serodiscordant couples in Ouagadougou, Burkina Faso].

    Science.gov (United States)

    Guira, O; Tiéno, H; Sawadogo, S; Drabo, J Y

    2013-02-01

    This article is a contribution to improve the management of serodiscordant couples in Ouagadougou. The aim of the study was to explore sexuality and the risk for sexual transmission of HIV among serodiscordant couples followed-up in CHU-YO. The study consisted of a descriptive cross-sectional study conducted over 6 months, from 1 January 2010 to 30 June 2010. A total of 80 heterosexual serodiscordant couples participated. Women were infected with HIV in most cases (75%). The mean age was 37.5 years for HIV partners and 40 years for seronegatives. Men were significantly older than women (p = 0.01). The couples weremarried (83.7%) or cohabiting (16.3%). The average of serodiscordance duration was 4 years. Seventy-four couples (92.5%) engaged in sexual intercourses, mostly vaginal intercourses. Both partners were satisfied only in 9 couples (12.2%). Although most couples (97.5%) knew the use of condoms for HIV prevention, 59.5% did not use it consistently, particularly when women were the seropositive partners (p = 0.01). The lack of privacy (37.5%) and desire of childbearing (26.25%) were the main reasons for not consistently using condoms among couples. Sexual dysfunction was a concern with 97.5% of the couples. The decrease in libido was most common (37.2%). Sexual intercourses with an outside partner were reported in 20 couples (25%), mostly regarding men (p = 0.03). Specific management could improve the quality of sexual life for couples in the light of the difficulties they face and reduce the risk for HIV transmission to negative partners.

  5. The HIV Modes of Transmission model: a systematic review of its findings and adherence to guidelines

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    Zara Shubber

    2014-06-01

    Full Text Available Introduction: The HIV Modes of Transmission (MOT model estimates the annual fraction of new HIV infections (FNI acquired by different risk groups. It was designed to guide country-specific HIV prevention policies. To determine if the MOT produced context-specific recommendations, we analyzed MOT results by region and epidemic type, and explored the factors (e.g. data used to estimate parameter inputs, adherence to guidelines influencing the differences. Methods: We systematically searched MEDLINE, EMBASE and UNAIDS reports, and contacted UNAIDS country directors for published MOT results from MOT inception (2003 to 25 September 2012. Results: We retrieved four journal articles and 20 UNAIDS reports covering 29 countries. In 13 countries, the largest FNI (range 26 to 63% was acquired by the low-risk group and increased with low-risk population size. The FNI among female sex workers (FSWs remained low (median 1.3%, range 0.04 to 14.4%, with little variability by region and epidemic type despite variability in sexual behaviour. In India and Thailand, where FSWs play an important role in transmission, the FNI among FSWs was 2 and 4%, respectively. In contrast, the FNI among men who have sex with men (MSM varied across regions (range 0.1 to 89% and increased with MSM population size. The FNI among people who inject drugs (PWID, range 0 to 82% was largest in early-phase epidemics with low overall HIV prevalence. Most MOT studies were conducted and reported as per guidelines but data quality remains an issue. Conclusions: Although countries are generally performing the MOT as per guidelines, there is little variation in the FNI (except among MSM and PWID by region and epidemic type. Homogeneity in MOT FNI for FSWs, clients and low-risk groups may limit the utility of MOT for guiding country-specific interventions in heterosexual HIV epidemics.

  6. Nevirapine resistance and breast-milk HIV transmission: effects of single and extended-dose nevirapine prophylaxis in subtype C HIV-infected infants.

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    Anitha Moorthy

    Full Text Available BACKGROUND: Daily nevirapine (NVP prophylaxis to HIV-exposed infants significantly reduces breast-milk HIV transmission. We assessed NVP-resistance in Indian infants enrolled in the "six-week extended-dose nevirapine" (SWEN trial who received single-dose NVP (SD-NVP or SWEN for prevention of breast-milk HIV transmission but who also acquired subtype C HIV infection during the first year of life. METHODS/FINDINGS: Standard population sequencing and cloning for viral subpopulations present at > or =5% frequency were used to determine HIV genotypes from 94% of the 79 infected Indian infants studied. Timing of infection was defined based on when an infant's blood sample first tested positive for HIV DNA. SWEN-exposed infants diagnosed with HIV by six weeks of age had a significantly higher prevalence of NVP-resistance than those who received SD-NVP, by both standard population sequencing (92% of 12 vs. 38% of 29; p = 0.002 and low frequency clonal analysis (92% of 12 vs. 59% of 29; p = 0.06. Likelihood of infection with NVP-resistant HIV through breast-milk among infants infected after age six weeks was substantial, but prevalence of NVP-resistance did not differ among SWEN or SD-NVP exposed infants by standard population sequencing (15% of 13 vs. 15% of 20; p = 1.00 and clonal analysis (31% of 13 vs. 40% of 20; p = 0.72. Types of NVP-resistance mutations and patterns of persistence at one year of age were similar between the two groups. NVP-resistance mutations did differ by timing of HIV infection; the Y181C variant was predominant among infants diagnosed in the first six weeks of life, compared to Y188C/H during late breast-milk transmission. CONCLUSIONS/SIGNIFICANCE: Use of SWEN to prevent breast-milk HIV transmission carries a high likelihood of resistance if infection occurs in the first six weeks of life. Moreover, there was a continued risk of transmission of NVP-resistant HIV through breastfeeding during the first year of life, but did not

  7. Effects of postnatal interventions for the reduction of vertical HIV transmission on infant growth and non-HIV infections: a systematic review

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    Moleen Zunza

    2013-12-01

    Full Text Available Introduction: Guidelines in resource-poor settings have progressively included interventions to reduce postnatal HIV transmission through breast milk. In addition to HIV-free survival, infant growth and non-HIV infections should be considered. Determining the effect of these interventions on infant growth and non-HIV infections will inform healthcare decisions about feeding HIV-exposed infants. We synthesize findings from studies comparing breast to formula feeding, early weaning to standard-duration breastfeeding, breastfeeding with extended antiretroviral (ARV to short-course ARV prophylaxis, and alternative preparations of infant formula to standard formula in HIV-exposed infants, focusing on infant growth and non-HIV infectious morbidity outcomes. The review objectives were to collate and appraise evidence of interventions to reduce postnatal vertical HIV transmission, and to estimate their effect on growth and non-HIV infections from birth to two years of age among HIV-exposed infants. Methods: We searched PubMed, SCOPUS, and Cochrane CENTRAL Controlled Trials Register. We included randomized trials and prospective cohort studies. Two authors independently extracted data and evaluated risk of bias. Rate ratios and mean differences were used as effect measures for dichotomous and continuous outcomes, respectively. Where pooling was possible, we used fixed-effects meta-analysis to pool results across studies. Quality of evidence was assessed using the GRADE approach. Results and discussion: Prospective cohort studies comparing breast- versus formula-fed HIV-exposed infants found breastfeeding to be protective against diarrhoea in early life [risk ratio (RR=0.31; 95% confidence interval (CI=0.13 to 0.74]. The effect of breastfeeding against diarrhoea [hazard ratio (HR=0.74; 95% CI=0.57 to 0.97] and respiratory infections (HR=0.65; 95% CI=0.41 to 1.00 was significant through two years of age. The only randomized controlled trial (RCT available

  8. Community-Based Management of Child Malnutrition in Zambia: HIV/AIDS Infection and Other Risk Factors on Child Survival.

    Science.gov (United States)

    Moramarco, Stefania; Amerio, Giulia; Ciarlantini, Clarice; Chipoma, Jean Kasengele; Simpungwe, Matilda Kakungu; Nielsen-Saines, Karin; Palombi, Leonardo; Buonomo, Ersilia

    2016-01-01

    (1) BACKGROUND: Supplementary feeding programs (SFPs) are effective in the community-based treatment of moderate acute malnutrition (MAM) and prevention of severe acute malnutrition (SAM); (2) METHODS: A retrospective study was conducted on a sample of 1266 Zambian malnourished children assisted from 2012 to 2014 in the Rainbow Project SFPs. Nutritional status was evaluated according to WHO/Unicef methodology. We performed univariate and multivariate Cox proportional risk regression to identify the main predictors of mortality. In addition, a time-to event analysis was performed to identify predictors of failure and time to cure events; (3) RESULTS: The analysis included 858 malnourished children (19 months ± 9.4; 49.9% males). Program outcomes met international standards with a better performance for MAM compared to SAM. Cox regression identified SAM (3.8; 2.1-6.8), HIV infection (3.1; 1.7-5.5), and WAZ death. Time to event showed 80% of children recovered by SAM/MAM at 24 weeks. (4) CONCLUSIONS: Preventing deterioration of malnutrition, coupled to early detection of HIV/AIDS with adequate antiretroviral treatment, and extending the duration of feeding supplementation, could be crucial elements for ensuring full recovery and improve child survival in malnourished Zambian children. PMID:27376317

  9. Community-Based Management of Child Malnutrition in Zambia: HIV/AIDS Infection and Other Risk Factors on Child Survival

    Science.gov (United States)

    Moramarco, Stefania; Amerio, Giulia; Ciarlantini, Clarice; Chipoma, Jean Kasengele; Simpungwe, Matilda Kakungu; Nielsen-Saines, Karin; Palombi, Leonardo; Buonomo, Ersilia

    2016-01-01

    (1) Background: Supplementary feeding programs (SFPs) are effective in the community-based treatment of moderate acute malnutrition (MAM) and prevention of severe acute malnutrition (SAM); (2) Methods: A retrospective study was conducted on a sample of 1266 Zambian malnourished children assisted from 2012 to 2014 in the Rainbow Project SFPs. Nutritional status was evaluated according to WHO/Unicef methodology. We performed univariate and multivariate Cox proportional risk regression to identify the main predictors of mortality. In addition, a time-to event analysis was performed to identify predictors of failure and time to cure events; (3) Results: The analysis included 858 malnourished children (19 months ± 9.4; 49.9% males). Program outcomes met international standards with a better performance for MAM compared to SAM. Cox regression identified SAM (3.8; 2.1–6.8), HIV infection (3.1; 1.7–5.5), and WAZ <−3 (3.1; 1.6–5.7) as predictors of death. Time to event showed 80% of children recovered by SAM/MAM at 24 weeks. (4) Conclusions: Preventing deterioration of malnutrition, coupled to early detection of HIV/AIDS with adequate antiretroviral treatment, and extending the duration of feeding supplementation, could be crucial elements for ensuring full recovery and improve child survival in malnourished Zambian children. PMID:27376317

  10. SUBSTANCE USE AND SEXUAL RISK BEHAVIOR AND FACTORS ASSOCIATED WITH HIV TRANSMISSION IN SOUTHERN ETHIOPIA

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    Likawunt Samuel and Mulugeta Tarekegn Angamo*

    2012-04-01

    Full Text Available Background: Evidences notify that most of higher learning students rush to range of maladaptive high-risk activities like, substance and sexual abuse which predispose to HIV. More often this is unrecognized and not well researched. Objective: To determine magnitude of substance use and risky sexual behavior for HIV transmission among students in Hosanna Health Science College from December 1, 2010 to December 30, 2010.Methods and Materials: Cross sectional study undertaken among statistically determined (n =428 and randomly selected Students from all departments and years of study in Hossana Health Science College. Piloted and self-administered questionnaire were used to collect data. Summary measures like mean, chi-square and regression were utilized to quantify magnitude and identify independently associated factors. Results: Majority 267 (63.1% of study participants were female, and 379 (89.5% in age group (17-24. From 423 participants, 330(78.0% were, sexually experienced. Khat (27.7% and Alcohol (21.7% were the commonly used substances and having multiple sexual partners (47.6%, inconsistent condom use (20.0% were common sexual risk behaviors for HIV transmission. Female [AOR=1.5], fresh students [OR=2.4] and alcohol users [OR=3.5] were more likely to engage in sexual risk practices. Conclusions: Substance use and risky sexual practices were significantly higher among study participants. Practicing sex with multiple partners, inconsistent condom use and commencing sex with female commercial sex workers, which were highly risky sexual behaviors for HIV infection transmission among study participants, were commonly practiced among study participants.

  11. Hepatitis B virus infection among HIV-infected pregnant women in Malawi and transmission to infants

    Science.gov (United States)

    Chasela, Charles S.; Kourtis, Athena P.; Wall, Patrick; Drobeniuc, Jan; King, Caroline C.; Thai, Hong; Teshale, Eyasu H.; Hosseinipour, Mina; Ellington, Sascha; Codd, Mary B.; Jamieson, Denise J.; Knight, Rod; Fitzpatrick, Patricia; Kamili, Saleem; Hoffman, Irving; Kayira, Dumbani; Mumba, Noel; Kamwendo, Deborah D.; Martinson, Francis; Powderly, William; Teo, Chong-Gee; van der Horst, Charles

    2015-01-01

    Background & Aims The extent of HBV infection to infants of HBV/HIV-coinfected pregnant women in sub-Saharan Africa is unknown. The aim of this study was to assess prevalence of HBV infection among antiretroviral-naïve, HIV-infected pregnant women in Malawi and examine HBV transmission to their infants. Methods Plasma from 2048 HIV-infected, Malawian women and their infants were tested for markers of HBV infection. Study participants were provided standard-of-care health services, which included administration of pentavalent vaccine to infants at 6, 10, and 14 weeks of age. Results One-hundred and three women (5%) were HBsAg-positive; 70 of these HBsAg-positive women were also HBV-DNA-positive. Sixteen women (0.8%) were HBV-DNA-positive but HBsAg-negative. Five of 51 infants (9.8%) born to HBsAg-positive and/or HBV-DNA-positive women were HBV-DNA-positive by 48 weeks of age. HBV DNA concentrations of two infants of mothers who received extended lamivudine-containing anti-HIV prophylaxis were <4 log10 IU/ml compared to ≥8 log10 IU/ml in three infants of mothers who did not. Conclusions HBV DNA was detected in nearly 10% of infants born to HBV/HIV-coinfected women. Antenatal testing for HIV and HBV, if instituted, can facilitate implementation of prophylactic measures against infant infection by both viruses. Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver. PMID:24211737

  12. Gay men's estimates of the likelihood of HIV transmission in sexual behaviours.

    Science.gov (United States)

    Gold, R S; Skinner, M J

    2001-04-01

    In 3 studies we recorded gay men's estimates of the likelihood that HIV would be transmitted in various sexual behaviours. In Study 1 (data collected 1993, n=92), the men were found to believe that transmissibility is very much greater than it actually is; that insertive unprotected anal intercourse (UAI) by an HIV-infected partner is made safer by withdrawal before ejaculation, and very much safer by withdrawal before either ejaculation or pre-ejaculation; that UAI is very much safer when an infected partner is receptive rather than insertive; that insertive oral sex by an infected partner is much less risky than even the safest variant of UAI; that HIV is less transmissible very early after infection than later on; and that risk accumulates over repeated acts of UAI less than it actually does. In Study 2 (data collected 1997/8, n=200), it was found that younger and older uninfected men generally gave similar estimates of transmissibility, but that infected men gave somewhat lower estimates than uninfected men; and that estimates were unaffected by asking the men to imagine that they themselves, rather than a hypothetical other gay man, were engaging in the behaviours. Comparison of the 1993 and 1997/8 results suggested that there had been some effect of an educational campaign warning of the dangers of withdrawal; however, there had been no effect either of a campaign warning of the dangers of receptive UAI by an infected partner, or of publicity given to the greater transmissibility of HIV shortly after infection. In Study 3 (data collected 1999, n=59), men induced into a positive mood were found to give lower estimates of transmissibility than either men induced into a neutral mood or men induced into a negative mood. It is argued that the results reveal the important contribution made to gay men's transmissibility estimates by cognitive strategies (such as the 'availability heuristic' and 'anchoring and adjustment') known to be general characteristics of human

  13. Hepatitis B virus infection among HIV-infected pregnant women in Malawi and transmission to infants

    Science.gov (United States)

    Chasela, Charles S.; Kourtis, Athena P.; Wall, Patrick; Drobeniuc, Jan; King, Caroline C.; Thai, Hong; Teshale, Eyasu H.; Hosseinipour, Mina; Ellington, Sascha; Codd, Mary B.; Jamieson, Denise J.; Knight, Rod; Fitzpatrick, Patricia; Kamili, Saleem; Hoffman, Irving; Kayira, Dumbani; Mumba, Noel; Kamwendo, Deborah D.; Martinson, Francis; Powderly, William; Teo, Chong-Gee; van der Horst, Charles

    2015-01-01

    Background & Aims The extent of HBV infection to infants of HBV/HIV-coinfected pregnant women in sub-Saharan Africa is unknown. The aim of this study was to assess prevalence of HBV infection among antiretroviral-naïve, HIV-infected pregnant women in Malawi and examine HBV transmission to their infants. Methods Plasma from 2048 HIV-infected, Malawian women and their infants were tested for markers of HBV infection. Study participants were provided standard-of-care health services, which included administration of pentavalent vaccine to infants at 6, 10, and 14 weeks of age. Results One-hundred and three women (5%) were HBsAg-positive; 70 of these HBsAg-positive women were also HBV-DNA-positive. Sixteen women (0.8%) were HBV-DNA-positive but HBsAg-negative. Five of 51 infants (9.8%) born to HBsAg-positive and/or HBV-DNA-positive women were HBV-DNA-positive by 48 weeks of age. HBV DNA concentrations of two infants of mothers who received extended lamivudine-containing anti-HIV prophylaxis were Elsevier B.V. on behalf of the European Association for the Study of the Liver. PMID:24211737

  14. The social construction of male 'homosexuality' in India: implications for HIV transmission and prevention.

    Science.gov (United States)

    Asthana, S; Oostvogels, R

    2001-03-01

    Over the past 20 years, there has been a growing recognition of the relativity of sexual norms and of the difficulties of exporting Western conceptions of sexuality to different socio-cultural settings. This view has been most clearly articulated in studies of men who have sex with men (MSM) which suggest that the ways in which male-male sexual activity is shaped and constituted vary significantly from place to place. Despite this, 'homosexuality' continues to be treated as an unproblematic category in HIV/AIDS discourse, epidemiological studies of and HIV prevention strategies for MSM in widely different contexts being based on the North American/West European example of gay men. This paper, which draws upon ethnographic research in Madras, highlights important differences between India and the West, not only in the sexual identities and circuits of MSM, but in their sexual partnerships and practices. These differences, it is argued, are not only significant to the epidemiology of HIV transmission, but have important implications for the development and implementation of HIV prevention strategies. PMID:11218175

  15. The genealogical population dynamics of HIV-1 in a large transmission chain: bridging within and among host evolutionary rates.

    Science.gov (United States)

    Vrancken, Bram; Rambaut, Andrew; Suchard, Marc A; Drummond, Alexei; Baele, Guy; Derdelinckx, Inge; Van Wijngaerden, Eric; Vandamme, Anne-Mieke; Van Laethem, Kristel; Lemey, Philippe

    2014-04-01

    Transmission lies at the interface of human immunodeficiency virus type 1 (HIV-1) evolution within and among hosts and separates distinct selective pressures that impose differences in both the mode of diversification and the tempo of evolution. In the absence of comprehensive direct comparative analyses of the evolutionary processes at different biological scales, our understanding of how fast within-host HIV-1 evolutionary rates translate to lower rates at the between host level remains incomplete. Here, we address this by analyzing pol and env data from a large HIV-1 subtype C transmission chain for which both the timing and the direction is known for most transmission events. To this purpose, we develop a new transmission model in a Bayesian genealogical inference framework and demonstrate how to constrain the viral evolutionary history to be compatible with the transmission history while simultaneously inferring the within-host evolutionary and population dynamics. We show that accommodating a transmission bottleneck affords the best fit our data, but the sparse within-host HIV-1 sampling prevents accurate quantification of the concomitant loss in genetic diversity. We draw inference under the transmission model to estimate HIV-1 evolutionary rates among epidemiologically-related patients and demonstrate that they lie in between fast intra-host rates and lower rates among epidemiologically unrelated individuals infected with HIV subtype C. Using a new molecular clock approach, we quantify and find support for a lower evolutionary rate along branches that accommodate a transmission event or branches that represent the entire backbone of transmitted lineages in our transmission history. Finally, we recover the rate differences at the different biological scales for both synonymous and non-synonymous substitution rates, which is only compatible with the 'store and retrieve' hypothesis positing that viruses stored early in latently infected cells preferentially

  16. The genealogical population dynamics of HIV-1 in a large transmission chain: bridging within and among host evolutionary rates.

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    Bram Vrancken

    2014-04-01

    Full Text Available Transmission lies at the interface of human immunodeficiency virus type 1 (HIV-1 evolution within and among hosts and separates distinct selective pressures that impose differences in both the mode of diversification and the tempo of evolution. In the absence of comprehensive direct comparative analyses of the evolutionary processes at different biological scales, our understanding of how fast within-host HIV-1 evolutionary rates translate to lower rates at the between host level remains incomplete. Here, we address this by analyzing pol and env data from a large HIV-1 subtype C transmission chain for which both the timing and the direction is known for most transmission events. To this purpose, we develop a new transmission model in a Bayesian genealogical inference framework and demonstrate how to constrain the viral evolutionary history to be compatible with the transmission history while simultaneously inferring the within-host evolutionary and population dynamics. We show that accommodating a transmission bottleneck affords the best fit our data, but the sparse within-host HIV-1 sampling prevents accurate quantification of the concomitant loss in genetic diversity. We draw inference under the transmission model to estimate HIV-1 evolutionary rates among epidemiologically-related patients and demonstrate that they lie in between fast intra-host rates and lower rates among epidemiologically unrelated individuals infected with HIV subtype C. Using a new molecular clock approach, we quantify and find support for a lower evolutionary rate along branches that accommodate a transmission event or branches that represent the entire backbone of transmitted lineages in our transmission history. Finally, we recover the rate differences at the different biological scales for both synonymous and non-synonymous substitution rates, which is only compatible with the 'store and retrieve' hypothesis positing that viruses stored early in latently infected

  17. The genealogical population dynamics of HIV-1 in a large transmission chain: bridging within and among host evolutionary rates.

    Science.gov (United States)

    Vrancken, Bram; Rambaut, Andrew; Suchard, Marc A; Drummond, Alexei; Baele, Guy; Derdelinckx, Inge; Van Wijngaerden, Eric; Vandamme, Anne-Mieke; Van Laethem, Kristel; Lemey, Philippe

    2014-04-01

    Transmission lies at the interface of human immunodeficiency virus type 1 (HIV-1) evolution within and among hosts and separates distinct selective pressures that impose differences in both the mode of diversification and the tempo of evolution. In the absence of comprehensive direct comparative analyses of the evolutionary processes at different biological scales, our understanding of how fast within-host HIV-1 evolutionary rates translate to lower rates at the between host level remains incomplete. Here, we address this by analyzing pol and env data from a large HIV-1 subtype C transmission chain for which both the timing and the direction is known for most transmission events. To this purpose, we develop a new transmission model in a Bayesian genealogical inference framework and demonstrate how to constrain the viral evolutionary history to be compatible with the transmission history while simultaneously inferring the within-host evolutionary and population dynamics. We show that accommodating a transmission bottleneck affords the best fit our data, but the sparse within-host HIV-1 sampling prevents accurate quantification of the concomitant loss in genetic diversity. We draw inference under the transmission model to estimate HIV-1 evolutionary rates among epidemiologically-related patients and demonstrate that they lie in between fast intra-host rates and lower rates among epidemiologically unrelated individuals infected with HIV subtype C. Using a new molecular clock approach, we quantify and find support for a lower evolutionary rate along branches that accommodate a transmission event or branches that represent the entire backbone of transmitted lineages in our transmission history. Finally, we recover the rate differences at the different biological scales for both synonymous and non-synonymous substitution rates, which is only compatible with the 'store and retrieve' hypothesis positing that viruses stored early in latently infected cells preferentially

  18. HIV-Related Sexual Behaviors among Migrants and Non-migrants in Rural Ethiopia: Role of Rural to Urban Migration in HIV Transmission

    OpenAIRE

    Tamiru, Melesse; Hailemariam, Damen; Mitike, Getnet; Haidar, Jemal

    2011-01-01

    Objective: To compare HIV-related sexual risk behavior among temporary rural to urban migrants and non-migrants and to explore the role of migration in HIV transmission in a rural area of Ethiopia. Methods: A cross-sectional comparative study was conducted in Bure Woreda, West Gojam, Amhara Region, Ethiopia. A total of 1,310 male subjects (655 rural to urban migrants and 655 non-migrants) were selected randomly and were assessed, analyzed using SPSS version 17 software for their HIV related s...

  19. Assessing the role of masculinity in the transmission of HIV: a systematic review to inform HIV risk reduction counseling interventions for men who have sex with men.

    Science.gov (United States)

    Zeglin, Robert J

    2015-10-01

    HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: (1) number of partners, (2) attitudes toward condoms, (3) drug use, (4) sexual positioning, (5) condom decision-making, (6) attitudes toward testing, and (7) treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a masculinity model of community HIV transmission. Opportunities for counseling interventions include identifying how masculinity informs a client's cognitions, emotions, and behaviors as well as adapting gender-transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence.

  20. Intergenerational transmission of social anxiety: the role of paternal and maternal fear of negative child evaluation and parenting behaviour

    NARCIS (Netherlands)

    W. de Vente; M. Majdandžić; C. Colonnesi; S.M. Bögels

    2011-01-01

    Parents' fear of negative child evaluation (FNCE) by others has been proposed as a mechanism explaining the intergenerational transmission of social anxiety. Parents' FNCE may result in child social anxiety through various learning processes, including those associated with parenting. To test these

  1. A transmission model for HIV with application to the Australian epidemic.

    Science.gov (United States)

    Becker, N G; Egerton, L R

    1994-02-01

    An age-specific transmission model is proposed to describe the spread of HIV in a homosexual population. The model incorporates developments in the treatment of patients and the change in the surveillance definition of AIDS. The model is applied to the Australian epidemic with the aim of determining the extent of behavioral changes during the epidemic and assessing the extent to which therapy has changed the course of the epidemic. It is found that therapy and the adoption of totally safe sex practices by individuals who have tested HIV positive cannot explain the recent downturn in the rate of increase of observed AIDS incidence. A significant change in behavior within the general homosexual community is indicated.

  2. Meta-analyses on behavioral interventions to reduce the risk of transmission of HIV.

    Science.gov (United States)

    Vergidis, Paschalis I; Falagas, Matthew E

    2009-06-01

    Different behavioral interventions have found to be efficacious in reducing high-risk sexual activity. Interventions have been evaluated in both original research and meta-analytic reviews. Most of the studies have shown that interventions are efficacious among different study populations. In adolescents, both in- and out-of-the classroom interventions showed a decrease in the risk of unprotected sex. In African Americans, greater efficacy was found for interventions including peer education. For Latinos, effect was larger in interventions with segmentation in the same gender. Geographic and social isolation are barriers in approaching MSM. For IDUs, interventions provided within a treatment program have an impact on risk reduction above that produced by drug treatment alone. Finally, people diagnosed with HIV tend to reduce their sexual risk behavior. However, adherence to safe sex practices for life can be challenging. Relentless efforts for implementation of behavioral interventions to decrease high-risk behavior are necessary to decrease HIV transmission. PMID:19393911

  3. Phylogenetic analysis consistent with a clinical history of sexual transmission of HIV-1 from a single donor reveals transmission of highly distinct variants

    Directory of Open Access Journals (Sweden)

    McClure Myra

    2011-07-01

    Full Text Available Abstract Background To combat the pandemic of human immunodeficiency virus 1 (HIV-1, a successful vaccine will need to cope with the variability of transmissible viruses. Human hosts infected with HIV-1 potentially harbour many viral variants but very little is known about viruses that are likely to be transmitted, or even if there are viral characteristics that predict enhanced transmission in vivo. We show for the first time that genetic divergence consistent with a single transmission event in vivo can represent several years of pre-transmission evolution. Results We describe a highly unusual case consistent with a single donor transmitting highly related but distinct HIV-1 variants to two individuals on the same evening. We confirm that the clustering of viral genetic sequences, present within each recipient, is consistent with the history of a single donor across the viral env, gag and pol genes by maximum likelihood and Bayesian Markov Chain Monte Carlo based phylogenetic analyses. Based on an uncorrelated, lognormal relaxed clock of env gene evolution calibrated with other datasets, the time since the most recent common ancestor is estimated as 2.86 years prior to transmission (95% confidence interval 1.28 to 4.54 years. Conclusion Our results show that an effective design for a preventative vaccine will need to anticipate extensive HIV-1 diversity within an individual donor as well as diversity at the population level.

  4. Transmission selects for HIV-1 strains of intermediate virulence: a modelling approach.

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    George Shirreff

    2011-10-01

    Full Text Available Recent data shows that HIV-1 is characterised by variation in viral virulence factors that is heritable between infections, which suggests that viral virulence can be naturally selected at the population level. A trade-off between transmissibility and duration of infection appears to favour viruses of intermediate virulence. We developed a mathematical model to simulate the dynamics of putative viral genotypes that differ in their virulence. As a proxy for virulence, we use set-point viral load (SPVL, which is the steady density of viral particles in blood during asymptomatic infection. Mutation, the dependency of survival and transmissibility on SPVL, and host effects were incorporated into the model. The model was fitted to data to estimate unknown parameters, and was found to fit existing data well. The maximum likelihood estimates of the parameters produced a model in which SPVL converged from any initial conditions to observed values within 100-150 years of first emergence of HIV-1. We estimated the 1 host effect and 2 the extent to which the viral virulence genotype mutates from one infection to the next, and found a trade-off between these two parameters in explaining the variation in SPVL. The model confirms that evolution of virulence towards intermediate levels is sufficiently rapid for it to have happened in the early stages of the HIV epidemic, and confirms that existing viral loads are nearly optimal given the assumed constraints on evolution. The model provides a useful framework under which to examine the future evolution of HIV-1 virulence.

  5. Scale up use of family planning services to prevent maternal transmission of HIV among discordant couples: a cross-sectional study within a resource-limited setting

    Science.gov (United States)

    Kuete, Martin; Yuan, HongFang; Tchoua Kemayou, Aude Laure; Songo, Emmanuel Ancel; Yang, Fan; Ma, XiuLan; Xiong, ChengLiang; Zhang, HuiPing

    2016-01-01

    Background Integration of family planning services (FPS) into human immunodeficiency virus (HIV) care for HIV-infected women is an important aspect of the global prevention of mother-to-child transmission (PMTCT) strategy. We assessed the integration of FPS into routine care of HIV-infected mothers by evaluating the uptake and barriers of contraception and PMTCT services. Methods We conducted an interventional study using the interrupted time series approach in the health care facilities located in Yaounde, Cameroon. First, structured questionnaires related to family planning use, PMTCT services use, and infection risk of the sexual partner were administered to the first trimester pregnant women who were HIV infected and living with uninfected partners. Second, 2 weeks before the delivery date, the women were interviewed according to the prior counseling interventions received, in order to assess their behavior on FPS, antiretroviral therapy (ART) use, delivery option, and infant nourishment to be adopted. P-values below 0.05 were considered statistically significant in the statistical analyses. Results Of 94 HIV-infected women, 69% were stable couples. Only 13% of women had attended FPS before conception. Although the vast majority were knowledgeable about modern and traditional contraception methods, only 19% had experienced effective contraceptive methods. However, 66% preferred condom use, 45% having three children still expressed a desire to conceive, while 44% reported abortions, 65% had tried to avoid the current pregnancy, and 12% of women were ART naïve. Several predictors such as education, abortion rate, unplanned pregnancies, and partners’ decision were associated with the nonuse of effective contraceptive methods. Moreover, barriers including sex inequity, lack of partner support, ART shortages, and lack of HIV viral load monitoring were prevalent among the participants (P=0.001). However FPS use, ART compliance, and safe options to PMTCT

  6. International consultation on the criminalization of HIV transmission: 31 October-2 November 2007, Geneva, Switzerland. Joint United Nations Programme on HIV/AIDS (UNAIDS) Geneva, United Nations Development Programme (UNDP), New York, 2007.

    Science.gov (United States)

    2009-11-01

    Since the beginning of the HIV epidemic, some jurisdictions have applied criminal law to the transmission of HIV. In 2002, UNAIDS issued a policy options paper on this issue. In light of renewed calls for the application of criminal law to HIV transmission and concerns raised in this regard by the UNAIDS Reference Group on HIV and Humans Rights and others, UNDP and the UNAIDS Secretariat decided to bring together a number of legal experts and other concerned stakeholders to discuss this issue in the context of an effective human rights and public health response to HIV. The discussion would inform a UNAIDS/UNDP policy brief on this subject. It was clarified that the consultation would focus primarily on HIV transmission through sexual contact, although it was noted that concerns exist in relation to applying criminal law to HIV transmission in other contexts. This Bookshelf article consists of excerpts from the report of the meeting.

  7. Efficacy of WHO recommendation for continued breastfeeding and maternal cART for prevention of perinatal and postnatal HIV transmission in Zambia

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    Mary S Ngoma

    2015-07-01

    Full Text Available Introduction: To prevent mother-to-child transmission (MTCT of HIV in developing countries, new World Health Organization (WHO guidelines recommend maternal combination antiretroviral therapy (cART during pregnancy, throughout breastfeeding for 1 year and then cessation of breastfeeding (COB. The efficacy of this approach during the first six months of exclusive breastfeeding has been demonstrated, but the efficacy of this approach beyond six months is not well documented. Methods: A prospective observational cohort study of 279 HIV-positive mothers was started on zidovudine/3TC and lopinavir/ritonavir tablets between 14 and 30 weeks gestation and continued indefinitely thereafter. Women were encouraged to exclusively breastfeed for six months, complementary feed for the next six months and then cease breastfeeding between 12 and 13 months. Infants were followed for transmission to 18 months and for survival to 24 months. Text message reminders and stipends for food and transport were utilized to encourage adherence and follow-up. Results: Total MTCT was 9 of 219 live born infants (4.1%; confidence interval (CI 2.2–7.6%. All breastfeeding transmissions that could be timed (5/5 occurred after six months of age. All mothers who transmitted after six months had a six-month plasma viral load >1,000 copies/ml (p<0.001. Poor adherence to cART as noted by missed dispensary visits was associated with transmission (p=0.04. Infant mortality was lower after six months of age than during the first six months of life (p=0.02. The cumulative rate of infant HIV infection or death at 18 months was 29/226 (12.8% 95 CI: 7.5–20.8%. Conclusions: Maternal cART may limit MTCT of HIV to the UNAIDS target of <5% for eradication of paediatric HIV within the context of a clinical study, but poor adherence to cART and follow-up can limit the benefit. Continued breastfeeding can prevent the rise in infant mortality after six months seen in previous studies, which

  8. Potential cost-effectiveness of schistosomiasis treatment for reducing HIV transmission in Africa--the case of Zimbabwean women.

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    Martial L Ndeffo Mbah

    Full Text Available BACKGROUND: Epidemiological data from Zimbabwe suggests that genital infection with Schistosoma haematobium may increase the risk of HIV infection in young women. Therefore, the treatment of Schistosoma haematobium with praziquantel could be a potential strategy for reducing HIV infection. Here we assess the potential cost-effectiveness of praziquantel as a novel intervention strategy against HIV infection. METHODS: We developed a mathematical model of female genital schistosomiasis (FGS and HIV infections in Zimbabwe that we fitted to cross-sectional data of FGS and HIV prevalence of 1999. We validated our epidemic projections using antenatal clinic data on HIV prevalence. We simulated annual praziquantel administration to school-age children. We then used these model predictions to perform a cost-effectiveness analysis of annual administration of praziquantel as a potential measure to reduce the burden of HIV in sub-Saharan Africa. FINDINGS: We showed that for a variation of efficacy between 30-70% of mass praziquantel administration for reducing the enhanced risk of HIV transmission per sexual act due to FGS, annual administration of praziquantel to school-age children in Zimbabwe could result in net savings of US$16-101 million compared with no mass treatment of schistosomiasis over a ten-year period. For a variation in efficacy between 30-70% of mass praziquantel administration for reducing the acquisition of FGS, annual administration of praziquantel to school-age children could result in net savings of US$36-92 million over a ten-year period. CONCLUSIONS: In addition to reducing schistosomiasis burden, mass praziquantel administration may be a highly cost-effective way of reducing HIV infections in sub-Saharan Africa. Program costs per case of HIV averted are similar to, and under some conditions much better than, other interventions that are currently implemented in Africa to reduce HIV transmission. As a cost-saving strategy, mass

  9. In Vivo HIV-1 Cell-to-Cell Transmission Promotes Multicopy Micro-compartmentalized Infection

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    Kenneth M. Law

    2016-06-01

    Full Text Available HIV-1 infection is enhanced by adhesive structures that form between infected and uninfected T cells called virological synapses (VSs. This mode of transmission results in the frequent co-transmission of multiple copies of HIV-1 across the VS, which can reduce sensitivity to antiretroviral drugs. Studying HIV-1 infection of humanized mice, we measured the frequency of co-transmission and the spatiotemporal organization of infected cells as indicators of cell-to-cell transmission in vivo. When inoculating mice with cells co-infected with two viral genotypes, we observed high levels of co-transmission to target cells. Additionally, micro-anatomical clustering of viral genotypes within lymphoid tissue indicates that viral spread is driven by local processes and not a diffuse viral cloud. Intravital splenic imaging reveals that anchored HIV-infected cells induce arrest of interacting, uninfected CD4+ T cells to form Env-dependent cell-cell conjugates. These findings suggest that HIV-1 spread between immune cells can be anatomically localized into infectious clusters.

  10. Assessment of topical microbicides to prevent HIV-1 transmission: concepts, testing, lessons learned.

    Science.gov (United States)

    Friend, David R; Kiser, Patrick F

    2013-09-01

    The development of topically applied products capable of preventing vaginal and rectal transmission of HIV-1 has been on-going for nearly 20 years. Despite this, only one clinical trial has demonstrated protection against sexual transmission of HIV-1 in women. This review covers the development of microbicides, also referred to as topical pre-exposure prophylaxis (PrEP), through three stages. The first stage focused on nonspecific agents, including surfactants such as nonoxynol-9 (N-9), to prevent HIV-1 transmission. Unfortunately, N-9 enhanced susceptibility to sexual transmission of HIV-1 when evaluated for efficacy. Soon thereafter, other nonspecific agents (polyanions) were quickly moved into large efficacy trials. Due to a lack of coordination among investigators and funders, a large investment was made in a class of compounds shown ultimately to be ineffective, although poor adherence may have contributed to these findings. The second stage involved the assessment of the antiretroviral drug tenofovir, formulated as a vaginal gel, which was found to be modestly effective in a Phase IIb trial (CAPRISA-004) when dosed in a coitally-dependent manner. In another Phase IIb trial, VOICE (MTN-003), tenofovir gel was found to be ineffective when dosed once-daily in a coitally-independent manner. Based on pharmacokinetic data, it was concluded the participants were poorly adherent to this dosing regimen, leading to a lack of efficacy. Tenofovir gel is currently in a Phase III safety and efficacy trial in South Africa (FACTS-001), using the coitally-dependent dosing regimen employed in CAPRISA-004. We are now in the third stage of microbicide research. The antiretroviral drug dapivirine is currently in two Phase III safety and efficacy studies formulated as a vaginal ring. It is hoped that the once-monthly dosing regimen will lead to higher adherence than found in the VOICE study. It is now clear that product adherence could be the greatest challenge to demonstrating

  11. From parent to child? Transmission of educational attainment within immigrant families: methodological considerations.

    Science.gov (United States)

    Luthra, Renee Reichl; Soehl, Thomas

    2015-04-01

    One in five U.S. residents under the age of 18 has at least one foreign-born parent. Given the large proportion of immigrants with very low levels of schooling, the strength of the intergenerational transmission of education between immigrant parent and child has important repercussions for the future of social stratification in the United States. We find that the educational transmission process between parent and child is much weaker in immigrant families than in native families and, among immigrants, differs significantly across national origins. We demonstrate how this variation causes a substantial overestimation of the importance of parental education in immigrant families in studies that use aggregate data. We also show that the common practice of "controlling" for family human capital using parental years of schooling is problematic when comparing families from different origin countries and especially when comparing native and immigrant families. We link these findings to analytical and empirical distinctions between group- and individual-level processes in intergenerational transmission.

  12. Prospective study on the prevention of vertical transmission of HIV in Campo Grande, Mato Grosso do Sul, Brazil, from 1996 to 2001

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    Márcia Maria Ferrairo Janini Dal Fabbro

    2005-02-01

    Full Text Available This prospective study, involving 76 pregnant women infected with HIV, paired with their 79 exposed infants, was carried out between May 1996 and October 2001, at the Reference Department for Pregnant Women Infected with HIV in Campo Grande, Mato Grosso do Sul. The mean age of the pregnant women was 24 years; 88% (67/76 apparently were infected due to sexual practices; 88% (67/76 were housewives; 823% (63/76 graduated from junior high school; 14.5% (11/76 reported co-infection with Hepatitis C, 9.2% with Syphilis; 51% (39/76 learned the diagnosis during prenatal care; 67% (51/76 reported HIV clinical symptomatology and 9.2% (7/76 reported opportunistic infections. Elective cesareans were performed in 57% (43/76. The mean gestational age at delivery was 38 weeks and we found 12.5% (10/80 pronatis; 97% (74/76 had a ruptured membrane time after less than four hours and one child (1.3% was nursed. ACTG 076 Protocol (AIDS Clinical Trial Group 076 was used in 80% (61/76 of the pregnant women, with 100% adherence; 62% (38/61 used zidovudine plus another antiretroviral in the gestation; 92% (73/79 of the infants used zidovudine after the birth and 19% (14/73 used zidovudine and lamivudine. The transmission rate in this study was 2.5%.

  13. A dual chamber model of female cervical mucosa for the study of HIV transmission and for the evaluation of candidate HIV microbicides.

    Science.gov (United States)

    Van Herrewege, Yven; Michiels, Jo; Waeytens, Anouk; De Boeck, Gitte; Salden, Evelyne; Heyndrickx, Leo; van den Mooter, Guy; de Béthune, Marie-Pierre; Andries, Koen; Lewi, Paul; Praet, Marleen; Vanham, Guido

    2007-05-01

    A dual chamber system was established to model heterosexual HIV transmission. Cell-associated, but not cell-free HIV, added to a confluent layer of cervical epithelial cells in the apical chamber, reproducibly infected monocyte-derived dendritic cells (MO-DC) and CD4(+) T cells in the basal compartment. Only minimal epithelial transmigration of HIV-infected mononuclear cells (HIV-PBMCs) was observed. Most evidence points to transepithelial migration of virus, released from HIV-PBMCs after their activation by epithelial cells. We used this model for evaluation of the therapeutic index of various potentially preventive antiviral compounds, including non-nucleoside reverse transcriptase inhibitors (NNRTIs, including UC781 and various diaryltriazines and diarylpyrimidines), poly-anionic entry inhibitors (including PRO2000, cellulose sulphate, dextrane sulphate 5000 and polystyrene sulphonate) and the fusion inhibitor T-20. The epithelium was pre-treated with compound and incubated with HIV-PBMCs for 24 h. Afterwards the apical chamber was removed and MO-DC/CD4(+) T cell co-cultures were further cultured without compound. NNRTIs, including a TMC120 gel, blocked infection of the sub-epithelial targets at sub-micromolar concentrations. Polyanionic entry inhibitors (up to 100 microg/ml) and T-20 (up to 449 microg/ml) failed to inhibit transmission. Moreover, whereas the NNRTIs used interfered with epithelial integrity with cervical epithelium only at very high concentrations, the evaluated entry inhibitors showed toxicity at concentrations that did not prevent infection. PMID:17097156

  14. Potential pathways to HIV/AIDS transmission in the Niger Delta of Nigeria: Poverty, migration and commercial sex

    OpenAIRE

    Udoh, IA; Mantell, JE; Sandfort, T; Eighmy, MA

    2009-01-01

    HIV prevalence in the Niger Delta of Nigeria is generally attributed to concurrent sexual partnerships and weak public sector health care and education systems. This paper examines the likelihood of additional factors, such as the intersection of widespread poverty, migration, and sex work, as contributory channels of HIV transmission in the region. To explore this issue, we conducted a Delphi survey with 27 experts to formulate consensus about the impact of poverty, migration, and commercial...

  15. Does effective depression treatment alone reduce secondary HIV transmission risk? Equivocal findings from a randomized controlled trial

    OpenAIRE

    Tsai, AC; Mimiaga, MJ; Dilley, JW; Hammer, GP; Karasic, DH; Charlebois, ED; Sorensen, JL; Safren, SA; Bangsberg, DR

    2013-01-01

    Depressed mood has been associated with HIV transmission risk behavior. To determine whether effective depression treatment could reduce the frequency of sexual risk behavior, we analyzed secondary outcome data from a 36-week, two-arm, parallel-design, randomized controlled trial, in which homeless and marginally housed, HIV-infected persons with comorbid depressive disorders were randomized to receive either: (a) directly observed treatment with the antidepressant medication fluoxetine, or (...

  16. Migrancy, masculine identities and AIDS: the psychosocial context of HIV transmission on the South African gold mines.

    Science.gov (United States)

    Campbell, C

    1997-07-01

    Levels of HIV infection are particularly high amongst migrant workers in sub-Saharan Africa. This paper presents a case study of one such vulnerable group of migrants-underground workers on the South African gold mines-and highlights the psychosocial context of HIV transmission in the mining setting. On the assumption that social identities serve as an important influence on peoples' sexual behaviour, the study examines the way in which miners construct their social identities within the parameters of their particular living and working conditions. It also identifies some of the key narratives used by miners to make sense of their experience in the realms of health, ill-health, HIV and sexuality. Masculinity emerged as a leading narrative in informants' accounts of their working life, health and sexuality, and the paper examines the way in which the construction of masculine identities renders miners particularly vulnerable to HIV. The implications of these findings for HIV educational interventions are discussed.

  17. Transmissão vertical do HIV em população atendida no serviço de referência Vertical transmission of HIV in the population treated at a reference center

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    Sueli Teresinha Cruz Rodrigues

    2013-01-01

    Full Text Available OBJETIVO: Identificar a taxa de transmissão vertical do HIV e avaliar os fatores envolvidos em partes materna e fetal. MÉTODOS: Estudo transversal realizado no Serviço de Atendimento Especializado. Foram investigados 102 prontuários de mulheres com HIV que deram à luz a recém-nascidos vivos. RESULTADOS: A prevalência de 6,6% de transmissão vertical. Entre as crianças infectadas: 40,0% de mães sem pré-natal e 75% sem a profilaxia com anti-retrovirais durante o pré-natal, 50,0% sem profilaxia com AZT com oral e amamentado. Entre as crianças não infectadas: 91,5% iniciaram a profilaxia com AZT oral ao nascimento e 84,1% das mães receberam ARV. CONCLUSÃO: A ocorrência de transmissão vertical do HIV no serviço de referência correspondeu a 6,6%, o que indica uma alta prevalência.OBJECTIVE: To identify the rate of vertical transmission of HIV and assess the factors involved in maternal and fetal share. METHODS: Cross-sectional study conducted in the Specialized Care Service. We investigated 102 clinical records of HIV positive women who had given birth to live newborns. The primary variable was the occurrence of vertical transmission of HIV and the secondary variables were the factors associated with vertical transmission of HIV. RESULTS: Prevalence of 6.6% of vertical transmission. Among the infected children: 40.0% of mothers with out prenatal care and 75% without prophylaxis with antiretroviral drugs during the prenatal, 50.0% without AZT prophylaxis with oral and breast-fed. Among the uninfected children: 91.5% were started on prophylaxis with oral AZT at birth and 84.1% of mothers received ARV delivery. CONCLUSION: The occurrence of vertical transmission of HIV in the reference service corresponded to 6.6%, indicating a high prevalence.

  18. Socio-cultural influences on the transmission of HIV among gay men in rural China.

    Science.gov (United States)

    Koo, Fung Kuen; Chow, Eric P F; Gao, Liangmin; Fu, Xiaoxing; Jing, Jun; Chen, Liang; Zhang, Lei

    2014-02-21

    Bisexual behaviours are relatively common among men who have sex with men in China. This pilot study aims to reveal the complex processes through which such men manage their sexuality, family responsibilities and sexual behaviours in a rural Chinese setting. A total of 15 men who have sex with men were recruited by purposive sampling. Face-to-face in-depth interviews were conducted to explore participants' views about their sexual experiences and practices. The Chinese traditional moral code, family values and gender roles that form the crucial components of Confucianism were reflected in the participants' efforts to maintain familial and social harmony through a compromised form of sexual partnership. Most study participants demonstrated a mixed experience of social stigma, sexual naiveté and ignorance of HIV and sexually transmitted infections (STIs). Under cultural and family pressure, men who have sex with men entered heterosexual marriages with the intention of maintaining a balance between their collectivist (familial) obligations and their individualistic (same-sex sexual) desires. However, the opaque nature of their concurrent sexual relationships may endanger their personal health and accelerate HIV and STI transmission. Reducing the stigma and social prejudice associated with male same-sex sexual relations is essential for any culturally sensitive HIV-prevention programme to succeed in rural China. PMID:24555479

  19. Predictors of sexual transmission risk behaviors among HIV-positive young men.

    Science.gov (United States)

    Stein, J A; Rotheram-Borus, M-J; Swendeman, D; Milburn, N G

    2005-05-01

    Reduction in the incidence of high-risk sexual behaviors among HIV-positive men is a priority. We examined the roles of proximal substance use and delinquency-related variables, and more distal demographic and psychosocial variables as predictors of serious high-risk sexual behaviors among 248 HIV-positive young males, aged 15-24 years. In a mediated latent variable model, demographics (ethnicity, sexual orientation and poverty) and background psychosocial factors (coping style, peer norms, emotional distress, self-esteem and social support) predicted recent problem behaviors (delinquency, common drug use and hard drug use), which in turn predicted recent high-risk sexual behaviors. Hard drug use and delinquency were found to predict sexual risk behaviors directly, as did lower self-esteem, white ethnicity and being gay/bisexual. Negative peer norms strongly influenced delinquency and substance use and positive coping predicted less delinquency. In turn, less positive coping and negative peer norms exerted indirect effects on sexual transmission risk behavior through delinquency and hard drug use. Results suggest targeting hard drug use, delinquency, maladaptive peer norms, dysfunctional styles of escaping stress and self-esteem in the design of intervention programs for HIV-positive individuals. PMID:16036228

  20. HIV-1 genomic RNA diversification following sexual and parenteral virus transmission.

    Science.gov (United States)

    Wolfs, T F; Zwart, G; Bakker, M; Goudsmit, J

    1992-07-01

    Human immunodeficiency virus type 1 (HIV-1) genomic RNA variation was studied in seven presumed donor-recipient pairs directly following sexual (6/7) or parenteral (1/7) transmission. The first RNA-positive serum sample of each recipient and the serum sample of the virus transmitter, identified by epidemiological history and taken within a time bracket of three months of the recipient seroconversion, were analyzed by polymerase chain reaction amplification followed by sequencing of eight cDNA clones of 276 bp, including the V3 coding region. The sequence populations of the recipients were without exception homogeneous, while the sequence populations of the transmitters showed varying degrees of heterogeneity. Nucleotide distance between consensus sequences of unrelated individuals from the Amsterdam population (interpatient variation) averaged 11% (range 7-15%). The largest distance between two clonal sequences of one individual (intrapatient variation) was also 11%. Consensus sequences of five recipients differed by only 0-1% from the consensus sequence of the presumed transmitter, including two pairs of which the transmission was either proven or highly probable. This contrasted with a difference of 10-12% in two pairs, casting doubt on the epidemiological relatedness. Antibody reactivity to a panel of V3 peptides with varying degrees of similarity to the V3 sequences obtained did not augment the discriminatory power of sequence analysis. Results of the sequential sequencing of samples of one transmitter suggest that this was due to an anamnestic antibody response of the transmitter to early variants. From the loss of sequence heterogeneity following transmission and the consensus sequence similarities observed within five transmitter-recipient pairs, we conclude that HIV-1 transmission results in the selection of a limited number of genomes carrying on the infection in the new host, but does not generally lead to a shift in the sequence population as defined by

  1. Reductions in Transmission Risk Behaviors in HIV-Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project

    Science.gov (United States)

    Gasiorowicz, Mari; Llanas, Michelle R.; DiFranceisco, Wayne; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Hoxie, Neil J.; Reiser, William J.; Vergeront, James M.

    2005-01-01

    Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV…

  2. Compassionate Love as a Predictor of Reduced HIV Disease Progression and Transmission Risk

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    Heidemarie Kremer

    2013-01-01

    Full Text Available Objectives. This study examined if compassionate love (CL predicts HIV disease progression and transmission risk. Scientific study of CL emerged with Underwood’s working model of other-centered CL, defining five criteria: free choice, cognitive understanding, valuing/empowering, openness/receptivity for spirituality, and response of the heart. Method. This 10-year cohort study collected 6-monthly interviews/essays on coping with HIV and trauma of 177 people with HIV in South Florida. Secondary qualitative content analysis on other-centered CL inductively added the component of CL towards self. Deductively, we coded the presence of the five criteria of CL and rated the benefit of CL for the recipient on a 6-point Likert scale. Growth-curve modeling (reduced to 4 years due to cohort effects investigated if CL predicts CD4 slope (HIV disease progression and cumulative viral load detection (transmission risk. Results. Valuing/empowering and cognitive understanding were the essential criteria for CL to confer long-term benefits. CL had a higher benefit for recipients if given out of free choice. High scores of CL towards self were reciprocal with receiving (93% and giving (77% other-centered CL. Conversely, those rated low on CL towards self were least likely to score high on receiving (38% and giving (49% other-centered CL. Growth-curve modeling showed that CL towards self predicted 4-year cumulative undetectable viral load (independent from sociocultural differences, substance use disorder, baseline CD4 and viral load. Those high versus low on CL self were 2.25 times more likely to have undetectable viral load at baseline and 1.49 times more likely to maintain undetectable viral load over time. CL towards self predicted CD4 preservation after controlling for differences in CL giving. Conclusions. CL towards self is potentially the seed of being expressive and receptive of CL. Health care professionals prepared to walk the extra mile for those who

  3. HIV-1 tat promotes integrin-mediated HIV transmission to dendritic cells by binding Env spikes and competes neutralization by anti-HIV antibodies.

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    Paolo Monini

    Full Text Available Use of Env in HIV vaccine development has been disappointing. Here we show that, in the presence of a biologically active Tat subunit vaccine, a trimeric Env protein prevents in monkeys virus spread from the portal of entry to regional lymph nodes. This appears to be due to specific interactions between Tat and Env spikes that form a novel virus entry complex favoring R5 or X4 virus entry and productive infection of dendritic cells (DCs via an integrin-mediated pathway. These Tat effects do not require Tat-transactivation activity and are blocked by anti-integrin antibodies (Abs. Productive DC infection promoted by Tat is associated with a highly efficient virus transmission to T cells. In the Tat/Env complex the cysteine-rich region of Tat engages the Env V3 loop, whereas the Tat RGD sequence remains free and directs the virus to integrins present on DCs. V2 loop deletion, which unshields the CCR5 binding region of Env, increases Tat/Env complex stability. Of note, binding of Tat to Env abolishes neutralization of Env entry or infection of DCs by anti-HIV sera lacking anti-Tat Abs, which are seldom present in natural infection. This is reversed, and neutralization further enhanced, by HIV sera containing anti-Tat Abs such as those from asymptomatic or Tat-vaccinated patients, or by sera from the Tat/Env vaccinated monkeys. Thus, both anti-Tat and anti-Env Abs are required for efficient HIV neutralization. These data suggest that the Tat/Env interaction increases HIV acquisition and spreading, as a mechanism evolved by the virus to escape anti-Env neutralizing Abs. This may explain the low effectiveness of Env-based vaccines, which are also unlikely to elicit Abs against new Env epitopes exposed by the Tat/Env interaction. As Tat also binds Envs from different clades, new vaccine strategies should exploit the Tat/Env interaction for both preventative and therapeutic interventions.

  4. The Prevalence of Different Human Immunodeficiency Virus Transmission Routes and Knowledge about AIDS in Infected People with HIV in Sirjan

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    Mahin Behzadpour

    2012-06-01

    Full Text Available Background & Objective: The immune system of Patients with Acquired Immune Deficiency Syndrome (AIDS is weekend because of Human immunodeficiency virus (HIV infection, and they become vulnerable to several opportunistic and non-opportunistic pathogens and different carcinomas. IV drug abuse, sexual contact, occupational transmission, blood transfusion and maternal-fetal transmission are well known transmission routes for HIV infection. This study was under taken to investigate the prevalence of HIV transmission routs in the HIV infected population of Sirjan, and their knowledge about the disease, in order to plan better preventive strategies. Materials & Methods: A cross sectional study was planned. During a 6-month period in 2010, all of the HIV infected people in Sirjan (old and new cases who had a file at the consultation center for high risk behavior, completed a valid and reliable questionnaire. Results: The definite route of transmission was not clear in any of the patients because they had more than one suspicious route. Injected drug abusers were the most common (88.4% followed by those who got tattoos (79.1%, invasive therapeutic procedures, dentistry, surgery and endoscopy (56.1%, high risk sexual behavior (62.8%, bloodletting (9.3%, injuries in the barbershop (9.3% and blood transfusion (2.3%. Conclusion: All of the HIV infected cases in Sirjan were involved with several high risk behaviors, but the major route of transmission, similar to other parts of the country was injected drug abuse. Educational programs for prevention of AIDS should be followed seriously and special attention should be paid to groups with multiple high risk behaviors.

  5. Transmission dynamics of HIV-1 subtype B in the Basque Country, Spain.

    Science.gov (United States)

    Patiño-Galindo, J A; Thomson, Michael M; Pérez-Álvarez, Lucía; Delgado, Elena; Cuevas, María Teresa; Fernández-García, Aurora; Nájera, Rafael; Iribarren, José A; Cilla, Gustavo; López-Soria, Leyre; Lezaun, María J; Cisterna, Ramón; González-Candelas, F

    2016-06-01

    This work was aimed to study the HIV-1 subtype B epidemics in the Basque Country, Spain. 1727 HIV-1 subtype B sequences comprising protease and reverse transcriptase (PR/RT) coding regions, sampled between 2001 and 2008, were analyzed. 156 transmission clusters were detected by means of phylogenetic analyses. Most of them comprised less than 4 individuals and, in total, they included 441 patients. Six clusters comprised 10 or more patients and were further analyzed in order to study their origin and diversification. Four clusters included men who had unprotected homosexual sex (MSM), one group was formed by intravenous drug users (IDUs), and another included both IDUs and people infected through unprotected heterosexual sex (HTs). Most of these clusters originated from the mid-1980s to the mid-1990s. Only one cluster, formed by MSM, originated after 2000. The time between infections was significantly lower in MSM groups than in those containing IDUs (P-value Country is significant. Public health control measures should be reinforced to prevent the further expansion of transmission clusters and resistant mutations occurring within them.

  6. A comparative analysis of teenagers and older pregnant women in the utilization of prevention of mother to child transmission [PMTCT] services in, Western Nigeria

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    Amoran Olorunfemi E

    2012-08-01

    Full Text Available Abstract Introduction Most HIV/AIDS infections in women occur at a younger age, during the first few years after sexual debut. This study was therefore designed to assess factors associated with the knowledge and utilization of the prevention of mother-to-child transmission (PMTCT services by the teenage pregnant women when compared to mature pregnant women in Ogun state, Nigeria. Methods This study is an analytical cross-sectional study. A total sample of all pregnant women [52 teenagers and 148 adults] attending the primary health care centres in Sagamu local government area, Ogun State, Nigeria within a 2 months period were recruited into the study. Results A total of 225 respondents were recruited into the study. The overall point prevalence of HIV/AIDS infection among those that had been tested and disclosed their result was 4 [2.8%]. The prevalence of HIV among the teenagers was 2 [7.4%] compared with 2 [1.8%] among older women. Only 85 [37.8%] of all respondents were tested through the Voluntary counseling and testing (VCCT programme and 53 (23.7% were aware of antiretroviral therapy while 35 (15.6% have ever used the PMTCT services before. There was no statistically significant difference in the knowledge of the teenage pregnant women when compared with the older women about mother to child transmission (MTCT [OR = 1.47, C.I = 0.57-3.95] and its prevention [OR = 0.83, C.I = 0.38-1.84]. The teenagers were 3 times less likely to use the services when compared with the older women. [OR = 0.34, C.I = 0.10-1.00]. Those from the low socio-economic background were about 6 times more likely to utilize PMTCT facilities when compared to those from high socioeconomic background [OR = 6.01, C.I = 1.91-19.19]. Conclusion The study concludes that the teenage pregnant women who were more vulnerable to HIV/AIDS infection did not utilize PMTCT services as much as the older pregnant women. Special consideration should be

  7. Morphological changes of the adenohypophysis of the child on a background of maternal HIV infection

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    Sherstiuk S.A.

    2014-09-01

    Full Text Available Background. A key element of adaptive-compensatory mechanism of the endocrine system of the body is the anterior pituitary. Despite the obvious importance of the adenohypophysis in the development of the endocrine system of the fetus, its age morphology described only in a few papers. Objective. Identification of morphological and functional changes in the adenohypophysis of the child on a background of HIV infected mothers. Methods. Immunohistochemical examination was performed using the indirect method of Coons modifications M.Brosman. ACTH (adrenocorticotropic hormone and TSH (thyroid stimulating hormone were detected by mAb (monoclonal antibody to ACTH and TSH firm Chemicon international (a Serological company. Immunohistochemical study was carried out in the luminescent microscope «Axioskor 40" using the software Biostat. exe. The optical density was determined by immunofluorescence method Gubina Vakulik-GI and co-workers. Histological morphometric research was carried out on the microscope Olympus BX-41 using programs Olympus DP-Soft (Version 3: 1, and Microsoft Excel. The density of the cellular elements 400 recalculated by increasing at 10 the limited fields of view. All digital data is processed by methods of mathematical statistics using variations and alternative analysis. Results. Children did not demonstrate any violation of the adenohypophysis in embryogenesis, but influence of stress for a long period of time, including the prenatal period, leading to tension, and subsequently to the disruption of the adaptive-compensatory possibilities of the adenohypophysis. These immunohistochemical studies show a progressive reduction in the intensity of luminescence in thyrotropocytes and adrenocorticotropocytes; it also evidence depression of the functional state of the adenohypophysis. In the adenohypophysis we found profound functional exhaustion, manifested by the massive growth of the stroma, increasing the relative volume chromophilic

  8. HIV Treatment: The Basics

    Science.gov (United States)

    HIV Treatment HIV Treatment: The Basics (Last updated 3/1/2016; last reviewed 3/1/2016) Key Points Antiretroviral therapy (ART) ... reduces the risk of HIV transmission . How do HIV medicines work? HIV attacks and destroys the infection- ...

  9. New emerging recombinant HIV-1 strains and close transmission linkage of HIV-1 strains in the Chinese MSM population indicate a new epidemic risk.

    Directory of Open Access Journals (Sweden)

    Jianjun Wu

    Full Text Available In recent years, the population of men who have sex with men (MSM have become the most significant increasing group of HIV-1 transmission in China. To identify new recombinant strains and transmission patterns of HIV-1 in Chinese MSM population, a cross-sectional investigation of MSM in Anhui Province (in south-eastern China was performed in 2011. The diagnosed AIDS case rate, CD4 T-cell counts, HIV subtypes, and origin of the recombinant strains were investigated in 138 collected samples. The phylogenetic and bootscan analyses demonstrated that, apart from three previously reported circulating strains (CRF07_BC, CRF01_AE, subtype B, various recombinant strains among subtype B, subtype C, CRF01_AE, and CRF07_BC were simultaneously identified in Chinese MSM for the first time. The introducing time of B subtype in Chinese MSM populations was estimated in 1985, CRF01_AE in 2000, and CRF07_BC in 2003; the latter two account for more than 85% of MSM infections. Notably, in comparison with B subtype infections in Anhui MSM, CRF01_AE, with the highest prevalence rate, may accelerate AIDS progression. Over half of patients (56% infected with new recombinant strains infection are diagnosed as progression into AIDS. Both Bayes and phylogenetic analyses indicated that there was active HIV transmission among MSM nationwide, which may facilitate the transmission of the new 01B recombinant strains in MSM. In conclusion, new recombinant strains and active transmission were identified in the Chinese MSM population, which may lead to a new alarming HIV pandemic in this population due to the increased pathogenesis of the newly emerging strains.

  10. Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda

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    Dorsey Grant

    2009-11-01

    Full Text Available Abstract Background HIV infection increases the risk of placental malaria, which is associated with poor maternal and infant outcomes. Recommendations in Uganda are for HIV-infected pregnant women to receive daily trimethoprim-sulphamethoxazole (TS and HIV-uninfected women to receive intermittent sulphadoxine-pyrimethamine (SP. TS decreases the risk of malaria in HIV-infected adults and children but has not been evaluated among pregnant women. Methods This was a cross sectional study comparing the prevalence of placental malaria between HIV-infected women prescribed TS and HIV-uninfected women prescribed intermittent preventive therapy with sulphadoxine-pyrimethamine (IPT-SP in a high malaria transmission area in Uganda. Placental blood was evaluated for malaria using smear and PCR. Results Placentas were obtained from 150 HIV-infected women on TS and 336 HIV-uninfected women on IPT-SP. The proportion of HIV-infected and HIV-uninfected women with placental malaria was 19% vs. 26% for those positive by PCR and 6% vs. 9% for those positive by smear, respectively. Among all infants, smear+ placental malaria was most predictive of low birth weight (LBW. Primigravidae were at higher risk than multigravidae of having placental malaria among HIV-uninfected, but not HIV-infected, women. Adjusting for gravidity, age, and season at the time of delivery, HIV-infected women on TS were not at increased risk for placental malaria compared to HIV-uninfected women on IPT-SP, regardless of the definition used. Conclusion Prevalence of placental malaria was similar in HIV-infected women on TS and HIV-uninfected women on IPT-SP. Nonetheless, while nearly all of the women in this study were prescribed anti-folates, the overall risk of placental malaria and LBW was unacceptably high. The population attributable risk of placental malaria on LBW was substantial, suggesting that future interventions that further diminish the risk of placental malaria may have a

  11. Social network based recruitment successfully reveals HIV-1 transmission networks among high risk individuals in El Salvador

    Science.gov (United States)

    Dennis, Ann M.; Murillo, Wendy; de Maria Hernandez, Flor; Guardado, Maria Elena; Nieto, Ana Isabel; de Rivera, Ivette Lorenzana; Eron, Joseph J.; Paz-Bailey, Gabriela

    2013-01-01

    Objective HIV in Central America is concentrated among certain groups such as men who have sex with men (MSM) and female sex workers (FSW). We compared social recruitment chains and HIV transmission clusters from 699 MSM and 757 FSW to better understand factors contributing to ongoing HIV transmission in El Salvador. Methods Phylogenies were reconstructed using pol sequences from 119 HIV-positive individuals recruited by respondent driven sampling (RDS) and compared to RDS chains in three cities in El Salvador. Transmission clusters with a mean pairwise genetic distance ≤0.015 and Bayesian posterior probabilities=1 were identified. Factors associated with cluster membership were evaluated among MSM. Results Sequences from 34 (43%) MSM and 4 (10%) FSW grouped in 14 transmission clusters. Clusters were defined by risk group (12 MSM clusters) and geographic residence (only one spanned separate cities). In 4 MSM clusters (all n=2), individuals were also members of the same RDS chain but only 2 had members directly linked through recruitment. All large clusters (n≥3) spanned more than one RDS chain. Among MSM, factors independently associated with cluster membership included recent infection by BED assay (P=0.02), sex with stable male partners (P=0.02), and sex with ≥3 male partners in past year (P=0.04). Conclusions We found few HIV transmissions corresponding directly with the social recruitment. However, we identified clustering in nearly one half of MSM suggesting RDS recruitment was indirectly but successfully uncovering transmission networks, particularly among recent infections. Interrogating RDS chains with phylogenetic analyses may help refine methods for identifying transmission clusters. PMID:23364512

  12. Cell-cell transmission enables HIV-1 to evade inhibition by potent CD4bs directed antibodies.

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    Irene A Abela

    Full Text Available HIV is known to spread efficiently both in a cell-free state and from cell to cell, however the relative importance of the cell-cell transmission mode in natural infection has not yet been resolved. Likewise to what extent cell-cell transmission is vulnerable to inhibition by neutralizing antibodies and entry inhibitors remains to be determined. Here we report on neutralizing antibody activity during cell-cell transmission using specifically tailored experimental strategies which enable unambiguous discrimination between the two transmission routes. We demonstrate that the activity of neutralizing monoclonal antibodies (mAbs and entry inhibitors during cell-cell transmission varies depending on their mode of action. While gp41 directed agents remain active, CD4 binding site (CD4bs directed inhibitors, including the potent neutralizing mAb VRC01, dramatically lose potency during cell-cell transmission. This implies that CD4bs mAbs act preferentially through blocking free virus transmission, while still allowing HIV to spread through cell-cell contacts. Thus providing a plausible explanation for how HIV maintains infectivity and rapidly escapes potent and broadly active CD4bs directed antibody responses in vivo.

  13. Cell-cell transmission enables HIV-1 to evade inhibition by potent CD4bs directed antibodies.

    Science.gov (United States)

    Abela, Irene A; Berlinger, Livia; Schanz, Merle; Reynell, Lucy; Günthard, Huldrych F; Rusert, Peter; Trkola, Alexandra

    2012-01-01

    HIV is known to spread efficiently both in a cell-free state and from cell to cell, however the relative importance of the cell-cell transmission mode in natural infection has not yet been resolved. Likewise to what extent cell-cell transmission is vulnerable to inhibition by neutralizing antibodies and entry inhibitors remains to be determined. Here we report on neutralizing antibody activity during cell-cell transmission using specifically tailored experimental strategies which enable unambiguous discrimination between the two transmission routes. We demonstrate that the activity of neutralizing monoclonal antibodies (mAbs) and entry inhibitors during cell-cell transmission varies depending on their mode of action. While gp41 directed agents remain active, CD4 binding site (CD4bs) directed inhibitors, including the potent neutralizing mAb VRC01, dramatically lose potency during cell-cell transmission. This implies that CD4bs mAbs act preferentially through blocking free virus transmission, while still allowing HIV to spread through cell-cell contacts. Thus providing a plausible explanation for how HIV maintains infectivity and rapidly escapes potent and broadly active CD4bs directed antibody responses in vivo. PMID:22496655

  14. Maleic anhydride-modified chicken ovalbumin as an effective and inexpensive anti-HIV microbicide candidate for prevention of HIV sexual transmission

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    Chen Xi

    2010-04-01

    Full Text Available Abstract Background Previous studies have shown that 3-hydroxyphthalic anhydride (HP-modified bovine milk protein, β-lactoglobulin (β-LG, is a promising microbicide candidate. However, concerns regarding the potential risk of prion contamination in bovine products and carcinogenic potential of phthalate derivatives were raised. Here we sought to replace bovine protein with an animal protein of non-bovine origin and substitute HP with another anhydride for the development of anti-HIV microbicide for preventing HIV sexual transmission. Results Maleic anhydride (ML, succinic anhydride (SU and HP at different conditions and variable pH values were used for modification of proteins. All the anhydrate-modified globulin-like proteins showed potent anti-HIV activity, which is correlated with the percentage of modified lysine and arginine residues in the modified protein. We selected maleic anhydride-modified ovalbumin (ML-OVA for further study because OVA is easier to obtain than β-LG, and ML is safer than HP. Furthermore, ML-OVA exhibited broad antiviral activities against HIV-1, HIV-2, SHIV and SIV. This modified protein has no or low in vitro cytotoxicity to human T cells and vaginal epithelial cells. It is resistant to trypsin hydrolysis, possibly because the lysine and arginine residues in OVA are modified by ML. Mechanism studies suggest that ML-OVA inhibits HIV-1 entry by targeting gp120 on HIV-1 virions and also the CD4 receptor on the host cells. Conclusion ML-OVA is a potent HIV fusion/entry inhibitor with the potential to be developed as an effective, safe and inexpensive anti-HIV microbicide.

  15. Correlation between HIV and HCV in Brazilian prisoners: evidence for parenteral transmission inside prison Correlação entre HIV e HCV em prisioneiros brasileiros: evidência de transmissão parenteral no encarceramento

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    MN Burattini

    2000-10-01

    Full Text Available OBJECTIVE: It is an accepted fact that confinement conditions increase the risk of some infections related to sexual and/or injecting drugs practices. Mathematical techniques were applied to estimate time-dependent incidence densities of HIV infection among inmates. METHODS: A total of 631 prisoners from a Brazilian prison with 4,900 inmates at that time were interviewed and their blood drawn. Risky behavior for HIV infection was analyzed, and serological tests for HIV, hepatitis C and syphilis were performed, intended as surrogates for parenteral and sexual HIV transmission, respectively. Mathematical techniques were used to estimate the incidence density ratio, as related to the time of imprisonment. RESULTS: Prevalence were: HIV -- 16%; HCV -- 34%; and syphilis -- 18%. The main risk behaviors related to HIV infection were HCV prevalence (OR=10.49 and the acknowledged use of injecting drugs (OR=3.36. Incidence density ratio derivation showed that the risk of acquiring HIV infection increases with the time of imprisonment, peaking around three years after incarceration. CONCLUSIONS: The correlation between HIV and HCV seroprevalence and the results of the mathematical analysis suggest that HIV transmission in this population is predominantly due to parenteral exposure by injecting drug, and that it increases with time of imprisonment.OBJETIVO: É um fato correntemente aceito que as condições de confinamento aumentam o risco de algumas infecções relacionadas às práticas sexuais e/ou ao uso de drogas injetáveis. Realizou-se estudo para estimar a densidade de incidência da infecção pelo HIV na população prisional com aplicação de técnicas matemáticas. MÉTODOS: Foram entrevistados em São Paulo, SP, 631 prisioneiros da maior prisão da América do Sul, que abrigava aproximadamente 4.900 presos na ocasião do estudo. Foi colhido sangue da população entrevistada, analisado o risco para a infecção pelo HIV e realizados testes

  16. HIV-1 gp41 envelope IgA is frequently elicited after transmission but has an initial short response half-life

    OpenAIRE

    Yates, N L; Stacey, A R; Nolen, T L; Vandergrift, N A; Moody, M.A.; Montefiori, D C; Weinhold, K J; Blattner, W. A.; Borrow, P; Shattock, R.; Cohen, M.S.; Haynes, B. F.; Tomaras, G.D.

    2013-01-01

    Prevention of HIV-1 transmission at mucosal surfaces will likely require durable pre-existing mucosal anti-HIV-1 antibodies (Abs). Defining the ontogeny, specificities and potentially protective nature of the initial mucosal virus-specific B-cell response will be critical for understanding how to induce protective Ab responses by vaccination. Genital fluids from patients within the earliest stages of acute HIV-1 infection (Fiebig I–VI) were examined for multiple anti-HIV specificities. Gp41 (...

  17. Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review

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    Leila Katirayi

    2012-07-01

    Full Text Available Introduction: Numerous barriers to optimal uptake of prevention of mother to child transmission (PMTCT services occur at community level (i.e., outside the healthcare setting. To achieve elimination of paediatric HIV, therefore, interventions must also work within communities to address these barriers and increase service use and need to be informed by evidence. This paper reviews community-based approaches that have been used in resource-limited settings to increase rates of PMTCT enrolment, retention in care and successful treatment outcomes. It aims to identify which interventions work, why they may do so and what knowledge gaps remain. Methods: First, we identified barriers to PMTCT that originate outside the health system. These were used to construct a social ecological framework categorizing barriers to PMTCT into the following levels of influence: individual, peer and family, community and sociocultural. We then used this conceptual framework to guide a review of the literature on community-based approaches, defined as interventions delivered outside of formal health settings, with the goal of increasing uptake, retention, adherence and positive psychosocial outcomes in PMTCT programmes in resource-poor countries. Results: Our review found evidence of effectiveness of strategies targeting individuals and peer/family levels (e.g., providing household HIV testing and training peer counsellors to support exclusive breastfeeding and at community level (e.g., participatory women's groups and home-based care to support adherence and retention. Evidence is more limited for complex interventions combining multiple strategies across different ecological levels. There is often little information describing implementation; and approaches such as “community mobilization” remain poorly defined. Conclusions: Evidence from existing community approaches can be adapted for use in planning PMTCT. However, for successful replication of evidence

  18. Effect of cytomegalovirus infection on breastfeeding transmission of HIV and on the health of infants born to HIV-infected mothers

    Science.gov (United States)

    Chang, Tiffany S.; Wiener, Jeffrey; Dollard, Sheila C.; Amin, Minal M.; Ellington, Sascha; Chasela, Charles; Kayira, Dumbani; Tegha, Gerald; Kamwendo, Deborah; Jamieson, Denise J.; van der Horst, Charlie; Kourtis, Athena P.

    2015-01-01

    Background Cytomegalovirus (CMV) infection can be acquired in utero or postnatally through horizontal transmission and breastfeeding. The effect of postnatal CMV infection on postnatal HIV transmission is unknown. Methods The Breastfeeding, Antiretrovirals and Nutrition study, conducted in Malawi, randomized 2369 mothers and their infants to three antiretroviral prophylaxis arms –mother (triple regimen), infant (nevirapine), or neither – for 28 weeks of breastfeeding, followed by weaning. Stored plasma and peripheral blood mononuclear cell specimens were available for 492 infants at 24 weeks and were tested with CMV PCR. Available samples from infants who were CMV PCR-positive at 24 weeks were also tested at birth (N = 242), and from infants PCR-negative at 24 weeks were tested at 48 weeks (N = 96). Cox proportional-hazards models were used to determine if CMV infection was associated with infant morbidity, mortality, or postnatal HIV acquisition. Results At 24 weeks of age, CMV DNA was detected in 345/492 infants (70.1%); the estimated congenital CMV infection rate was 2.3%, and the estimated rate of CMV infection at 48 weeks was 78.5%. CMV infection at 24 weeks was associated with subsequent HIV acquisition through breastfeeding or infant death between 24 and 48 weeks of age (hazard ratio 4.27, P = 0.05). Conclusion Most breastfed infants of HIV-infected mothers in this resource-limited setting are infected with CMV by 24 weeks of age. Early CMV infection may be a risk factor for subsequent infant HIV infection through breastfeeding, pointing to the need for comprehensive approaches in order to achieve elimination of breastfeeding transmission of HIV. PMID:25985405

  19. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices

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    Millson Peggy

    2008-06-01

    Full Text Available Abstract Background Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM and prisoners' risky HIV-related behaviors was examined. Results Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices.

  20. Differences in the Selection Bottleneck between Modes of Sexual Transmission Influence the Genetic Composition of the HIV-1 Founder Virus

    Science.gov (United States)

    Tully, Damien C.; Ogilvie, Colin B.; Batorsky, Rebecca E.; Bean, David J.; Power, Karen A.; Ghebremichael, Musie; Bedard, Hunter E.; Gladden, Adrianne D.; Seese, Aaron M.; Amero, Molly A.; Lane, Kimberly; McGrath, Graham; Bazner, Suzane B.; Tinsley, Jake; Lennon, Niall J.; Henn, Matthew R.; Brumme, Zabrina L.; Norris, Philip J.; Rosenberg, Eric S.; Mayer, Kenneth H.; Jessen, Heiko; Kosakovsky Pond, Sergei L.; Walker, Bruce D.; Altfeld, Marcus; Carlson, Jonathan M.; Allen, Todd M.

    2016-01-01

    Due to the stringent population bottleneck that occurs during sexual HIV-1 transmission, systemic infection is typically established by a limited number of founder viruses. Elucidation of the precise forces influencing the selection of founder viruses may reveal key vulnerabilities that could aid in the development of a vaccine or other clinical interventions. Here, we utilize deep sequencing data and apply a genetic distance-based method to investigate whether the mode of sexual transmission shapes the nascent founder viral genome. Analysis of 74 acute and early HIV-1 infected subjects revealed that 83% of men who have sex with men (MSM) exhibit a single founder virus, levels similar to those previously observed in heterosexual (HSX) transmission. In a metadata analysis of a total of 354 subjects, including HSX, MSM and injecting drug users (IDU), we also observed no significant differences in the frequency of single founder virus infections between HSX and MSM transmissions. However, comparison of HIV-1 envelope sequences revealed that HSX founder viruses exhibited a greater number of codon sites under positive selection, as well as stronger transmission indices possibly reflective of higher fitness variants. Moreover, specific genetic “signatures” within MSM and HSX founder viruses were identified, with single polymorphisms within gp41 enriched among HSX viruses while more complex patterns, including clustered polymorphisms surrounding the CD4 binding site, were enriched in MSM viruses. While our findings do not support an influence of the mode of sexual transmission on the number of founder viruses, they do demonstrate that there are marked differences in the selection bottleneck that can significantly shape their genetic composition. This study illustrates the complex dynamics of the transmission bottleneck and reveals that distinct genetic bottleneck processes exist dependent upon the mode of HIV-1 transmission. PMID:27163788

  1. Differences in the Selection Bottleneck between Modes of Sexual Transmission Influence the Genetic Composition of the HIV-1 Founder Virus.

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    Damien C Tully

    2016-05-01

    Full Text Available Due to the stringent population bottleneck that occurs during sexual HIV-1 transmission, systemic infection is typically established by a limited number of founder viruses. Elucidation of the precise forces influencing the selection of founder viruses may reveal key vulnerabilities that could aid in the development of a vaccine or other clinical interventions. Here, we utilize deep sequencing data and apply a genetic distance-based method to investigate whether the mode of sexual transmission shapes the nascent founder viral genome. Analysis of 74 acute and early HIV-1 infected subjects revealed that 83% of men who have sex with men (MSM exhibit a single founder virus, levels similar to those previously observed in heterosexual (HSX transmission. In a metadata analysis of a total of 354 subjects, including HSX, MSM and injecting drug users (IDU, we also observed no significant differences in the frequency of single founder virus infections between HSX and MSM transmissions. However, comparison of HIV-1 envelope sequences revealed that HSX founder viruses exhibited a greater number of codon sites under positive selection, as well as stronger transmission indices possibly reflective of higher fitness variants. Moreover, specific genetic "signatures" within MSM and HSX founder viruses were identified, with single polymorphisms within gp41 enriched among HSX viruses while more complex patterns, including clustered polymorphisms surrounding the CD4 binding site, were enriched in MSM viruses. While our findings do not support an influence of the mode of sexual transmission on the number of founder viruses, they do demonstrate that there are marked differences in the selection bottleneck that can significantly shape their genetic composition. This study illustrates the complex dynamics of the transmission bottleneck and reveals that distinct genetic bottleneck processes exist dependent upon the mode of HIV-1 transmission.

  2. Differences in the Selection Bottleneck between Modes of Sexual Transmission Influence the Genetic Composition of the HIV-1 Founder Virus.

    Science.gov (United States)

    Tully, Damien C; Ogilvie, Colin B; Batorsky, Rebecca E; Bean, David J; Power, Karen A; Ghebremichael, Musie; Bedard, Hunter E; Gladden, Adrianne D; Seese, Aaron M; Amero, Molly A; Lane, Kimberly; McGrath, Graham; Bazner, Suzane B; Tinsley, Jake; Lennon, Niall J; Henn, Matthew R; Brumme, Zabrina L; Norris, Philip J; Rosenberg, Eric S; Mayer, Kenneth H; Jessen, Heiko; Kosakovsky Pond, Sergei L; Walker, Bruce D; Altfeld, Marcus; Carlson, Jonathan M; Allen, Todd M

    2016-05-01

    Due to the stringent population bottleneck that occurs during sexual HIV-1 transmission, systemic infection is typically established by a limited number of founder viruses. Elucidation of the precise forces influencing the selection of founder viruses may reveal key vulnerabilities that could aid in the development of a vaccine or other clinical interventions. Here, we utilize deep sequencing data and apply a genetic distance-based method to investigate whether the mode of sexual transmission shapes the nascent founder viral genome. Analysis of 74 acute and early HIV-1 infected subjects revealed that 83% of men who have sex with men (MSM) exhibit a single founder virus, levels similar to those previously observed in heterosexual (HSX) transmission. In a metadata analysis of a total of 354 subjects, including HSX, MSM and injecting drug users (IDU), we also observed no significant differences in the frequency of single founder virus infections between HSX and MSM transmissions. However, comparison of HIV-1 envelope sequences revealed that HSX founder viruses exhibited a greater number of codon sites under positive selection, as well as stronger transmission indices possibly reflective of higher fitness variants. Moreover, specific genetic "signatures" within MSM and HSX founder viruses were identified, with single polymorphisms within gp41 enriched among HSX viruses while more complex patterns, including clustered polymorphisms surrounding the CD4 binding site, were enriched in MSM viruses. While our findings do not support an influence of the mode of sexual transmission on the number of founder viruses, they do demonstrate that there are marked differences in the selection bottleneck that can significantly shape their genetic composition. This study illustrates the complex dynamics of the transmission bottleneck and reveals that distinct genetic bottleneck processes exist dependent upon the mode of HIV-1 transmission. PMID:27163788

  3. Family planning use among women living with HIV: knowing HIV positive status helps - results from a national survey

    OpenAIRE

    Habte, Dereje; Namasasu, Jane

    2015-01-01

    Background Women living with HIV continues to encounter unintended pregnancies with a concomitant risk of mother-to-child transmission of HIV infection. Preventing unintended pregnancy among HIV-infected women is one of the strategies in the prevention of new HIV infections among children. The aim of this analysis was to assess the practice of family planning (FP) among HIV-infected women and the influence of women’s awareness of HIV positive status in the practice of FP. Methods The analysis...

  4. [The organization of key populations connected to HIV transmission: an intervention to abate stigma; Mexico, 2005-2009].

    Science.gov (United States)

    Cuadra-Hernández, Silvia Magali; Zarco-Mera, Ángel; Infante-Xibillé, César; Caballero-García, Marta

    2012-01-01

    A qualitative and quantitative approach forms the base of this analysis of the results of "Vida Digna," a project aimed at abating stigma and discrimination in the HIV transmission field with actions taken by civil society organizations from 2005 to 2009 in the Mexican region of El Bajío. The results were analyzed in 2009 and 2010. The organizations involved were made up of key populations, defined as groups vulnerable to infection but also capable of resisting and controlling the transmission of HIV and the stigma and discrimination that are important barriers in the seeking of care and the achievement of effective HIV control. We describe and analyze the actions taken and the strengthening of the participating organizations. The visibility of new social actors such as transgender women and injecting drug users, as well as informative activities directed at journalists, the police and the military to prevent the criminalization and persecution of these groups, are highlighted.

  5. Ten years' trend of HIV seroprevalence among Indian pregnant women attending antenatal clinic at tertiary hospital in Dhule, Maharashtra, India

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    Vaishali Milind Patil

    2016-05-01

    Conclusions: Declining HIV seroprevalence rate is noted among pregnant women attending the antenatal clinics from 2004 to 2013. The effective implementation of prevention of parent to child transmission of HIV/AIDS (PPTCT programmed is helping in control of the spread of HIV. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1514-1519

  6. Maternal well-being, mother-child interaction and child psychosocial outcome in the context of HIV/AIDS : a literature review with a keen eye on sub-Saharan Africa

    OpenAIRE

    Moyo, Kathrine Rasch

    2008-01-01

    The paper reviews the psychosocial literature regarding the impact of maternal HIV on mothers and their uninfected children. Drawing on the ecological theory of Urie Bronfenbrenner, the review proposes a framework that both demonstrates the link between maternal HIV and child psychosocial outcome, and examines the pathways that account for this relationship. Maternal HIV has been found to potentially affect a mother’s well-being negatively through a host of mediation factors associated with h...

  7. Dendritic cell-mediated HIV-1 transmission to T cells of LAD-1 patients is impaired due to the defect in LFA-1

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    Kuijpers Taco W

    2006-11-01

    Full Text Available Abstract Background Dendritic cells (DC have been proposed to mediate sexual HIV-1 transmission by capturing the virus in the mucosa and subsequently presenting it to CD4+ T cells. We have demonstrated before that DC subsets expressing higher levels of intercellular adhesion molecule-1 (ICAM-1 are better HIV-1 transmitters. ICAM-1 binds leukocyte function-associated molecule-1 (LFA-1 on T cells, an integrin responsible for adhesion and signaling at the immunological synapse. To corroborate the importance of the ICAM-1— LFA-1 interaction, we performed transmission experiments to LFA-1 negative leukocytes from Leukocyte Adhesion Deficiency type 1 (LAD-1 patients. Results We clearly show that DC-mediated HIV-1 transmission to LAD-1 T cells is impaired in comparison to healthy controls. Furthermore, HIV-1 transmission to T cells from a unique LAD-1 patient with a well characterized LFA-1 activation defect was impaired as well, demonstrating that activation of LFA-1 is crucial for efficient transmission. Decreased cell adhesion between DC and LAD-1 T cells could also be illustrated by significantly smaller DC-T cell clusters after HIV-1 transmission. Conclusion By making use of LFA-1 defect cells from unique patients, this study provides more insight into the mechanism of HIV-1 transmission by DC. This may offer new treatment options to reduce sexual transmission of HIV-1.

  8. Barriers to control syphilis and HIV vertical transmission in the health care system in the city of Sao Paulo

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    Valdete Maria Ramos

    2014-12-01

    Full Text Available OBJECTIVE: The objective of this study was to identify possible barriers to control vertical transmission of syphilis and HIV through the analysis of the orientation process of pregnant women from prenatal care to the obstetric center at an university hospital in Sao Paulo (Reference and their return (with their exposed babies for follow-up after hospital discharge (counter-reference. METHODS: It is a retrospective cross-sectional study including interviews with healthcare personnel. Pregnant women with syphilis and/or HIV-infection admitted for labor or miscarriage were identified from August 2006 to August 2007. Routine care for mothers and babies were analyzed. RESULTS: 56 pregnant women were identified: 43 were HIV-infected, 11 had syphilis and two were coinfected (syphilis/HIV; 22 health care professionals were interviewed. Prenatal care was identified in 91.1% of these women: 7/11 (63.6% with syphilis; 44/45 (97.8% HIV-infected or coinfected. The reference for delivery was satisfactory for 57.7% of the syphilis-infected women and 97.7% of the HIV-infected ones. The counter-reference was satisfactory for all babies and mothers at hospital discharge, besides the non-adherence to this recommendation. Interviews with health care professionals showed there are better routines for assisting and following-up pregnant women, puerperal women and HIV-infected or exposed babies than for those infected with syphilis. The epidemiological report and surveillance system are also better for HIV-infected patients. CONCLUSION: The difficulties in the reference and counter-reference system of these women and their babies are evident barriers to control the vertical transmission of these infectious diseases.

  9. Transmission of chimeric HIV by mating in conventional mice: prevention by pre-exposure antiretroviral therapy and reduced susceptibility during estrus.

    Science.gov (United States)

    Hadas, Eran; Chao, Wei; He, Hongxia; Saini, Manisha; Daley, Eleen; Saifuddin, Mohammed; Bentsman, Galina; Ganz, Eric; Volsky, David J; Potash, Mary Jane

    2013-09-01

    Heterosexual transmission accounts for the majority of new human immunodeficiency virus (HIV) cases worldwide. The current approach to investigate HIV heterosexual transmission in animals involves application of virus stock to the vaginal surface, a method that does not reproduce the physiological conditions of vaginal intercourse that influence the rate of transmission. We have previously described efficient infection of conventional mice using EcoHIV/NL4-3 and EcoHIV/NDK, chimeric HIV molecular clones constructed to express all HIV structural and regulatory genes except envelope, which is replaced by a rodent-tropic envelope gene. Here we investigated whether EcoHIV/NDK-infected male mice transmit virus to females during coitus, and the sensitivity of this transmission to HIV pre-exposure prophylaxis and the estrus state. Our general approach was to allow mating between EcoHIV/NDK-infected male mice and uninfected females for 1-7 nights. At 1-6 weeks after mating, mice were euthanized and virus burdens were measured by quantitative PCR (qPCR) amplification of HIV RNA or DNA in peritoneal macrophages, inguinal lymph node cells, spleen cells or vas deferens, or by ELISA for antibodies to HIV Gag. We found that 70-100% of female mice mated to EcoHIV/NDK-infected males acquired infection. Pericoital treatment of females with either 2',3'-dideoxcytidine (ddC) or tenofovir largely prevented their EcoHIV/NDK infection by mating (P<0.05 and P<0.003, respectively). In males, T cells were dispensable for virus transmission. The rate of EcoHIV/NDK sexual transmission to females in estrus declined sharply (P=0.003) but their infection by injection was unaffected, indicating that the local environment in the female reproductive tract influences susceptibility to HIV. We conclude that this system of EcoHIV/NDK transmission during mouse mating reproduces key features of heterosexual transmission of HIV in humans and can be used to investigate its biology and control.

  10. Transmission of chimeric HIV by mating in conventional mice: prevention by pre-exposure antiretroviral therapy and reduced susceptibility during estrus

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    Eran Hadas

    2013-09-01

    Heterosexual transmission accounts for the majority of new human immunodeficiency virus (HIV cases worldwide. The current approach to investigate HIV heterosexual transmission in animals involves application of virus stock to the vaginal surface, a method that does not reproduce the physiological conditions of vaginal intercourse that influence the rate of transmission. We have previously described efficient infection of conventional mice using EcoHIV/NL4-3 and EcoHIV/NDK, chimeric HIV molecular clones constructed to express all HIV structural and regulatory genes except envelope, which is replaced by a rodent-tropic envelope gene. Here we investigated whether EcoHIV/NDK-infected male mice transmit virus to females during coitus, and the sensitivity of this transmission to HIV pre-exposure prophylaxis and the estrus state. Our general approach was to allow mating between EcoHIV/NDK-infected male mice and uninfected females for 1–7 nights. At 1–6 weeks after mating, mice were euthanized and virus burdens were measured by quantitative PCR (qPCR amplification of HIV RNA or DNA in peritoneal macrophages, inguinal lymph node cells, spleen cells or vas deferens, or by ELISA for antibodies to HIV Gag. We found that 70–100% of female mice mated to EcoHIV/NDK-infected males acquired infection. Pericoital treatment of females with either 2′,3′-dideoxcytidine (ddC or tenofovir largely prevented their EcoHIV/NDK infection by mating (P<0.05 and P<0.003, respectively. In males, T cells were dispensable for virus transmission. The rate of EcoHIV/NDK sexual transmission to females in estrus declined sharply (P=0.003 but their infection by injection was unaffected, indicating that the local environment in the female reproductive tract influences susceptibility to HIV. We conclude that this system of EcoHIV/NDK transmission during mouse mating reproduces key features of heterosexual transmission of HIV in humans and can be used to investigate its biology and control.

  11. An agent-based epidemic simulation of social behaviors affecting HIV transmission among Taiwanese homosexuals.

    Science.gov (United States)

    Huang, Chung-Yuan

    2015-01-01

    Computational simulations are currently used to identify epidemic dynamics, to test potential prevention and intervention strategies, and to study the effects of social behaviors on HIV transmission. The author describes an agent-based epidemic simulation model of a network of individuals who participate in high-risk sexual practices, using number of partners, condom usage, and relationship length to distinguish between high- and low-risk populations. Two new concepts-free links and fixed links-are used to indicate tendencies among individuals who either have large numbers of short-term partners or stay in long-term monogamous relationships. An attempt was made to reproduce epidemic curves of reported HIV cases among male homosexuals in Taiwan prior to using the agent-based model to determine the effects of various policies on epidemic dynamics. Results suggest that when suitable adjustments are made based on available social survey statistics, the model accurately simulates real-world behaviors on a large scale.

  12. MUC1 in human milk blocks transmission of human immunodeficiency virus from dendritic cells to T cells

    NARCIS (Netherlands)

    Saeland, E.; Jong, de M.A.W.P.; Nabatov, A.; Kalay, H.; Kooijk, van Y.; Geijtenbeek, T.B.H.

    2009-01-01

    Mother-to-child transmission of human immunodeficiency virus-1 (HIV-1) occurs frequently via breast-feeding. HIV-1 targets DC-SIGN+ dendritic cells (DCs) in mucosal areas that allow efficient transmission of the virus to T cells. Here, we demonstrate that the epithelial mucin MUC1, abundant in milk,

  13. HIV-1 Nef enhances dendritic cell-mediated viral transmission to CD4+ T cells and promotes T-cell activation.

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    Corine St Gelais

    Full Text Available HIV-1 Nef enhances dendritic cell (DC-mediated viral transmission to CD4(+ T cells, but the underlying mechanism is not fully understood. It is also unknown whether HIV-1 infected DCs play a role in activating CD4(+ T cells and enhancing DC-mediated viral transmission. Here we investigated the role of HIV-1 Nef in DC-mediated viral transmission and HIV-1 infection of primary CD4(+ T cells using wild-type HIV-1 and Nef-mutated viruses. We show that HIV-1 Nef facilitated DC-mediated viral transmission to activated CD4(+ T cells. HIV-1 expressing wild-type Nef enhanced the activation and proliferation of primary resting CD4(+ T cells. However, when co-cultured with HIV-1-infected autologous DCs, there was no significant trend for infection- or Nef-dependent proliferation of resting CD4(+ T cells. Our results suggest an important role of Nef in DC-mediated transmission of HIV-1 to activated CD4(+ T cells and in the activation and proliferation of resting CD4(+ T cells, which likely contribute to viral pathogenesis.

  14. 孕前或孕期感染人类免疫缺陷病毒后的母婴传播%Analysis on mother-to-child transmission after maternal acquired human immunodeficiency virus prenatally or before pregnancy

    Institute of Scientific and Technical Information of China (English)

    梁科; 桂希恩; 张元珍; 邓莉萍; 热孜艳·斯拉夫; 严智昭; 王胜勇

    2012-01-01

    Objective To investigate the situation of mother to child transmission of HIV after mothers acquired HIV prenatally or before pregnancy and the related factors. Methods Two hundred and seventy-seven mothers who acquired HIV prenatally or before pregnancy and their 322children from Yi-ning city of Xinjiang Uygur autonomous region and some counties of central China were enrolled in this study from January 2000 to December 2009.Subtypes of HIV were determined by detection of Gag sequence,the rate of HIV transmission from mother to child was calculated and its related factors were analyzed by Chi-square test and Logistic regression analysis. Results The HIV subtype of all mothers who were infected through blood (n=174) was B'.The major subtype of mothers who were infected via sexuality (n =58) was recombined subtype CRF01-BC (n=35) and CRF-AE (n=20),accounting for 60.3% and 34.5%,respectively,and only 3 mothers with B'subtype (5.2%).Twelve infants died before HIV detection,and 108 infants out of the rest 310infants were found to be HIV positive, giving the HIV mother-to-child transmission rate of 34.8% (95% CI:29.5%-40.1%).The infection rate of bottle feeding infants was lower than that of breastfeeding infants [12.5% (6/48) vs 38.9% (102/262),x2 =12.484,P=0.000].The infection rate of the infants whose mothers' HIV infection <7 years was lower than that of the infants whose mothers' HIV infection ≥7 years [28.8% (46/160) vs 54.2% (32/59),x2 =12.211,P=0.000].Multi-factor Logistic analysis showed that the duration of maternal HIV infection (OR =1.342,95% CI:1.189-1.515,P=0.000) and duration of breastfeeding (OR =1.137,95% CI:1.053-1.227,P=0.001) were risk factors of HIV vertical transmission. Conclusions The HIV subtypes might be associated with transmission route.Formula feeding could decrease the vertical transmission rate of HIV,while long duration of maternal HIV infection and breastfeeding might increase the vertical transmission rate

  15. Transmission dynamics of HIV-1 subtype B in the Basque Country, Spain.

    Science.gov (United States)

    Patiño-Galindo, J A; Thomson, Michael M; Pérez-Álvarez, Lucía; Delgado, Elena; Cuevas, María Teresa; Fernández-García, Aurora; Nájera, Rafael; Iribarren, José A; Cilla, Gustavo; López-Soria, Leyre; Lezaun, María J; Cisterna, Ramón; González-Candelas, F

    2016-06-01

    This work was aimed to study the HIV-1 subtype B epidemics in the Basque Country, Spain. 1727 HIV-1 subtype B sequences comprising protease and reverse transcriptase (PR/RT) coding regions, sampled between 2001 and 2008, were analyzed. 156 transmission clusters were detected by means of phylogenetic analyses. Most of them comprised less than 4 individuals and, in total, they included 441 patients. Six clusters comprised 10 or more patients and were further analyzed in order to study their origin and diversification. Four clusters included men who had unprotected homosexual sex (MSM), one group was formed by intravenous drug users (IDUs), and another included both IDUs and people infected through unprotected heterosexual sex (HTs). Most of these clusters originated from the mid-1980s to the mid-1990s. Only one cluster, formed by MSM, originated after 2000. The time between infections was significantly lower in MSM groups than in those containing IDUs (P-value <0.0001). Nucleoside RT and non-nucleoside RT inhibitor (NRTI and NNRTI)-resistance mutations to antiretroviral treatment were found in these six clusters except the most recent MSM group, but only the IDU clusters presented protease inhibitor (PI)-resistance mutations. The most prevalent mutations for each inhibitor class were PI L90M, NRTI T215D/Y/F, and NNRTI K103N, which were also among the most prevalent resistant variants in the whole dataset. In conclusion, while most infections occur as isolated introductions into the population, the number of infections found to be epidemiologically related within the Basque Country is significant. Public health control measures should be reinforced to prevent the further expansion of transmission clusters and resistant mutations occurring within them. PMID:26921800

  16. The fear of mother’s milk in the era of HIV: A qualitative study among HIV positive mothers and health professionals, Addis Ababa, Ethiopia

    OpenAIRE

    Koricho, Absera Teshome

    2008-01-01

    Background: Breastfeeding remains normative and vital for child survival in the developing world. However, the knowledge of HIV transmission through breastfeeding has become an enormous public health dilemma, and has brought to the forefront of attention the controversy linked to whether breastfeeding can safely be promoted in high HIV epidemic areas. Exclusive replacement feeding can fully prevent postnatal transmission of HIV infection in children, however, it is neither acceptable nor a fe...

  17. Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

    OpenAIRE

    McCoy, Sandra I.; Raluca Buzdugan; Ralph, Lauren J.; Angela Mushavi; Agnes Mahomva; Anna Hakobyan; Constancia Watadzaushe; Jeffrey Dirawo; Cowan, Frances M; Padian, Nancy S

    2014-01-01

    BACKGROUND: Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. METHODS: We analyzed baseline data from the evaluation of Zimbabwe's Accelerated National PMTCT Program. Eligible women were randomly sampled from the cat...

  18. Community voices: barriers and opportunities for programmes to successfully prevent vertical transmission of HIV identified through consultations among people living with HIV

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    Christoforos Mallouris

    2012-07-01

    Full Text Available Introduction: In 2010, two global networks of people living with HIV, the International Community of Women Living with HIV (ICW Global and the Global Network of People living with HIV (GNP +  were invited to review a draft strategic framework for the global scale up of prevention of vertical transmission (PVT through the primary prevention of HIV and the prevention of unintended pregnancies among women living with HIV. In order to ensure recommendations were based on expressed needs of people living with HIV, GNP+ and ICW Global undertook a consultation amongst people living with HIV which highlighted both facilitators and barriers to prevention services. This commentary summarizes the results of that consultation. Discussion: The consultation was comprised of an online consultation (moderated chat-forum with 36 participants from 16 countries, an anonymous online e-survey (601 respondents from 58 countries, and focus-group discussions with people living with HIV in Jamaica (27 participants. The consultation highlighted the discrepancies across regions with respect to access to essential packages of PVT services. However, the consultation participants also identified common barriers to access, including a lack of trustworthy sources of information, service providers’ attitudes, and gender-based violence. In addition, participant re