Mosalagae, Diphetogo; Pfukenyi, Davies Mubika; Matope, Gift
A cross-sectional questionnaire-based study was conducted to assess milk producers' awareness of milk-borne zoonoses in selected smallholder and commercial dairy farms of Zimbabwe. The questionnaire was designed to obtain information on dairy breeds, milk production, dairy farmers' knowledge and awareness of zoonoses with particular emphasis on milk-borne zoonoses and farmers' behavioural practices that may lead to increased risk of milk-borne zoonoses transmission. A total of 119 dairy farmers were interviewed, and 41.5% were aware of milk-borne zoonoses with a significantly (Pzoonoses transmission were; consumption of raw milk (68.1%), sale of raw milk to the local public (25.2%), lack of cooling facilities by smallholder farmers (98%), and no routine testing (84.9%) and medical check-ups (89.1%) for milk-borne zoonoses. General hygienic and disease control practices need to be integrated in the milk production process particularly at the smallholder level. Awareness, teaching and training programmes for smallholder dairy farmers can improve disease control in animals and reduce the public health risk of milk-borne zoonoses.
... a Preventive HIV Vaccine? HIV/AIDS Clinical Trials HIV Prevention The Basics of HIV Prevention Preventing Mother-to-Child Transmission of HIV Post- ... Related Content Protecting Baby from HIV (infographic) AIDSource | HIV Prevention: Mother-to-Child Transmission MedlinePlus | HIV/AIDS and ...
Pinkerton, S D; Abramson, P R
The consistent use of latex condoms continues to be advocated for primary prevention of HIV infection despite limited quantitative evidence regarding the effectiveness of condoms in blocking the sexual transmission of HIV. Although recent meta-analyses of condom effectiveness suggest that condoms are 60 to 70% effective when used for HIV prophylaxis, these studies do not isolate consistent condom use, and therefore provide only a lower bound on the true effectiveness of correct and consistent condom use. A reexamination of HIV seroconversion studies suggests that condoms are 90 to 95% effective when used consistently, i.e. consistent condom users are 10 to 20 times less likely to become infected when exposed to the virus than are inconsistent or non-users. Similar results are obtained utilizing model-based estimation techniques, which indicate that condoms decrease the per-contact probability of male-to-female transmission of HIV by about 95%. Though imperfect, condoms provide substantial protection against HIV infection. Condom promotion therefore remains an important international priority in the fight against AIDS.
Walshe, Deirdre P; Garner, Paul; Adeel, Ahmed A; Pyke, Graham H; Burkot, Thomas R
-target species. Fish that feed on mosquito larvae for preventing malaria transmission What is the aim of this review? Adult female Anopheles mosquitoes transmit the Plasmodium parasites that cause malaria. The aim of this Cochrane Review was to evaluate whether introducing fish that eat mosquito larvae and pupae (early life stages of mosquitoes) into water sources near where people live will decrease the adult Anopheles mosquito population and thus the number of people infected with Plasmodium parasites. Key messages We do not know if introducing fish that eat mosquito larvae and pupae has an impact on the number of people with malaria or on the adult Anopheles mosquito population. What was studied in the review? The review authors examined the available research that evaluated introducing fish that eat larvae ('larvivorous') to Anopheles mosquito larval habitats in areas where malaria was common. Fifteen small studies looked at the effects of larvivorous fish on Anopheles larvae and pupae in different larval habitats, including localized water bodies (such as wells, domestic water containers, fishponds, and pools; seven studies), riverbed pools below dams (two studies), rice field plots (four studies), and water canals (two studies). These studies were undertaken in Sri Lanka (two studies), India (three studies), Ethiopia (one study), Kenya (two studies), Sudan (one study), Grande Comore Island (one study), Korea (two studies), Indonesia (one study), and Tajikistan (two studies). This is an update of a 2013 Cochrane Review and includes some older unpublished studies from Tajikistan and a new trial from India. What are the main results of the review? In our main analysis, we found no studies that looked at the effects of larvivorous fish on adult Anopheles mosquito populations or on the number of people infected with Plasmodium parasites. In our analysis exploring the effect of fish introduction on the number of Anopheles larvae and pupae in water collections, these studies
Hicar, Mark D.
Although pharmacological interventions have been successful in reducing prevention of maternal to child transmission (PMTCT) of HIV, there is concern that complete elimination through this mode of transmission will require other measures. Immunotherapies in infants or pregnant mothers may be able to eradicate this form of transmission. A recent vaccine trial in adults showed encouraging results, but as in most HIV safety and efficacy vaccine trials, the question of MTCT was not addressed. Con...
Objectives: To determine potential partners for pregnant women in the prevention of mother to child transmission of HIV and to determine pregnant women\\'s perceptions towards selected potential HIV prevention efforts. Design: Cross sectional, questionnaire-administered study. Setting: Ante-natal clinics of eleven public ...
Philipps, A F; Dvorák, B; Kling, P J; Grille, J G; Koldovský, O
Insulin-like growth factors (IGFs) are potent mitogens that have been implicated in control of growth and development during the perinatal period. These hormones are also present in biologically significant quantities in mammalian milks. Although one site of action of these IGFs may be at the intestinal level, current information about whether they pass intact into the circulation is conflicting. To test the hypothesis that milk-borne IGFs are absorbed into blood in receptor-active form, suckling rats were given either recombinant human (rh)125I-IGF-I or -II (4 x 10(6) counts per minute [cpm]), and the activity present in portal and cardiac blood was examined at 5, 10, 20, and 30 minutes after ingestion for presence of appropriate molecular weight peptides in these samples. In selected samples, purified radioactive samples were tested for their ability to bind competitively to crude membranes bearing IGF receptors. The results of these studies indicate that rh125I-IGF-I is absorbed in receptor-active form into the portal circulation and that maximal amounts are present 20 to 30 minutes after ingestion. Estimation of the presence of intact hormone was made on the basis of the elution profile of samples when run on gel chromatography as well as reversed-phase high-performance liquid chromatography. Isolated samples from portal blood also bound competitively to placental membranes bearing IGF receptors. In contrast, rh125I-IGF-II could not be demonstrated in receptor-active form in portal blood. Chromatography showed appropriate sized peaks with greater activity in portal than cardiac samples, but competitive binding was not appreciated. It is likely that at least milk-borne IGF-I is absorbed intact and may exert effects on liver and other peripheral tissues. In addition, this study lends further credence to the possibility of an enterohepatic circulation for IGF-I.
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 ...
Aug 2, 2004 ... prevention of mother-to-child transmission (PMTCT) of. HIV1 were presented at an evening satellite session. ... They complement other guidelines on treatment issued by the WHO and the 3 by 5 Initiative. ..... Further work on infant feeding and programmatic experiences added to the knowledge base.
Aug 21, 2014 ... Original Research http://www.hsag.co.za doi:10.4102/hsag.v19i1.774. Prevention of Mother-to-Child Transmission of HIV data completeness and accuracy ... Methods: This is a retrospective record review study which involved collecting PMTCT .... service delivery in the public health sector of South Africa.
infection include the high rate of maternal HIV infection, high birth rates, lack of access to currently available and feasible interventions, and the widespread practice of prolonged breastfeeding.1 The transmission risk for a child born to an HIV infected mother in an. African setting without intervention for prevention of mother ...
. 31 of infected are children under 15 years, 12 of them are infected from the mother. The analysis and research of HIV/AIDS epidemic situation and prevention of a prenatal transmission of the HIV on territory of republic was held. Thus 311 ...
Context: With increasing feminization of the human immunodeficiency virus (HIV) pandemic especially in Africa, more seropositive women are getting pregnant. There is therefore an increasing need for prevention of mother to child transmission (PMTCT) of HIV and increased need for awareness by our women. Objective: ...
Rasmussen, M.B.; Rasmussen, J.B.; Nielsen, V.R.
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...... was not initiated. CONCLUSION: As long as preventive treatment strategies are followed, there is no transmission of HIV from mother to child, neither during pregnancy nor during or after birth Udgivelsesdato: 2008/8/18......INTRODUCTION: Human immunodeficiency virus (HIV) is a RNA virus that can be transmitted parenterally, sexually or vertically. An effective prevention strategy has been implemented in industrialised countries, thereby reducing vertical transmission from 15-25% to
Mi-Ichi, Fumika; Yoshida, Hiroki; Hamano, Shinjiro
Amebiasis is caused by Entamoeba histolytica infection and can produce a broad range of clinical signs, from asymptomatic cases to patients with obvious symptoms. The current epidemiological and clinical statuses of amebiasis make it a serious public health problem worldwide. The Entamoeba life cycle consists of the trophozoite, the causative agent for amebiasis, and the cyst, the form responsible for transmission. These two stages are connected by "encystation" and "excystation." Hence, developing novel strategies to control encystation and excystation will potentially lead to new measures to block the transmission of amebiasis by interrupting the life cycle of the causative agent. Here, we highlight studies investigating encystation using inhibitory chemicals and categorize them based on the molecules inhibited. We also present a perspective on new strategies to prevent the transmission of amebiasis.
Azkune, Harkaitz; Ibarguren, Maialen; Camino, Xabier; Iribarren, José Antonio
In these almost thirty years since the epidemic of HIV infection strategies have been developed to decrease the transmission risk when a non-infected person comes into contact with HIV. One of the key landmarks was the use zidovudine was shown to reduce the risk of HIV infection by vertical transmission from 25% to 8% when given from the second trimester of pregnancy, during partum and for several weeks in the newborn. These strategies have been subsequently perfected until achieving vertical transmission rates less than 1%. Almost at the same time, strategies have been developed in an attempt to reduce the risk of transmission of infection after occupational accidents and, in the last few years prophylaxis after non-occupational exposure has been a field of particular concern. Even in this past year several experiments on pre-exposure prophylaxis have been published, which are generating an intense debate on is applicability. In this article, we analyse the state of the art in the prevention of vertical transmission and occupational and non-occupational prophylaxis, from a perspective of applying this in the developed world. We also review the published data on pre-exposure prophylaxis. Copyright © 2011 Elsevier España, S.L. All rights reserved.
Balogh, Zsuzsanna; Egyed, László; Ferenczi, Emőke; Bán, Enikő; Szomor, Katalin N; Takács, Mária; Berencsi, György
The aim of this work was to study the tick-borne encephalitis virus (TBEV) infection of goats and the possibilities to prevent human milk-borne infections either by immunizing animals or the heat treatment of milk. An experiment was conducted with 20 milking goats. Ten goats (half of them immunized) were challenged with live TBEV and 10 were left uninfected. Clinical signs and body temperatures of the animals were recorded and milk samples were collected daily. The presence of viral RNA and infectious virions in milk were detected by RT-PCR and intracerebral inoculation of suckling mice, respectively. Milk samples containing infectious virions were subjected to various heat treatment conditions and retested afterwards to assess the effect on infectivity. The infected goats did not show any clinical signs or fever compared to uninfected ones. Infectious virions were detected for 8-19 days from the milk samples (genome for 3-18 days by PCR) of infected goats. Immunized goats did not shed the virus. After heat treatment of the milk, the inoculated mice survived. Goats shed the virus with their milk without showing any symptoms. Human milk-borne infections can be avoided both by immunizing goats and boiling/pasteurizing infected milk. Copyright © 2011 S. Karger AG, Basel.
Rasmussen, M.B.; Rasmussen, J.B.; Nielsen, V.R.
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 ... 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...... was not initiated. CONCLUSION: As long as preventive treatment strategies are followed, there is no transmission of HIV from mother to child, neither during pregnancy nor during or after birth Udgivelsesdato: 2008/8/18...
Friend, David R
Multipurpose Prevention Technologies (MPTs) are designed to address two or more indications from a single product. The overall goal is to prevent unintended pregnancy and transmission of one or more STIs including HIV-1. The topics covered herein are advances in over the past three years. Advances include development of novel intravaginal rings capable of releasing microbicides to prevent transmission of HIV-1 and unintended pregnancy. These rings include the potential to prevent transmission of more than one STI and unintended pregnancy. There are also gels that can potentially accomplish the same thing. Finally, combination of a drug and barrier device are also covered. There has been considerable advance in this field over the past three years. There is one ring currently in a Phase I clinical trial and others are soon to follow. Some of these drug delivery systems are by necessity rather complicated and hence could be prohibitively expensive in the developing world. Conducting multiple clinical trials to support regulatory approval of two or more indications represents a significant barrier. It remains unclear that women will be more motivated to use MPT products than has been observed in recent microbicide-only clinical trials. Despite these challenges, the need for MPTs remain acute hopefully ensuring they will continue to be developed over the coming years.
Erasmus, Vicki; Sun, Xinying; Shi, Yuhui; Richardus, Jan Hendrik
This 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 three-round web-based Delphi study among a panel of 62 experts between October 2012 and March 2013. The panelists were purposely selected using a stepwise procedure to represent topic-related areas of expertise. The response rate per round ranges from 21% to 81%. The panelists identified 19 possible determinants of condom use and reported 16 intervention methods they considered successful. They agreed that attitude towards condom use was the most important and changeable determinant, while applying behavioral theory, increasing sexual education and condom access, performing worksite health promotion, detecting risk factors, and working closely with relevant organizations and the government were effective and feasible methods to increase condom use among internal migrants in China. In conclusion, results of this study highlight the importance of attitude in changing condom use and underscore the need to apply behavior theory and integrate multiple educational approaches for developing behavioral HIV prevention interventions targeting internal migrants in China. PMID:25610903
Inzaule, Seth C.; Hamers, Raph L.; Calis, Job; Boerma, Ragna; Sigaloff, Kim; Zeh, Clement; Mugyenyi, Peter; Akanmu, Sulaimon; Rinke de Wit, Tobias F.
: The scale-up of antiretroviral prophylaxis to prevent mother-to-child transmission of HIV has significantly reduced new pediatric infections in sub-Saharan Africa. However, among infants who become HIV-infected despite prevent mother-to-child transmission, more than 50% have drug-resistant HIV.
Santmyire, B R
The impact of the human immunodeficiency virus (HIV) epidemic in sub-Saharan Africa on future mortality rates of infants, children, and mothers, life expectancy, and economic growth is profound. Vertical transmission of HIV, transmission from mother to child, is a major factor in the increasing rates of HIV infection in sub-Saharan Africa. Vertical transmission of HIV occurs in utero, intrapartum during labor and delivery, and postpartum during breast-feeding. Because of the large numbers of HIV-infected mothers in developing countries, the majority trials regarding prevention of vertical transmission of HIV have been conducted in sub-Saharan Africa. Thus, sub-Saharan Africa has become a human laboratory, which demonstrates both the successes and failures of preventative methods to reduce vertical transmission of HIV. This review summarizes the body of research dedicated to understanding the pathophysiology of vertical transmission of HIV and pharmacology of inhibition of vertical transmission of HIV. While many debate the ethics of conducting trials in developing countries where effective prevention modalities have been slow to be implemented for economic, social and political reasons, studies continue and researchers continue to discover therapies and preventative methods, which may reduce the future devastation of HIV both in sub-Saharan Africa and throughout the world.
Mindel, Adrian; Sawleshwarkar, Shailendra
The present review assesses the protection that condoms offer against sexually transmissible infections (STI) and the impact that social, political and religious opinion in the USA has had in the past 8 years on promoting condoms for safer sex. Condoms offer protection against most STI. However, the degree of protection depends on correct and consistent use, the type of sexual activity and the biological characteristics of different infections. Cross-sectional and case-control studies and other observational data provide the majority of evidence for STI prevention. Condoms provide a high level of protection against those infections that are transmitted mainly via infected secretions, including HIV, gonorrhoea, chlamydia and trichomoniasis. Protection against those infections transmitted via skin and mucous membrane contact, including Herpes simplex virus infection and human papilloma virus, appears to be less. The Bush administration, driven by conservative political, social and religious elements in the USA, has mounted a concerted campaign to undermine the role of the condom in health-promotion activities in the USA and overseas by undervaluing and misrepresenting scientific data, and through a sustained and well-funded promotion of abstinence-only education. However, this has lead to considerable controversy and disillusionment with abstinence-only education, both at home and abroad, and there is now incontrovertible evidence that abstinence-only programs are ineffectual.
Ludwig, Jens; Mayer, Susan
Many U.S. policymakers support changing the "culture" of poor parents to encourage marriage, work, and religion as a means to end the intergenerational transmission of poverty. In this article Jens Ludwig and Susan Mayer review and evaluate research on how parental work, marriage, and religion affect children's socioeconomic status as adults, as well as on the likelihood that changing these indicators of parental behavior will reduce poverty in the next generation. They conclude that even if policymakers were able to ensure that all children had married, working, and religious parents, the result would be a far smaller reduction in poverty among the children's generation than many people believe. The explanation for this "poverty-prevention paradox," say Ludwig and Mayer, is that the poverty rate in the children's generation depends not only on how many poor children grow up to be poor adults, but also on how many nonpoor children grow up to be poor adults. Reducing the chances that poor children become poor adults will dramatically lower future poverty rates only if most poor adults begin life as poor children. But most poor adults grow up as nonpoor children in the type of "pro-social" households that policymakers are pushing to attain. Moreover, little good evidence supports the idea that such parental behaviors as marriage, work, and religious adherence have strong causal effects on children's long-term economic success. The authors argue that encouraging positive social behaviors in the parents of poor children is a worthwhile goal in its own right. But they stress that policymakers should recognize the limits of this strategy for reducing poverty among future generations. There may be no substitute for a system of social insurance and income transfers for those children who do wind up poor as adults.
Potts, M; Short, R V
Humans being fundamentally polygamous, condoms should be recognized and promoted as central to an integrated approach for family planning, HIV prevention, and the control of sexually transmitted diseases. They must be more widely and effectively distributed and promoted in both more developed and developing nations. Available data on the ability of condoms to stem the transmission of HIV are limited, yet nonetheless indicative of condoms' general protective effect. Comparatively high prevalence and use of condoms are, however, found only in Japan, Sweden, Finland, Denmark, Singapore, and Trinidad and Tobago. Use in the U.S. is under that of a generation ago, while only extremely low levels are found throughout most of Africa, Asia, and South America. The industrialized nations of the West are most readily in the position of affording increased condom prevalence and use through increased manufacturing capacity and intensified promotion of moderate behavioral change among users. The nations of the 3rd World, however, lack the monetary and logistical resources to finance a rapid increase in condom prevalence, and are demanded to focus their energies more than ever where they are most needed, and expected to produce most significant impact. Up to $1 billion/year would be needed from donor agencies to meet universal need for condoms in Africa alone. Simple and cheap though condoms may be, such cost is too high to bear. The use of social marketing is therefore endorsed to target high-risk groups of populations as a means of maximizing resources for greatest potential impact. NGOs will play a major role in condom distribution, and should expect to work with, instead of through, ministries of health.
Jun 2, 2016 ... Abstract: Background: Sub- Sa- hara Africa including Nigeria has the second largest global burden of chronic carriers of hepatitis B virus (HBV) infection after Asia. Mother-to-child transmission. (MTCT) of HBV is the most com- monroute of transmission in high endemic areas .MTCT of hepatitis. B virus ...
Mother-to-child transmission (MTCT) of HBV is the most commonroute of transmission in high endemic areas .MTCT of hepatitis B virus infection continues to occur despite the interventions of hepatitis B vaccinations and immunoglobulins in settings where it is practiced. Infants most at risk are those whose mothers have ...
... Infographic Related Links Unexplained Respiratory Disease Outbreaks Red Book® Online RSV Transmission Recommend on Facebook Tweet Share Compartir ... year. Related Links Unexplained Respiratory Disease Outbreaks Red Book® Online File Formats Help: How do I view different ...
Ngasala, J Uma Bukuku; Nonga, Hezron Emmanuel; Mtambo, Mkumbukwa Madundo Angelo
A cross-sectional study was conducted to assess the quality of raw milk and stakeholders' awareness on milk-borne health risks and factors for poor milk hygiene in Arusha City and Meru District, Tanzania between October and December 2012. A total of 105 smallholder dairy farmers, milk vendors and milk retailers were interviewed, and milk samples were collected for physical, microbial and antibiotic residue analysis using standard procedures. Questionnaire results indicated high level of awareness (94 %) that drinking raw milk can predispose consumers to milk-borne diseases; nevertheless, 65 % of respondents consumed raw milk. Physicochemical analyses showed some of the milk had sediments (20 %), bad smell (21 %) and had clotted on alcohol test (27 %). About 36 % of milk samples had pH below 6.6, and 25 % had specific gravity below 1.028 g/ml. The mean total viable count (TVC) of milk from vendors is significantly (P milk samples assessed had a higher TVC than the level recommended (2.0 × 10(5) cfu/ml) by the East African Community (EAC) standards. Up to 91 % of the milk samples had bacterial growth that included Eschericia coli (66 %), Staphylococcus aureus (33 %), Corynebacterium (11 %) and Pseudomonas (10 %). All smallholder dairy farmers were aware of drug residues, but majority (57 %) were unaware of human health effects caused by veterinary drug residues in milk. Up to 97 % of respondents reported to comply with drug withdrawal periods. This possibly led to all milk samples analysed to be negative from detectable levels of antibiotic residues. It is concluded that the level of awareness on milk quality is high, although practices associated with milking and post-harvest handling predispose milk to bacterial contamination which is a public health risk to milk consumers.
Misconceptions about how HIV can be transmitted or prevented often prevent individuals from making informed choices and taking appropriate action. The purpose of the research was to explore the socio-demographic and behavioural factors in Botswana that are associated with misconceptions about HIV prevention and ...
TRANSMISSION (PMTCT) OF HIV SERVICES AMONG PREGNANT WOMEN IN A. SECONDARY HEALTH FACILITY IN ... of HIV were during pregnancy (86.0%) and from breastfeeding (86.0%). More than 80% knew that having good ..... The Role of HIV related stigma in utilisation of skilled childbirth services in rural ...
for the first six months and then complementary feeding from six months but an alternative option of EFF method was recommended if formula was acceptable, .... mother to child HIV transmission programme through health system redesign: quality improvement, protocol adjustment and resource addition. PLoS ONE.
been met with denial, procrastination and bungling. From a public health point of view this has been a disaster. Will we again miss the chance to act decisively when it comes to perinatal transmission? For African scientists to try to politicise criticism of placebo trials as intervention from the. West is wrong. Rather, they must ...
With seed-borne and ease in mechanical transmission, an increasing number of viroid outbreaks have been reported in recent years. Such major surge in viroid epidemics is likely enhanced by the intensive ‘hands-on’ activities in greenhouse tomato production. Although viroids are resilient to heat tre...
infected and 370,000 children died due to HIV. The vast majority of children ac- quired HIV through vertical transmission from mother to child.1. During 2006 the sero-positive HIV prevalence amongst women attending antenatal clinics in the public health sector within South Africa was 29.1%.2. The province with the lowest ...
Seibert, Christopher W.; Rahmat, Saad; Krause, Jens C.; Eggink, Dirk; Albrecht, Randy A.; Goff, Peter H.; Krammer, Florian; Duty, J. Andrew; Bouvier, Nicole M.; García-Sastre, Adolfo
A serum hemagglutination inhibition (HAI) titer of 40 or greater is thought to be associated with reduced influenza virus pathogenesis in humans and is often used as a correlate of protection in influenza vaccine studies. We have previously demonstrated that intramuscular vaccination of guinea pigs with inactivated influenza virus generates HAI titers greater than 300 but does not protect vaccinated animals from becoming infected with influenza virus by transmission from an infected cage mate. Only guinea pigs intranasally inoculated with a live influenza virus or a live attenuated virus vaccine, prior to challenge, were protected from transmission (A. C. Lowen et al., J. Virol. 83:2803–2818, 2009.). Because the serum HAI titer is mostly determined by IgG content, these results led us to speculate that prevention of viral transmission may require IgA antibodies or cellular immune responses. To evaluate this hypothesis, guinea pigs and ferrets were administered a potent, neutralizing mouse IgG monoclonal antibody, 30D1 (Ms 30D1 IgG), against the A/California/04/2009 (H1N1) virus hemagglutinin and exposed to respiratory droplets from animals infected with this virus. Even though HAI titers were greater than 160 1 day postadministration, Ms 30D1 IgG did not prevent airborne transmission to passively immunized recipient animals. In contrast, intramuscular administration of recombinant 30D1 IgA (Ms 30D1 IgA) prevented transmission to 88% of recipient guinea pigs, and Ms 30D1 IgA was detected in animal nasal washes. Ms 30D1 IgG administered intranasally also prevented transmission, suggesting the importance of mucosal immunity in preventing influenza virus transmission. Collectively, our data indicate that IgG antibodies may prevent pathogenesis associated with influenza virus infection but do not protect from virus infection by airborne transmission, while IgA antibodies are more important for preventing transmission of influenza viruses. PMID:23698296
Gosalamang Ricardo Kelatlhegile
Full Text Available We formulate and analyze a deterministic mathematical model for the prevention of a disease transmitted horizontally and vertically in a population of varying size. The model incorporates prevention of disease on individuals at birth and adulthood and allows for natural recovery from infection. The main aim of the study is to investigate the impact of a preventive strategy applied at birth and at adulthood in reducing the disease burden. Bifurcation analysis is explored to determine existence conditions for establishment of the epidemic states. The results of the study showed that in addition to the disease-free equilibrium there exist multiple endemic equilibria for the model reproduction number below unity. These results may have serious implications on the design of intervention programs and public health policies. Numerical simulations were carried out to illustrate analytical results.
Full Text Available Abstract Malaria in pregnancy is one of the major causes of maternal morbidity and adverse birth outcomes. In high transmission areas, its prevention has recently changed, moving from a weekly or bimonthly chemoprophylaxis to intermittent preventive treatment (IPTp. IPTp consists in the administration of a single curative dose of an efficacious anti-malarial drug at least twice during pregnancy – regardless of whether the woman is infected or not. The drug is administered under supervision during antenatal care visits. Sulphadoxine-pyrimethamine (SP is the drug currently recommended by the WHO. While SP-IPTp seems an adequate strategy, there are many issues still to be explored to optimize it. This paper reviewed data on IPTp efficacy and discussed how to improve it. In particular, the determination of both the optimal number of doses and time of administration of the drug is essential, and this has not yet been done. As both foetal growth and deleterious effects of malaria are maximum in late pregnancy women should particularly be protected during this period. Monitoring of IPTp efficacy should be applied to all women, and not only to primi- and secondigravidae, as it has not been definitively established that multigravidae are not at risk for malaria morbidity and mortality. In HIV-positive women, there is an urgent need for specific information on drug administration patterns (need for higher doses, possible interference with sulpha-based prophylaxis of opportunistic infections. Because of the growing level of resistance of parasites to SP, alternative drugs for IPTp are urgently needed. Mefloquine is presently one of the most attractive options because of its long half life, high efficacy in sub-Saharan Africa and safety during pregnancy. Also, efforts should be made to increase IPTp coverage by improving the practices of health care workers, the motivation of women and their perception of malaria complications in pregnancy. Because IPTp
Franco Maria Ruggeri
Full Text Available Rotavirus and poliovirus are paradigmatic viruses for causing major diseases affecting the human population. The impact of poliovirus is remarkably diminished because of vaccination during the last half century. Poliomyelitis due to wild polio currently affects a limited number of countries, and since 2000 sporadic outbreaks have been associated to neurovirulent vaccine-derived polioviruses. Conversely, rotavirus is presently very diffuse, accounting for the largest fraction of severe gastroenteritis among children <5 years-old. Vaccination towards rotavirus is still in its dawn, and zoonotic strains contribute to the emergence and evolution of novel strains pathogenic to man. The environment, particularly surface water, is a possible vehicle for large transmission of both viruses, but environmental surveillance of circulating strains can help promptly monitor entry of new virulent strains into a country, their shedding and spread.
de La Fuente, J; Kocan, K M; Contreras, M
Ticks and tick-borne pathogens have evolved together, resulting in a complex relationship in which the pathogen's life cycle is perfectly coordinated with the tick's feeding cycle, and the tick can harbour high pathogen levels without affecting its biology. Tick-borne diseases (TBDs) continue to emerge and/or spread, and pose an increasing threatto human and animal health. The disruptive impacts of global change have resulted in ecosystem instability and the future outcomes of management and control programmes for ticks and TBDs are difficult to predict. In particular, the selection of acaricide-resistant ticks has reduced the value of acaricides as a sole means of tick control. Vaccines provide an alternative control method, but the use of tick vaccines has not advanced since the first vaccines were registered in the early 1990s. An understanding of the complex molecular relationship between hosts, ticks and pathogens and the use of systems biology and vaccinomics approaches are needed to discover proteins with the relevant biological function in tick feeding, reproduction, development, immune response, the subversion of host immunity and pathogen transmission, all of which mediate tick and pathogen success. The same approaches will also be required to characterise candidate protective antigens and to validate vaccine formulations. Tick vaccines with a dual effect on tick infestations and pathogen transmission could reduce both tick infestations and their vector capacity for humans, animals and reservoir hosts. The development of integrated tick control strategies, including vaccines and synthetic and botanical acaricides, in combination with managing drug resistance and educating producers, should lead to the sustainable control of ticks and TBDs.
Escobar Pinzón, L C; Sweers, H
On the basis of their aims, the Deutsche AIDS-Hilfe focuses on lifestyle-oriented structural prevention and health promotion as well as the continuously changing (social, cultural, sexual, medical, etc.) conditions. In doing so, they stress the collective responsibility of the local AIDS service organizations and of other agents involved in prevention as well as of policy, administration, economy and society. In the face of the modified perception of HIV infection, the disentanglement of sexuality from the "dictatorship of fear" and the growing individualization and differentiation in matters of risk management, it is necessary to enhance the life style and service orientation in prevention and health promotion, to enhance the utilization of all media available in the age of information, particularly the internet, and to convey clear(er) messages on new forms of risk management to ensure what has been achieved so far (compared to other European countries a low rate of newly diagnosed infections and a largely non-discriminatory attitude towards the people affected) and to gain substantial improvements.
Greenfield, Andy; Braude, Peter; Flinter, Frances; Lovell-Badge, Robin; Ogilvie, Caroline; Perry, Anthony C F
Mitochondria are essential cytoplasmic organelles that generate energy (ATP) by oxidative phosphorylation and mediate key cellular processes such as apoptosis. They are maternally inherited and in humans contain a 16,569-base-pair circular genome (mtDNA) encoding 37 genes required for oxidative phosphorylation. Mutations in mtDNA cause a range of pathologies, commonly affecting energy-demanding tissues such as muscle and brain. Because mitochondrial diseases are incurable, attention has focused on limiting the inheritance of pathogenic mtDNA by mitochondrial replacement therapy (MRT). MRT aims to avoid pathogenic mtDNA transmission between generations by maternal spindle transfer, pronuclear transfer or polar body transfer: all involve the transfer of nuclear DNA from an egg or zygote containing defective mitochondria to a corresponding egg or zygote with normal mitochondria. Here we review recent developments in animal and human models of MRT and the underlying biology. These have led to potential clinical applications; we identify challenges to their technical refinement.
Bisio, Francesca; Masini, Giulia; Blasi Vacca, Elisabetta; Calzi, Anna; Cardinale, Francesco; Bruzzone, Bianca; Bruzzi, Paolo; Viscoli, Claudio
To evaluate the effectiveness of a prevention programme against the vertical transmission of HIV in a resource-limited setting and to investigate variables associated with compliance. The Kento-Mwana project (2005-2008) provided counselling, serological and biomolecular testing and prophylaxis/therapy to HIV-positive pregnant women and their children attending four antenatal clinics in Pointe Noire, Republic of Congo. Expected and actual rates of vertical transmission of HIV were compared. Univariate and multivariate analyses were performed in order to identify variables associated with non-compliance. The observed transmission rate in the group who completed follow-up was 5/290 (1.7%, 95% CI 0.6%-4.1%). The overall estimated transmission rate in the target population, computed taking into account the expected vertical transmission of HIV among drop-outs, was 67-115/638 (10.5%-18.0%). A comparison between this rate and the expected transmission rate in the absence of intervention (25%-40%) showed that the programme was able to prevent approximately 50% of vertical transmissions. Older age (OR 0.33, 95% CI 0.16-0.66, P = 0.002), telephone availability (OR 0.42, 95% CI 0.24-0.72, P = 0.002) and occupation (OR 0.57, 95% CI 0.29-1.10, P = 0.092) were associated with better compliance. Despite the vast majority of women accepting counselling and testing, many of them refused prophylaxis or dropped out, thus reducing the effectiveness of the intervention from an ideal 2% to a still important but less impressive median transmission rate of 15% (range 10.5%-18%). Promoting participation and compliance, rather than increasing the potency of antiretroviral regimens, is crucial for preventing the vertical transmission of HIV in Africa.
Coutsoudis, Anna; Kwaan, Leith; Thomson, Mairi
One of the most exciting areas of HIV research is that of prevention of vertical transmission from mother to child, since it accounts for 90% of childhood HIV infections, and therefore prevention in this context has an enormous potential impact on the spread of HIV among children. Focused research has yielded highly successful strategies for reducing infant infection rates, particularly in the developed world, and much work is underway to implement appropriate strategies in resource-limited settings, although this is not without challenges. Although transmission rates in some settings have been reduced to approximately 1%, scale-up and widespread implementation and application of strategic interventions for prevention of mother-to-child transmission of HIV during pregnancy, delivery and breastfeeding are needed in the developing world.
Patricio, Fátima Rejane Lemos; Rutherford, George Williams; Barreto, José Henrique Silva; Rodamilans, Cynthia; Badaró, Roberto
Antiretroviral therapy and prophylaxis during the antepartum, intrapartum and postpartum periods, cesarean delivery and avoidance of breast milk significantly reduce vertical transmission of HIV. To evaluate the effectiveness prevention of mother-to-child transmission of HIV and determine the rate of vertical transmission in a public sexually transmitted infection and HIV referral center in Salvador, Bahia, in the period immediately prior to the initiation of universal antiretroviral therapy in pregnant women. Cross-sectional study using data collected from medical records of children born to HIV infected mothers in Bahia from 2005 to 2008 who were referred to the Reference Center for Diagnosis and Research of Sexually Transmitted Diseases and HIV/AIDS for care. Of 232 HIV-exposed infants, 19 (8.2%) had confirmed HIV infection. One hundred eighty-eight (81%) mothers received antenatal care, 120 (52%) antepartum antiretroviral therapy or prophylaxis, and 168 (72%) intrapartum zidovudine. Two hundred twenty-three (96%) infants received zidovudine. In multivariable models, the combination of intrapartum and postpartum antiretroviral prophylaxis was associated with decreased adjusted odds of mother-to-child transmission. Low levels of antenatal screening and access to prevention of mother-to-child transmission were significant limitations in the cascade of prevention of mother-to-child transmission at our center in this period. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.
Granich, Reuben; Crowley, Siobhan; Vitoria, Marco; Smyth, Caoimhe; Kahn, James G; Bennett, Rod; Lo, Ying-Ru; Souteyrand, Yves; Williams, Brian
An estimated 33 million people are living with HIV and universal access remains a dream for millions of people. By the end of year 2008, four million people were on treatment; however, over five million needed treatment, and in 2007, there were 2.7 million new infections. Without significant improvement in prevention, we are unlikely to meet universal access targets including the growing demand for highly active antiretroviral treatment (HAART). This review examines HAART as a potential tool for preventing HIV transmission. We discuss recent scientific evidence regarding the treatment and prevention gap, importance viral load and HIV transmission, HAART and HIV transmission, when to start, HIV counseling and testing, modeling results and next steps. HAART has considerable treatment and prevention benefits and it needs to be considered as a key element of combination prevention. To explore HAART as an effective prevention strategy, we recommend further evaluation of human rights and ethical considerations, clarification of research priorities and exploration of feasibility and acceptability issues.
one third of live deliveries can be reduced to <2% through antiretroviral prophylaxis. The study was done to determine the effectiveness of prevention of mother to child transmission (PMTCT) of HIV/AIDS in Eritrea where skilled care delivery is less than 30%. Objective: The objective of this study was to assess the use of ...
Prevention of mother-to-child transmission (PMTCT) of HIV programme is aimed at reducing HIV/AIDS in children to its barest minimum. The aim of the present study is to determine the impact of PMTCT programme on HIV exposed infants in the Federal Capital Territory (FCT), Abuja Method: A six month prospective study of ...
Catania, Joseph A.; And Others
Growing number of Acquired Immune Deficiency Syndrome (AIDS) cases among older Americans is of increasing concern. In context of primary prevention, reviews findings that bear on modes of human immunodeficiency virus (HIV) transmission (blood transfusions, sexual) among older individuals and knowledge of magnitude of the AIDS problem represented…
Prevention of mother-to-child transmission of HIV guidelines: Nurses' views at four primary healthcare facilities in the Limpopo Province. ... Conclusion: In spite of the successes of the PMTCT programme, considerable challenges still prevail; lack of patient education, poor facilities management and staff shortages could ...
Lasry, Arielle; Sansom, Stephanie L; Wolitski, Richard J; Green, Timothy A; Borkowf, Craig B; Patel, Pragna; Mermin, Jonathan
The number of strategies to prevent HIV transmission has increased following trials evaluating antiretroviral therapy (ART), preexposure prophylaxis (PrEP) and male circumcision. Serodiscordant couples need guidance on the effects of these strategies alone, and in combination with each other, on HIV transmission. We estimated the sexual risk of HIV transmission over 1-year and 10-year periods among male-male and male-female serodiscordant couples. We assumed the following reductions in transmission: 80% from consistent condom use; 54% from circumcision in the negative male partner of a heterosexual couple; 73% from circumcision in the negative partner of a male-male couple; 71% from PrEP in heterosexual couples; 44% from PrEP in male-male couples; and 96% from ART use by the HIV-infected partner. For couples using any single prevention strategy, a substantial cumulative risk of HIV transmission remained. For a male-female couple using only condoms, estimated risk over 10 years was 11%; for a male-male couple using only condoms, estimated risk was 76%. ART use by the HIV-infected partner was the most effective single strategy in reducing risk; among male-male couples, adding consistent condom use was necessary to keep the 10-year risk below 10%. Focusing on 1-year and longer term transmission probabilities gives couples a better understanding of risk than those illustrated by data for a single sexual act. Long-term transmission probabilities to the negative partner in serodiscordant couples can be high, though these can be substantially reduced with the strategic use of preventive methods, especially those that include ART.
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
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
Haire, Bridget; Kaldor, John
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Frerichs, Leah M; Araz, Ozgur M; Huang, Terry T-K
Research evidence indicates that obesity has spread through social networks, but lever points for interventions based on overlapping networks are not well studied. The objective of our research was to construct and parameterize a system dynamics model of the social transmission of behaviors through adult and youth influence in order to explore hypotheses and identify plausible lever points for future childhood obesity intervention research. Our objectives were: (1) to assess the sensitivity of childhood overweight and obesity prevalence to peer and adult social transmission rates, and (2) to test the effect of combinations of prevention and treatment interventions on the prevalence of childhood overweight and obesity. To address the first objective, we conducted two-way sensitivity analyses of adult-to-child and child-to-child social transmission in relation to childhood overweight and obesity prevalence. For the second objective, alternative combinations of prevention and treatment interventions were tested by varying model parameters of social transmission and weight loss behavior rates. Our results indicated child overweight and obesity prevalence might be slightly more sensitive to the same relative change in the adult-to-child compared to the child-to-child social transmission rate. In our simulations, alternatives with treatment alone, compared to prevention alone, reduced the prevalence of childhood overweight and obesity more after 10 years (1.2-1.8% and 0.2-1.0% greater reduction when targeted at children and adults respectively). Also, as the impact of adult interventions on children was increased, the rank of six alternatives that included adults became better (i.e., resulting in lower 10 year childhood overweight and obesity prevalence) than alternatives that only involved children. The findings imply that social transmission dynamics should be considered when designing both prevention and treatment intervention approaches. Finally, targeting adults may
Leah M Frerichs
Full Text Available Research evidence indicates that obesity has spread through social networks, but lever points for interventions based on overlapping networks are not well studied. The objective of our research was to construct and parameterize a system dynamics model of the social transmission of behaviors through adult and youth influence in order to explore hypotheses and identify plausible lever points for future childhood obesity intervention research. Our objectives were: (1 to assess the sensitivity of childhood overweight and obesity prevalence to peer and adult social transmission rates, and (2 to test the effect of combinations of prevention and treatment interventions on the prevalence of childhood overweight and obesity. To address the first objective, we conducted two-way sensitivity analyses of adult-to-child and child-to-child social transmission in relation to childhood overweight and obesity prevalence. For the second objective, alternative combinations of prevention and treatment interventions were tested by varying model parameters of social transmission and weight loss behavior rates. Our results indicated child overweight and obesity prevalence might be slightly more sensitive to the same relative change in the adult-to-child compared to the child-to-child social transmission rate. In our simulations, alternatives with treatment alone, compared to prevention alone, reduced the prevalence of childhood overweight and obesity more after 10 years (1.2-1.8% and 0.2-1.0% greater reduction when targeted at children and adults respectively. Also, as the impact of adult interventions on children was increased, the rank of six alternatives that included adults became better (i.e., resulting in lower 10 year childhood overweight and obesity prevalence than alternatives that only involved children. The findings imply that social transmission dynamics should be considered when designing both prevention and treatment intervention approaches. Finally
Kuhn, Louise; Sinkala, Moses; Thea, Don M; Kankasa, Chipepo; Aldrovandi, Grace M
Clinical and epidemiologic research has identified increasingly effective interventions to reduce mother to child HIV transmission in resource-limited settings These scientific breakthroughs have been implemented in some programmes, although much remains to be done to improve coverage and quality of these programmes. But prevention of HIV transmission is not enough. It is necessary also to consider ways to improve maternal health and protect child survival.A win-win approach is to ensure that all pregnant and lactating women with CD4 counts of <350 cells/mm3 have access to antiretroviral therapy. On its own, this approach will substantially improve maternal health and markedly reduce mother to child HIV transmission during pregnancy and delivery and through breastfeeding. This approach can be combined with additional interventions for women with higher CD4 counts, either extended prophylaxis to infants or extended regimens of antiretroviral drugs to women, to reduce transmission even further.Attempts to encourage women to abstain from all breastfeeding or to shorten the optimal duration of breastfeeding have led to increases in mortality among both uninfected and infected children. A better approach is to support breastfeeding while strengthening programmes to provide antiretroviral therapy for pregnant and lactating women who need it and offering antiretroviral drug interventions through the duration of breastfeeding. This will lead to reduced HIV transmission and will protect the health of women without compromising the health and well-being of infants and young children.
Paul W Denton
Full Text Available Worldwide, vaginal transmission now accounts for more than half of newly acquired HIV-1 infections. Despite the urgency to develop and implement novel approaches capable of preventing HIV transmission, this process has been hindered by the lack of adequate small animal models for preclinical efficacy and safety testing. Given the importance of this route of transmission, we investigated the susceptibility of humanized mice to intravaginal HIV-1 infection.We show that the female reproductive tract of humanized bone marrow-liver-thymus (BLT mice is reconstituted with human CD4+ T and other relevant human cells, rendering these humanized mice susceptible to intravaginal infection by HIV-1. Effects of HIV-1 infection include CD4+ T cell depletion in gut-associated lymphoid tissue (GALT that closely mimics what is observed in HIV-1-infected humans. We also show that pre-exposure prophylaxis with antiretroviral drugs is a highly effective method for preventing vaginal HIV-1 transmission. Whereas 88% (7/8 of BLT mice inoculated vaginally with HIV-1 became infected, none of the animals (0/5 given pre-exposure prophylaxis of emtricitabine (FTC/tenofovir disoproxil fumarate (TDF showed evidence of infection (Chi square = 7.5, df = 1, p = 0.006.The fact that humanized BLT mice are susceptible to intravaginal infection makes this system an excellent candidate for preclinical evaluation of both microbicides and pre-exposure prophylactic regimens. The utility of humanized mice to study intravaginal HIV-1 transmission is particularly highlighted by the demonstration that pre-exposure prophylaxis can prevent intravaginal HIV-1 transmission in the BLT mouse model.
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.
Garraud, O; Assal, A; Pelletier, B; Danic, B; Kerleguer, A; David, B; Joussemet, M; de Micco, P
Plasmodial transmission by blood donation is rare in non-endemic countries, but a very serious complication of blood transfusion. The French national blood service (Etablissement Français du Sang and Centre de Transfusion sanguine des Armees) intended to revise the measures to strengthen blood safety with regard to Plasmodiae as transmissible pathogens. To limit the risk of transmission during infusion, serious additive measures have been taken for more than a decade in France, which is the European country with the highest rate of exposure to imported plasmodial infections or malaria. These measures were revised and strengthened after the occurrence of a lethal transfusion-transmitted infection in 2002, but did not prevent another occurrence in 2006. This report examines the weaknesses of the systems and aims at emphasizing the safety measures already taken and addresses issues to best respond to that risk.
Seefeld, U; Bansky, G; Jaeger, M; Schmid, M
In a prospective study we examined the efficacy of a standardized disinfection method in preventing the transmission of hepatitis B virus by the gastrointestinal fibrescope. Four HBSAg- and Dane particle-positive patients who have been endoscoped served as possible sources of hepatitis B virus infection. We cleaned the instrument with a 10% aldehyde liquid and used it immediately thereafter in 10 HBSAg-negative patients. Eight of them were followed-up for 7 months after the endoscopic procedure. None of them showed serological evidence of an endoscopically transmitted hepatitis B virus infection. It is concluded that disinfection with an aldehyde liquid is effective in preventing the transmission of hepatitis B virus by the fibrescope.
Full Text Available Abstract With the continuing march of the AIDS epidemic and little hope for an effective vaccine in the near future, work to develop a topical strategy to prevent HIV infection is increasingly important. This stated, the track record of large scale "microbicide" trials has been disappointing with nonspecific inhibitors either failing to protect women from infection or even increasing HIV acquisition. Newer strategies that target directly the elements needed for viral entry into cells have shown promise in non-human primate models of HIV transmission and as these agents have not yet been broadly introduced in regions of highest HIV prevalence, they are particularly attractive for prophylaxis. We review here the agents that can block HIV cellular entry and that show promise as topical strategies or "virustats" to prevent mucosal transmission of HIV infection
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.
Kilembe, William; Wall, Kristin M.; Mokgoro, Mammekwa; Mwaanga, Annie; Dissen, Elisabeth; Kamusoko, Miriam; Phiri, Hilda; Sakulanda, Jean; Davitte, Jonathan; Reddy, Tarylee; Brockman, Mark; Ndung’u, Thumbi; Allen, Susan
Objective 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. Design Pre- and post-CVCT knowledge surveys were administered to a selection of individuals seeking CVCT services. Methods Changes in knowledge scores were assessed with McNemar Chi-square tests for balanced data and generalized estimating equation methods for unbalanced data. Results 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). Conclusions 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. PMID:25894583
Full Text Available Behailu Merdekios1, Adebola A Adedimeji2 1College of Medicine and Health Sciences, Arba Minch University, Ethiopia; 2Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, New York, USA Background: In Ethiopia, Progress in Reducing Mother-to-Child-Transmission (PMTCT of human immunodeficiency virus (HIV is being curtailed by behavioral and cultural factors that continue to put unborn children at risk, and mother-to-child transmission is responsible for more than 90% of HIV infection in children. The objective of this study was to assess PMTCT services by examining knowledge about reducing vertical transmission among pregnant women. Methods: A multistaged sampling institution-based survey was conducted in 113 pregnant women in Arba Minch. Qualitative and quantitative data were obtained. Results: Of the 113 respondents, 89.4% were from Arba Minch, 43.4% were at least 25 years of age, 73.4% had formal education at primary level or above, 100% reported acceptance of voluntary counseling and testing, 92.0% were knowledgeable about mother-to-child transmission, and 90.3% were aware of the availability of the PMTCT service in the health facility. Of 74 HIV-positive women in PMTCT, only three (4.1% had had skilled birth attendants at delivery. There was an unacceptable degree of loss of women from PMTCT. Maternal educational level had a statistical association with income (P < 0.001 and voluntary counseling and testing for pregnant women (P < 0.05. Factors that determined use of PMTCT included culture, socioeconomic status, and fear of stigma and discrimination. Conclusion: In the area studied, intervention to reduce mother-to-child transmission of HIV is failing to reach its goal. This is an alarming discovery requiring quick reconsideration and strengthening of preventive strategies at all levels. Keywords: human immunodeficiency virus, mother-to-child transmission, pregnant women, Ethiopia
Burgess, Colleen; Peace, Angela; Everett, Rebecca; Allegri, Buena; Garman, Patrick
Military personnel are deployed abroad for missions ranging from humanitarian relief efforts to combat actions; delay or interruption in these activities due to disease transmission can cause operational disruptions, significant economic loss, and stressed or exceeded military medical resources. Deployed troops function in environments favorable to the rapid and efficient transmission of many viruses particularly when levels of protection are suboptimal. When immunity among deployed military populations is low, the risk of vaccine-preventable disease outbreaks increases, impacting troop readiness and achievement of mission objectives. However, targeted vaccination and the optimization of preexisting immunity among deployed populations can decrease the threat of outbreaks among deployed troops. Here we describe methods for the computational modeling of disease transmission to explore how preexisting immunity compares with vaccination at the time of deployment as a means of preventing outbreaks and protecting troops and mission objectives during extended military deployment actions. These methods are illustrated with five modeling case studies for separate diseases common in many parts of the world, to show different approaches required in varying epidemiological settings.
Full Text Available Military personnel are deployed abroad for missions ranging from humanitarian relief efforts to combat actions; delay or interruption in these activities due to disease transmission can cause operational disruptions, significant economic loss, and stressed or exceeded military medical resources. Deployed troops function in environments favorable to the rapid and efficient transmission of many viruses particularly when levels of protection are suboptimal. When immunity among deployed military populations is low, the risk of vaccine-preventable disease outbreaks increases, impacting troop readiness and achievement of mission objectives. However, targeted vaccination and the optimization of preexisting immunity among deployed populations can decrease the threat of outbreaks among deployed troops. Here we describe methods for the computational modeling of disease transmission to explore how preexisting immunity compares with vaccination at the time of deployment as a means of preventing outbreaks and protecting troops and mission objectives during extended military deployment actions. These methods are illustrated with five modeling case studies for separate diseases common in many parts of the world, to show different approaches required in varying epidemiological settings.
This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy. PMID:27081586
Nyondo, Alinane Linda; Chimwaza, Angela Faith; Muula, Adamson Sinjani
Background Male Involvement (MI) in the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services is essential in a patriarchal society where men are decision makers of the household. Male partners have a role in the woman’s risk of acquiring HIV, uptake of HIV testing and participation in Mother to Child Transmission (MTCT) prevention programmes. Although MI is important for uptake of PMTCT interventions, it remains low in Africa. The purpose of this s...
Ndyomugyenyi, Richard; Clarke, Siân E; Hutchison, Coll L.
-randomised placebo-controlled trial involving 5775 women of all parities examined the effect of IPTp, ITNs alone, or ITNs used in combination with IPTp on maternal anaemia and low birth weight (LBW) in a highland area of southwestern Uganda. The overall prevalence of malaria infection, maternal anaemia and LBW...... services was observed. With ITNs offering a number of advantages over IPTp, yet showing comparable efficacy, we discuss why ITNs could be an appropriate preventive strategy for malaria control during pregnancy in areas of low and unstable transmission....
Nacro, Boubacar; Barro, Makoura; Gaudreault, Suzanne; Dao, Blami
A survey of the knowledge of women about HIV and breastfeeding. The study employed a voluntary questionnaire. Data were analyzed using Epi info 6 with chi(2) test and P wet nurse. Two hundred and eighty (69.8%) would accept to serve as the wet nurse for an infant born to an HIV-infected woman. There was an association between acceptance of HIV screening and willingness to breastfeed (P = 0.00206529). Appropriate Prevention of Mother-To-Child Transmission (PMTCT) measures must be made available to HIV-infected women. Detailed studies must be performed to evaluate the feasibility of this approach in resource limited settings.
There are currently several ongoing or planned trials evaluating the efficacy of pre-exposure prophylaxis (PrEP) as a preventative approach to reducing the transmission of HIV. PrEP may prove ineffective, demonstrate partial efficacy, or show high efficacy and have the potential to reduce HIV infection in a significant way. However, in addition to the trial results, it is important that issues related to delivery, implementation and further research are also discussed. As a part of the ongoing discussion, in June 2009, the Bill & Melinda Gates Foundation sponsored a Planning for PrEP conference with stakeholders to review expected trial results, outline responsible educational approaches, and develop potential delivery and implementation strategies. The conference reinforced the need for continued and sustained dialogue to identify where PrEP implementation may fit best within an integrated HIV prevention package. This paper identifies the key action points that emerged from the Planning for PrEP meeting. PMID:20624303
Wells, Jennifer; Clark, Khaya; Sarno, Karen
The efficacy of a computer-based interactive multimedia HIV/AIDS prevention program for men with intellectual disability (ID) was examined using a quasi-experimental within-subjects design. Thirty-seven men with mild to moderate intellectual disability evaluated the program. The pretest and posttest instruments assessed HIV/AIDS knowledge (high-risk fluids, HIV transmission, and condom facts) and condom application skills. All outcome measures showed statistically significant gains from pretest to posttest, with medium to large effect sizes. In addition, a second study was conducted with twelve service providers who work with men with ID. Service providers reviewed the HIV/AIDS prevention program, completed a demographics questionnaire, and a program satisfaction survey. Overall, service providers rated the program highly on several outcome measures (stimulation, relevance, and usability).
Reitzel, Ruth; Rosenblatt, Joel; Jiang, Ying; Hachem, Ray; Raad, Issam
Transmission of organisms by contact of gloves with surfaces following contact with a pathogen source has been recognized as an important vector for pathogenesis of health care-associated infections. In these cases, the gloves protect the wearer from contact with the pathogenic organisms; however, this personal protection can facilitate the wearer unwittingly becoming a carrier of the pathogens from one location to another. A novel gendine (combination of chlorhexidine and gentian violet) antiseptic coating for the external surface of the glove was developed as a potential intervention to prevent this mode of transmission. We characterized the ability of the coating to rapidly kill bacterial and fungal pathogens within 1 minute of contact with the glove surface. The International Organization of Standardization 22196 concentrated inoculum contact testing methodology was followed. The gendine-coated gloves were able to fully eradicate multidrug-resistant organisms included methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterocci, multidrug-resistant Pseudomonas aeruginosa, and Klebsiella pneumoniae carbapenemase producing. In addition, Candida albicans, Candida glabarata, and 2 pathogenic Escherichia coli strains commonly associated with invasive gastroenteritis were also fully eradicated within 1 minute of contact. The gendine coating did not adversely impact the finish or integrity of the disposable gloves. The highly efficacious gendine-coated antimicrobial gloves potentially provide an additional means of protection against horizontal transmission of common pathogens in a hospital setting. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
Full Text Available Background: On February 1st 2016 the WHO declared the Zika Virus (ZIKV infection a worldwide public health emergency because of its rapid expansion and severe complications, such as Guillain-Barré Syndrome or microcephaly in newborn. The huge amount of people traveling to endemic areas and the presence of Aedes albopictus in Barcelona increase the risk of autochtonous transmission. The objective of this study was to describe the first ZIKV cases diagnosed in our city and to analyze the surveillance, prevention, and control measures implemented to avoid autochthonous transmission.Methods: An observational cross-sectional population-based study in Barcelona, Spain was performed.An analysis of the socio-demographic, epidemiological, clinical characteristics, and mosquito control activities of the ZIKV cases detected between January 1st and December 2016 was carried out using a specific ZIKV epidemiological survey of the Barcelona Public Health Agency.Results: A total of 118 notifications of possible ZIKV infections were received, and 44 corresponded to confirmed cases in Barcelona residents.Amongst these, the median age was 35 years and 57% were women. All cases were imported, 48% were Spanish-born and 52% foreign-born. Dominican Republic was the most visited country amongst foreign-born patients and Nicaragua amongst Spanish-born. The most frequent symptoms were exanthema, fever, and arthralgia. Among the 24 diagnosed women, 6 (25% were pregnant. There was one case of microcephaly outside Barcelona city. Entomological inspections were done at the homes of 19 cases (43.2% of the total and in 34 (77.3% public spaces. Vector activity was found in one case of the 44 confirmed cases, and 134 surveillance and vector control were carried out associated to imported ZIKV cases. In all cases prevention measures were recommended to avoid mosquito bites on infected cases.Conclusion: Epidemiological and entomological surveillance are essential for the
Cohen, Myron S; Gay, Cynthia; Kashuba, Angela D M; Blower, Sally; Paxton, Lynn
Antiretroviral therapy (ART) has prolonged and improved the lives of persons infected with HIV. Theoretically, it can also be used to prevent the transmission of HIV. The pharmacology of ART in the male and female genital tract can be expected to affect the success of the intervention, and ART agents differ considerably in their ability to concentrate in genital tract secretions. Emergency ART is considered to be the standard of care after occupational exposures to fluids or tissues infected with HIV. More recently, ART for prophylaxis after nonoccupational HIV exposures has been widely used and most countries have developed specific guidelines for its implementation. However, developing clinical trials to prove the efficacy of ART postexposure prophylaxis has not been possible. Experiments with rhesus macaques suggest that therapy must be offered as soon as possible after exposure (within 72 hours) and must be continued for 28 days. Additional nonhuman primate experiments have demonstrated protection from HIV infection with ART preexposure prophylaxis, and several clinical trials are under way to evaluate the safety and efficacy of this approach. The degree to which ART offered to infected persons reduces infectiousness is of considerable public health importance, but the question has not been sufficiently answered. This article provides a review of the data on the use of ART to prevent the sexual transmission of HIV and identify challenges to improving and clarifying this approach.
Full Text Available Abstract Background To assess the economic aspects of HBV (hepatitis B virus transmission prevention for premarriage individuals in a country with cultural backgrounds like Iran and intermediate endemicity of HBV infection. Methods A cost-effectiveness analysis model was used from the health care system and society perspectives. The effectiveness was defined as the number of chronic HBV infections averted owing to one of the following strategies: 1 HBsAg screening to find those would-be couples one of whom is HBsAg positive and putting seronegative subjects on a protection protocol comprising HBV vaccination, single dose HBIG and condom protection. 2 HBsAg screening as above, in addition to performing HBcAb screening in the HBsAg negative spouses of the HBsAg positive persons and giving the protocol only to HBcAb negative ones. Sensitivity and threshold analyses were conducted. Results The cost of each chronic infection averted was 202$ and 197$ for the strategies 1 and 2, respectively. Sensitivity analysis showed that strategy 2 was always slightly cheaper than strategy 1. The discounted threshold value for the lifetime costs of chronic liver disease, above which the model was cost saving was 2818$ in strategy 1 and 2747$ in strategy 2. Conclusions Though premarriage prevention of HBV transmission in the countries with cultural backgrounds similar to Iran seems cost saving, further studies determining precise costs of HBV infection in Iran can lead to a better analysis.
Deniaud, F; Melman, C
Over the past few years in France, the incidence of human immunodeficiency virus (HIV) has not decreased. Among the most frequent sexually transmissible diseases (STD) in France (condyloma, genitoanal herpes, chlamydia infections), certain STD, considered as negligible, have reappeared: gonorrhoea and syphilis affect male homosexuals and, to a lesser degree, men and women whose epidemiological profile remains to be determined. The health organization is not in favour of associating STD with HIV in its anti-aids strategy. However, acute STD are not only indicator of habits at risk for HIV, but are also potent co-factors of its sexual transmission. Fighting against HIV without creating a dialogue on STD is a waste of time and efficiency. From our experience with the STD, anonymous and free screening and the inter-disciplinary health education centres, we recommend the following: improved screening for HIV and other STD: concomitantly whenever possible, less invasive, free or reimbursed STD sampling, reliable and standardized techniques (polymerisation chain reaction or PCR and derivatives), itinerant screening for STD for persons who do not consult; ensured early, medical, social and psychological care of HIV and STD, emphasising the importance of compliance to treatment and prevention; ensured easy access and low cost of the male and female condoms; renewal and diversification of health relays, particularly in the private sector; staff training on STD and their epidemiological novelty; insisting on a transversal (HIV-other STD, curative-preventive, among others) and pragmatic approach (intervention studies resulting in local action); renewal of the information and advice for the public: information on the relationship between HIV and other STD, on the frequent STD that are lesser known, such as condyloma and chlamydia infections, emphasis on compliance to prevention measures (abstinence or use of condoms) during at least three months after a risk of HIV
A. V. Chechetkin
Full Text Available The aim of organizational aspects of preventing the transmission of hepatitis C virus with donor blood and its components.Materials and methods. An activity of the blood service establishments in Russia for the prevention of HCV infection through transfusion of blood and its components on the basis of the analysis of sectoral statistical surveys was studied.Results. The frequency of detection of antibodies to hepatitis C virus in blood donors and its components during 2009–2013 decreased by more than 1,5 times. The percentage of donors who have identified markers of hepatitis C virus was significantly different in different regions: from 0,51% to 1,36%. The activity of the blood service implemented method of plasma quarantine resulting annually rejected from 0,32% to 0,23% as a result of the identified markers of HCV. Pathogen inactivated plasma volume increased in 3 times, the platelet concentrate in 3,2 times.Conclusion. To ensure the safety of donated blood and its components in the blood service effectively the modern technology use for to prevention transmission of the HCV: quarantine of plasma, donor selection and development, inactivation of pathogens. The degree of implementation in practice of nonpaid voluntary blood transfusions significantly increased and is characterized by regional features in recent years .
Hartley, Oliver; Martins, Elsa; Scurci, Ilaria
Of the two million people estimated to be newly infected with human immunodeficiency virus (HIV) every year, 95% live in poorer regions of the world where effective HIV treatment is not universally available. Strategies to reduce the spread of HIV infection, which predominantly occurs via sexual contact, are urgently required. In the absence of an effective vaccine, a number of approaches to prevent HIV infection have been developed. These include using potent anti-HIV drugs prophylactically, either through systemic administration or topical application to the mucosal tissues that HIV initially encounters during sexual transmission. Genetic deficiency of the chemokine receptor CCR5 provides individuals with a remarkable degree of protection from HIV acquisition. This is because CCR5 is the major coreceptor used by HIV to infect new target cells. Since CCR5 deficiency does not appear to carry any health disadvantages, targeting the receptor is a promising strategy for both therapy and prevention of HIV. In this review we first describe the advantages and limitations of the currently available strategies for HIV prevention, then we focus on strategies targeting CCR5, covering the progress that has been made in developing different classes of CCR5 inhibitors for prophylaxis, and the perspectives for their future development as new weapons in the global fight against HIV/AIDS.
Castetbon, K; Leroy, V; Spira, R; Dabis, F
African women of childbearing age are particularly vulnerable to HIV infection, and this has led to an increase in the number of pediatric HIV infections reported due to the risk of mother-to-child transmission (MTCT) of HIV during pregnancy, delivery and breastfeeding. Various approaches to preventing MTCT have been, or are being, evaluated in developing countries, especially in Africa. New data from these trials are becoming available and have implications for population-based intervention programs that require urgent consideration. We performed a critical review of 18 randomized trials and other relevant studies from developing and industrialized countries, to assess public health perspectives and to identify new research issues. Most African results relate to trials of antiretroviral drugs (ARVs) given to mothers during the last month of pregnancy, and for up to one week after delivery, and to the neonate during the first week of life, or simpler and shorter regimens. They indicate that zidovudine treatment, with or without lamivudine, and nevirapine treatment given alone, reduce transmission during the first six months of life by 30 % to 50%. Preliminary results suggest that zidovudine treatment is effective in the long term. One randomized study showed that the replacement of breast feeding with breast milk substitutes was effective at reducing the overall risk of MTCT. Antiseptic disinfection and micronutrient supplementation have been shown to reduce maternal and infant mortality and morbidity, but not the MTCT of HIV. Voluntary, confidential HIV counseling and testing for pregnant women, a short course of peripartum ARVs and alternatives to breast feeding such as early weaning and breast milk substitutes from birth, are currently the best means of reducing the MTCT of HIV in Africa. Pilot programs based on these findings are currently being implemented in several African countries. Prevention of the MTCT of HIV should also be considered as part of the
Badiaga, Sékéné; Raoult, Didier; Brouqui, Philippe
Homelessness is an increasing public health problem. Because of poor living conditions and limited access to healthcare systems, homeless persons are exposed to many communicable infections. We summarize the intervention measures reported to be efficient for the control and the prevention of common transmissible infections among homeless populations. Evidence suggests that appropriate street- or shelter-based interventions for targeted populations are the most efficient methods. Depending on the populations targeted, these interventions may include education, free condom distribution, syringe and needle prescription programs, chest radiography screening for tuberculosis, directly observed therapy for tuberculosis treatment, improvement of personal clothing and bedding hygiene, and widespread use of ivermectin for scabies and body louse infestation. Systematic vaccination against hepatitis B virus, hepatitis A virus, influenza, Streptococcus pneumoniae, and diphtheria is strongly recommended. National public health programs specific to homeless populations are required.
Tshitenge, Stephane; Citeya, Andre; Ganiyu, Adewale
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. This audit aimed to identify gaps between the current PMTCT clinical practice in Xhosa clinic and the Botswana PMTCT national guidelines. This audit took place in Xhosa clinic in the urban village of Mahalapye, in the Central District of Botswana. This was a retrospective audit using PMTCT Xhosa clinic records of pregnant mothers and HIV-exposed babies seen from January 2013 to June 2013. 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. 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.
Perez, Freddy; Orne-Gliemann, Joanna; Mukotekwa, Tarisai; Miller, Anna; Glenshaw, Monica; Mahomva, Agnes; Dabis, François
Zimbabwe has one of the highest rates of HIV seroprevalence in the world. In 2001 only 4% of women and children in need of services for prevention of mother to child transmission of HIV were receiving them. Pilot implementation of the first programme for prevention of mother to child transmission of HIV in rural Zimbabwe. 120 bed district hospital in Buhera district (285,000 inhabitants), Manicaland, Zimbabwe. Programme uptake indicators monitored for 18 months; impact of policy evaluated by assessing up-scaling of programme. Voluntary counselling and testing services for HIV were provided in the hospital antenatal clinic. Women identified as HIV positive and informed of their serostatus and their newborn were offered a single dose antiretroviral treatment of nevirapine; mother-child pairs were followed up through routine health services. Nursing staff and social workers were trained, and community mobilisation was conducted. No services for prevention of mother to child transmission of HIV were available at baseline. Within 18 months, 2298 pregnant women had received pretest counselling, and the acceptance of HIV testing reached 93.0%. Of all 2137 women who had an HIV test, 1588 (74.3%) returned to collect their result; 326 of the 437 HIV positive women diagnosed had post-test counselling, and 104 (24%) mother-child pairs received nevirapine prophylaxis. Minimum staffing, an enhanced training programme, and involvement of district health authorities are needed for the implementation and successful integration of services for prevention of mother to child transmission of HIV. Voluntary counselling and testing services are important entry points for HIV prevention and care and for referral to community networks and medical HIV care services. A district approach is critical to extend programmes for prevention of mother to child transmission of HIV in rural settings. The lessons learnt from this pilot programme have contributed to the design of the national expansion
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
Hill, L L; Hovell, M; Benenson, A S
Hepatitis B is a cause of disability and death worldwide, with high rates of perinatal transmission in third world countries, including those of Indochina. Prevention of transmission by active and passive immunization has been available since 1982. This study looked at the serological response of Indo-Chinese refugees to these products in an outpatient primary care clinic and at the compliance problems found in this setting. The carrier rate of all patients screened was 81/446 (18.5%), with 37/233 (15.8%) of prenatal patients as carriers. Newborns whose mothers were carriers were started on an immunization program. The combination of HBIG and vaccine was more than 90% effective in inducing immunity and preventing the carrier state; only two children of the 26 studied who received both active and passive immunization became carriers. Both failures were in children of HBeAg positive mothers. In contrast, those children exposed who had not received treatment (because of birth prior to 1982) had a 33% carrier rate. This success rate was found despite compliance problems in completing the immunizations on schedule. Only 23% of children received their vaccine within four weeks of the recommended schedule, with a mean delay of 1.3 months. Of the 79 children beginning immunizations, 11 moved before completion. All children remaining in San Diego completed the regimen. Thus, the benefits of giving the passive and active immunization to infants of hepatitis B carriers were clear. However, compliance problems jeopardize the effectiveness of a hepatitis B immunization program in this population.(ABSTRACT TRUNCATED AT 250 WORDS)
Yah, Clarence S
Despite the shift in antiretroviral therapy (ARVs) eligibility cascade from CD4 ≤ 200 to CD4 ≤ 350 to CD4 ≤ 500 mm 3 , HIV related morbidity and mortality continue to escalate annually, as do HIV infections. The new paradigm of treatment for all HIV positives individual irrespective of CD4 count may significantly reduce HIV and related illnesses. The author assumes that all HIV infected partners should be eligible for HIV treatment and care, irrespective of CD4 count. A second assumption is that high risk HIV negative partners have free access to continuum of HIV pre-exposure prophylaxis (PrEP), post exposure prophylaxis (PEP) and other prevention packages. A literature review search was used to extract evidence-based ARVs-HIV treatment and prevention interventions among HIV positives and high risk partners respectively. Only articles published in English and indexed in journal nuclei were used for the study. The information was used to nurture understanding of HIV treatment and prevention approaches as well as HIV incidence multiplier effect among HIV serodiscordant partners. The imputed HIV incident reference was assumed at 1.2 per 100 person-years (2). This was based on the imputation that retention in care, adherence and other predetermined factors are functions of an effective health care delivery system. The model showed a reduced HIV transmission from 1.2 per 100 person-years to 1.032 per 100 person-years in 6 months. The average threshold period of HIV suppressed partners on ARVs to an undetectable level. The combined multiplier protective-effect probability of transmitting HIV from HIV positive partners on ARVs-suppressed viremic load to HIV negative partners on PrEP/PEP-prevention was detected at 86. The model showed a significant reduction in HIV incidence. Placing serodiscordant sexual partners in HIV treatment and prevention plays a significant role in reducing and controlling HIV infection. Therefore, the policy of enrolling all HIV positives
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.
Polo Rodríguez, Rosa; Muñoz Galligo, Eloy; Iribarren, José Antonio; Domingo Pedrol, Pere; Leyes García, María; Maiques Montesinos, Vicente; Miralles Martín, Pilar; Noguera Julian, Antoni; Ocampo Hernández, Antonio; Péres Bares, María Lourdes; López Rojano, Marta; Suy Franch, Anna; Viñuela Beneitez, María Carmen; González Tomé, María Isabel
The main objective in the management of HIV-infected pregnant women is prevention of mother-to-child transmission; therefore, it is essential to provide universal antiretroviral treatment, regardless of CD4 count. All pregnant women must receive adequate information and undergo HIV serology testing at the first visit. We assembled a panel of experts appointed by the Secretariat of the National AIDS Plan (SPNS) and the other participating Scientific Societies, which included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists. Four panel members acted as coordinators. Scientific information was reviewed in publications and conference reports up to November 2012. In keeping with the criteria of the Infectious Diseases Society of America, 2levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C), and the level of empirical evidence (I, II, III). This approach has already been used in previous documents from SPNS. The aim of this paper was to review current scientific knowledge, and, accordingly, develop a set of recommendations regarding antiretroviral therapy (ART), regarding the health of the mother, and from the perspective of minimizing mother-to-child transmission (MTCT), also taking into account the rest of the health care of pregnant women with HIV infection. We also discuss and evaluate other strategies to reduce the MTCT (elective Cesarean, child's treatment…), and different aspects of the topic (ARV regimens, their toxicity, monitoring during pregnancy and postpartum, etc.). Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
Full Text Available HIV/AIDS prevention is very important and absolutely necessary. HIV transmission is now entering a fairly alarming level, in which people with HIV/AIDS in certain subpopulations are emerging. Special steps and resources are thus needed to cope with the condition. There are some phenomena potentially encourage HIV transmissions, such as the increasingly common free sex, homosexuality, the use of unsafe and unsterile syringes in narcotics consumption, commercial sex workers and various high-risk sexual activities. One of the crucial concerns that arises when sending prostitutes back to their hometowns without any coordinated and holistic mechanism is that the prostitutes may cause the spreading of HIV/AIDS in their hometowns. The research objective is to provide the material (input how the prostitutes themselves may cause the spreading of HIV/AIDS. The research employed descriptive method with a qualitative approach. The results showed that the implementation and the role division in the closure have been highly coordinated and holistic. The leading sector in the role division is the Social Welfare epartment of the Government in Surabaya. In terms of health aspects for the former prostitutes sent back to their hometowns, there has been no policies related to medical screening designed to identify the disease early. Screening is very important for early diagnosis during the post-closure phase. The screening mechanism is that the Provincial Health Department has to optimize the monitoring, coordination, cooperation, agreements and partnerships with stakeholders such as the Local Health Department and the National/Provincial/Distric AIDS Commission, NGOs that are concerned with the problems of HIV-AIDS, international organizations, professional organizations, community leaders, religious leaders and universities.
Full Text Available Facemasks and respirators have been stockpiled during pandemic preparedness. However, data on their effectiveness for limiting transmission are scarce. We evaluated the effectiveness of facemask use by index cases for limiting influenza transmission by large droplets produced during coughing in households.A cluster randomized intervention trial was conducted in France during the 2008-2009 influenza season. Households were recruited during a medical visit of a household member with a positive rapid influenza A test and symptoms lasting less than 48 hours. Households were randomized either to the mask or control group for 7 days. In the intervention arm, the index case had to wear a surgical mask from the medical visit and for a period of 5 days. The trial was initially intended to include 372 households but was prematurely interrupted after the inclusion of 105 households (306 contacts following the advice of an independent steering committee. We used generalized estimating equations to test the association between the intervention and the proportion of household contacts who developed an influenza-like illness during the 7 days following the inclusion. Influenza-like illness was reported in 24/148 (16.2% of the contacts in the intervention arm and in 25/158 (15.8% of the contacts in the control arm and the difference between arms was 0.40% (95%CI: -10% to 11%, P = 1.00. We observed a good adherence to the intervention. In various sensitivity analyses, we did not identify any trend in the results suggesting effectiveness of facemasks.This study should be interpreted with caution since the lack of statistical power prevents us to draw formal conclusion regarding effectiveness of facemasks in the context of a seasonal epidemic.clinicaltrials.gov NCT00774774.
Osungbade, Kayode O.; Oladunjoye, Olubunmi O.
Objectives. Review of burden of congenital transmission of malaria, challenges of preventive measures, and implications for health system strengthening in sub-Saharan Africa. Methods. Literature from Pubmed (MEDLINE), Biomed central, Google Scholar, and Cochrane Database were reviewed. Results. The prevalence of congenital malaria in sub-Saharan Africa ranges from 0 to 23%. Diagnosis and existing preventive measures are constantly hindered by weak health systems and sociocultural issues. WHO ...
Peters Ronald J
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
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.
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
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. 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. 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%). 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.
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Bunnell, Rebecca; Ekwaru, John Paul; Solberg, Peter; Wamai, Nafuna; Bikaako-Kajura, Winnie; Were, Willy; Coutinho, Alex; Liechty, Cheryl; Madraa, Elizabeth; Rutherford, George; Mermin, Jonathan
The impact of antiretroviral therapy (ART) on sexual risk behavior and HIV transmission among HIV-infected persons in Africa is unknown. To assess changes in risky sexual behavior and estimated HIV transmission from HIV-infected adults after 6 months of ART. A prospective cohort study was performed in rural Uganda. Between May 2003 and December 2004 a total of 926 HIV-infected adults were enrolled and followed in a home-based ART program that included prevention counselling, voluntary counseling and testing (VCT) for cohabitating partners and condom provision. At baseline and follow-up, participants' HIV plasma viral load and partner-specific sexual behaviors were assessed. Risky sex was defined as inconsistent or no condom use with partners of HIV-negative or unknown serostatus in the previous 3 months. The rates of risky sex were compared using a Poisson regression model and transmission risk per partner was estimated, based on established viral load-specific transmission rates. Six months after initiating ART, risky sexual behavior reduced by 70% [adjusted risk ratio, 0.3; 95% confidence interval (CI), 0.2-0.7; P = 0.0017]. Over 85% of risky sexual acts occurred within married couples. At baseline, median viral load among those reporting risky sex was 122 500 copies/ml, and at follow-up, transmission from cohort members declined by 98%, from 45.7 to 0.9 per 1000 person years. Providing ART, prevention counseling, and partner VCT was associated with reduced sexual risk behavior and estimated risk of HIV transmission among HIV-infected Ugandan adults during the first 6 months of therapy. Integrated ART and prevention programs may reduce HIV transmission in Africa.
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.
Poppe, Lisa K; Chunda-Liyoka, Catherine; Kwon, Eun H; Gondwe, Clement; West, John T; Kankasa, Chipepo; Ndongmo, Clement B; Wood, Charles
The objectives of this study were to determine HIV drug resistance (HIVDR) prevalence in Zambian infants upon diagnosis, and to determine how changing prevention of mother-to-child transmission (PMTCT) drug regimens affect drug resistance. Dried blood spot (DBS) samples from infants in the Lusaka District of Zambia, obtained during routine diagnostic screening, were collected during four different years representing three different PMTCT drug treatment regimens. DNA extracted from dried blood spot samples was used to sequence a 1493 bp region of the reverse transcriptase gene. Sequences were analyzed via the Stanford HIVDRdatabase (http://hivdb.standford.edu) to screen for resistance mutations. HIVDR in infants increased from 21.5 in 2007/2009 to 40.2% in 2014. Nonnucleoside reverse transcriptase inhibitor resistance increased steadily over the sampling period, whereas nucleoside reverse transcriptase inhibitor resistance and dual class resistance both increased more than threefold in 2014. Analysis of drug resistance scores in each group revealed increasing strength of resistance over time. In 2014, children with reported PMTCT exposure, defined as infant prophylaxis and/or maternal treatment, showed a higher prevalence and strength of resistance compared to those with no reported exposure. HIVDR is on the rise in Zambia and presents a serious problem for the successful lifelong treatment of HIV-infected children. PMTCT affects both the prevalence and strength of resistance and further research is needed to determine how to mitigate its role leading to resistance.
Maritz, Jean; Maharaj, Jayshree Narvin; Cotton, Mark Frederic; Preiser, Wolfgang
Suppression of HIV by antiretroviral drugs may be one of the reasons that indeterminate HIV-1 PCR results are obtained from testing HIV-exposed infants. This complicates the early identification of infected infants, potentially delaying initiating treatment early. There is uncertainty as to how different vertical HIV transmission prevention regimens (VTP) affect the rate and predictive value of indeterminate PCR results. To investigate rates of indeterminate PCR results, outcomes of subsequent samples and the predictive value of an indeterminate PCR for a later positive result in the setting of intensifying VTP in the Western Cape province of South Africa. Retrospective laboratory data analysis. Diagnostic PCR data of a public health laboratory from June 2009 to October 2014 was analysed and categorised by South African VTP regimens. First indeterminate HIV-1 PCRs in patients younger than 12 months were linked with follow-up HIV-1 PCRs and/or serological tests. Linked results sets were analysed by PCR amplification characteristics and subsequent patient outcome. Over intensified VTP regimens, the rate of indeterminate and positive PCRs decreased significantly (5.6-3.2% and 2.4-0.4%, respectively; both pHIV PCRs, although decreasing in frequency with Option B+, should be regarded with a high index of suspicion for being representative of true HIV-1 infections. Additional virological testing is required to arrive at a definitive diagnosis. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available C-type lectins are a family of proteins with carbohydrate-binding activity. Several C-type lectins in mammals or arthropods are employed as receptors or attachment factors to facilitate flavivirus invasion. We previously identified a C-type lectin in Aedes aegypti, designated as mosquito galactose specific C-type lectin-1 (mosGCTL-1, facilitating the attachment of West Nile virus (WNV on the cell membrane. Here, we first identified that 9 A. aegypti mosGCTL genes were key susceptibility factors facilitating DENV-2 infection, of which mosGCTL-3 exhibited the most significant effect. We found that mosGCTL-3 was induced in mosquito tissues with DENV-2 infection, and that the protein interacted with DENV-2 surface envelop (E protein and virions in vitro and in vivo. In addition, the other identified mosGCTLs interacted with the DENV-2 E protein, indicating that DENV may employ multiple mosGCTLs as ligands to promote the infection of vectors. The vectorial susceptibility factors that facilitate pathogen invasion may potentially be explored as a target to disrupt the acquisition of microbes from the vertebrate host. Indeed, membrane blood feeding of antisera against mosGCTLs dramatically reduced mosquito infective ratio. Hence, the immunization against mosGCTLs is a feasible approach for preventing dengue infection. Our study provides a future avenue for developing a transmission-blocking vaccine that interrupts the life cycle of dengue virus and reduces disease burden.
Liu, Yang; Zhang, Fuchun; Liu, Jianying; Xiao, Xiaoping; Zhang, Siyin; Qin, Chengfeng; Xiang, Ye; Wang, Penghua; Cheng, Gong
C-type lectins are a family of proteins with carbohydrate-binding activity. Several C-type lectins in mammals or arthropods are employed as receptors or attachment factors to facilitate flavivirus invasion. We previously identified a C-type lectin in Aedes aegypti, designated as mosquito galactose specific C-type lectin-1 (mosGCTL-1), facilitating the attachment of West Nile virus (WNV) on the cell membrane. Here, we first identified that 9 A. aegypti mosGCTL genes were key susceptibility factors facilitating DENV-2 infection, of which mosGCTL-3 exhibited the most significant effect. We found that mosGCTL-3 was induced in mosquito tissues with DENV-2 infection, and that the protein interacted with DENV-2 surface envelop (E) protein and virions in vitro and in vivo. In addition, the other identified mosGCTLs interacted with the DENV-2 E protein, indicating that DENV may employ multiple mosGCTLs as ligands to promote the infection of vectors. The vectorial susceptibility factors that facilitate pathogen invasion may potentially be explored as a target to disrupt the acquisition of microbes from the vertebrate host. Indeed, membrane blood feeding of antisera against mosGCTLs dramatically reduced mosquito infective ratio. Hence, the immunization against mosGCTLs is a feasible approach for preventing dengue infection. Our study provides a future avenue for developing a transmission-blocking vaccine that interrupts the life cycle of dengue virus and reduces disease burden. PMID:24550728
Eugene T Richardson
Full Text Available BACKGROUND: Despite an improvement in the overall TB cure rate from 40-74% between 1995 and 2011, TB incidence in South Africa continues to increase. The epidemic is notably disquieting in schools because the vulnerable population is compelled to be present. Older learners (age 15-19 are at particular risk given a smear-positive rate of 427 per 100,000 per year and the significant amount of time they spend indoors. High schools are therefore important locations for potential TB infection and thus prevention efforts. METHODS AND FINDINGS: Using portable carbon dioxide monitors, we measured CO2 in classrooms under non-steady state conditions. The threshold for tuberculosis transmission was estimated using a carbon dioxide-based risk equation. We determined a critical rebreathed fraction of carbon dioxide (ƒ(c of 1 · 6%, which correlates with an indoor CO2 concentration of 1000 ppm. These values correspond with a ventilation rate of 8 · 6 l/s per person or 12 air exchanges per hour (ACH for standard classrooms of 180 m(3. CONCLUSIONS: Given the high smear positive rate of high-school adolescents in South Africa, the proposal to achieve CO2 levels of 1000 ppm through natural ventilation (in the amount 12 ACH will not only help achieve WHO guidelines for providing children with healthy indoor environments, it will also provide a low-cost intervention for helping control the TB epidemic in areas of high prevalence.
Bagny, A; Bathaix Yao, F; Bangoura, D; Kouame, D H; Kacou Ya Kissi-Anzouan, H; De, O; Diallo, K; Lawson-Ananisoh, L M; Mahassadi, K A; Attia Koffi, A; Ndri-Yoman, T
Prevention of mother-to-child transmission of hepatitis B virus (HBV) assumes and requires good practices by midwives. The objective of this study was to evaluate their practices for this prevention. This prospective, descriptive study in Abidjan took place from January 2 to May 31, 2014 and included the midwives in Abidjan (recruited from university hospitals, general hospitals, and peripheral health care facilities) at the time of the survey who agreed to complete this written survey. Univariate analyses were done with Pearson Chi 2 tests or Fisher's test, as appropriate, Ppractices, including HBsAg testing (P = 0.023) and immunization of the newborn at birth (P = 0.005). Midwives' practices for the prevention of mother-to-child transmission of HBV in Abidjan are improving.
J Gerardo García-Lerma
Full Text Available In the absence of an effective vaccine, HIV continues to spread globally, emphasizing the need for novel strategies to limit its transmission. Pre-exposure prophylaxis (PrEP with antiretroviral drugs could prove to be an effective intervention strategy if highly efficacious and cost-effective PrEP modalities are identified. We evaluated daily and intermittent PrEP regimens of increasing antiviral activity in a macaque model that closely resembles human transmission.We used a repeat-exposure macaque model with 14 weekly rectal virus challenges. Three drug treatments were given once daily, each to a different group of six rhesus macaques. Group 1 was treated subcutaneously with a human-equivalent dose of emtricitabine (FTC, group 2 received orally the human-equivalent dosing of both FTC and tenofovir-disoproxil fumarate (TDF, and group 3 received subcutaneously a similar dosing of FTC and a higher dose of tenofovir. A fourth group of six rhesus macaques (group 4 received intermittently a PrEP regimen similar to group 3 only 2 h before and 24 h after each weekly virus challenge. Results were compared to 18 control macaques that did not receive any drug treatment. The risk of infection in macaques treated in groups 1 and 2 was 3.8- and 7.8-fold lower than in untreated macaques (p = 0.02 and p = 0.008, respectively. All six macaques in group 3 were protected. Breakthrough infections had blunted acute viremias; drug resistance was seen in two of six animals. All six animals in group 4 that received intermittent PrEP were protected.This model suggests that single drugs for daily PrEP can be protective but a combination of antiretroviral drugs may be required to increase the level of protection. Short but potent intermittent PrEP can provide protection comparable to that of daily PrEP in this SHIV/macaque model. These findings support PrEP trials for HIV prevention in humans and identify promising PrEP modalities.
Full Text Available BACKGROUND: Uganda has one of the highest total fertility rates (TFR worldwide. We compared the effects of antiretroviral (ARV prophylaxis for the prevention of mother-to-child HIV transmission (PMTCT to that of existing family planning (FP use and estimated the burden of pediatric HIV disease due to unwanted fertility. METHODOLOGY/PRINCIPAL FINDINGS: Using the demographic software Spectrum, a baseline mathematical projection to estimate the current pediatric HIV burden in Uganda was compared to three hypothetical projections: 1 without ARV-PMTCT (to estimate the effect of ARV-PMTCT, 2 without contraception (effect of existing FP use, 3 without unwanted fertility (effect of unmet FP needs. Key input parameters included HIV prevalence, ARV-PMTCT uptake, MTCT probabilities, and TFR. We estimate that in 2007, an estimated 25,000 vertical infections and 17,000 pediatric AIDS deaths occurred (baseline projection. Existing ARV-PMTCT likely averted 8.1% of infections and 8.5% of deaths. FP use likely averted 19.7% of infections and 13.1% of deaths. Unwanted fertility accounted for 21.3% of infections and 13.4% of deaths. During 2008-2012, an estimated 131,000 vertical infections and 71,000 pediatric AIDS deaths will occur. The projected scale up of ARV-PMTCT (from 39%-57% may avert 18.1% of infections and 24.5% of deaths. Projected FP use may avert 21.6% of infections and 18.5% of deaths. Unwanted fertility will account for 24.5% of infections and 19.8% of deaths. CONCLUSIONS: Existing FP use contributes as much or more than ARV-PMTCT in mitigating pediatric HIV in Uganda. Expanding FP services can substantially contribute towards PMTCT.
Catherine H. Thurling
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.
Roghmann, Mary-Claire; Lydecker, Alison; Mody, Lona; Mullins, C Daniel; Onukwugha, Eberechukwu
OBJECTIVE To estimate the costs of 3 MRSA transmission prevention scenarios compared with standard precautions in community-based nursing homes. DESIGN Cost analysis of data collected from a prospective, observational study. SETTING AND PARTICIPANTS Care activity data from 401 residents from 13 nursing homes in 2 states. METHODS Cost components included the quantities of gowns and gloves, time to don and doff gown and gloves, and unit costs. Unit costs were combined with information regarding the type and frequency of care provided over a 28-day observation period. For each scenario, the estimated costs associated with each type of care were summed across all residents to calculate an average cost and standard deviation for the full sample and for subgroups. RESULTS The average cost for standard precautions was $100 (standard deviation [SD], $77) per resident over a 28-day period. If gown and glove use for high-risk care was restricted to those with MRSA colonization or chronic skin breakdown, average costs increased to $137 (SD, $120) and $125 (SD, $109), respectively. If gowns and gloves were used for high-risk care for all residents in addition to standard precautions, the average cost per resident increased substantially to $223 (SD, $127). CONCLUSIONS The use of gowns and gloves for high-risk activities with all residents increased the estimated cost by 123% compared with standard precautions. This increase was ameliorated if specific subsets (eg, those with MRSA colonization or chronic skin breakdown) were targeted for gown and glove use for high-risk activities. Infect Control Hosp Epidemiol 2016;37:962-966.
Cecchini, Diego; Martinez, Marina; Astarita, Viviana; Nieto, Claudia; Giesolauro, Rafael; Rodriguez, Claudia
To describe characteristics of mother-child binomium (MCB), antiretroviral (ARV) prophylaxis, time trends, and variables associated with vertical transmission of HIV-1 in a population assisted by a tertiary public hospital in Argentina. Prospective descriptive study undertaken by the Hospital Cosme Argerich s Vertical Transmission Working Group, Buenos Aires city, Argentina 1998-2008. Periods 1998-2003 vs. 2004-2008 were compared and variables associated with vertical transmission identified. Of 357 MCB, 21.0% of the mothers had HCV coinfection and 68.0% CD4 vertical transmission was 3.3% (10/302). Comparing both periods, an increase in triple ARV and VL vertical transmission for 2004-2008 was 1.3% vs. 6.3% in Buenos Aires city (official statistics). Absence of maternal/intrapartum prophylaxis and prematurity were associated with vertical transmission (P vertical transmission between the two periods was observed attributable to increased coverage of maternal/neonatal ARV administration and increased use of triple therapy. The absence of maternal/intrapartum prophylaxis was the main factor associated with vertical transmission, emphasizing the need to improve accessibility of MCB to the local public health system.
Haas, Andreas D; van Oosterhout, Joep J; Tenthani, Lyson; Jahn, Andreas; Zwahlen, Marcel; Msukwa, Malango T; Davies, Mary-Ann; Tal, Kali; Phiri, Nozgechi; Spoerri, Adrian; Chimbwandira, Frank; Egger, Matthias; Keiser, Olivia
In Malawi, HIV-infected pregnant and breastfeeding women are offered lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage (Option B+). Their HIV-exposed children are enrolled in the national prevention of mother-to-child transmission (PMTCT) programme, but many are lost to follow-up. We estimated the cumulative incidence of vertical HIV transmission, taking loss to follow-up into account. We abstracted data from HIV-exposed children enrolled into care between September 2011 and June 2014 from patient records at 21 health facilities in central and southern Malawi. We used competing risk models to estimate the probability of loss to follow-up, death, ART initiation and discharge, and used pooled logistic regression and inverse probability of censoring weighting to estimate the vertical HIV transmission risk. A total of 11,285 children were included; 9285 (82%) were born to women who initiated ART during pregnancy. At age 30 months, an estimated 57.9% (95% CI 56.6-59.2) of children were lost to follow-up, 0.8% (0.6-1.0) had died, 2.6% (2.3-3.0) initiated ART, 36.5% (35.2-37.9) were discharged HIV-negative and 2.2% (1.5-2.8) continued follow-up. We estimated that 5.3% (95% CI 4.7-5.9) of the children who enrolled were HIV-infected by the age of 30 months, but only about half of these children (2.6%; 95% CI 2.3-2.9) were diagnosed. Confirmed mother-to-child transmission rates were low, but due to poor retention only about half of HIV-infected children were diagnosed. Tracing of children lost to follow-up and HIV testing in outpatient clinics should be scaled up to ensure that all HIV-positive children have access to early ART.
Full Text Available Abstract Background Intrauterine infection is the main contributor to maternal-infantile transmission of HBV. This is a retrospective study of 158 HBsAg-positive pregnant women who delivered children from Jan 1st, 2004 to Dec.31th, 2006 in Wuhan City, China. We investigated the measures taken to prevent maternal-infantile transmission of hepatitis B virus and the infection status of children. Methods HBsAg-positive pregnant women were selected by a random sampling method when they accepted prenatal care in district-level Maternal and Child Health Hospitals. On a voluntary basis, these women completed questionnaires by face-to-face or phone interviews. The collected data were used to evaluate the immunization programs that pregnant women had received for preventing hepatitis B maternal-infantile transmission. Results Among the 158 women, 143(90.5% received Hepatitis B immune globulin during pregnancy, and 86.0% of their children were given Hepatitis B immune globulin and Hepatitis B vaccine. The rate of cesarean section was 82.3%, and 28.5% of these were aimed at preventing HBV infection. The rate of bottle feeding was 51.9%, and 89.0% of bottle feeding cases were for the purpose of preventing HBV infection. There were 71 cases of participants who were HBeAg-positive. Compared with the HBsAg+ HBeAg- group (only HBsAg-positive, the HBsAg + HBeAg+ group (HBsAg-positive and HBeAg-positive had significantly higher rates of the caesarean section and bottle feeding resulting from hepatitis B (P Conclusion Most HBsAg positive pregnant women have a growing awareness of maternal-infantile transmission of Hepatitis B virus and are receiving some form of preventative treatment, like combined immunization. Caesarean and bottle feeding are very common, often primarily to prevent transmission. Relatively few intrauterine infections were identified in this sample, but many infants did not appear to seroconvert after vaccination.
Galárraga, Omar; Wirtz, Veronika J.; Figueroa-Lara, Alejandro; Santa-Ana-Tellez, Yared; Coulibaly, Ibrahima; Viisainen, Kirsi; Medina-Lara, Antonieta; Korenromp, Eline L.
Background As antiretroviral treatment (ART) for HIV/AIDS is scaled-up globally, information on per-person costs is critical to improve efficiency in service delivery and maximize coverage and health impact. Objective To review studies on delivery unit costs for adult and pediatric ART provision per-patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in low- and middle-income countries. Methods Systematic review of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analyzed by country income level and cost component. All costs were standardized to 2009 US dollars. Results Analyses covered 29 eligible, comprehensive costing studies. In the base case, in low-income countries (LIC), median, ART cost per patient-year was $792 (mean: $839, range: $682-$1089); for lower-middle-income countries (LMIC), the median was $932 (mean: $1246, range: $156-$3904); and for upper-middle-income countries (UMIC) the median was $1454 (mean: $2783, range: $1230-$5667). ARV drugs were largest component of overall ART cost in all settings (62%, 50% and 47% in LIC, LMIC and UMIC respectively). Out of 26 ART studies, 14 report which drug regimes were used, and only one study explicitly reported second line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 19.5%) whereas it was personnel costs in UMIC (26%). Two studies specified the types of laboratory tests costed, and three studies specifically included above-facility-level personnel costs. Three studies reported detailed PMTCT costs, and two studies reported on pediatric ART. Conclusions There is a paucity of data on the full ART and PMTCT delivery unit costs, in particular for low-and middle-income countries. Heterogeneity in activities costed and insufficient detail regarding
Full Text Available Abstract Background Internationally, guidelines to prevent secondary transmission of Shigella infection vary widely. Cases, their contacts with diarrhoea, and those in certain occupational groups are frequently excluded from work, school, or daycare. In the Netherlands, all contacts attending pre-school (age 0–3 and junior classes in primary school (age 4–5, irrespective of symptoms, are also excluded pending microbiological clearance. We identified risk factors for secondary Shigella infection (SSI within households and evaluated infection control policy in this regard. Methods This retrospective cohort study of households where a laboratory confirmed Shigella case was reported in Amsterdam (2002–2009 included all households at high risk for SSI (i.e. any household member under 16 years. Cases were classified as primary, co-primary or SSIs. Using univariable and multivariable binomial regression with clustered robust standard errors to account for household clustering, we examined case and contact factors (Shigella serotype, ethnicity, age, sex, household size, symptoms associated with SSI in contacts within households. Results SSI occurred in 25/ 337 contacts (7.4%: 20% were asymptomatic, 68% were female, and median age was 14 years (IQR: 4–38. In a multivariable model adjusted for case and household factors, only diarrhoea in contacts was associated with SSI (IRR 8.0, 95% CI:2.7-23.8. In a second model, factors predictive of SSI in contacts were the age of case (0–3 years (IRRcase≥6 years:2.5, 95% CI:1.1-5.5 and 4–5 years (IRRcase≥6 years:2.2, 95% CI:1.1-4.3 and household size (>6 persons (IRR2-4 persons 3.4, 95% CI:1.2-9.5. Conclusions To identify symptomatic and asymptomatic SSI, faecal screening should be targeted at all household contacts of preschool cases (0–3 years and cases attending junior class in primary school (4–5 years and any household contact with diarrhoea. If screening was limited to these groups, only
The objective of this study was to assess the level of integration of prevention of mother-to-child HIV transmission (PMTCT) in facilities providing services for maternal, newborn, and child health (MNCH) and reproductive health (RH) in Senegal. The survey, conducted from August through November, 2014, comprised five parts : a literature review to assess the place of this integration in the health policies, standards, and protocols in effect in Senegal; an analysis by direct observation of attitudes and practices of 25 healthcare providers at 5 randomly-selected obstetrics and gynecology departments representative of different levels of the health pyramid; a questionnaire evaluating knowledge and attitudes of 10 providers about the integration of PMTCT services into MNCH/RH facilities; interviews to collect the opinions of 70 clients, including 16 HIV-positive, about the quality of PMTCT services they received; and a questionnaire evaluating knowledge and opinions of 14 policy-makers/managers of health programs focusing on mothers and children about this integration. The literature review revealed several constraints impeding this integration : the policy documents, standards, and protocols of each of the programs involved do not clearly indicate the modalities of this integration; the programs are housed in two different divisions while the national Program against the Human Immunodeficiency Virus reports directly to the Prime Minister; program operations remains generally vertical; the resources for the different programs are not sufficiently shared; there is no integrated training module covering integrated management of pregnancy and delivery; and supervision for each of the different programs is organized separately.The observation of the providers supporting women during pregnancy, during childbirth, and in the postpartum period, showed an effort to integrate PMTCT into the MNCH/RH services delivered daily to clients. But this desire is hampered by many
La transmission Mère Enfant du VIH/SIDA est le mode de contamination essentielle des enfants dans les pays en développement. Objectif : Evaluer les résultats de la Prévention de la Transmission Mère-Enfant (PTME) du VIH au CHU-Kara. Méthode: Il s'est agi d'une étude rétrospective descriptive de juillet 2005 à Juin ...
In this thesis a study of the HVDC related phenomenon core saturation instability and methods to prevent this phenomenon is performed. It is reason to believe that this phenomenon caused disconnection of the Skagerrak HVDC link 10 August 1993. Internationally, core saturation instability has been reported at several HVDC schemes and thorough complex studies of the phenomenon has been performed. This thesis gives a detailed description of the phenomenon and suggest some interesting methods to prevent the development of it. Core saturation instability and its consequences can be described in a simplified way as follows: It is now assumed that a fundamental harmonic component is present in the DC side current. Due to the coupling between the AC side and the DC side of the HVDC converter, a subsequent second harmonic positive-sequence current and DC currents will be generated on the AC side. The DC currents will cause saturation in the converter transformers. This will cause the magnetizing current to also have a second harmonic positive-sequence component. If a high second harmonic impedance is seen from the commutation bus, a high positive-sequence second harmonic component will be present in the commutation voltages. This will result in a relatively high fundamental frequency component in the DC side voltage. If the fundamental frequency impedance at the DC side is relatively low the fundamental component in the DC side current may become larger than it originally was. In addition the HVDC control system may contribute to the fundamental frequency component in the DC side voltage, and in this way cause a system even more sensitive to core saturation instability. The large magnetizing currents that eventually will flow on the AC side cause large zero-sequence currents in the neutral conductors of the AC transmission lines connected to the HVDC link. This may result in disconnection of the lines. Alternatively, the harmonics in the large magnetizing currents may cause
Full Text Available Background: Approximately 5% of newborns were infected by hepatitis B virus (HBV via intrauterine transmission, but most of the infants born to HBV-positive mothers are protected from infection. However, the mechanisms by which intrauterine transmission is avoided remain elusive, and the roles of toll-like receptors (TLRs have been proposed. The aims of this study were to clarify if TLR 7 and 8 are involved in the prevention of intrauterine transmission of HBV. Methods: Real time polymerase-chain reaction (PCR was used to determine the expression of TLRs and cytokines in placenta and trophoblasts. The expression of MyD88 was interfered with small interfering RNA (siRNA in trophoblasts. An in intro model mimicking trophoblast barrier was established to evaluate the effect of MyD88 siRNA on HBV transmission across trophoblast barrier. Results: There were significant differences in placental expression of TLR7 (F=3.263, P=0.048 and TLR8 (F=3.257, P=0.048 among control (HBV-negative women, non-infected group (HBV-positive women whose infants were not infected and infected group (HBV-positive women whose infants were infected. The expression of TLR7 was significantly higher in non-infected group than infected group (P=0.039 and control (P=0.043. There was a significant difference in TLR8 expression between non-infected group and control (P=0.014, and the difference was close to but not significant (P=0.074 between non-infected and infected groups. Exposure of trophoblast to HBV significantly induced the expression of TLR7 (PConclusions: TLR7 and TLR8 on trophoblastic cells play an important role in the prevention of intrauterine HBV transmission by inhibiting HBV translocation across trophoblast.
McNairy, Margaret L; Deryabina, Anna; Hoos, David; El-Sadr, Wafaa M
Interest in the use of antiretroviral therapy (ART) for prevention stems from mounting evidence from research studies demonstrating that ART is associated with a decrease in sexual HIV transmission among serodiscordant couples and, perhaps, in other populations at risk. There is paucity of data on the efficacy of ART for prevention in key populations, including persons who inject drugs (PWID). In this paper, we examine the current status of HIV services for PWID in Central Asia, the use of ART by this population and explore ART for prevention for PWID in this context. We also discuss research and implementation questions with relevance to such a strategy in the region. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Enns, Eva Andrea; Kao, Szu-Yu; Kozhimannil, Katy Backes; Kahn, Judith; Farris, Jill; Kulasingam, Shalini L
Mathematical models are important tools for assessing prevention and management strategies for sexually transmitted infections. These models are usually developed for a single infection and require calibration to observed epidemiological trends in the infection of interest. Incorporating other outcomes of sexual behavior into the model, such as pregnancy, may better inform the calibration process. We developed a mathematical model of chlamydia transmission and pregnancy in Minnesota adolescents aged 15 to 19 years. We calibrated the model to statewide rates of reported chlamydia cases alone (chlamydia calibration) and in combination with pregnancy rates (dual calibration). We evaluated the impact of calibrating to different outcomes of sexual behavior on estimated input parameter values, predicted epidemiological outcomes, and predicted impact of chlamydia prevention interventions. The two calibration scenarios produced different estimates of the probability of condom use, the probability of chlamydia transmission per sex act, the proportion of asymptomatic infections, and the screening rate among men. These differences resulted in the dual calibration scenario predicting lower prevalence and incidence of chlamydia compared with calibrating to chlamydia cases alone. When evaluating the impact of a 10% increase in condom use, the dual calibration scenario predicted fewer infections averted over 5 years compared with chlamydia calibration alone [111 (6.8%) vs 158 (8.5%)]. While pregnancy and chlamydia in adolescents are often considered separately, both are outcomes of unprotected sexual activity. Incorporating both as calibration targets in a model of chlamydia transmission resulted in different parameter estimates, potentially impacting the intervention effectiveness predicted by the model.
Kalichman, Seth C
... of New South Wales, Australia Rise Goldstein, Center for HIV Identiﬁcation, Prevention, and Treatment Services, Department of Psychiatry University of California, Los Angeles Lauren K. Gooden,...
Background: The total number of AIDS death since the epidemic started is estimated at 21.8 million worldwide, of which 4.3 million were in children. Most of these children will have acquired their infection as a result of mother to child transmission (MTCT). This is a growing problem because greater than 90% of women who ...
Objective. To determine outcomes of pregnant women and their infants at McCord Hospital in Durban, South Africa, where dual and triple therapy to reduce HIV vertical transmission have been used since 2004 despite national guidelines recommending simpler regimens. Method. We retrospectively examined records of all ...
B. W. Butler; T. Wallace; J. Hogge
Towers and poles supporting power transmission and telecommunication lines have collapsed due to heating from wildland fires. Such occurrences have led to interruptions in power or communication in large municipal areas with associated social and political implications as well as increased immediate danger to humans. Vegetation clearance standards for overhead...
B. W. Butler; J. Webb; J. Hogge; T. Wallace
Towers and poles supporting power transmission and telecommunication lines have collapsed due to heating from wildland fires. Such occurrences have led to interruptions in power or communication in large municipal areas with associated social and political implications as well as increased immediate danger to humans. Unfortunately, no studies address the question of...
Liu, Hongjie; Detels, Roger; Li, Xiaoming; Stanton, Bonita; Hu, Zhi; Yang, Hongmei
Little is known about HIV transmission at the family level in China. : We examined the risks for HIV transmission between husbands and wives and from parents to children in a rural area where HIV spread among former commercial blood donors. A cross-sectional study was conducted among 605 (302 couples) marriage license applicants. More males (64.6%) than females (52.1%) reported having had premarital sex and multiple sex partners (12.6% and 6.9%, respectively). Among those having had multiple sex partners, 8.5% reported often or always using condoms. Only 36.8% of the couples agreed that they would not plan to have a baby after knowing the status of HIV infection. Approximately 43% of the couples agreed that they would use condoms consistently if 1 of them were HIV-positive. There is an urgent need for national programs to prevent HIV infection within couples in rural areas.
Polo Rodríguez, Rosa; Muñoz Galligo, Eloy; Iribarren, José Antonio; Domingo Pedrol, Pere; Leyes García, María; Maiques Montesinos, Vicente; Miralles Martín, Pilar; Noguera Julian, Antoni; Ocampo Hernandez, Antonio; Peres Bares, María Lourdes; López Rojano, Marta; Suy Franch, Anna; Viñuela Beneitez, M Carmen; González Tomé, María Isabel
The main objective in the management of HIV-infected pregnant women is prevention of mother-to-child transmission; therefore, it is essential to provide universal antiretroviral treatment, regardless of CD4 count. All pregnant women must receive adequate information and undergo HIV serology testing at the first visit. If the serological status is unknown at the time of delivery, or in the immediate postpartum, HIV serology testing has to be performed as soon as possible. In this document, recommendations are made regarding the health of the mother and from the perspective of minimizing mother-to-child transmission. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
Kim, Yonghyan; Yang, My; Goyal, Sagar M; Cheeran, Maxim C-J; Torremorell, Montserrat
The effectiveness of biosecurity methods to mitigate the transmission of porcine epidemic diarrhea virus (PEDV) via farm personnel or contaminated fomites is poorly understood. This study was undertaken to evaluate the effectiveness of biosecurity procedures directed at minimizing transmission via personnel following different biosecurity protocols using a controlled experimental setting. PEDV RNA was detected from rectal swabs of experimentally infected (INF) and sentinel pigs by real-time reverse transcription polymerase chain reaction (rRT-PCR). Virus shedding in INF pigs peaked at 1 day post infection (dpi) and viral RNA levels remained elevated through 19 dpi. Sentinel pigs in the low biosecurity group (LB) became PEDV positive after the first movement of study personnel from the INF group. However, rectal swabs from pigs in the medium biosecurity (MB) and high biosecurity (HB) groups were negative during the 10 consecutive days of movements and remained negative through 24 days post movement (dpm) when the first trial was terminated. Viral RNA was detected at 1 dpm through 3 dpm from the personal protective equipment (PPE) of LB personnel. In addition, at 1 dpm, 2 hair/face swabs from MB personnel were positive; however, transmission of virus was not detected. All swabs of fomite from the HB study personnel were negative. These results indicate that indirect PEDV transmission through contaminated PPE occurs rapidly (within 24 h) under modeled conditions. Biosecurity procedures such as changing PPE, washing exposed skin areas, or taking a shower are recommended for pig production systems and appear to be an effective option for lowering the risk of PEDV transmission between groups of pigs.
In resource-rich settings, universal adoption of a 4- rather than 6-week neonatal antiretroviral (ARV) prophylaxis regimen could reduce toxicity and results in cost savings, provided prevention of mother-to-child transmission program effectiveness is not compromised.
Elaine S. Pires Araujo
Conclusions: Access to the full package of interventions for the prevention of HIV vertical transmission was low, with no significant trend of improvement over the years. The vertical transmission rates observed were higher than those found in reference services in the municipality of Rio de Janeiro and in the richest regions of the country.
Hughes, Carmel; Tunney, Michael; Bradley, Marie C
Nursing homes for older people provide an environment likely to promote the acquisition and spread of meticillin-resistant Staphylococcus aureus (MRSA), putting residents at increased risk of colonisation and infection. It is recognised that infection prevention and control strategies are important in preventing and controlling MRSA transmission. To determine the effects of infection prevention and control strategies for preventing the transmission of MRSA in nursing homes for older people. In August 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Database of Abstracts of Reviews of Effects (DARE, The Cochrane Library), Ovid MEDLINE, OVID MEDLINE (In-process and Other Non-Indexed Citations), Ovid EMBASE, EBSCO CINAHL, Web of Science and the Health Technology Assessment (HTA) website. Research in progress was sought through Current Clinical Trials, Gateway to Reseach, and HSRProj (Health Services Research Projects in Progress). All randomised and controlled clinical trials, controlled before and after studies and interrupted time series studies of infection prevention and control interventions in nursing homes for older people were eligible for inclusion. Two review authors independently reviewed the results of the searches. Another review author appraised identified papers and undertook data extraction which was checked by a second review author. For this third update only one study was identified, therefore it was not possible to undertake a meta-analysis. A cluster randomised controlled trial in 32 nursing homes evaluated the effect of an infection control education and training programme on MRSA prevalence. The primary outcome was MRSA prevalence in residents and staff, and a change in infection control audit scores which measured adherence to infection control standards. At the end of the 12 month study, there was no change in MRSA
Kordi, R; Wallace, W A
Athletes are at risk of blood borne infections through bleeding injuries or injection of drugs with contaminated syringes. Prevention should focus on reducing non-sport associated risky behaviour, as well as dealing appropriately with bleeding injuries. The risk of transmission of hepatitis B virus is particularly high in athletes in contact and collision sports, those who live in or travel to endemic regions, injecting drug abusers, and those who practice first aid when there is no healthcare practitioner available. It is recommended that such athletes, and also adolescent athletes, should be vaccinated against the virus as a routine.
Hurst, Stacey A; Appelgren, Kristie E; Kourtis, Athena P
The prevention of mother-to-child transmission (PMTCT) of HIV is one of the great public health successes of the past 20 years. Much concerted research efforts and dedicated work have led to the achievement of very low rates of PMTCT of HIV in settings that can implement optimal prophylaxis. Though several implementation challenges remain, global elimination of pediatric HIV infection seems now more than ever to be an attainable goal. Often overlooked, the role of prophylaxis of the newborn is nevertheless a very important component of PMTCT. In this paper, we focus on the role of neonatal and infant prophylaxis, discuss mechanisms of protection, and present the clinical trial-generated evidence that led to the current recommendations for preventing infections in breastfed and non-breastfed infants. PMTCT of HIV should not end at birth; a continuum of care extending postpartum and postnatally is required to minimize the risk of new pediatric HIV infections.
Full Text Available Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia.We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel.An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600.A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country.
Chowers, Michal; Carmeli, Yehuda; Shitrit, Pnina; Elhayany, Asher; Geffen, Keren
Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600. A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country.
Fernandes, Anand M; Balasegaram, Sooria; Willis, Caroline; Wimalarathna, Helen M L; Maiden, Martin C; McCarthy, Noel D
Cattle are the second most common source of human campylobacteriosis. However, routes to account for this scale of transmission have not been identified. In contrast to chicken, red meat is not heavily contaminated at point of sale. Although effective pasteurization prevents milk-borne infection, apparently sporadic infections may include undetected outbreaks from raw or perhaps incompletely pasteurized milk. A rise in Campylobacter gastroenteritis in an isolated population was investigated using whole-genome sequencing (WGS), an epidemiological study, and environmental investigations. A single strain was identified in 20 cases, clearly distinguishable from other local strains and a reference population by WGS. A case-case analysis showed association of infection with the outbreak strain and milk from a single dairy (odds ratio, 8; Fisher exact test P value = .023). Despite temperature records indicating effective pasteurization, mechanical faults likely to lead to incomplete pasteurization of part of the milk were identified by further testing and examination of internal components of dairy equipment. Here, milk distribution concentrated on a small area, including school-aged children with low background incidence of campylobacteriosis, facilitated outbreak identification. Low-level contamination of widely distributed milk would not produce as detectable an outbreak signal. Such hidden outbreaks may contribute to the substantial burden of apparently sporadic Campylobacter from cattle where transmission routes are not certain. The effective discrimination of outbreak isolates from a reference population using WGS shows that integrating these data and approaches into surveillance could support the detection as well as investigation of such outbreaks. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
Santelli, J S; Celentano, D D; Rozsenich, C; Crump, A D; Davis, M V; Polacsek, M; Augustyn, M; Rolf, J; McAlister, A L; Burwell, L
The AIDS Prevention for Pediatric Life Enrichment (APPLE) project is a community-based program to prevent perinatal HIV infection by preventing infection in women. One project component tested a primary prevention model developed from principles of cognitive social learning theory which used street outreach and community-targeted small media materials to increase the use of condoms. Formative research was used to explore community perceptions about HIV/AIDS and to design media materials. Program evaluation employed a two-community, time series, quasi-experimental design. Annual street surveys samples individuals in areas where they were likely to encounter outreach workers. Baseline surveys found substantial pre-programmatic behavior change. After two years considerable APPLE name recognition (40%), contact with media materials (63%), and contact with outreach workers (36%) were found and norms reflecting social acceptability of condoms were more positive among women in the intervention community. Condom use at last sexual encounter rose in both communities but was significantly higher in the intervention community. Condom use also was higher among women who reported exposure to either small media or small media plus street outreach. Other self-reported HIV-prevention behaviors did not show change in the initial period.
D'Cruz, Osmond J; Waurzyniak, Barbara; Uckun, Fatih M
WHI-07 [5-bromo-6-methoxy-5,6-dihydro-3'-azidothymidine-5'-(p-bromophenyl)-methoxy alaninyl phosphate] is a novel dual-function aryl phosphate derivative of zidovudine with potent anti-human immunodeficiency virus (HIV) and spermicidal activities. WHI-07 was active against the feline immunodeficiency virus (FIV). This study evaluated whether topical application of WHI-07 as a single agent and in combination with an organometallic vanadium complex, vanadocene dithiocarbamate (VDDTC), via a nontoxic gel microemulsion can block vaginal as well as rectal transmission of feline AIDS (FAIDS) by chronically FIV-infected feline T cells in the natural host model. Genital transmission of FIV was monitored in recipient cats by the appearance of viral antibodies to FIV Gag proteins and by virus isolation of blood leukocytes as measured by FIV reverse transcriptase activity and FIV-specific PCR. Microbicidal activity was considered effective when the treated cats did not show evidence of FIV infection for up to 18 weeks postchallenge. An aggregate analysis of 46 specific-pathogen-free cats revealed that a single dose of the infected cell inoculum efficiently transmitted FIV infection when delivered into the vagina (100%) or rectum (66%). Pretreatment of the vagina or rectum with 2% WHI-07 alone or in combination with 0.25% VDDTC significantly (P = 0.004) protected cats from genital transmission by the highly infectious inoculum (7 million FIV(Bangston)-infected feline T cells). Collectively, using the vaginal and rectal transmucosal model for FAIDS, our studies demonstrated that WHI-07 either alone or in combination with a vanadocene has clinical potential for the development of a dual-function anti-HIV microbicide for sexually active women.
Lemos, Lígia Mara Dolce de; Rocha, Thaísa Fonseca Siqueira; Conceição, Marcos Vinícius da; Silva, Eduardo de Lemos; Santos, Alessandro Henrique da Silva; Gurgel, Ricardo Queiroz
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. 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. 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. 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.
Lígia Mara Dolce de Lemos
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.
Viray, Melissa A; Morley, James C; Coopersmith, Craig M; Kollef, Marin H; Fraser, Victoria J; Warren, David K
Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive care unit (ICU)-acquired S. aureus infection among ICU patients. Prospective pre-post-intervention study with control unit. A 1,250-bed tertiary care teaching hospital. Medical and surgical ICU patients. Active surveillance for MRSA colonization was performed in both ICUs. In June 2005, a chlorhexidine bathing protocol was implemented in the surgical ICU. Changes in S. aureus transmission and infection rate before and after implementation were analyzed using time-series methodology. The intervention unit had a 20.68% decrease in MRSA acquisition after institution of the bathing protocol (12.64 cases per 1,000 patient-days at risk before the intervention vs 10.03 cases per 1,000 patient-days at risk after the intervention; β, -2.62 [95% confidence interval (CI), -5.19 to -0.04]; P = .046). There was no significant change in MRSA acquisition in the control ICU during the study period (10.97 cases per 1,000 patient-days at risk before June 2005 vs 11.33 cases per 1,000 patient-days at risk after June 2005; β, -11.10 [95% CI, -37.40 to 15.19]; P = .40). There was a 20.77% decrease in all S. aureus (including MRSA) acquisition in the intervention ICU from 2002 through 2007 (19.73 cases per 1,000 patient-days at risk before the intervention to 15.63 cases per 1,000 patient-days at risk after the intervention [95% CI, -7.25 to -0.95]; P = .012)]. The incidence of ICU-acquired MRSA infections decreased by 41.37% in the intervention ICU (1.96 infections per 1,000 patient-days at risk before the intervention vs 1.15 infections per 1,000 patient-days at risk after the intervention; P = .001). Institution of daily chlorhexidine bathing in an ICU resulted in a decrease in the transmission of S. aureus, including MRSA. These data support the use of routine daily chlorhexidine baths to decrease rates of S. aureus transmission and
Leiss, O; Exner, M; Niebel, J
For prevention of transfer of infective agents by the contaminated endoscope the importance of thorough mechanical cleaning of the endoscope and adequate disinfection is stressed. Mode of action and side effects of liquid disinfectants as well as resistance of microorganisms (spores and some mycobacteria) to germicidal chemicals are mentioned. The different steps of disinfection procedures and potential causes of failure are discussed. Automatic disinfection systems are required for a higher degree of security of both patient and staff of the endoscopic unit. A regular control of the efficacy of the disinfection process is recommended and models for implementation are discussed. For prevention of occupationally acquired infection general precaution guidelines (use of gloves, prevention of needle-stick injuries) and vaccination programs are stressed.
Jungerman, M Robynne; Vonnahme, Laura A; Washburn, Faith; Alvarado-Ramy, Francisco
Individuals with certain communicable diseases may pose risks to the health of the traveling public; there has been documented transmission on commercial aircraft of tuberculosis (TB), measles, and severe acute respiratory syndrome (SARS). Federal public health travel restrictions (PHTR) prevent commercial air or international travel of persons with communicable diseases that pose a public health threat. We described demographics and clinical characteristics of all cases considered for PHTR because of suspected or confirmed communicable disease from May 22, 2007, to December 31, 2015. We reviewed 682 requests for PHTR; 414 (61%) actions were completed to place 396 individuals on PHTR. The majority (>99%) had suspected (n = 27) or confirmed (n = 367) infectious pulmonary TB; 58 (16%) had multidrug-resistant-TB. There were 128 (85%) interceptions that prevented the initiation or continuation of travel. PHTR were removed for 310 (78%) individuals after attaining noninfectious status and 86 (22%) remained on PHTR at the end of the analysis period. PHTR effectively prevent exposure during commercial air travel to persons with potentially infectious diseases. In addition, they are effective tools available to public health agencies to prevent commercial travel of individuals with certain communicable diseases and possibly reconnect them with public health authorities. Published by Elsevier Ltd.
Full Text Available Background: HIV transmission from HIV-infected mother to child can occur through pregnancy, birth and lactation process; therefore, there should be Prevention of Mother to Child Transmission or PMTCT. Aims & Objectives: This research aimed to study the HIV-infected poor women’s accessibility to the Prevention of Mother to Child Transmission Service in Surakarta Indonesia. Material & Methods: This study was a qualitative research with explorative approach conducted in October-December 2015 and HIV-infected poor women as the unit of analysis. The sampling technique used was maximum variation sampling. Techniques of collecting data used were observation, in-depth interview and documentation, while data analysis was conducted using an Interactive Model of analysis with materialist theory. Results: Structural, financial and personal or cultural constraints were found: less target-appropriate health insurance policy, expensive cost of delivery with section caesarian surgery and breastfeed-substituting formula milk, and limited knowledge, experience and negotiation with the service provider leading to the HIV-infected Poor Women’s limited accessibility to comprehensive and sustainable PMTCT. PMTCT socialization, the giving-birth insurance and Food Supplementation program activation by Empowerment Work Group in AIDS Coping Commission in Surakarta City was the opportunity to access PMTCT service. Conclusion: Although PMTCT resulted in some problems, particularly formula milk administration and delivery process with section caesarian surgery, this attempt should be taken to make the baby born healthy. For that reasons, PMTCT service and health insurance should be improved from beneficiary data to accessible and sustainable procedure.
Hudgens, Michael G; Taha, Taha E; Omer, Saad B; Jamieson, Denise J; Lee, Hana; Mofenson, Lynne M; Chasela, Charles; Kourtis, Athena P; Kumwenda, Newton; Ruff, Andrea; Bedri, Abubaker; Jackson, J Brooks; Musoke, Philippa; Bollinger, Robert C; Gupte, Nikhil; Thigpen, Michael C; Taylor, Allan; van der Horst, Charles
In resource-limited settings, mothers infected with human immunodeficiency virus type 1 (HIV-1) face a difficult choice: breastfeed their infants but risk transmitting HIV-1 or not breastfeed their infants and risk the infants dying of other infectious diseases or malnutrition. Recent results from observational studies and randomized clinical trials indicate daily administration of nevirapine to the infant can prevent breast-milk HIV-1 transmission. Data from 5396 mother-infant pairs who participated in 5 randomized trials where the infant was HIV-1 negative at birth were pooled to estimate the efficacy of infant nevirapine prophylaxis to prevent breast-milk HIV-1 transmission. Four daily regimens were compared: nevirapine for 6 weeks, 14 weeks, or 28 weeks, or nevirapine plus zidovudine for 14 weeks. The estimated 28-week risk of HIV-1 transmission was 5.8% (95% confidence interval [CI], 4.3%-7.9%) for the 6-week nevirapine regimen, 3.7% (95% CI, 2.5%-5.4%) for the 14-week nevirapine regimen, 4.8% (95% CI, 3.5%-6.7%) for the 14-week nevirapine plus zidovudine regimen, and 1.8% (95% CI, 1.0%-3.1%) for the 28-week nevirapine regimen (log-rank test for trend, P < .001). Cox regression models with nevirapine as a time-varying covariate, stratified by trial site and adjusted for maternal CD4 cell count and infant birth weight, indicated that nevirapine reduces the rate of HIV-1 infection by 71% (95% CI, 58%-80%; P < .001) and reduces the rate of HIV infection or death by 58% (95% CI, 45%-69%; P < .001). Extended prophylaxis with nevirapine or with nevirapine and zidovudine significantly reduces postnatal HIV-1 infection. Longer duration of prophylaxis results in a greater reduction in the risk of infection.
Zeng, Huan; Chow, Eric P F; Zhao, Yong; Wang, Yang; Tang, Maozhi; Li, Leyu; Tang, Xue; Liu, Xi; Zhong, Yi; Wang, Ailing; Lo, Ying-Ru; Zhang, Lei
Introduction The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade. Methods Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003–2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas antiretroviral (ARV) prophylaxis uptake increased from 35.2% (12.2% to 47.3%) and 26.9% (24.3% to 28.9%) to 86.2% (53.2% to 97.2%) and 90.3% (85.5% to 93.7%). HIV vertical transmission rate substantially decreased from 31.8% (25.7% to 38.6%) prior to the programme to 2.3% (1.4% to 3.8%) in 2011. During 2003–2011, among 25 312 (23 995–26 644) infants born to HIV-positive mothers who received ARV prophylaxis, 975 (564–1395) were diagnosed with HIV, corresponding to an average transmission rate of 3.9% (3.2% to 4.6%). However, while including transmissions among HIV-positive pregnant women who were lost along the cascade, the average transmission rate during 2003–2011 was 17.4% (15.8% to 19.0%). Conclusions PMTCT programmes have reduced HIV mother-to-child transmission in China. Further improvements in the continuum of care remain essential in realising the full potential of the programme. PMID:25935929
Taenzler, Janina; Liebenberg, Julian; Roepke, Rainer K A; Heckeroth, Anja R
The preventive effect of fluralaner chewable tablets (Bravecto™) against transmission of Babesia canis by Dermacentor reticulatus ticks was evaluated. Sixteen dogs, tested negative for B. canis by PCR and IFAT, were allocated to two study groups. On day 0, dogs in one group (n = 8) were treated once orally with a fluralaner chewable tablet according to label recommendations and dogs in the control group (n = 8) remained untreated. On days 2, 28, 56, 70 and 84, dogs were infested with 50 (±4) B. canis infected D. reticulatus ticks with tick in situ thumb counts 48 ± 4 h post-infestation. Prior to each infestation, the D. reticulatus ticks were confirmed to harbour B. canis by PCR analysis. On day 90, ticks were counted and removed from all dogs. Efficacy against ticks was calculated for each assessment time point. After treatment, all dogs were physically examined in conjunction with blood collection for PCR every 7 days, blood samples for IFAT were collected every 14 days and the dog's rectal body temperature was measured thrice weekly. From dogs displaying symptoms of babesiosis or were PCR positive, a blood smear was taken, and, if positive, dogs were rescue treated and replaced with a replacement dog. The preventive effect was evaluated by comparing infected dogs in the treated group with infected dogs in the untreated control group. All control dogs became infected with B. canis, as confirmed by PCR and IFAT. None of the 8 treated dogs became infected with B. canis, as IFAT and PCR were negative throughout the study until day 112. Fluralaner chewable tablet was 100 % effective against ticks on days 4, 30, 58, and 90 and an efficacy of 99.6 % and 99.2 % was achieved on day 72 and day 86 after treatment, respectively. Over the 12-week study duration, a 100 % preventive effect against B. canis transmission was demonstrated. A single oral administration of fluralaner chewable tablets effectively prevented the transmission of B. canis by infected
Mlynarova, L.; Conner, A.J.; Nap, J.P.H.
A major challenge for future genetically modified (GM) crops is to prevent undesired gene flow of transgenes to plant material intended for another use. Recombinase-mediated auto excision of transgenes directed by a tightly controlled microspore-specific promoter allows efficient removal of either
Justin T Clark
Full Text Available The HIV/AIDS pandemic and its impact on women prompt the investigation of prevention strategies to interrupt sexual transmission of HIV. Long-acting drug delivery systems that simultaneously protect womenfrom sexual transmission of HIV and unwanted pregnancy could be important tools in combating the pandemic. We describe the design, in silico, in vitro and in vivo evaluation of a dual-reservoir intravaginal ring that delivers the HIV-1 reverse transcriptase inhibitor tenofovir and the contraceptive levonorgestrel for 90 days. Two polyether urethanes with two different hard segment volume fractions were used to make coaxial extruded reservoir segments with a 100 µm thick rate controlling membrane and a diameter of 5.5 mm that contain 1.3 wt% levonorgestrel. A new mechanistic diffusion model accurately described the levonorgestrel burst release in early time points and pseudo-steady state behavior at later time points. As previously described, tenofovir was formulated as a glycerol paste and filled into a hydrophilic polyurethane, hollow tube reservoir that was melt-sealed by induction welding. These tenofovir-eluting segments and 2 cm long coaxially extruded levonorgestrel eluting segments were joined by induction welding to form rings that released an average of 7.5 mg tenofovir and 21 µg levonorgestrel per day in vitro for 90 days. Levonorgestrel segments placed intravaginally in rabbits resulted in sustained, dose-dependent levels of levonorgestrel in plasma and cervical tissue for 90 days. Polyurethane caps placed between segments successfully prevented diffusion of levonorgestrel into the tenofovir-releasing segment during storage.Hydrated rings endured between 152 N and 354 N tensile load before failure during uniaxial extension testing. In summary, this system represents a significant advance in vaginal drug delivery technology, and is the first in a new class of long-acting multipurpose prevention drug delivery systems.
Clark, Justin T.; Clark, Meredith R.; Shelke, Namdev B.; Johnson, Todd J.; Smith, Eric M.; Andreasen, Andrew K.; Nebeker, Joel S.; Fabian, Judit; Friend, David R.; Kiser, Patrick F.
The HIV/AIDS pandemic and its impact on women prompt the investigation of prevention strategies to interrupt sexual transmission of HIV. Long-acting drug delivery systems that simultaneously protect womenfrom sexual transmission of HIV and unwanted pregnancy could be important tools in combating the pandemic. We describe the design, in silico, in vitro and in vivo evaluation of a dual-reservoir intravaginal ring that delivers the HIV-1 reverse transcriptase inhibitor tenofovir and the contraceptive levonorgestrel for 90 days. Two polyether urethanes with two different hard segment volume fractions were used to make coaxial extruded reservoir segments with a 100 µm thick rate controlling membrane and a diameter of 5.5 mm that contain 1.3 wt% levonorgestrel. A new mechanistic diffusion model accurately described the levonorgestrel burst release in early time points and pseudo-steady state behavior at later time points. As previously described, tenofovir was formulated as a glycerol paste and filled into a hydrophilic polyurethane, hollow tube reservoir that was melt-sealed by induction welding. These tenofovir-eluting segments and 2 cm long coaxially extruded levonorgestrel eluting segments were joined by induction welding to form rings that released an average of 7.5 mg tenofovir and 21 µg levonorgestrel per day in vitro for 90 days. Levonorgestrel segments placed intravaginally in rabbits resulted in sustained, dose-dependent levels of levonorgestrel in plasma and cervical tissue for 90 days. Polyurethane caps placed between segments successfully prevented diffusion of levonorgestrel into the tenofovir-releasing segment during storage.Hydrated rings endured between 152 N and 354 N tensile load before failure during uniaxial extension testing. In summary, this system represents a significant advance in vaginal drug delivery technology, and is the first in a new class of long-acting multipurpose prevention drug delivery systems. PMID:24599325
Hafez, M.T.; Radwan, M.H.; Jones, D.G.
At the start of the 1990s there were concerns over the increasing threat of corrosion to the integrity of high-pressure oil and gas transmission pipelines. For example: corrosion was the major cause of reportable incidents in North America (1]. Corrosion was the major cause of pipeline failure in the Gulf of Mexico . Corrosion in a North American onshore oil pipeline had required over $1 billion in repairs(3]. Internal corrosion along the complete length of pipelines had resulted in replacement . However, the worldwide published failure statistics indicate that the incidents of corrosion are not increasing year on year(5-9]. Indeed, CONCA WE[8,9] statistics (for pipelines In Western Europe) show that the failure rate from corrosion (the most likely failure mode with increasing age) has not increased with pipeline age (Figure 1). In fact the statistics for gas pipelines in Europe
Kamarulzaman, Adeeba; Reid, Stewart E; Schwitters, Amee; Wiessing, Lucas; El-Bassel, Nabila; Dolan, Kate; Moazen, Babak; Wirtz, Andrea L; Verster, Annette; Altice, Frederick L
The prevalence of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis are higher in prisons than in the general population in most countries worldwide. Prisons have emerged as a risk environment for these infections to be further concentrated, amplified, and then transmitted to the community after prisoners are released. In the absence of alternatives to incarceration, prisons and detention facilities could be leveraged to promote primary and secondary prevention strategies for these infections to improve prisoners health and reduce risk throughout incarceration and on release. Effective treatment of opioid use disorders with opioid agonist therapies (eg, methadone and buprenorphine) prevents blood-borne infections via reductions in injection in prison and after release. However, large gaps exist in the implementation of these strategies across all regions. Collaboration between the criminal justice and public health systems will be required for successful implementation of these strategies. Copyright © 2016 Elsevier Ltd. All rights reserved.
Manji, A; Peña, R; Dubrow, R
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.
Honsberger, Nicole A; Six, Robert H; Heinz, Thomas J; Weber, Angela; Mahabir, Sean P; Berg, Thomas C
The efficacy of sarolaner (Simparica™, Zoetis) to prevent transmission primarily of Borrelia burgdorferi and secondarily of Anaplasma phagocytophilum from infected wild-caught Ixodes scapularis to dogs was evaluated in a placebo-controlled laboratory study. Twenty-four purpose-bred laboratory Beagles seronegative for B. burgdorferi and A. phagocytophilum antibodies were allocated randomly to one of three treatment groups: placebo administered orally on Days 0 and 7, or sarolaner at 2mg/kg administered orally on Day 0 (28 days prior to tick infestation) or on Day 7 (21 days prior to tick infestation). On Day 28, each dog was infested with approximately 25 female and 25 male wild caught adult I. scapularis that were determined to have prevalence of 57% for B. burgdorferi and 6.7% for A. phagocytophilum by PCR. In situ tick counts were conducted on Days 29 and 30. On Day 33, all ticks were counted and removed. Acaricidal efficacy was calculated based on the reduction of geometric mean live tick counts in the sarolaner-treated groups compared to the placebo-treated group for each tick count. Blood samples collected from each dog on Days 27, 49, 63, 77, 91 and 104 were tested for the presence of B. burgdorferi and A. phagocytophilum antibodies using the SNAP(®) 4Dx(®) Plus Test, and quantitatively assayed for B. burgdorferi antibodies using an ELISA test. Skin biopsies collected on Day 104 were tested for the presence of B. burgdorferi by bacterial culture and PCR. Geometric mean live tick counts for placebo-treated dogs were 14.8, 12.8, and 19.1 on Days 29, 30, and 33, respectively. The percent reductions in mean live tick counts at 1, 2, and 5 days after infestation were 86.3%, 100%, and 100% for the group treated with sarolaner 21 days prior to infestation, and 90.9%, 97.1%, and 100% for the group treated with sarolaner 28 days prior to infestation. Geometric mean live tick counts for both sarolaner-treated groups were significantly lower than those for the
McCarthy, Fergus P
BACKGROUND: Cytomegalovirus (CMV) is a herpesvirus and the most common cause of congenital infection in developed countries. Congenital CMV infection can have devastating consequences to the fetus. The high incidence and the serious morbidity associated with congenital CMV infection emphasise the need for effective interventions to prevent the antenatal transmission of CMV infection. OBJECTIVES: The aim of this review was to assess the benefits and harms of interventions used during pregnancy to prevent mother to fetus transmission of CMV infection. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group\\'s Trials Register (31 December 2010). SELECTION CRITERIA: All randomised controlled trials (RCTs) and quasi RCTs investigating antenatal interventions for preventing the transmission of CMV from the mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion. MAIN RESULTS: We identified six studies from the search. None of these studies met the pre-defined criteria for inclusion in this review. AUTHORS\\' CONCLUSIONS: To date, no RCTs are available that examine antenatal interventions for preventing the transmission of CMV from the infected mother to fetus during pregnancy and adverse outcomes in the congenitally infected infant. Further research is needed to assess the efficacy of interventions aimed at preventing the transmission of CMV from the mother to fetus during pregnancy including a long-term follow-up of exposed infants and a cost effective analysis.
Gray, Richard T; Watson, Jo; Cogle, Aaron J; Smith, Don E; Hoy, Jennifer F; Bastian, Lisa A; Finlayson, Robert; Drummond, Fraser M; Whittaker, Bill; Law, Matthew G; Petoumenos, Kathy
Background The aim of this study is to estimate the reduction in new HIV infections and resultant cost outcomes of providing antiretroviral treatment (ART) through Australia's 'universal access' health scheme to all temporary residents with HIV infection living legally in Australia, but currently deemed ineligible to access subsidised ART via this scheme. A mathematical model to estimate the number of new HIV infections averted and the associated lifetime costs over 5 years if all HIV-positive temporary residents in Australia had access to ART and subsidised medical care was developed. Input data came from a cohort of 180 HIV-positive temporary residents living in Australia who are receiving free ART donated by pharmaceutical companies for up to 4 years. Expanding ART access to an estimated total 450 HIV+ temporary residents in Australia for 5 years could avert 80 new infections. The model estimated the total median discounted (5%) cost for ART and associated care to be A$36million, while the total savings in lifetime-discounted costs for the new infections averted was A$22million. It is estimated that expanded access to ART for all HIV-positive temporary residents in Australia will substantially reduce HIV transmission to their sexual partners at little additional cost. In the context of Australia's National HIV strategy and Australia's endorsement of global goals to provide universal access to ART for all people with HIV, this is an important measure to remove inequities in the provision of HIV-related treatment and care.
Ndondoki, Camille; Dicko, Fatoumata; Ahuatchi Coffie, Patrick
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....... 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.......04). CONCLUSIONS: Despite a low data quality, PMTCT-exposed West African children did not have a poorer 12-month response to ART than others. Immunodeficiency and AIDS events at ART initiation remain the main predictors associated with treatment failure in this operational context....
Villar-Loubet, Olga M; Bruscantini, Laura; Shikwane, Molatelo Elisa; Weiss, Stephen; Peltzer, Karl; Jones, Deborah L
HIV-seroconversion during pregnancy is a serious concern throughout South Africa, where an estimated 35 to 40% of pregnant women have HIV/AIDS and drop-out is high at all stages of the prevention-of-mother-to-child-transmission (PMTCT) process. The likelihood of PMTCT success may be linked to partner support, yet male involvement in antenatal care remains low. This qualitative study examined the influence of pregnant couples' expectations, experiences and perceptions on sexual communication and male involvement in PMTCT. A total of 119 couples participated in a comprehensive intervention in 12 antenatal clinics throughout South Africa. Data were collected between December 2010 to June 2011 and analysed using a grounded theory approach. Findings point to the importance of sexual communication as a factor influencing PMTCT male involvement. Analysis of themes lends support to improving communication between couples, encouraging dialogue among men and increasing male involvement in PMTCT to bridge the gap between knowledge and sexual behaviour change.
Kelley, Colleen F.; Kraft, Colleen S.; de Man, Tom J.B.; Duphare, Chandni; Lee, Hyun-Woo; Yang, Jing; Easley, Kirk A.; Tharp, Gregory K.; Mulligan, Mark J.; Sullivan, Patrick S.; Bosinger, Steven E.; Amara, Rama R.
Most HIV transmissions among men who have sex with men (MSM), the group that accounted for 67% of new US infections in 2014, occur via exposure to the rectal mucosa. However, it is unclear how the act of condomless receptive anal intercourse (CRAI) may alter the mucosal immune environment in HIV negative MSM. Here, we performed a comprehensive characterization of the rectal mucosal immune environment for the phenotype and production of pro-inflammatory cytokines by CD4 and CD8 T cells, global transcriptomic analyses, and the composition of microbiota in HIV negative MSM. Our results show that compared to men who had never engaged in anal intercourse, the rectal mucosa of MSM engaging in CRAI has a distinct phenotype characterized by higher levels of Th17 cells, greater CD8+ T cell proliferation and production of pro-inflammatory cytokines, molecular signatures associated with mucosal injury and repair likely mediated by innate immune cells, and a microbiota enriched for the Prevotellaceae family. These data provide a high-resolution model of the immunological, molecular, and microbiological perturbations induced by CRAI, will have direct utility in understanding rectal HIV transmission among MSM, and will enhance the design of future biomedical prevention interventions, including candidate HIV vaccines. PMID:27848950
Chan, J Hy; Law, C K; Hamblion, E; Fung, H; Rudge, J
Hand, foot, and mouth disease continues to cause seasonal epidemics in the Asia-Pacific Region. Since the current Enterovirus 71 vaccines do not provide cross-protection for all Enterovirus species that cause hand, foot, and mouth disease, there is an urgent need to identify appropriate detection tools and best practice to prevent its transmission and to effectively control its outbreaks. This systematic review aimed to identify characteristics of outbreak and assess the impact and effectiveness of detection tools and public health preventive measures to interrupt transmission. The findings will be used to recommend policy on the most effective responses and interventions in Hong Kong to effectively minimise and contain the spread of the disease within childcare facilities. We searched the following databases for primary studies written in Chinese or English: MEDLINE, EMBASE, Global Health, WHO Western Pacific Region Index Medicus database, China National Knowledge Infrastructure Databases, and Chinese Scientific Journals Database. Studies conducted during or retrospective to outbreaks of hand, foot, and mouth disease caused by Enterovirus 71 from 1980 to 2012 within childcare facilities and with a study population of 0 to 6 years old were included. Sixteen studies conducted on outbreaks in China showed that hand, foot, and mouth disease spread rapidly within the facility, with an outbreak length of 4 to 46 days, especially in those with delayed notification (after 24 hours) of clustered outbreak (with five or more cases discovered within the facility) to the local Center for Disease Control and Prevention and delayed implementation of a control response. The number of classes affected ranged from 1 to 13, and the attack rate for children ranged from 0.97% to 28.18%. Communication between key stakeholders about outbreak confirmation, risk assessment, and surveillance should be improved. Effective communication facilitates timely notification (within 24 hours) of
Harris, R J; Martin, N K; Rand, E; Mandal, S; Mutimer, D; Vickerman, P; Ramsay, M E; De Angelis, D; Hickman, M; Harris, H E
New direct-acting antivirals have the potential to transform the hepatitis C (HCV) treatment landscape, with rates of sustained viral response in excess of 90%. As these new agents are expensive, an important question is whether to focus on minimizing the consequences of severe liver disease, or reducing transmission via 'treatment as prevention'. A back-calculation model was used to estimate the impact of treatment of mild, moderate and compensated cirrhosis on incident cases of HCV-related end-stage liver disease/hepatocellular carcinoma (ESLD/HCC). In addition, a dynamic model was used to determine the impact on incidence and prevalence of chronic infection in people who inject drugs (PWID), the main risk group in England. Treating 3500 cirrhotics per year was predicted to reduce ESLD/HCC incidence from 1100 (95% CrI 970-1240) cases per year in 2015 to 630 (95% CrI 530-770) in 2020, around half that currently expected, although treating moderate-stage disease will also be needed to sustain this reduction. Treating mild-stage PWID was required to make a substantial impact on transmission: with 2500 treated per year, chronic prevalence/annual incidence in PWID was reduced from 34%/4.8% in 2015 to 11%/1.4% in 2030. There was little overlap between the two goals: treating mild stage had virtually no impact on ESLD/HCC within 15 years, but the long timescale of liver disease means relatively few PWID reach cirrhosis before cessation of injecting. Strategies focussing on treating advanced disease have the potential for dramatic reductions in severe morbidity, but virtually no preventative impact. © 2016 The Authors. Journal of Viral Hepatitis Published by John Wiley & Sons Ltd.
Rodriguez, Violeta J; LaCabe, Richard P; Privette, C Kyle; Douglass, K Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo Willy; Horigian, Viviana; Weiss, Stephen M; Jones, Deborah L
The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff-patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.
Rodriguez, Violeta J.; LaCabe, Richard P.; Privette, C. Kyle; Douglass, K. Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo “Willy”; Horigian, Viviana; Weiss, Stephen M.; Jones, Deborah L.
Abstract The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff–patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention. PMID:28922974
Essien, Ekere J; Meshack, Angela F; Peters, Ronald J; Ogungbade, Gbadebo O; Osemene, Nora I
Background As part of qualitative research for developing a culturally sensitive and developmentally appropriate videotape-based HIV prevention intervention for heterosexual African- American men, six focus groups were conducted with thirty African-American men to determine their perceptions of AIDS as a threat to the African-American community, characteristics of past situations that have placed African Americans at risk for HIV infection, their personal high risk behaviors, and suggestions on how HIV intervention videotapes could be produced to achieve maximum levels of interest among African-American men in HIV training programs. Methods The groups took place at a low-income housing project in Houston, Texas, a major epicenter for HIV/AIDS. Each group was audiotaped, transcribed, and analyzed using theme and domain analysis. Results The results revealed that low-income African-American men perceive HIV/AIDS as a threat to their community and they have placed themselves at risk of HIV infection based on unsafe sex practices, substance abuse, and lack of knowledge. They also cite lack of income to purchase condoms as a barrier to safe sex practice. They believe that HIV training programs should address these risk factors and that videotapes developed for prevention should offer a sensationalized look at the effects of HIV/AIDS on affected persons. They further believe that programs should be held in African-American communities and should include condoms to facilitate reduction of risk behaviors. Conclusions The results indicate that the respondents taking part in this study believe that HIV and AIDS are continued threats to the African-American community because of sexual risk taking behavior, that is, failure to use condoms. Further, African-American men are having sex without condoms when having sex with women often when they are under the influence of alcohol or other mind-altering substances and they are having sex with men while incarcerated and become
Pires Araujo, Elaine S; Khalili Friedman, Ruth; Bastos Camacho, Luis Antonio; Derrico, Monica; Ismério Moreira, Ronaldo; Amaral Calvet, Guilherme; Santini de Oliveira, Marília; Gonçalves Veloso, Valdilea; Pilotto, José Henrique; Grinsztejn, Beatriz
To describe the access to the interventions for the prevention of Human Immunodeficiency Virus (HIV) mother to child transmission and mother to child transmission rates in the outskirts of Rio de Janeiro, from 1999 to 2009. This is a retrospective cohort study. Prevention of HIV mother to child transmission interventions were accessed and mother to child transmission rates were calculated. The study population is young (median: 26 years; interquartile range: 22.0-31.0), with low monthly family income (40.4% up to one Brazilian minimum wage) and schooling (62.1% less than 8 years). Only 47.1% (n=469) knew the HIV status of their partner; of these women, 39.9% had an HIV-seronegative partner. Among the 1259 newborns evaluated, access to the antenatal, intrapartum and postpartum prevention of HIV mother to child transmission components occurred in 59.2%, 74.2%, and 97.5% respectively; 91.0% of the newborns were not breastfed. Overall 52.7% of the newborns have benefited from all the recommended interventions. In subsequent pregnancies (n=289), 67.8% of the newborns received the full package of interventions. The overall rate of HIV vertical transmission was 4.7% and the highest annual rate occurred in 2005 (7.4%), with no definite trend in the period. Access to the full package of interventions for the prevention of HIV vertical transmission was low, with no significant trend of improvement over the years. The vertical transmission rates observed were higher than those found in reference services in the municipality of Rio de Janeiro and in the richest regions of the country. Copyright © 2014. Published by Elsevier Editora Ltda.
Full Text Available Background. Hepatitis B virus (HBV infections are perinatally transmitted from chronically infected mothers. Supplemental antiviral therapy during late pregnancy with lamivudine (LAM, telbivudine (LdT, or tenofovir (TDF can substantially reduce perinatal HBV transmission compared to postnatal immunoprophylaxis (IP alone. However, the cost-effectiveness of these measures is not clear. Aim. This study evaluated the cost-effectiveness from a societal perspective of supplemental antiviral agents for preventing perinatal HBV transmission in mothers with high viral load (>6 log10 copies/mL. Methods. A systematic review and network meta-analysis were performed for the risk of perinatal HBV transmission with antiviral therapies. A decision analysis was conducted to evaluate the clinical and economic outcomes in China of four competing strategies: postnatal IP alone (strategy IP, or in combination with perinatal LAM (strategy LAM + IP, LdT (strategy LdT + IP, or TDF (strategy TDF + IP. Antiviral treatments were administered from week 28 of gestation to 4 weeks after birth. Outcomes included treatment-related costs, number of infections, and quality-adjusted life years (QALYs. One- and two-way sensitivity analyses were performed to identify influential clinical and cost-related variables. Probabilistic sensitivity analyses were used to estimate the probabilities of being cost-effective for each strategy. Results. LdT + IP and TDF + IP averted the most infections and HBV-related deaths, and gained the most QALYs. IP and TDF + IP were dominated as they resulted in less or equal QALYs with higher associated costs. LdT + IP had an incremental $2,891 per QALY gained (95% CI [$932–$20,372] compared to LAM + IP (GDP per capita for China in 2013 was $6,800. One-way sensitivity analyses showed that the cost-effectiveness of LdT + IP was only sensitive to the relative risk of HBV transmission comparing LdT + IP with LAM + IP. Probabilistic sensitivity analyses
Bendle, Meenakshi; Bajpai, Smrati; Choudhary, Ashwini; Pazare, Amar
In India, parent to child transmission is the most important source of HIV infection in children below fifteen years of age. Transmission of HIV from mother to child can occur even at low or undetectable HIV virus levels. CD4 count or HIV RNA levels should not be the determining factor when deciding whether to use antiretroviral drugs for prevention of perinatal transmission of HIV. Use of single dose nevirapine during labour, in prevention of parent to child transmission (PPTCT) programme for pregnant females with CD4 count > 250 cells/cumm has less efficacy in reducing perinatal transmission. And there are high chances of development of nevirapine resistance to both mother and baby after single dose nevirapine exposure. Short course Protease inhibitor(PI) based triple drug combination ART from 28 weeks till delivery for perinatal prophylaxis is effective in reducing perinatal HIV transmission. PI's are safe in pregnancy and also have less chances of development of resistance when used for perinatal prophylaxis and stopped post delivery.Hence, it is opined that PI based combination ART should be offered to pregnant females in PPTCT programme, thereby preventing occurrence of paediatric HIV infection in India. This can have significant impact on the society at large.
Balbin, Jessie R.; Cruz, Febus Reidj G.; Abu, Jon Ervin A.; Siño, Carlo G.; Ubaldo, Paolo E.; Zulueta, Christelle Jianne T.
Automobiles have become essential parts of our everyday lives. It can correlate many factors that may affect a vehicle primarily those which may inconvenient or in some cases harm lives or properties. Thus, focusing on detecting an automatic transmission vehicle engine, body and other parts that cause vibration and sound may help prevent car problems using MATLAB. By using sound, vibration, and temperature sensors to detect the defects of the car and with the help of the transmitter and receiver to gather data wirelessly, it is easy to install on to the vehicle. A technique utilized from Toyota Balintawak Philippines that every car is treated as panels(a, b, c, d, and e) 'a' being from the hood until the front wheel of the car and 'e' the rear shield to the back of the car, this was applied on how to properly place the sensors so that precise data could be gathered. Data gathered would be compared to the normal graph taken from the normal status or performance of a vehicle, data that would surpass 50% of the normal graph would be considered that a problem has occurred. The system is designed to prevent car accidents by determining the current status or performance of the vehicle, also keeping people away from harm.
Flávia Alves Ferreira Rossini
Full Text Available INTRODUCTION: Vancomycin-resistant enterococci (VRE can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs, who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7% colonized and 11 (7.3% infected. Seventy-three percent were cared for in non-ICUs (p = 0.028. Infection was more frequent in patients with a central-line (p = 0.043, mechanical ventilation (p = 0.013, urinary catheter (p = 0.049, or surgical drain (p = 0.049. Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%, 31 (20.7%, 24 (16%, and 24 (16% patients, respectively. Death was more frequent in infected (73% than in colonized (17% patients (p < 0.001. After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001. CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.
Decker, Sarah; Rempis, Eva; Schnack, Alexandra; Braun, Vera; Rubaihayo, John; Busingye, Priscilla; Tumwesigye, Nazarius Mbona; Harms, Gundel; Theuring, Stefanie
Since 2012, the WHO recommends Option B+ for the prevention of mother-to-child transmission of HIV. This approach entails the initiation of lifelong antiretroviral therapy in all HIV-positive pregnant women, also implying protection during breastfeeding for 12 months or longer. Research on long-term adherence to Option B+ throughout breastfeeding is scarce to date. Therefore, we conducted a prospective observational cohort study in Fort Portal, Western Uganda, to assess adherence to Option B+ until 18 months postpartum. In 2013, we recruited 67 HIV-positive, Option B+ enrolled women six weeks after giving birth and scheduled them for follow-up study visits after six, twelve and 18 months. Two adherence measures, self-reported drug intake and amount of drug refill visits, were combined to define adherence, and were assessed together with feeding information at all study visits. At six months postpartum, 51% of the enrolled women were considered to be adherent. Until twelve and 18 months postpartum, adherence for the respective follow-up interval decreased to 19% and 20.5% respectively. No woman was completely adherent until 18 months. At the same time, 76.5% of the women breastfed for ≥12 months. Drug adherence was associated with younger age (ptravel costs (p = 0.02), and lower number of previous deliveries (p = 0.04). Long-term adherence to Option B+ seems to be challenging. Considering that in our cohort, prolonged breastfeeding until ≥12 months was widely applied while postpartum adherence until the end of breastfeeding was poor, a potential risk of postpartum vertical transmission needs to be taken seriously into account for Option B+ implementation.
Full Text Available Since 2012, the WHO recommends Option B+ for the prevention of mother-to-child transmission of HIV. This approach entails the initiation of lifelong antiretroviral therapy in all HIV-positive pregnant women, also implying protection during breastfeeding for 12 months or longer. Research on long-term adherence to Option B+ throughout breastfeeding is scarce to date. Therefore, we conducted a prospective observational cohort study in Fort Portal, Western Uganda, to assess adherence to Option B+ until 18 months postpartum. In 2013, we recruited 67 HIV-positive, Option B+ enrolled women six weeks after giving birth and scheduled them for follow-up study visits after six, twelve and 18 months. Two adherence measures, self-reported drug intake and amount of drug refill visits, were combined to define adherence, and were assessed together with feeding information at all study visits. At six months postpartum, 51% of the enrolled women were considered to be adherent. Until twelve and 18 months postpartum, adherence for the respective follow-up interval decreased to 19% and 20.5% respectively. No woman was completely adherent until 18 months. At the same time, 76.5% of the women breastfed for ≥12 months. Drug adherence was associated with younger age (p<0.01, lower travel costs (p = 0.02, and lower number of previous deliveries (p = 0.04. Long-term adherence to Option B+ seems to be challenging. Considering that in our cohort, prolonged breastfeeding until ≥12 months was widely applied while postpartum adherence until the end of breastfeeding was poor, a potential risk of postpartum vertical transmission needs to be taken seriously into account for Option B+ implementation.
Maredza, Mandy; Bertram, Melanie Y; Saloojee, Haroon; Chersich, Matthew F; Tollman, Stephen M; Hofman, Karen J
Despite increasing availability of perinatal interventions to prevent mother-to-child transmission (MTCT) of HIV in South Africa, MTCT remains high due to breastfeeding. To inform policy decisions in the country, cost-effectiveness of alternative infant-feeding interventions was conducted. Mathematical modelling was used to simulate post-natal transmission and mortality due to infant feeding in a hypothetical cohort of 1 000 HIV-exposed infants. Lifetime costs to the health system were calculated for each strategy. Interventions compared with current practice were: increasing coverage of extended nevirapine prophylaxis (ENP) to infants from 30% (base case) to 60% without changing current feeding practices; actively supporting breastfeeding with ENP to infants for 12 months; and actively supporting exclusive formula (replacement) feeding for 6 months. HIV-free survival at 24 months and disability-adjusted life years (DALYs) averted were estimated for typical rural and certain urban settings. Base-case analysis revealed that expanding coverage of nevirapine prophylaxis with breastfeeding is cost-saving and improves HIV-free survival. Changing feeding practices is beneficial, depending on context. Breastfeeding is dominant (less costly, more effective) in rural settings, whilst formula feeding is a dominant strategy in urban settings. Cost-effectiveness was most sensitive to proportion of women on lifelong antiretroviral therapy (ART) and infant mortality rate (IMR). When >55% of women are on ART, breastfeeding dominates in the urban settings modelled, whilst formula feeding is cost-effective in rural settings when IMR ≤ 45/1000. The study concludes that strategies to support breastfeeding are essential. Strengthening health systems is critical to ensure optimal nevirapine delivery during breastfeeding. A case can be made for formula feeding or breastfeeding in HIV-infected women in specific contexts.
Rowan Mark R
Full Text Available Abstract Substantial improvements have been made in recent years in the ability to engraft human cells and tissues into immunodeficient mice. The use of human hematopoietic stem cells (HSCs leads to multi-lineage human hematopoiesis accompanied by production of a variety of human immune cell types. Population of murine primary and secondary lymphoid organs with human cells occurs, and long-term engraftment has been achieved. Engrafted cells are capable of producing human innate and adaptive immune responses, making these models the most physiologically relevant humanized animal models to date. New models have been successfully infected by a variety of strains of Human Immunodeficiency Virus Type 1 (HIV-1, accompanied by virus replication in lymphoid and non-lymphoid organs, including the gut-associated lymphoid tissue, the male and female reproductive tracts, and the brain. Multiple forms of virus-induced pathogenesis are present, and human T cell and antibody responses to HIV-1 are detected. These humanized mice are susceptible to a high rate of rectal and vaginal transmission of HIV-1 across an intact epithelium, indicating the potential to study vaccines and microbicides. Antiviral drugs, siRNAs, and hematopoietic stem cell gene therapy strategies have all been shown to be effective at reducing viral load and preventing or reversing helper T cell loss in humanized mice, indicating that they will serve as an important preclinical model to study new therapeutic modalities. HIV-1 has also been shown to evolve in response to selective pressures in humanized mice, thus showing that the model will be useful to study and/or predict viral evolution in response to drug or immune pressures. The purpose of this review is to summarize the findings reported to date on all new humanized mouse models (those transplanted with human HSCs in regards to HIV-1 sexual transmission, pathogenesis, anti-HIV-1 immune responses, viral evolution, pre- and post
Full Text Available BACKGROUND: Highly active antiretroviral treatment (HAART has only been recently recommended for HIV-infected pregnant women requiring treatment for their own health in resource-limited settings. However, there are few documented experiences from African countries. We evaluated the short-term (4 wk and long-term (12 mo effectiveness of a two-tiered strategy of prevention of mother-to-child transmission of HIV (PMTCT in Africa: women meeting the eligibility criteria of the World Health Organization (WHO received HAART, and women with less advanced HIV disease received short-course antiretroviral (scARV PMTCT regimens. METHODS AND FINDINGS: The MTCT-Plus Initiative is a multi-country, family-centred HIV care and treatment program for pregnant and postpartum women and their families. Pregnant women enrolled in Abidjan, Côte d'Ivoire received either HAART for their own health or short-course antiretroviral (scARV PMTCT regimens according to their clinical and immunological status. Plasma HIV-RNA viral load (VL was measured to diagnose peripartum infection when infants were 4 wk of age, and HIV final status was documented either by rapid antibody testing when infants were aged > or = 12 mo or by plasma VL earlier. The Kaplan-Meier method was used to estimate the rate of HIV transmission and HIV-free survival. Between August 2003 and June 2005, 107 women began HAART at a median of 30 wk of gestation, 102 of them with zidovudine (ZDV, lamivudine (3TC, and nevirapine (NVP and they continued treatment postpartum; 143 other women received scARV for PMTCT, 103 of them with sc(ZDV+3TC with single-dose NVP during labour. Most (75% of the infants were breast-fed for a median of 5 mo. Overall, the rate of peripartum HIV transmission was 2.2% (95% confidence interval [CI] 0.3%-4.2% and the cumulative rate at 12 mo was 5.7% (95% CI 2.5%-9.0%. The overall probability of infant death or infection with HIV was 4.3% (95% CI 1.7%-7.0% at age week 4 wk and 11.7% (95
Ambia, Julie; Mandala, Justin
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. 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. 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, I(2)=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, I(2)=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, I(2)=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, I(2)=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Our findings indicate that mobile phone-based reminders may increase the uptake
Nyondo, Alinane Linda; Chimwaza, Angela Faith; Muula, Adamson Sinjani
Male Involvement (MI) in the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services is essential in a patriarchal society where men are decision makers of the household. Male partners have a role in the woman's risk of acquiring HIV, uptake of HIV testing and participation in Mother to Child Transmission (MTCT) prevention programmes. Although MI is important for uptake of PMTCT interventions, it remains low in Africa. The purpose of this study was to identify factors that promote and hinder MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. Understanding of the factors that influence MI will assist in developing strategies that will involve men more in the programme thereby improving the uptake of PMTCT and HIV testing and counselling services by women and men respectively. 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 health care workers and four Focus Group discussions (FGDs) with 18 men and 17 pregnant women attending antenatal care at the clinic. 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 analysed using thematic content analysis. Participants in both FGDs and KIIs identified the following barriers: lack of knowledge of MI in PMTCT, socioeconomic factors, relationship issues, timidity to be seen in a woman's domain, unplanned and or extramarital pregnancies, fear of knowing one's HIV status, unwillingness to be associated with the service, health facility based factors, peer influence and cultural factors. The factors that would potentially promote male involvement were categorized into community, health facility and personal or family level factors. The factors that may hinder or promote MI arise from different
Background Male Involvement (MI) in the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services is essential in a patriarchal society where men are decision makers of the household. Male partners have a role in the woman’s risk of acquiring HIV, uptake of HIV testing and participation in Mother to Child Transmission (MTCT) prevention programmes. Although MI is important for uptake of PMTCT interventions, it remains low in Africa. The purpose of this study was to identify factors that promote and hinder MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. Understanding of the factors that influence MI will assist in developing strategies that will involve men more in the programme thereby improving the uptake of PMTCT and HIV testing and counselling services by women and men respectively. Methods 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 health care workers and four Focus Group discussions (FGDs) with 18 men and 17 pregnant women attending antenatal care at the clinic. 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 analysed using thematic content analysis. Results Participants in both FGDs and KIIs identified the following barriers: lack of knowledge of MI in PMTCT, socioeconomic factors, relationship issues, timidity to be seen in a woman’s domain, unplanned and or extramarital pregnancies, fear of knowing one's HIV status, unwillingness to be associated with the service, health facility based factors, peer influence and cultural factors. The factors that would potentially promote male involvement were categorized into community, health facility and personal or family level factors. Conclusions The factors that may
Evans, Alison A; Cohen, Chari; Huang, Peixin; Qian, Liping; London, W Thomas; Block, Joan M; Chen, Gang
In regions where hepatitis B virus (HBV) is endemic, perinatal transmission is common. Infected newborns have a 90% chance of developing chronic HBV infection, and 1 in 4 will die prematurely from HBV-related liver disease. In 2010, the Hepatitis B Foundation and the Haimen City CDC launched the Gateway to Care campaign in Haimen City, China to improve awareness, prevention, and control of HBV infection citywide. The campaign included efforts to prevent perinatal HBV transmission by screening all pregnant women for hepatitis B surface antigen (HBsAg), following those who tested positive, and administering immunoprophylaxis to their newborns at birth. Of 5407 pregnant women screened, 185 were confirmed HBsAg-positive and followed until delivery. At age one, 175 babies were available for follow up testing. Of those, 137 tested negative for HBsAg and positive for antibodies to HBsAg, indicating protection. An additional 34 HBsAg-negative babies also tested negative for antibodies to HBsAg or had indeterminate test results, were considered to have had inadequate immune responses to the vaccine, and were given a booster dose. A higher prevalence of nonresponse to HBV vaccine was observed among babies born to hepatitis B e antigen (HBeAg)-positive mothers and mothers with high HBV DNA titers. The remaining 4 babies tested positive for HBsAg and negative for antibodies, indicative of active HBV infection. The mothers of all 4 had viral loads ≥8×10(6) copies/ml in the third trimester. Although inadequate response or nonresponse to HBV vaccine was more common among babies born to HBeAg-positive and/or high viral load mothers, these risk factors did not completely predict nonresponsiveness. All babies born to HBV-infected mothers should be tested upon completion of the vaccine series to ascertain adequate protection. Some babies of HBeAg-positive mothers with high viral load may still become HBV infected despite timely immunoprophylaxis with HBV vaccine and HBIG
Full Text Available White spot syndrome virus (WSSV has become epidemic in Indonesia and affecting shrimp aquaculture interm of its production. White spot syndrome virus is transmitted from one to other ponds, through crustacean, included planktonic copepode as carrier for WSSV and through water from affected shrimp pond. A cluster model, consist of shrimp grow out ponds surrounded by non-shrimp pond as a role of biosecurity has been developed. The model aimed to prevent white spot virus transmission in extensive giant tiger shrimp pond. The study was conducted in two sites at Demak District, Central Java Province. As the treatment, a cluster consist of three shrimp ponds in site I, and two shrimp ponds in site II, each was surrounded by buffer ponds rearing only finfish. As the control, five extensive shrimp grow out ponds in site I and three shrimp grow out ponds in site II, with shrimp pond has neither applied biosecurity nor surrounded by non-shrimp pond as biosecurity as well considered as control ponds. The results found that treatment of cluster shrimp ponds surrounded by non-shrimp ponds could hold shrimp at duration of culture in the grow out pond (DOC 105.6±4.5 days significantly much longer than that of control that harvested at 60.9±16.0 days due to WSSV outbreak. Survival rate in trial ponds was 77.6±3.6%, significantly higher than that of control at 22.6±15.8%. Shrimp production in treatment ponds has total production of 425.1±146.6 kg/ha significantly higher than that of control that could only produced 54.5±47.6 kg/ha. Implementation of Better Management Practices (BMP by arranging shrimp ponds in cluster and surrounding by non-shrimp ponds proven effectively prevent WSSV transmission from traditional shrimp ponds in surrounding area.
Neubert, Jennifer; Pfeffer, Maren; Borkhardt, Arndt; Niehues, Tim; Adams, Ortwin; Bolten, Mareike; Reuter, Stefan; Stannigel, Hans; Laws, Hans-Juergen
Antiretroviral drugs including zidovudine (ZDV) are effective in reducing HIV mother to child transmission (MTCT), however safety concern remains. The optimal duration of postnatal ZDV has not been established in clinical studies and there is a lack of consensus regarding optimal management. The objective of this study was to investigate the effectiveness and safety of a risk adapted two week course of oral postnatal ZDV as part of a combined intervention to reduce MTCT. 118 mother infant pairs were treated according to the German-Austrian recommendations for HIV therapy in pregnancy and in HIV exposed newborns between 2000-2010. In the absence of factors associated with an increased HIV-1 transmission risk, children were assigned to the low risk group and treated with an abbreviated postnatal regimen with oral ZDV for 2 weeks. In the presence of risk factors, postnatal ZDV was escalated accordingly. Of 118 mother-infant pairs 79 were stratified to the low risk group, 27 to the high risk group and 11 to the very high risk group for HIV-1 MTCT. 4 children were lost to follow up. Overall Transmission risk in the group regardless of risk factors and completion of prophylaxis was 1.8% (95% confidence interval (CI) 0.09-6.6). If transmission prophylaxis was complete, transmission risk was 0.9% (95% CI 0.01-5.7). In the low risk group receiving two week oral ZDV transmission risk was 1.4% (95% CI 0.01-8.4) These data demonstrate the effectiveness of a short neonatal ZDV regimen in infants of women on stable ART and effective HIV-1 suppression. Further evaluation is needed in larger studies.
Full Text Available Abstract Background Antiretroviral drugs including zidovudine (ZDV are effective in reducing HIV mother to child transmission (MTCT, however safety concern remains. The optimal duration of postnatal ZDV has not been established in clinical studies and there is a lack of consensus regarding optimal management. The objective of this study was to investigate the effectiveness and safety of a risk adapted two week course of oral postnatal ZDV as part of a combined intervention to reduce MTCT. Methods 118 mother infant pairs were treated according to the German-Austrian recommendations for HIV therapy in pregnancy and in HIV exposed newborns between 2000–2010. In the absence of factors associated with an increased HIV–1 transmission risk, children were assigned to the low risk group and treated with an abbreviated postnatal regimen with oral ZDV for 2 weeks. In the presence of risk factors, postnatal ZDV was escalated accordingly. Results Of 118 mother-infant pairs 79 were stratified to the low risk group, 27 to the high risk group and 11 to the very high risk group for HIV–1 MTCT. 4 children were lost to follow up. Overall Transmission risk in the group regardless of risk factors and completion of prophylaxis was 1.8% (95% confidence interval (CI 0.09–6.6. If transmission prophylaxis was complete, transmission risk was 0.9% (95% CI 0.01-5.7. In the low risk group receiving two week oral ZDV transmission risk was 1.4% (95% CI 0.01–8.4 Conclusion These data demonstrate the effectiveness of a short neonatal ZDV regimen in infants of women on stable ART and effective HIV–1 suppression. Further evaluation is needed in larger studies.
Filippitzi, M. E.; Kruse, Amanda Brinch; Postma, M.
This study aimed to review the transmission routes of important infectious pig diseases and to translate these into biosecurity measures preventing or reducing the transmission between and within pig herds. Furthermore, it aimed to identify the level of implementation of these measures in different...... European countries and discuss the observed variations to identify potentials for improvement. First, a literature review was performed to show which direct and indirect transmission routes of 24 infectious pig diseases can be prevented through different biosecurity measures. Second, a quantitative...... on biosecurity since 1971 in Denmark. However, the observed pattern may also be attributed to differences in data collection methods. The qualitative analysis identified differences in applied policies, legislation, disease status, pig farm density, farming culture and habits between countries that can be used...
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.
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…
Fraser, Hannah; Martin, Natasha K.; Brummer-Korvenkontio, Henrikki; Carrieri, Patrizia; Dalgard, Olav; Dillon, John; Goldberg, David; Hutchinson, Sharon; Jauffret-Roustide, Marie; Kåberg, Martin; Matser, Amy A.; Matičič, Mojca; Midgard, Havard; Mravcik, Viktor; Øvrehus, Anne; Prins, Maria; Reimer, Jens; Robaeys, Geert; Schulte, Bernd; van Santen, Daniela K.; Zimmermann, Ruth; Vickerman, Peter; Hickman, Matthew
Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs)
Maryland State Dept. of Health and Mental Hygiene, Baltimore.
Guidelines to prevent the transmission of blood-borne diseases, especially those caused by the Human Immunodeficiency Virus (HIV) and the Hepatitis B Virus (HBV), in the school setting are provided in this resource manual for school staff. Sections include information on the reasons for the development of this manual; a summary of the means of HIV…
Maryland State Dept. of Health and Mental Hygiene, Baltimore.
This Maryland resource manual provides local education agencies with guidelines on how to handle body fluids to prevent the transmission of diseases, especially Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV), in the school setting. The first section summarizes the reasons for development of the manual. The second section summarizes…
Kuznik, Andreas; Lamorde, Mohammed; Hermans, Sabine; Castelnuovo, Barbara; Auerbach, Brandon; Semeere, Aggrey; Sempa, Joseph; Ssennono, Mark; Ssewankambo, Fred; Manabe, Yukari C.
Objective To model the cost-effectiveness in Uganda of combination antiretroviral therapy (ART) to prevent mother-to-child transmission of human immunodeficiency virus (HIV). Methods The cost-effectiveness of ART was evaluated on the assumption that ART reduces the risk of an HIV-positive pregnant
Gammeltoft, Tine; Rasch, Vibeke; Bui, Kim Chi
'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, plays...
Nguyen, T.A.; Oosterhoff, P.; Yen, P.N.; Hardon, A.; Wright, P.
Background: Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have
Nkuoh, Godlove N; Meyer, Dorothy J; Tih, Pius M; Nkfusai, Joseph
Men's role in HIV prevention is pivotal to changing the course of the epidemic. When men participate in Prevention of Mother-to-Child Transmission (PMTCT) programs, their knowledge of HIV increases, their behavior becomes supportive, and their receptiveness to HIV testing increases. In Cameroon, Africa, multiple efforts have been implemented that encourage men to "follow" their wives to obstetric/PMTCT care and to undergo HIV testing. However, only 18% of men have participated in this care. As a quality improvement initiative, a survey was administered to identify men's knowledge and attitudes regarding antenatal care (ANC), PMTCT, and HIV. The survey consisted of a questionnaire with an emphasis on identifying barriers to men's participation in PMTCT programs and obtaining HIV testing. A convenience sampling method was used, and no participant identifying information was collected. Men's participation in ANC/PMTCT is affected by sociocultural barriers centered in tribal beliefs and traditional gender roles. The barriers identified included the belief that pregnancy is a "woman's affair"; the belief that a man's role is primarily to provide financial support for the woman's care; the man's perception that he will be viewed as jealous by the community if he comes to clinic with his pregnant wife; and cultural gender-based patterns of communication. Most men consider accompanying their wife to ANC/PMTCT a good practice. Yet fewer men actually do this, because they feel that the provision of finance for ANC registration and delivery fees is their most important role in supporting their wife's pregnancy. Health care workers should encourage individuals and community leaders to build upon the traditional value of financial responsibility, expanding a man's involvement to include supportive social roles in obstetric care, PMTCT, and HIV testing. Copyright 2010 American College of Nurse-Midwives. Published by Elsevier Inc. All rights reserved.
Full Text Available Background: The South African government intervened by implementing the prevention of mother–to-child transmission programme (PMTCT to curb the HIV transmission from mother to child during and after pregnancy. The PMTCT programme has been at the forefront of global prevention efforts since 1998. Without treatment, the risk of transmission ranges from one in five to one in two newborns; however, the risk of mother-to-child transmission can be reduced to as low as 2%–5% with evidenced interventions. Sub-Saharan Africa, and most particularly South Africa, is the most affected by the pandemic despite having the largest financial investment in PMTCT services across the continent.Objectives: The objectives of the study were to describe and explore the female perspectives of male inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal.Methodology: A qualitative, descriptive, explorative study was conducted through in-depth individual interview of pregnant women until data saturation.Results: The findings of the study revealed that the existing design of public hospitals was not wholly conducive to facilitating male inclusion in maternal and child health services. Resources were largely insufficient to support the participation of pregnant mothers and any attempts to support the inclusion of males needed to be based on a clear increase in service provision.Conclusion: The study recommended male partners’ inclusion in the prevention of mother- to-child HIV transmission to support effective management of HIV in pregnancy and PMTCT programmes. The inclusion of men will provide the holistic support needed by pregnant women on PMTCT programmes.
Sau, Mealiny Sokun; Balamane, Maya; Lurie, Mark; Harwell, Joseph; Welle, Emily; Mean, Chhivun; Cu-Uvin, Susan
Elimination of pediatric HIV requires a robust program for the prevention of mother-to-child transmission (PMTCT). The goal of this study was to assess the implementation of these services in Cambodia. This prospective study was conducted in Bantey Meanchey at 2 sites. Staff reviewed daily clinic and laboratory registration logs to gather data on PMTCT service access among antenatal women. A total of 12 140 pregnant women received antenatal care. Only 4034 (33.2%) received pre-HIV test counseling. Of which 3407 (84.5%) received an HIV test. Eighteen (94.7%) of 19 women testing HIV-seropositive received triple-combination antiretroviral (ARV) medication. Fifteen HIV-exposed infants were delivered during the study. One infant tested HIV positive and is on ARV medication. Acceptance for HIV testing was high among women who received pretest counseling. An increase in the number of counselors may improve the rates of HIV testing. Follow-up mechanisms targeting mother-baby pairs should focus on increasing timely service uptake in the public sector. © The Author(s) 2015.
Nuwagaba-Biribonwoha, H; Mayon-White, R T; Okong, P; Carpenter, L M
To report the experience of health workers who had played key roles in the early stages of implementing the prevention of mother-to-child HIV transmission services (PMTCT) in Uganda. Interviews were conducted with 15 key informants including counsellors, obstetricians and PMTCT coordinators at the five PMTCT test sites in Uganda to investigate the benefits, challenges and sustainability of the PMTCT programme. Audio-taped interviews were held with each informant between January and June 2003. These were transcribed verbatim and manually analysed using the framework approach. The perceived benefits reported by informants were improvement of general obstetric care, provision of antiretroviral prophylaxis for HIV-positive mothers, staff training and community awareness. The main challenges lay in the reluctance of women to be tested for HIV, incomplete follow-up of participants, non-disclosure of HIV status and difficulties with infant feeding for HIV-positive mothers. Key informants thought that the programme's sustainability depended on maintaining staff morale and numbers, on improving services and providing more resources, particularly antiretroviral therapy for the HIV-positive women and their families. Uganda's experience in piloting the PMTCT programme reflected the many challenges faced by health workers. Potentially resource-sparing strategies such as the 'opt-out' approach to HIV testing required further evaluation.
Hodson, Nathan; Bewley, Susan
Improved prevention of vertical transmission of HIV is an essential part of the global response to HIV. The Option B+ strategy took the extraordinary step of treating many non-pregnant women living with HIV (those with CD4 cell counts >350 cells/mm 3 ) in the absence of evidence that they themselves would benefit from ART. This example of so-called AIDS exceptionalism reflects an understanding that the global response to HIV demands a different set of morals. This philosophical article explores a retrospective analysis of the ethical arguments made in support of Option B+ incorporating utilitarian, feminist and equity-based frameworks. A number of inconsistencies were found in the arguments made for the introduction of Option B+ well before results were available from the START and TEMPRANO trials. Although some people think 'the ends justify the means', we conclude that erroneous justifications were initially given in support of Option B+. We identify tensions that remain in light of these results and argue that future strategies would benefit from a community-focused, human rights-based approach.
Full Text Available Abstract Background Ukraine was the epicentre of the HIV epidemic in Eastern Europe, which has the most rapidly accelerating HIV epidemic world-wide today; national HIV prevalence is currently estimated at 1.6%. Our objective was to evaluate the uptake and effectiveness of interventions for prevention of mother-to-child transmission (PMTCT over an eight year period within operational settings in Ukraine, within the context of an ongoing birth cohort study. Methods The European Collaborative Study (ECS is an ongoing birth cohort study in which HIV-infected pregnant women identified before or during pregnancy or at delivery were enrolled and their infants prospectively followed. Three centres in Ukraine started enrolling in 2000, with a further three joining in September 2006. Results Of the 3356 women enrolled, 21% (689 reported current or past injecting drug use (IDU. Most women were diagnosed antenatally and of those, the proportion diagnosed in the first/second trimester increased from 47% in 2000/01 (83/178 to 73% (776/1060 in 2006/07 (p Conclusion There have been substantial improvements in use of PMTCT interventions in Ukraine, including earlier diagnosis of HIV-infected pregnant women and increasing coverage with antiretroviral prophylaxis and the initial MTCT rate has more than halved. Future research should focus on hard-to-reach populations such as IDU and on missed opportunities for further reducing the MTCT rate.
Mohammad Hosein Baghianimoghadam
Full Text Available Introduction The aim of this study was to determine the knowledge, attitude, and practice of AIDS patients with regard to the prevention of disease transmission in Yazd and Ahvaz, Iran. Methods In this cross-sectional study, we evaluated the knowledge, attitude, and practice of 130 patients, selected via simple sampling, with regard to the prevention of disease transmission in Yazd and Ahvaz, Iran (65 cases from each city. Data were collected by researchers, using a questionnaire and a checklist. For statistical analysis, descriptive and analytical tests were performed, using SPSS version 16. Results In this study, the sample included 130 AIDS patients from Yazd and Ahvaz. Overall, 67.6% of the patients were male; on the other hand, 29.2% and 32.3% of the participants from Yazd and Ahvaz were female, respectively. As the findings revealed, 44.6% and 55.4% of the patients from Yazd and Ahvaz were married, respectively. The mean scores of knowledge, attitude, and practice of the patients regarding the prevention of HIV transmission were 40.31 ± 3.3, 41.92 ± 8.8, and 43.28 ± 5.3 in Yazd, respectively. Also, the mean scores of knowledge, attitude, and practice with regard to the prevention of HIV transmission were 40.68 ± 3.2.5, 42.52 ± 9.05, and 43.24 ± 6.08 among patients from Ahvaz, respectively. Overall, the results showed that the knowledge, attitude, and practice of most patients were at a medium level. Also, most of the participants from Yazd (70.8% and Ahvaz (56.9% had obtained information at AIDS counseling centers. Conclusions The results highlighted the need to educate patients regarding the prevention of HIV transmission.
Seibert, Dorothy J; Speroni, Karen Gabel; Oh, Kyeung Mi; DeVoe, Mary C; Jacobsen, Kathryn H
Health care workers (HCWs) play a critical role in prevention of health care-associated infections such as methicillin-resistant Staphylococcus aureus (MRSA), but glove and gown contact precautions and hand hygiene may not be consistently used with vulnerable patients. A cross-sectional survey of MRSA knowledge, attitudes/perceptions, and practices among 276 medical, nursing, allied health, and support services staff at an acute-care hospital in the eastern United States was completed in 2012. Additionally, blinded observations of hand hygiene behaviors of 104 HCWs were conducted. HCWs strongly agreed that preventive behaviors reduce the spread of MRSA. The vast majority reported that they almost always engage in preventive practices, but observations of hand hygiene found lower rates of adherence among nearly all HCW groups. HCWs who reported greater comfort with telling others to take action to prevent MRSA transmission were significantly more likely to self-report adherence to recommended practices. It is important to reduce barriers to adherence with preventive behaviors and to help all HCWs, including support staff who do not have direct patient care responsibilities, to translate knowledge about MRSA transmission prevention methods into consistent adherence of themselves and their coworkers to prevention guidelines. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
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
Hauser, Andrea; Sewangi, Julius; Mbezi, Paulina; Dugange, Festo; Lau, Inga; Ziske, Judith; Theuring, Stefanie; Kuecherer, Claudia; Harms, Gundel; Kunz, Andrea
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. 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 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. 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 the frequency of AZT-resistance mutations. Given its impact on
Stanly Fon Tebug
Full Text Available Milk production using local cattle breed-types is an age-old practice in Malawi. Although dairy farming is becoming more common as a result of the increasing population and demand for milk and milk products, there is limited knowledge of the farmers’ awareness of zoonotic disease risks, their preventative practices and the disease burden in animals. This study determined dairy farmers’ general knowledge of zoonoses, assessed their risks for infection with zoonotic bovine tuberculosis (bTB and brucellosis, and evaluated farm practices to prevent disease transmission. A questionnaire was drawn up and administered by the authors. It was used to collect information about the knowledge and preventive practices of 140 out of 684 registered dairy farmers at Mzuzu Agricultural Development Division, northern Malawi. During a second visit to 60 out of the 140 farms, a total of 156 and 95 cattle were tested for brucellosis and tuberculosis, respectively. Most farmers (77.1% knew or had heard of zoonotic diseases, whilst 75.0% correctly named at least one zoonotic disease. More survey participants named tuberculosis as a zoonotic disease compared to brucellosis (74.3% versus 2.9%. The most commonly named means of transmission were milk (67.0% and meat (56.0%. Almost all survey participants (96.4% practised at least one farm activity that could lead to potential transmission of brucellosis or bTB, including sale (67.0% and consumption (34.0% of unpasteurised milk. Antibodies against brucellosis were found in 12 cattle (7.7%, whilst one animal (1.1% reacted to the tuberculin skin test. General knowledge about possible transmission of diseases between humans and animals was high, although most farmers practised risk behaviours that could potentially expose the public to milk-borne zoonotic diseases such as brucellosis and bTB. Furthermore, some animals had positive results for brucellosis and tuberculosis tests. Therefore, improvement of zoonotic disease
Tebug, Stanly Fon; Njunga, Gilson R; Chagunda, Mizeck G G; Mapemba, Jacob P; Awah-Ndukum, Julius; Wiedemann, Steffi
Milk production using local cattle breed-types is an age-old practice in Malawi. Although dairy farming is becoming more common as a result of the increasing population and demand for milk and milk products, there is limited knowledge of the farmers' awareness of zoonotic disease risks, their preventative practices and the disease burden in animals. This study determined dairy farmers' general knowledge of zoonoses, assessed their risks for infection with zoonotic bovine tuberculosis (bTB) and brucellosis, and evaluated farm practices to prevent disease transmission. A questionnaire was drawn up and administered by the authors. It was used to collect information about the knowledge and preventive practices of 140 out of 684 registered dairy farmers at Mzuzu Agricultural Development Division, northern Malawi. During a second visit to 60 out of the 140 farms, a total of 156 and 95 cattle were tested for brucellosis and tuberculosis, respectively. Most farmers (77.1%) knew or had heard of zoonotic diseases, whilst 75.0% correctly named at least one zoonotic disease. More survey participants named tuberculosis as a zoonotic disease compared to brucellosis (74.3% versus 2.9%). The most commonly named means of transmission were milk (67.0%) and meat (56.0%). Almost all survey participants (96.4%) practised at least one farm activity that could lead to potential transmission of brucellosis or bTB, including sale (67.0%) and consumption (34.0%) of unpasteurised milk. Antibodies against brucellosis were found in 12 cattle (7.7%), whilst one animal (1.1%) reacted to the tuberculin skin test. General knowledge about possible transmission of diseases between humans and animals was high, although most farmers practised risk behaviours that could potentially expose the public to milk-borne zoonotic diseases such as brucellosis and bTB. Furthermore, some animals had positive results for brucellosis and tuberculosis tests. Therefore, improvement of zoonotic disease prevention
Fraser, Hannah; Martin, Natasha K; Brummer-Korvenkontio, Henrikki
BACKGROUND: Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical to eliminating HCV in Europe. We estimate impact of current and scaled-up HCV treatment with and without scaling-up opioid substitution therapy (OST) and needle and syringe programmes...... (NSP) across Europe over the next 10 years. METHODS: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST and NSP coverage from 11 European settings. We parameterized a HCV transmission model to setting-specific data that projects chronic HCV prevalence and incidence...... among PWID. RESULTS: At baseline, chronic HCV prevalence varied from 55% (Finland/Sweden), and
Evans, Martin E; Kralovic, Stephen M; Simbartl, Loretta A; Freyberg, Ron W; Obrosky, D Scott; Roselle, Gary A; Jain, Rajiv
Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative was associated with significant declines in MRSA transmission and MRSA health care-associated infection rates in Veterans Affairs acute care facilities nationwide in the 33-month period from October 2007 through June 2010. Here, we show continuing declines in MRSA transmissions (P = .004 for trend, Poisson regression) and MRSA health care-associated infections (P < .001) from July 2010 through June 2012. The Veterans Affairs Initiative was associated with these effects, sustained over 57 months, in a large national health care system. Published by Mosby, Inc.
Auvinen, Jaana; Kylmä, Jari; Välimäki, Maritta; Bweupe, Max; Suominen, Tarja
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. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Nyondo, Alinane Linda; Chimwaza, Angela Faith; Muula, Adamson Sinjani
Male involvement (MI) in Prevention of mother to child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services remains low despite the progress registered in the implementation of the PMTCT program. Male involvement in PMTCT is a fairly new concept in Malawi that has not been fully implemented within PMTCT service provision despite its inclusion in the PMTCT guidelines. One of the reasons for the limited MI is the lack of knowledge on both its relevance and the role of men in the program. Currently, men have been encouraged to participate in PMTCT services without prior research on their understanding of the relevance and their role in PMTCT. This information is vital to the development of programs that will require MI in PMTCT. The objective of this study was to explore the views of men, pregnant women and health care providers on the importance and roles of MI in PMTCT services in Blantyre Malawi. An exploratory descriptive qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC) and its catchment area in Blantyre, Malawi. We conducted 6 key informant interviews (KIIs) with health care workers and 4 focus group discussions (FGDs) with 18 men and 17 pregnant women. Interviews and discussions were digitally recorded and simultaneously transcribed and translated into English. Data were analyzed using framework analysis approach. The major themes that emerged on the relevance of MI in PMTCT were a) uptake of interventions along the PMTCT cascade b) support mechanism and c) education strategy. Lack of MI in PMTCT was reported to result into non-disclosure of HIV test results and non-compliance with PMTCT interventions. Male involvement is paramount for the uptake of interventions at the different cascades of PMTCT. The absence of male involvement may compromise compliance with PMTCT interventions.
Veen, Christa A; van Kasteren, Marjo E E; Fiedeldeij, Cora A; Kuipers, Marien H J; van Dijken, Pim J; Obihara, Charles C
To evaluate the neonatal outcomes of the policy for the prevention of vertical HIV transmission in a non-university HIV centre. Retrospective, descriptive study. We analysed the HIV status of newborns of HIV-positive mothers during pregnancy in the period between 1 January 1995 and 31 December 2010 in St. Elisabeth Hospital, Tilburg, the Netherlands and compared these results with the Dutch HIV monitoring foundation (SHM) registration data. Eighty-seven children from 84 pregnancies and their 71 HIV-positive mothers were included. Compared with SHM data, more women were African, younger at HIV diagnosis and had less resistance to the usual combination antiretroviral therapy (cART). In line with SHM data, the percentage of elective caesarean sections declined in the study period. There were fewer preterm births than in SHM data. There were no significant differences between preterm birth (p = 0.18), SGA (p = 0.25) or congenital abnormality (p = 0.45) and detectable HIV-RNA or cART use during pregnancy. During 10 (12%) pregnancies the mother presented to the HIV centre too late. At the age of 18 months, all 72 tested children were HIV negative. Of the 15 children lost to follow-up, 8 (9%) left to an unknown destination. All newborns of HIV-positive mothers were HIV negative, 12% of the HIV-positive mothers presented too late and 9% of the children disappeared from medical control. These results emphasize the importance of better communication between HIV centres, medical services of asylum centres and first-line obstetric care for female asylum seekers and their children.
Ford, Catherine; Chibwesha, Carla J; Winston, Jennifer; Jacobs, Choolwe; Lubeya, Mwansa Ketty; Musonda, Patrick; Stringer, Jeffrey S A; Chi, Benjamin H
Women's empowerment is associated with engagement in some areas of healthcare, but its role in prevention of mother-to-child HIV transmission (PMTCT) services has not been previously considered. In this secondary analysis, we investigated the association of women's decision-making and uptake of health services for PMTCT. Using data from population-based household surveys, we included women who reported delivery in the 2-year period prior to the survey and were HIV-infected. We measured a woman's self-reported role in decision-making in her own healthcare, making of large purchases, schooling of children, and healthcare for children. For each domain, respondents were categorized as having an "active" or "no active" role. We investigated associations between decision-making and specific steps along the PMTCT cascade: uptake of maternal antiretroviral drugs, uptake of infant HIV prophylaxis, and infant HIV testing. We calculated unadjusted and adjusted odds ratios via logistic regression. From March to December 2011, 344 HIV-infected mothers were surveyed and 276 completed the relevant survey questions. Of these, 190 (69%) took antiretroviral drugs during pregnancy; 175 (64%) of their HIV-exposed infants received antiretroviral prophylaxis; and 160 (58%) had their infant tested for HIV. There was no association between decision-making and maternal or infant antiretroviral drug use. We observed a significant association between decision-making and infant HIV testing in univariate analyses (OR 1.56-1.85; p decision-making indicators were no longer statistically significant predictors of infant HIV testing in multivariate analyses. In conclusion, women who reported an active role in decision-making trended toward a higher likelihood of uptake of infant testing in the PMTCT cascade. Larger studies are needed to evaluate the impact of empowerment initiatives on the PMTCT service utilization overall and infant testing in particular.
Sellier, Pierre O; Maylin, Sarah; Berçot, Béatrice; Chopin, Dorothée; Lopes, Amanda; Simoneau, Guy; Evans, John; Delcey, Véronique; Bénifla, Jean-Louis; Simon, François; Bergmann, Jean-François
The risk of vertical transmission of hepatitis B virus (HBV) increases as maternal HBV DNA increase, despite serovaccination to newborns. From 1 July 2012 to 1 January 2016, all pregnant women in Lariboisiere Hospital, Paris, France, with HBV DNA of 5 log10 IU/ml and above were administered tenofovir from week 28 of pregnancy until delivery. HBV DNA was measured at months 1, 2 of tenofovir and at delivery. The newborns were serovaccinated, tested for hepatitis B surface antigen, hepatitis B core antibody (HBcAb)±HBV DNA, and hepatitis B surface antibody (HBsAb) when aged 9 months, and then 24 months. This study was registered in http://www.ClinicalTrials.gov (NCT02039362). Thirty-one women gave birth to 37 newborns. Maternal HBV DNA at baseline was 8.23 log10 IU/ml and above in 12 pregnancies. The mean (median) HBV DNA were 4.4±1.2 (4.8), 3.3±1.7 (3.8), and 2.1±1.9 (2.0) log10 IU/ml at months 1, 2 of tenofovir and at delivery, respectively. Twenty-seven newborns were followed up: none of the 19 children aged 9 months or older was positive for hepatitis B surface antigen when aged 9 months; 14 children tested positive for HBcAb (probably transferred maternal antibodies, not found when aged 24 months) and for HBsAb without HBV DNA. Four of the 19 children showed HBsAb without HBcAb, the last being doubtful for HBcAb and HBsAb without HBV DNA. Eight newborns aged less than 9 months were not tested. Tenofovir from week 28 of pregnancy to highly viremic HBV women plus serovaccination to newborns could prevent chronic and past infection.
Gupta, A K; Garg, C R; Joshi, B C; Rawat, N; Dabla, V; Gupta, A
In India, programme for prevention of mother-to-child transmission (PMTCT) of HIV is primarily implemented through public health system. State AIDS Control Societies (SACSs) encourage private hospitals to set up integrated counselling and testing centres (ICTCs). However, private hospitals of Delhi did not set up ICTCs. Consequently, there is no information on PMTCT interventions in private hospitals of Delhi. This study was undertaken by Delhi SACS during March 2013 through September 2013 to assess status of implementation of PMTCT programme in various private hospitals of Delhi to assist programme managers in framing national policy to facilitate uniform implementation of National PMTCT guidelines. Out of total 575 private hospitals registered with Government of Delhi, 336 (58.4%) catering to pregnant women were identified. About 100 private hospitals with facility of antenatal care, vaginal/caesarean delivery and postnatal care and minimum 10 indoor beds were selected for study. Study sample comprised of large corporate hospitals (≥100 beds; n = 29), medium-sized hospitals (25 to Policy, HIV testing was done without pre/post-test counselling/or consent of women, no PMTCT protocol existed, delivery of HIV-positive women was not undertaken and no efforts were made to link HIV-positive women to antiretroviral treatment. Major intervention observed was medical termination of pregnancy, which indicates lack of awareness in private hospitals about available interventions under national programme. The role of private hospitals in management of HIV in pregnant women must be recognized and mainstreamed in HIV control efforts. There is an urgent need for capacity building of private health care providers to improve standards of practice. National AIDS Control Organization may consider establishing linkages or adopting model developed by some countries with generalized epidemic for delivering PMTCT services in private health sector.
Full Text Available Abstract Introduction Although progressive improvements have been made in the coverage and quality of prevention of HIV/AIDS mother-to-child transmission (PMTCT services in Ethiopia, the national coverage remained persistently low. Analysis of the cascaded PMTCT services can reveal the advancements made and the biggest hurdles faced during implementation. Objective To examine the progresses and unaddressed needs in access and utilization of PMTCT services in Ethiopia from 2006 to 2010 thereby developing best-fit regression models to predict the values of key PMTCT indicators at critical future points. Methods Five-year national level PMTCT data were analyzed in a cascaded manner. Five levels of analysis were used for ten major PMTCT indicators. These included description of progress made, assessment of unaddressed needs, developing best-fit models, prediction for future points and estimation using constant prevalence. Findings were presented using numerical and graphic summaries. Results Based on the current trend, Ethiopia could achieve universal ANC coverage by 2015. The prevalence of HIV at PMTCT sites has shown a four-fold decrease during the five-year period. This study has found that only 53% of known HIV-positive mothers and 48% of known HIV-exposed infants have received ARV prophylaxis. Based on assumption of constant HIV prevalence, the estimated ARV coverage was found to be 11.6% for HIV positive mothers and 8.4% for their babies. Conclusion There has been a remarkable improvement in the potential coverage of PMTCT services due to rapid increase in the number of PMTCT service outlets. However, the actual coverage remained low. Integration of PMTCT services with grassroots level health systems could unravel the problem.
Full Text Available BACKGROUND: Consistent and correct condom use and suppressive antiretroviral therapy for the infected partner are two of the primary strategies recommended for prevention of heterosexual HIV transmission in serodiscordant couples today. The applied effectiveness of treatment as a prevention strategy in China is still under investigation, and much less is known about its effects in the presence of other prevention strategies such as consistent condom use. METHODS: We conducted a systematic search in PubMed and three Chinese language databases to identify relevant articles for the estimation of relative effectiveness of a consistent condom use and b ART use by index partners for preventing HIV transmission in serodiscordant couples. We also estimated the prevention effectiveness of ART stratified by condom use level and the prevention effectiveness of consistent condom use stratified by ART use level. RESULTS: Pooled results from the eleven eligible studies found a pooled HIV seroconversion incidence of 0.92 cases per 100 person years (PY among HIV-negative spouses whose index partners were taking ART versus 2.45 cases per 100 PY in untreated couples. The IRR comparing seroconversion in couples where the index-partner was on ART versus not on ART was 0.47 (95%CI: 0.43, 0.52, while stratified by condom use, the IRR was 0.33(0.17,0.64. The IRR comparing incidence in couples reporting "consistent condom use" versus those reporting otherwise was 0.02(95%CI:0.01,0.04, after stratified by ART use level, the IRR was 0.01(95%CI: 0.00, 0.06. CONCLUSIONS: ART use by index partners could reduce HIV transmission in serodiscordant couples, and the effectiveness of this prevention strategy could be further increased with consistent condom use.
Full Text Available Abstract Background Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have received inadequate health care services for prevention of mother-to-child transmission. We report here the health workers' perceptions on factors that lead to their failure to give good quality prevention of mother-to-child transmission services. Methods Semistructured interviews with 53 health workers and unstructured observations in nine health facilities in Hanoi were conducted. Selection of respondents was based on their function, position and experience in the development or implementation of prevention of mother-to-child transmission policies/programmes. Results Factors that lead to health workers' failure to give good quality services for prevention of mother-to-child transmission include their own fear of HIV infection; lack of knowledge on HIV and counselling skills; or high workloads and lack of staff; unavailability of HIV testing at commune level; shortage of antiretroviral drugs; and lack of operational guidelines. A negative attitude during counselling and provision of care, treating in a separate area and avoidance of providing service at all were seen by health workers as the result of fear of being infected, as well as distrust towards almost all HIV-infected patients because of the prevailing association with antisocial behaviours. Additionally, the fragmentation of the health care system into specialized vertical pillars, including a vertical programme for HIV/AIDS, is a major obstacle to providing a continuum of care. Conclusion Many hospital staff were not being able to provide good care or were even unwilling to provide appropriate care for HIV-positive pregnant women The study suggests that the quality of prevention of
Full Text Available Background HIV/AIDS is posing the most alarming public health challenges in worldwide. Based on research studies showed that school, pre‐university and university level students are not fully aware of the mode of transmissions, risk behaviour, attitudes, beliefs and prevention of HIV/AIDS. College students should be aware on the basic information, prevention and transmission of HIV/AIDS so that they can perceive themselves as having a personal responsibility for maintaining healthy life. Objectives This study was undertaken to evaluate the Effectiveness of Self Instructional Module on Knowledge regarding prevention and transmission of HIV/AIDS among bachelor level of management students. Methods Pre experimental research design was done. The samples were 100 bachelor level management students of selected colleges at Bangalore. A purposive sampling technique was used to select the samples for the study. A structured knowledge questionnaire was used to collect the data from the participants. The data was analyzed using descriptive and inferential statistics and interpreted in terms of objectives and hypothesis of the study. The level of significance was set at 0.05 levels. Results The mean pre‐test knowledge score was 41.8% (SD of ± 10.9 whereas the mean post‐test knowledge score was 84.2% (SD of ±8.2. A significant difference was found between mean pre‐test and post‐test knowledge scores (‘t’ = 39.35, p< 0.05. A significant association was found between age, gender, marital status, stream of education, place of origin, educational level of parents and the source of information received on prevention and transmission HIV/AIDS (χ2 = 5.18, 3.87, 7.68, 7.31, 7.53, 8.67, 7.84 at p< 0.05. Conclusion The samples had inadequate knowledge regarding all the aspects of prevention and transmission of HIV/AIDS. The study finding indicates that Self‐Instructional Module was effective in enhancing the knowledge of bachelor level management
... Risk of Transmission of Creutzfeldt-Jakob Disease (CJD) and Variant Creutzfeldt-Jakob Disease (vCJD) by... Creutzfeldt-Jakob Disease (CJD) and Variant Creutzfeldt-Jakob Disease (vCJD) by Blood and Blood Products... Measures to Reduce the Possible Risk of Transmission of Creutzfeldt-Jakob Disease (CJD) and Variant...
Eke, Ahizechukwu C; Eleje, George U; Eke, Uzoamaka A; Xia, Yun; Liu, Jiao
Hepatitis is a viral infection of the liver. It is mainly transmitted between people through contact with infected blood, frequently from mother to baby in-utero. Hepatitis B poses significant risk to the fetus and up to 85% of infants infected by their mothers at birth develop chronic hepatitis B virus (HBV) infection. Hepatitis B immunoglobulin (HBIG) is a purified solution of human immunoglobulin that could be administered to the mother, newborn, or both. HBIG offers protection against HBV infection when administered to pregnant women who test positive for hepatitis B envelope antigen (HBeAg) or hepatitis B surface antigen (HBsAg), or both. When HBIG is administered to pregnant women, the antibodies passively diffuse across the placenta to the child. This materno-fetal diffusion is maximal during the third trimester of pregnancy. Up to 1% to 9% infants born to HBV-carrying mothers still have HBV infection despite the newborn receiving HBIG plus active HBV vaccine in the immediate neonatal period. This suggests that additional intervention such as HBIG administration to the mother during the antenatal period could be beneficial to reduce the transmission rate in utero. To determine the benefits and harms of hepatitis B immunoglobulin (HBIG) administration to pregnant women during their third trimester of pregnancy for the prevention of mother-to-child transmission of hepatitis B virus infection. We searched the The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded (Web of Science), SCOPUS, African Journals OnLine, and INDEX MEDICUS up to June 2016. We searched ClinicalTrials.gov and portal of the WHO International Clinical Trials Registry Platform (ICTRP) in December 2016. We included randomised clinical trials comparing HBIG versus placebo or no intervention in pregnant women with HBV. Two authors extracted data independently. We analysed dichotomous outcome data using risk ratio (RR
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
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.
Full Text Available Background. Male involvement is an important determinant of prevention of mother-to-child transmission of HIV. However, male involvement in prevention of mother-to-child transmission of HIV in Ethiopia is not well known. Objectives. To assess male partners involvement in prevention of mother-to-child transmission of HIV and associated factors in Arba Minch town and Arba Minch Zuria woreda. Methods. Community based study was conducted in Arba Minch town and Arba Minch Zuria district. Multistage sampling technique was used and data were collected using interviewer administered standard questionnaire. Multiple logistic regression analysis was used to determine the presence of statistically significant associations between the outcome variable and the independent variables. Results. The level of male involvement in PMTCT program in Arba Minch town and Zuria district was 53%. Several factors appear to contribute to male involvement in the PMTCT program including age, residence, education level, knowledge on HIV, knowledge on PMTCT, accessibility of health facility, having weak perception for male involvement in PMTCT, having perception of ANC attendance being females’ responsibility, ever use of khat, and ever use of cigarette. Conclusion. Geographical accessibility of health facility and male’s knowledge on PMTCT should be improved to increase their involvement in PMTCT.
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.
Walter, Jan; Kuhn, Louise; Kankasa, Chipepo; Semrau, Katherine; Sinkala, Moses; Thea, Donald M; Aldrovandi, Grace M
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. 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. 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. These data suggest that the efficacy of SDNVP may not be diminished when reused in subsequent pregnancies.
Lin, Y; Zhang, S X; Yang, P C; Cai, Y L; Zou, Y H
Objective: To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B, and estimate the willing to pay and budget impacts on the PMTCT. Methods: The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention. The parameters in the model were obtained from literatures of national surveys or Meta-analysis. The costs, cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives, respectively. The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization. One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results. In addition, cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy. Results: The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier, which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention. Due to the strategy, a total of 24.516 1 QALYs per person would be gained, which was higher than that in those receiving no intervention. From societal perspective, the ICER was -59 136.6 yuan (RMB) per additional QALYs gained, indicating that the PMTCT is cost effective. The results were reliable indicated by one-way, multi-way and probability sensitivity analyses. By the CEAC, the willing to pay was much lower than the cost-effectiveness threshold. From the affordability curve of the PMTCT strategy, the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB), which was lower than the financial ability. Based on the results of cost-effectiveness affordability curves, the higher annual budget was determined
Butt, Taimur S; Koutlakis-Barron, Irene; AlJumaah, Suliman; AlThawadi, Sahar; AlMofada, Saleh
Transmission of Middle East respiratory syndrome-coronavirus (MERS-CoV) among health care workers (HCWs) and patients has been documented with mortality rate approximating 36%. We propose advanced infection control measures (A-IC) used in conjunction with basic infection control measures (B-IC) help reduce pathogen transmission. B-IC include standard and transmission-based precautions. A-IC are initiatives implemented within our center to enhance effectiveness of B-IC. Study effectiveness of combining B-IC and A-IC to prevent transmission of MERS-CoV to HCWs. A retrospective observational study was undertaken. A-IC measures include administrative support with daily rounds; infection control risk assessment; timely screening, isolation, and specimen analysis; collaboration; epidemic planning; stockpiling; implementation of contingency plans; full personal protective equipment use for advanced airway management; use of a real-time electronic isolation flagging system; infection prevention and control team on-call protocols; pretransfer MERS-CoV testing; and education. A total of 874 real-time polymerase chain reaction MERS-CoV tests were performed during the period beginning July 1, 2013, and ending January 31, 2015. Six hundred ninety-four non-HCWs were tested, of these 16 tested positive for MERS-CoV and their infection was community acquired. Sixty-nine percent of the confirmed MERS-CoV-positive cases were men, with an average age of 56 years (range, 19-84 years). Of the total tested for MERS-CoV, 180 individuals were HCWs with zero positivity. Adhering to a combination of B-IC and A-IC reduces the risk of MERS-CoV transmission to HCWs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Full Text Available Background Hepatitis B is one of the most common infectious diseases worldv.ide. Indonesia has moderate-high endemicity for hepatitis B infection. Perinatal transmission increases the risk for chronic hepatitis B. Infants from HBsAg-positive mothers should receive hepatitis B immunoglobulin (HBIG and vaccination within 12 hours of birth, but this practice is not routinely done in Indonesia due to financial constraints. Objectives To detennine the influence of Hep-B immunization on preventing Hepatitis B vertical transmission. Methods A descriptive cohort study was conducted from May 2009 - January 2010. Subjects were term infants born from HBsAg-positive mothers v.ith no history of HBIG administration. They had received complete hepatitis B immunization and 1 month after the last dose were evaluated for HBsAg and anti-HBs. Cord blood was also taken during labor to measure HBsAg. Results There were 22 infants born from HBsAg-positive mother who met the inclusion criteria. HBsAgwas positive in 6 of22 cord blood specimens. There were 15 infants who completed this study. One of 15 infants had positive HBsAg after completed hepatitis B immunization and 12 of 15 infants had protective level of anti-HBs. Effectiveness of hepatitis B immunization to prevent vertical transmission in this study was 70-90%. Conclusion Hepatitis B immunization can prevent vertical transmission of hepatitis B in infants born to mothers who are HBsAg-positive even without administration of HBIG.
Towards effective interventions for transgender people and their clients to prevent HIV infection and transmission : A study of the psychological determinants, sexual behavior s, and socio-demographic characteristics related to condom use and health care use
In Indonesia, transgender people (waria) have the second highest HIV prevalence (21.9%), the first being people who inject drugs (36.4%). To reduce HIV incidence among transgender people and prevent HIV transmission, they should have access to all prevention services including education, prevention
Zafer, Maryam; Horvath, Hacsi; Mmeje, Okeoma; van der Poel, Sheryl; Semprini, Augusto; Rutherford, George; Brown, Joelle
Objective To evaluate the effectiveness of semen washing in HIV-discordant couples in which the male partner is infected Design Systematic review and meta-analysis Setting All countries Patient(s) Forty single-arm, open label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen Intervention(s) Semen washing followed by IUI, IVF, or IVF/ICSI Main outcome measure(s) Primary outcome: HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy Result(s) No HIV transmission occurred in 11,585 cycles of assisted reproduction using washed semen among 3,994 women (95% confidence interval [CI] = 0–0.0001). Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women following 2,863 cycles of assisted reproduction using washed semen (95%CI= 0–0.0006). Studies that measured HIV transmission to infants reported no cases of vertical transmission (0/1,026, 95% CI= 0–0.0029). Overall, 56.3% (2,357/4,184, 95%CI=54.8%–57.8%) of couples achieved a clinical pregnancy using washed semen. Conclusion(s) Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized, controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help further reduce the spread of HIV. PMID:26688556
Saounde Temgoua, Edith Michele; Nkenfou, Celine Nguefeu; Zoung-Kanyi Bissek, Anne Cecile; Fokam, Joseph; Billong, Serge Clotaire; Sosso, Samuel Martin; Tangipumdu, Charlotte; Elong, Elise Lobe; Domkan, Irenee; Colizzi, Vittorio
Despite improvement in HIV prevention of mother-to-child transmission (PMTCT), there are still over 1,500 African infants newly infected daily. PMTCT elimination requires antiretroviral therapy (ART) throughout pregnancy and breastfeeding periods, while early infant diagnosis (EID) of HIV implies early treatment for those infected. Our study aimed at assessing the utility of EID program data in evaluating the implementation of PMTCT program in Cameroon, and in identifying the efficacy of existing PMTCT interventions and breastfeeding options on the events of HIV vertical transmission. A study was conducted from 2010-2011 using PMTCT data from EID sites of six regions of Cameroon. PMTCT ARV regimens, breastfeeding options, and the child's HIV DNA-polymerase chain reaction (PCR) results were recorded. Statistical analyses were performed using Mann Whitney U and Fisher exact tests, with pvertical transmission, against 31.3% (284/906) among mother-child pairs without exposure to any PMTCT intervention; pvertical transmission was recorded versus 19.9% (48/241) for mother-child pairs without intervention; pTransmission rates were similar across infant age range [2.7% (10/376) for age ≤6 weeks, versus 2.5% (43/1807) for age >6 weeks-6 months]. Interestingly, babies aged 6 weeks receiving FF showed a significantly lower transmission rate (3.2%, 9/277) as compared to their counterparts with EBF (7.7%, 12/156); pHIV MTCT may be achievable through access to ARV (option B+) and adequate infant feeding option (especially FF) in Cameroon. EID programme is therefore an effective routine approach for PMTCT programme evaluation in resource-limited settings.
Zafer, Maryam; Horvath, Hacsi; Mmeje, Okeoma; van der Poel, Sheryl; Semprini, Augusto E; Rutherford, George; Brown, Joelle
To evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)-discordant couples in which the male partner is infected. Systematic review and meta-analysis. Not applicable. Forty single-arm open-label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen. Semen washing followed by IUI, IVF, or IVF/ICSI. HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy. No HIV transmission occurred in 11,585 cycles of assisted reproduction with the use of washed semen among 3,994 women. Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women after 2,863 cycles of assisted reproduction with the use of washed semen. Studies that measured HIV transmission to infants reported no cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy with the use of washed semen. Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help to further reduce the spread of HIV. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
Wilken, Jason A; Pordell, Paran; Goode, Brant; Jarteh, Rachel; Miller, Zayzay; Saygar, Benjamin G; Maximore, Leroy; Borbor, Watta M; Carmue, Moses; Walker, Gregory W; Yeiah, Adolphus
In early 2015, a patient from a cluster of cases of Ebola Virus Disease (EVD) in Monrovia, Liberia traveled to a rural village in Margibi County, potentially exposing numerous persons. The patient died in the village and post-mortem testing confirmed Ebola Virus infection. Problem The Margibi County Health Team (CHT; Kakata, Margibi, Liberia) needed to prevent further transmission of EVD within and outside of the affected villages, and they needed to better understand the factors that support or impede compliance with measures to stop the spread of EVD. In February-March 2015, the Margibi CHT instituted a 21-day quarantine and active monitoring for two villages where the patient had contact with numerous residents, and a 21-day active monitoring for five other villages where the patient had possible contact with an unknown number of persons. One contact developed EVD and quarantine was extended an additional 12 days in one village. In April 2015, the Margibi CHT conducted a household-based EVD knowledge, attitudes, and practices (KAP) survey of the seven villages. From April 24-29, 2015, interview teams approached every household in the seven villages and collected information on demographics, knowledge of EVD, attitudes about quarantine to prevent the spread of EVD, and their quarantine experiences and practices. Descriptive statistics were calculated. One hundred fifteen interviews were conducted, representing the majority of the households in the seven villages. Most (99%) correctly identified touching an infected person's body fluids and contact with the body of someone who has died from EVD as transmission routes. However, interviewees sometimes incorrectly identified mosquito bites (58%) and airborne spread (32%) as routes of EVD transmission, and 72% incorrectly identified the longest EVD incubation period as ≤seven days. Eight of 16 households in the two quarantined villages (50%) reported times when there was not enough water or food during quarantine
Full Text Available Objectives. Despite the availability of services to prevent mother-to-child transmission (PMTCT of HIV, socio-cultural, health system and operational factors constrain many pregnant women from accessing services or returning for followup thereby increasing the risk of vertical transmission of HIV to newborns. We highlight and describe unique contextual factors contributing to low utilization of PMTCT services in Arba-Minch, Ethiopia. Methods. Qualitative research design was utilized to obtain data through focus group discussions and in-depth interviews with antenatal clinic attendees, health workers health facilities in the study area. Results. Awareness of PMTCT services and knowledge of its benefits was nearly universal, although socioeconomic, cultural and health system factors, including stigma and desire to prevent knowledge of serostatus, impede access to and utilization of services. Health system factors—lack of appropriate followup mechanisms, inadequate access to ARV drugs and poorly equipped manpower also contribute to low utilization of services. Conclusion. Reducing mother-to-child transmission of HIV in sub-Saharan Africa will be more effective when unique contextual factors are identified and addressed. Effectiveness of PMTCT interventions rests on a well functioning health system that recognize the importance of social, economic, cultural contexts that HIV positive pregnant women live in.
Thorne, Claire; Semenenko, Igor; Malyuta, Ruslan
Aims To compare clinical status, mother-to-child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV-infected injecting drug users (IDUs) and non-IDUs. Design and setting Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000–10. Participants Pregnant HIV-infected women, identified before/during pregnancy or intrapartum, and their live-born infants (n = 6200); 1028 women followed post-partum. Measurements Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW). Findings Of 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P Ukraine have worse clinical status, poorer access to prevention of mother-to-child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother-to-child transmission than non-injecting drug user women. PMID:21819473
M Kumi Smith
Full Text Available Sustained viral suppression through ART reduces sexual HIV transmission risk, but may require routine access to reliable and effective medical care which may be difficult to obtain in resource constrained areas. We investigated the roles of patient load and travel distance to HIV care clinic on transmission risk in HIV serodiscordant couples in Henan Province, China.Cox proportional hazard models were used to compare HIV transmission events across couples living near, medium, or farther distances from their assigned HIV care clinics, as well as those attending clinics where clinicians bore high versus low patient loads.Most (84·4% of the 3695 serodiscordant couples lived within 10 kilometers of their assigned HIV clinic, and most (73·5% attended clinics with patient-to-provider ratios of at least 100:1. In adjusted Cox models, attending clinics where clinicians bore average patient loads of 100 or more elevated HIV transmission risk (aHR, 1·50, 95% CI, 1·00-4·84, an effect amplified in village tier clinics (aHR = 1·55; 95% CI, 1·23-6·78. Travel distance was associated with HIV transmission only after stratification; traveling medium distances to village clinics (5-10km increased transmission risk (aHR = 1·83, 95% CI, 1·04-3·21 whereas traveling longer distances to township or county level clinics lowered transmission risk (aHR = 0·10, 95% CI, 0·01-0·75.Higher patient loads at HIV clinics was associated with risk of HIV transmission in our population, particularly at village level clinics. Farther travel distance had divergent effects based on clinic tier, suggesting unique mechanisms operating across levels of resource availability. The resource intensity of long-term HIV treatment may place significant strains on small rural clinics, for which investments in additional support staff or time-saving tools such as point-of-care laboratory testing may bring about impactful change in treatment outcomes.
Full Text Available Strategies to improve the uptake of Prevention of Mother-To-Child Transmission of HIV (PMTCT are needed. We integrated HIV and maternal, newborn and child health services in a One Stop Clinic to improve the PMTCT cascade in a rural Tanzanian setting.The One Stop Clinic of Ifakara offers integral care to HIV-infected pregnant women and their families at one single place and time. All pregnant women and HIV-exposed infants attended during the first year of Option B+ implementation (04/2014-03/2015 were included. PMTCT was assessed at the antenatal clinic (ANC, HIV care and labour ward, and compared with the pre-B+ period. We also characterised HIV-infected pregnant women and evaluated the MTCT rate.1,579 women attended the ANC. Seven (0.4% were known to be HIV-infected. Of the remainder, 98.5% (1,548/1,572 were offered an HIV test, 94% (1,456/1,548 accepted and 38 (2.6% tested HIV-positive. 51 were re-screened for HIV during late pregnancy and one had seroconverted. The HIV prevalence at the ANC was 3.1% (46/1,463. Of the 39 newly diagnosed women, 35 (90% were linked to care. HIV test was offered to >98% of ANC clients during both the pre- and post-B+ periods. During the post-B+ period, test acceptance (94% versus 90.5%, p<0.0001 and linkage to care (90% versus 26%, p<0.0001 increased. Ten additional women diagnosed outside the ANC were linked to care. 82% (37/45 of these newly-enrolled women started antiretroviral treatment (ART. After a median time of 17 months, 27% (12/45 were lost to follow-up. 79 women under HIV care became pregnant and all received ART. After a median follow-up time of 19 months, 6% (5/79 had been lost. 5,727 women delivered at the hospital, 20% (1,155/5,727 had unknown HIV serostatus. Of these, 30% (345/1,155 were tested for HIV, and 18/345 (5.2% were HIV-positive. Compared to the pre-B+ period more women were tested during labour (30% versus 2.4%, p<0.0001. During the study, the MTCT rate was 2.2%.The implementation of
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Sherman, Gayle G; Mazanderani, Ahmad Haeri; Barron, Peter; Bhardwaj, Sanjana; Niit, Ronelle; Okobi, Margaret; Puren, Adrian; Jackson, Debra J; Goga, Ameena Ebrahim
South Africa has utilized three independent data sources to measure the impact of its program for the prevention of mother-to-child transmission (PMTCT) of HIV. These include the South African National Health Laboratory Service (NHLS), the District Health Information System (DHIS), and South African PMTCT Evaluation (SAPMTCTE) surveys. We compare the results of each, outlining advantages and limitations, and make recommendations for monitoring transmission rates as South Africa works toward achieving elimination of mother-to-child transmission (eMTCT). HIV polymerase chain reaction (PCR) test data, collected between 1 January 2010 to 31 December 2014, from the NHLS, DHIS and SAPMTCTE surveys were used to compare early mother-to-child transmission (MTCT) rates in South Africa. Data from the NHLS and DHIS were also used to compare early infant diagnosis (EID) coverage. The age-adjusted NHLS early MTCT rates of 4.1% in 2010, 2.6% in 2011 and 2.3% in 2012 consistently fall within the 95% confidence interval as measured by three SAPMTCTE surveys in corresponding time periods. Although DHIS data over-estimated MTCT rates in 2010, the MTCT rate declines thereafter to converge with age-adjusted NHLS MTCT rates by 2012. National EID coverage from NHLS data increases from around 52% in 2010 to 87% in 2014. DHIS data over-estimates EID coverage, but this can be corrected by employing an alternative estimate of the HIV-exposed infant population. NHLS and DHIS, two routine data sources, provide very similar early MTCT rate estimates that fall within the SAPMTCTE survey confidence intervals for 2012. This analysis validates the usefulness of routine data sources to track eMTCT in South Africa.
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.
Full Text Available In a study of congenital transmission during acute infection of Toxoplasma gondii, 23 pregnant Balb/c mice were inoculated orally with two cysts each of the P strain. Eight mice were inoculated 6-11 days after becoming pregnant (Group 1. Eight mice inoculated on the 10th-15th day of pregnancy (Group 2 were treated with 100 mg/kg/day of minocycline 48 h after inoculation. Seven mice inoculated on the 10th-15th day of pregnancy were not treated and served as a control (Group 3. Congenital transmission was evaluated through direct examination of the brains of the pups or by bioassay and serologic tests. Congenital transmission was observed in 20 (60.6% of the 33 pups of Group 1, in one (3.6% of the 28 pups of Group 2, and in 13 (54.2% of the 24 pups of Group 3. Forty-nine Balb/c mice were examined in the study of congenital transmission of T. gondii during chronic infection. The females showed reproductive problems during this phase of infection. It was observed accentuated hypertrophy of the endometrium and myometrium. Only two of the females gave birth. Our results demonstrate that Balb/c mice with acute toxoplasmosis can be used as a model for studies of congenital T. gondii infection. Our observations indicate the potential of this model for testing new chemotherapeutic agents against congenital toxoplasmosis.
H. E. Simmons; Holly Prendeville; J. P. Dunham; M. J. Ferrari; J. D. Earnest; D. Pilson; G. P. Munkvold; E. C. Holmes; A. G. Stephenson
Zucchini yellow mosaic virus (ZYMV) is an economically important pathogen of cucurbits that is transmitted both horizontally and vertically. Although ZYMV is seed-transmitted in Cucurbita pepo, the potential for seed transmission in virus-resistant transgenic cultivars is not known. We crossed and backcrossed a transgenic...
Kalkowska, Dominika A; Duintjer Tebbens, Radboud J; Thompson, Kimberly M
India presented many challenges to the global effort to eliminate the transmission of wild polioviruses (WPVs) and poliomyelitis, with the last case of WPV type 2 in the world reported in northern India in 1999 and WPV types 1 and 3 circulating until early 2011. We used a differential equation-based model to characterize the dynamics of poliovirus transmission and various opportunities to increase and maintain high population immunity to poliovirus transmission for 2 high-risk areas in northern India. We explored options that India probably considered before 2011, to demonstrate the impact of strategies to accelerate WPV elimination and sustain high population immunity. We also characterized the impact of current and potential future vaccination strategies and explored the potential trade-offs associated with the various strategies. National immunization policy choices impact population immunity, which leads to different numbers of expected paralytic cases and risks of circulating vaccine-derived poliovirus outbreaks. Assuming that India maintains high vaccination intensity everywhere, we do not anticipate issues with outbreaks of circulating vaccine-derived poliovirus type 2 infection following globally coordinated cessation of type 2-containting oral poliovirus vaccine use. We find a relatively modest potential role for inactivated poliovirus vaccine. National policy makers should consider the impacts of their vaccine choices on population immunity to poliovirus transmission. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: email@example.com.
Ikechebelu, J I; Ugboaja, J O; Kalu, S O; Ugochukwu, E F
A lot of challenges face the current efforts at reducing Mother to Child transmission of HIV infection (MTCT) in Sub Saharan Africa due to limited access to Highly active antiretroviral therapy (HAART) and breast feeding practices. A regular review of progress is necessary in order to identify areas of need. This is a one year prospective descriptive study of seven hundred and twenty six mother-infant pairs managed in the PMTCT programme in Nnamdi Azikiwe University Teaching Hospital, Nnewi Southeast Nigeria. The babies HIV status was tested with PCR for HIV DNA while the mothers provided information on infant feeding pattern and the use of antiretroviral (ARV) drugs including prophylaxis for the baby. Information was augmented from the antenatal records. The transmission rate was 2.8% for mothers, who were on HAART, did not breastfeed and whose babies received ARV prophylactic therapy. But for mothers who did not receive HAART, did breastfeed and whose babies did not received ARV prophylactic therapy, the transmission rate was 37.5%. When both the mother and child received ARV drugs, the transmission rate was significantly lower in those who did not breastfeed (2.8%) than in those who breastfed (12.5%)(P < 0.001). When both the mother and child did not receive ARV drugs, the transmission rate significantly lower in those who did not breastfeed (21.1%)than in those who breastfed (37.5%) (P < 0.02). The use of HAART in PMTCT programme in the under resourced areas can achieve similar success rates to that in the industrialized countries. Breastfeeding reduces the efficacy achieved by the use of ARV drugs. Provision of wider access to HAART as well as adequate counselling and support for safer infant feeding practices is recommended.
Notario-Pérez, Fernando; Martín-Illana, Araceli; Cazorla-Luna, Raúl; Ruiz-Caro, Roberto; Bedoya, Luis-Miguel; Tamayo, Aitana; Rubio, Juan; Veiga, María-Dolores
The main challenges facing efforts to prevent the transmission of human immunodeficiency virus (HIV) are the lack of access to sexual education services and sexual violence against young women and girls. Vaginal formulations for the prevention of sexually transmitted infections are currently gaining importance in drug development. Vaginal mucoadhesive tablets can be developed by including natural polymers that have good binding capacity with mucosal tissues, such as chitosan or guar gum, semisynthetic polymers such as hydroxypropylmethyl cellulose, or synthetic polymers such as Eudragit® RS. This paper assesses the potential of chitosan for the development of sustained-release vaginal tablets of Tenofovir and compares it with different polymers. The parameters assessed were the permanence time of the bioadhesion—determined ex vivo using bovine vaginal mucosa as substrate—the drug release profiles from the formulation to the medium (simulated vaginal fluid), and swelling profiles in the same medium. Chitosan can be said to allow the manufacture of tablets that remain adhered to the vaginal mucosa and release the drug in a sustained way, with low toxicity and moderate swelling that ensures the comfort of the patient and may be useful for the prevention of sexual transmission of HIV. PMID:28230790
Notario-Pérez, Fernando; Martín-Illana, Araceli; Cazorla-Luna, Raúl; Ruiz-Caro, Roberto; Bedoya, Luis-Miguel; Tamayo, Aitana; Rubio, Juan; Veiga, María-Dolores
The main challenges facing efforts to prevent the transmission of human immunodeficiency virus (HIV) are the lack of access to sexual education services and sexual violence against young women and girls. Vaginal formulations for the prevention of sexually transmitted infections are currently gaining importance in drug development. Vaginal mucoadhesive tablets can be developed by including natural polymers that have good binding capacity with mucosal tissues, such as chitosan or guar gum, semisynthetic polymers such as hydroxypropylmethyl cellulose, or synthetic polymers such as Eudragit ® RS. This paper assesses the potential of chitosan for the development of sustained-release vaginal tablets of Tenofovir and compares it with different polymers. The parameters assessed were the permanence time of the bioadhesion-determined ex vivo using bovine vaginal mucosa as substrate-the drug release profiles from the formulation to the medium (simulated vaginal fluid), and swelling profiles in the same medium. Chitosan can be said to allow the manufacture of tablets that remain adhered to the vaginal mucosa and release the drug in a sustained way, with low toxicity and moderate swelling that ensures the comfort of the patient and may be useful for the prevention of sexual transmission of HIV.
Full Text Available The main challenges facing efforts to prevent the transmission of human immunodeficiency virus (HIV are the lack of access to sexual education services and sexual violence against young women and girls. Vaginal formulations for the prevention of sexually transmitted infections are currently gaining importance in drug development. Vaginal mucoadhesive tablets can be developed by including natural polymers that have good binding capacity with mucosal tissues, such as chitosan or guar gum, semisynthetic polymers such as hydroxypropylmethyl cellulose, or synthetic polymers such as Eudragit® RS. This paper assesses the potential of chitosan for the development of sustained-release vaginal tablets of Tenofovir and compares it with different polymers. The parameters assessed were the permanence time of the bioadhesion—determined ex vivo using bovine vaginal mucosa as substrate—the drug release profiles from the formulation to the medium (simulated vaginal fluid, and swelling profiles in the same medium. Chitosan can be said to allow the manufacture of tablets that remain adhered to the vaginal mucosa and release the drug in a sustained way, with low toxicity and moderate swelling that ensures the comfort of the patient and may be useful for the prevention of sexual transmission of HIV.
Kuete, Martin; Yuan, Hongfang; He, Qian; Tchoua Kemayou, Aude Laure; Ndognjem, Tita Pale; Yang, Fan; Hu, ZhiZong; Tian, BoZhen; Zhao, Kai; Zhang, HuiPing; Xiong, ChengLiang
The sexual and reproductive health of people living with HIV is fundamental for their well-being. Antiretroviral therapy and reproductive technologies have significantly improved quality of life of people living with HIV in developed countries. In sub-Saharan Africa, the epicenter of HIV, the sexual practices and fertility of women infected with HIV have been understudied. To assess the sexual behavior, fertility intentions, and awareness of preventing mother-to-child transmission of HIV in pregnant women with HIV-negative partners in Yaounde Central Hospital (Yaounde, Cameroon). A cross-sectional survey using a semistructured, interviewer-administered questionnaire was conducted at the antenatal unit and HIV clinic in 2014. Ninety-four pregnant women infected with HIV provided consistent information on (i) sociodemographic characteristics, (ii) sexual and fertility patterns, (iii) awareness of preventing mother-to-child transmission of HIV, and (iv) their unmet needs. Although sexual desire had significantly changed since their HIV diagnosis, the women were highly sexually active. Approximately 19% of women had more than one sexual partner and 40% had regular unprotected sex during the 12-month period before the interviews (P sexual intercourse and inconsistent condom use to delay pregnancy, but the abortion rate remained high. Age, marital status, and education affected women's awareness of mother-to-child transmission (P children and future pregnancies (rs = -0.217; P = .036). HIV-infected women living with HIV-negative partners in Cameroon expressed high sexual and fertility intentions with several unmet needs, including safer sexual practices and conception. Incorporating and supporting safe sexual educational practices and conception services in maternal care can decrease risky sexual behavior and vertical transmission. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
Knowledge and attitudes about HIV infection and prevention of mother to child transmission of HIV in an urban, low income community in Durban, South Africa: Perspectives of residents and health care volunteers
Conclusion: Innovative ways to impart knowledge particularly of PMTCT and updated standards of practice are essential. It is important that the community understands how transmission occurs so that prevention can follow.
Taenzler, Janina; Liebenberg, Julian; Roepke, Rainer K A; Heckeroth, Anja R
The preventive effect of fluralaner spot-on solution against transmission of Babesia canis by Dermacentor reticulatus ticks was evaluated. Sixteen dogs, tested negative for B. canis by polymerase chain reaction (PCR) and immunofluorescence assay test (IFAT), were allocated to two study groups. On day 0, dogs in one group (n = 8) were treated once topically with fluralaner spot-on solution (Bravecto™ Spot-on Solution) according to label recommendations and dogs in the control group (n = 8) remained untreated. On days 2, 28, 56, 70 and 84, all dogs were infested with 50 (±4) D. reticulatus ticks harbouring B. canis, with tick in situ thumb counts 48 ± 4 h after each infestation. On day 90, ticks were removed from all dogs and counted. Prior to each infestation, the presence of B. canis in the respective tick batch was confirmed by PCR, and 12-16 % of ticks were found to be infected with B. canis. Efficacy against ticks was 99.5 and 99.3 % on days 4 and 58 after treatment, respectively and 100 % on all other days. Replacement dogs were included for any B. canis infected control dog (in total 19). All control dogs (n = 27) became infected with B. canis, as confirmed by PCR, performed every 7 days, and by IFAT, performed every 14 days after treatment. None of the eight treated dogs became infected with B. canis, as they were tested negative by PCR and IFAT throughout the study until day 112. By comparing infected dogs in the treated group with infected dogs in the untreated control group, a 100 % preventive effect against B. canis transmission was demonstrated. A single topical administration of fluralaner spot-on solution effectively prevented the transmission of B. canis by infected D. reticulatus ticks over a 12-week period.
Filippitzi, M E; Brinch Kruse, A; Postma, M; Sarrazin, S; Maes, D; Alban, L; Nielsen, L R; Dewulf, J
This study aimed to review the transmission routes of important infectious pig diseases and to translate these into biosecurity measures preventing or reducing the transmission between and within pig herds. Furthermore, it aimed to identify the level of implementation of these measures in different European countries and discuss the observed variations to identify potentials for improvement. First, a literature review was performed to show which direct and indirect transmission routes of 24 infectious pig diseases can be prevented through different biosecurity measures. Second, a quantitative analysis was performed using the Biocheck.UGent™, a risk-based scoring system to evaluate biosecurity in pig herds, to obtain an insight into the implementation of these biosecurity measures. The database contained farm-specific biosecurity data from 574 pig farms in Belgium, Denmark, France, Germany, the Netherlands and Sweden, entered between January 2014 and January 2016. Third, a qualitative analysis based on a review of literature and other relevant information resources was performed for every subcategory of internal and external biosecurity in the Biocheck.UGent™ questionnaire. The quantitative analysis indicated that at the level of internal, external and overall biosecurity, Denmark had a significantly distinct profile with higher external biosecurity scores and less variation than the rest of the countries. This is likely due to a widely used specific pathogen-free (SPF) system with extensive focus on biosecurity since 1971 in Denmark. However, the observed pattern may also be attributed to differences in data collection methods. The qualitative analysis identified differences in applied policies, legislation, disease status, pig farm density, farming culture and habits between countries that can be used for shaping country-specific biosecurity advice to attain improved prevention and control of important pig diseases in European pig farms. © 2017 Blackwell
Alexandrova, E. A.; Alkondon, M.; Aracava, Y.; Pereira, E. F. R.; Albuquerque, E. X.
Galantamine, a drug currently approved for treatment of Alzheimer's disease, has recently emerged as an effective pretreatment against the acute toxicity and delayed cognitive deficits induced by organophosphorus (OP) nerve agents, including soman. Since cognitive deficits can result from impaired glutamatergic transmission in the hippocampus, the present study was designed to test the hypothesis that hippocampal glutamatergic transmission declines following an acute exposure to soman and that this effect can be prevented by galantamine. To test this hypothesis, spontaneous excitatory postsynaptic currents (EPSCs) were recorded from CA1 pyramidal neurons in hippocampal slices obtained at 1 h, 24 h, or 6-9 days after guinea pigs were injected with: (i) 1xLD50 soman (26.3 μg/kg, s.c.); (ii) galantamine (8 mg/kg, i.m.) followed 30 min later by 1xLD50 soman, (iii) galantamine (8 mg/kg, i.m.), or (iv) saline (0.5 ml/kg, i.m.). In soman-injected guinea pigs that were not pretreated with galantamine, the frequency of EPSCs was significantly lower than that recorded from saline-injected animals. There was no correlation between the severity of soman-induced acute toxicity and the magnitude of soman-induced reduction of EPSC frequency. Pretreatment with galantamine prevented the reduction of EPSC frequency observed at 6-9 days after the soman challenge. Prevention of soman-induced long-lasting reduction of hippocampal glutamatergic synaptic transmission may be an important determinant of the ability of galantamine to counter cognitive deficits that develop long after an acute exposure to the nerve agent. PMID:25064080
Full Text Available Abstract Background This study was performed to better assess the perceptions, motivating factors, and behaviors associated with the use of hand washing to prevent H1N1 influenza transmission during the peak pandemic period in Korea. Methods A cross-sectional survey questionnaire was completed by 942 students at a university campus in Suwon, Korea, between December 1 and 8, 2009. The survey included questions regarding individual perceptions, motivating factors, and behaviors associated with hand washing for the prevention of H1N1 influenza transmission. Results Compared to one year prior, 30.3% of participants reported increasing their hand washing frequency. Female students were more likely to practice more frequent hand washing. Women also perceived the effectiveness of hand washing to be lower, and illness severity and personal susceptibility to H1N1 infection to be higher. Study participants who were female (OR: 1.79-3.90 who perceived of hand washing to be effective (OR: 1.34-12.15 and illness severity to be greater (OR: 1.00-3.12 washed their hands more frequently. Conclusions Korean students increased their frequency of hand hygiene practices during the pandemic, with significant gender differences existing in the attitudes and behaviors related to the use of hand hygiene as a means of disease prevention. Here, the factors that affected hand washing behavior were similar to those identified at the beginning of the H1N1 or SARS pandemics, suggesting that public education campaigns regarding hand hygiene are effective in altering individual hand hygiene habits during the peak periods of influenza transmission.
Nyondo, Aliane Linda; Sinjani Muula, Adamson; Faith Chimwaza, Angela
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...
Full Text Available The aim of the study was to identify factors influencing the utilisation of Prevention of Mother-to-Child Transmission (PMTCT in a resource poor setting in South Africa. Opsomming Die doel van die studie was om faktore te identifiseer wat die benutting van die Voorkoming van Moeder-tot-Kind Oordrag (VMTKO beïnvloed in ‘n omgewing in Suid-Afrika wat arm is aan hulpbronne. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.
French, Clare E; McKenzie, Bruce C; Coope, Caroline; Rajanaidu, Subhadra; Paranthaman, Karthik; Pebody, Richard; Nguyen-Van-Tam, Jonathan S; Higgins, Julian P T; Beck, Charles R
Respiratory syncytial virus (RSV) causes a significant public health burden, and outbreaks among vulnerable patients in hospital settings are of particular concern. We reviewed published and unpublished literature from hospital settings to assess: (i) nosocomial RSV transmission risk (attack rate) during outbreaks, (ii) effectiveness of infection control measures. We searched the following databases: MEDLINE, EMBASE, CINAHL, Cochrane Library, together with key websites, journals and grey literature, to end of 2012. Risk of bias was assessed using the Cochrane risk of bias tool or Newcastle-Ottawa scale. A narrative synthesis was conducted. Forty studies were included (19 addressing research question one, 21 addressing question two). RSV transmission risk varied by hospital setting; 6-56% (median: 28·5%) in neonatal/paediatric settings (n = 14), 6-12% (median: 7%) in adult haematology and transplant units (n = 3), and 30-32% in other adult settings (n = 2). For question two, most studies (n = 13) employed multi-component interventions (e.g. cohort nursing, personal protective equipment (PPE), isolation), and these were largely reported to be effective in reducing nosocomial transmission. Four studies examined staff PPE; eye protection appeared more effective than gowns and masks. One study reported on RSV prophylaxis for patients (RSV-Ig/palivizumab); there was no statistical evidence of effectiveness although the sample size was small. Overall, risk of bias for included studies tended to be high. We conclude that RSV transmission risk varies widely during hospital outbreaks. Although multi-component control strategies appear broadly successful, further research is required to disaggregate the effectiveness of individual components including the potential role of palivizumab prophylaxis. © 2016 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.
Sheng, Q J; Ding, Y; Li, B J; Bai, H; Zhang, C; Han, C; Fan, Y X; Li, Y W; Dou, X G
To observe the success rate of telbivudine (LdT) for the prevention of perinatal transmission of hepatitis B virus (HBV) and the incidence of alanine aminotransferase (ALT) elevation during LdT treatment and after LdT withdrawal in HBV-infected pregnant woman with high viremia in immune-tolerant phase and receiving LdT treatment at the end of pregnancy, and to evaluate the efficacy of LdT in the prevention of perinatal transmission and the safety for pregnant women. Pregnant women infected with HBV in immune-tolerant phase who had normal ALT levels (≤40 U/L) and high viremia (HBV DNA ≥6 log10 IU/ml) with positive HBeAg were enrolled as subjects. All pregnant women received antiviral treatment with LdT at the end of pregnancy to prevent perinatal transmission of HBV. All infants received standard combined immunoprophylaxis. Failure for prevention of perinatal transmission of HBV was defined as positive HBsAg or HBV DNA in infants 7 months of age (or at one month after the third injection of hepatitis B vaccine). Liver function, HBV DNA, and HBV serological markers were evaluated at baseline, after 1 month of treatment, before childbirth, and 1, 3, and 6 months after drug withdrawal. SPSS 16.0 software was used to analyze the data. Between-group comparison of continuous data was made by t test, and comparison of categorical data was made by chi-square test. One hundred and four pregnant women (treatment group) received oral administration of 600 mg LdT once a day, and 25 pregnant women (observation group) did not receive any antiviral therapy. The success rate for the prevention of perinatal transmission was significantly higher in the treatment group than in the observation group (100% vs 89.47%, χ (2) = 9.862, P = 0.028). There was no significant difference in the incidence of ALT elevation during treatment and within 6 months after drug withdrawal between the treatment group and the observation group (4.81% (5/104) vs 4.00% (1/25), χ (2) = 0.030, P = 1
Full Text Available 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 was conducted on HIV infected pregnant mothers who gave birth and had follow up at anti-retroviral therapy (ART clinic for at least 6 months during a time period paired with their infants. The primary and secondary outcomes were rate of infant infection by HIV at 6 weeks and 6 months respectively. The Chi-square was used for the comparison of categorical data multivariate logistic regression model was used to identify the determinants of early mother-to-child transmission of HIV at 6 weeks. Cox proportional hazard model was used to analyze factors that affect the 6 month HIV free survival of infants born to HIV infected mothers. Results: A total of 180 mother infant pairs were considered for the final analysis, 90(50% mothers received single dose nevirapine (sdNVP designated as regimen-3, 67 (37.2% mothers were on different types of ARV regimens commonly AZT + 3TC + NVP (regimen-1, while the rest 23 (12.8% mothers were on short course dual regimen AZT + 3TC + sdNVP (regimen-2. Early mother-to-child transmission rate at 6 weeks for regimens 1, 2 and 3 were 5.9% (4/67, 8.6% (2/23, and 15.5% (14/90 respectively. The late cumulative mother-to-child transmission rate of HIV at 6 months regardless of regimen type was 15.5% (28/180. Postnatal transmission at 6 months was 28.5% (8/28 of infected children. Factors that were found to be associated with high risk of early mother-to-child transmission of HIV include duration of ARV regimen shorter than 2 months during pregnancy
Adriana S. Duran
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
Zumla, Alimuddin; Saeed, Abdulaziz Bin; Alotaibi, Badriah; Yezli, Saber; Dar, Osman; Bieh, Kingsley; Bates, Matthew; Tayeb, Tamara; Mwaba, Peter; Shafi, Shuja; McCloskey, Brian; Petersen, Eskild; Azhar, Esam I
Tuberculosis (TB) is now the most common infectious cause of death worldwide. In 2014, an estimated 9.6 million people developed active TB. There were an estimated three million people with active TB including 360000 with multidrug-resistant TB (MDR-TB) who were not diagnosed, and such people continue to fuel TB transmission in the community. Accurate data on the actual burden of TB and the transmission risk associated with mass gatherings are scarce and unreliable due to the small numbers studied and methodological issues. Every year, an estimated 10 million pilgrims from 184 countries travel to the Kingdom of Saudi Arabia (KSA) to perform the Hajj and Umrah pilgrimages. A large majority of pilgrims come from high TB burden and MDR-TB endemic areas and thus many may have undiagnosed active TB, sub-clinical TB, and latent TB infection. The Hajj pilgrimage provides unique opportunities for the KSA and the 184 countries from which pilgrims originate, to conduct high quality priority research studies on TB under the remit of the Global Centre for Mass Gatherings Medicine. Research opportunities are discussed, including those related to the definition of the TB burden, transmission risk, and the optimal surveillance, prevention, and control measures at the annual Hajj pilgrimage. The associated data are required to develop international recommendations and guidelines for TB management and control at mass gathering events. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Esser, Stefan; Krotzek, Judith; Dirks, Henrike; Scherbaum, Norbert; Schadendorf, Dirk
Rising incidence rates of HIV and STIs (sexually transmitted infections) among MSM (men who have sex with men) in Germany since 2001 call for new approaches in medical prevention. The present study addresses appropriate parameters to identify those HIV-positive MSM who are at high risk for transmitting HIV and STIs. Over a two-year period, 223 HIV-positive MSM attending the HIV outpatient clinic at the University Medical Center Essen (Germany) were systematically surveyed with respect to their sexual behavior, substance abuse, and psychological well-being in the preceding year. Data analyzed included laboratory and clinical data from the time of the initial HIV diagnosis until January 2014. In HIV-positive MSM, a history of substance abuse, promiscuity, younger age, and known STIs was associated with a greater incidence of unprotected sexual intercourse and STIs. Apart from a detectable viral load, additional HIV-specific parameters associated with an increased HIV transmission risk included untreated HIV infection, adherence problems, changes in antiretroviral treatment over the preceding twelve months, known multiresistant HIV infection, and a higher CD 4 nadir. Despite routine quarterly monitoring of viral loads - the result thereof was communicated to patients - only 60 % of individuals assessed their HIV transmission risk correctly. In HIV-positive MSM, patient history and routine laboratory tests allow for the establishment of patient profiles that suggest sexual behavior associated with a high risk of HIV and STI transmission, thus offering new approaches for medical prevention. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.
Anderson, Ginna; Caswell, Georgina; Edwards, Olive; Hsieh, Amy; Hull, Beri; Mallouris, Christoforos; Mason, Naisiadet; Nöstlinger, Christiana
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. 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 responses revealed common facilitators of access, including quality counselling on reproductive choices, male involvement, and decentralized services. The consultation provided some understanding and insight into the participants' experiences with and recommendations for PVT strategies. Participants agreed that successful, comprehensive PVT programming require greater efforts to both prevent primary HIV infection among young women and girls and, in particular, targeted efforts to ensure that women living with HIV and their partners are supported to avoid unintended pregnancies and to have safe, healthy pregnancies instead. In addition to providing the insights
Vogt, Florian; Ferreyra, Cecilia; Bernasconi, Andrea; Ncube, Lewis; Taziwa, Fabian; Marange, Winnie; Wachi, David; Becher, Heiko
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. 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. Median maternal age was 27 years (inter-quartile range [IQR] 23 to 32) and median CD4 count was 394 cells/µL(3) (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, pHIV 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 test result collection. The CHW-DT intervention did not reduce perinatal HIV transmission significantly. Retention improved moderately during the post
Duintjer Tebbens, Radboud J; Pallansch, Mark A; Wassilak, Steven G F; Cochi, Stephen L; Thompson, Kimberly M
Frequent supplemental immunization activities (SIAs) with the oral poliovirus vaccine (OPV) represent the primary strategy to interrupt poliovirus transmission in the last endemic areas. Using a differential-equation based poliovirus transmission model tailored to high-risk areas in Nigeria, we perform one-way and multi-way sensitivity analyses to demonstrate the impact of different assumptions about routine immunization (RI) and the frequency and quality of SIAs on population immunity to transmission and persistence or emergence of circulating vaccine-derived polioviruses (cVDPVs) after OPV cessation. More trivalent OPV use remains critical to avoid serotype 2 cVDPVs. RI schedules with or without inactivated polio vaccine (IPV) could significantly improve population immunity if coverage increases well above current levels in under-vaccinated subpopulations. Similarly, the impact of SIAs on overall population immunity and cVDPV risks depends on their ability to reach under-vaccinated groups (i.e., SIA quality). Lower SIA coverage in the under-vaccinated subpopulation results in a higher frequency of SIAs needed to maintain high enough population immunity to avoid cVDPVs after OPV cessation. National immunization program managers in northwest Nigeria should recognize the benefits of increasing RI and SIA quality. Sufficiently improving RI coverage and improving SIA quality will reduce the frequency of SIAs required to stop and prevent future poliovirus transmission. Better information about the incremental costs to identify and reach under-vaccinated children would help determine the optimal balance between spending to increase SIA and RI quality and spending to increase SIA frequency.
Radboud J Duintjer Tebbens
Full Text Available Frequent supplemental immunization activities (SIAs with the oral poliovirus vaccine (OPV represent the primary strategy to interrupt poliovirus transmission in the last endemic areas.Using a differential-equation based poliovirus transmission model tailored to high-risk areas in Nigeria, we perform one-way and multi-way sensitivity analyses to demonstrate the impact of different assumptions about routine immunization (RI and the frequency and quality of SIAs on population immunity to transmission and persistence or emergence of circulating vaccine-derived polioviruses (cVDPVs after OPV cessation.More trivalent OPV use remains critical to avoid serotype 2 cVDPVs. RI schedules with or without inactivated polio vaccine (IPV could significantly improve population immunity if coverage increases well above current levels in under-vaccinated subpopulations. Similarly, the impact of SIAs on overall population immunity and cVDPV risks depends on their ability to reach under-vaccinated groups (i.e., SIA quality. Lower SIA coverage in the under-vaccinated subpopulation results in a higher frequency of SIAs needed to maintain high enough population immunity to avoid cVDPVs after OPV cessation.National immunization program managers in northwest Nigeria should recognize the benefits of increasing RI and SIA quality. Sufficiently improving RI coverage and improving SIA quality will reduce the frequency of SIAs required to stop and prevent future poliovirus transmission. Better information about the incremental costs to identify and reach under-vaccinated children would help determine the optimal balance between spending to increase SIA and RI quality and spending to increase SIA frequency.
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
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.
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Shifting the paradigm in Dirofilaria immitis prevention: blocking transmission from mosquitoes to dogs using repellents/insecticides and macrocyclic lactone prevention as part of a multimodal approach
John W. McCall
Full Text Available Abstract Background This study assessed the influence of a topical ectoparasiticide (dinotefuran-permethrin-pyriproxyfen, DPP, Vectra® 3D, Ceva Animal Health combined with a macrocyclic lactone (milbemycin oxime, MBO, Interceptor®, Virbac on transmission of heartworm L3 from mosquitoes to dogs and subsequent development of worms in treated dogs exposed to infected mosquitoes. Methods Thirty-two beagle dogs were allocated to four groups of eight: Group 1, untreated controls; Group 2, treated topically with DPP on Day 0; Group 3, treated orally with MBO on Day 51; and Group 4, treated with DPP on Day 0 and MBO on Day 51. Dogs were exposed under sedation for 1 h to Dirofilaria immitis (JYD-34-infected Aedes aegypti on Days 21 and 28. At the end of each exposure, mosquitoes were classified as live, moribund, or dead and engorged or non-engorged. Live or moribund mosquitoes were incubated for daily survival assessment for 3 days. Mosquitoes were dissected before and after exposure to estimate the number of L3 transmitted to each dog. Dogs were necropsied 148 to 149 days postinfection. Results A total of 418 mosquitoes fed on the 16 dogs in Groups 1 and 3, while only 6 fed on the 16 DPP-treated dogs in Groups 2 and 4. Mosquito anti-feeding (repellency effect in Groups 2 and 4 was 98.1 and 99.1%, respectively. The estimated numbers of L3 transmitted to controls, DPP-treated, MBO-treated and DPP + MBO-treated dogs were 76, 2, 78, and 1, respectively. No heartworms were detected in any of the DPP + MBO-treated dogs (100% efficacy, while 8 out of 8 were infected in the control group (range, 21–66 worms per dog, 8 out of 8 were infected in the MBO-treated group (58% efficacy, and 3 out of 8 were infected in the DPP-treated group (96% efficacy. Conclusions DPP repelled and killed most mosquitoes that were capable of transmitting heartworm L3 to dogs. The “Double Defense” protocol of DPP + MBO had better efficacy for protecting dogs against
Shifting the paradigm in Dirofilaria immitis prevention: blocking transmission from mosquitoes to dogs using repellents/insecticides and macrocyclic lactone prevention as part of a multimodal approach.
McCall, John W; Varloud, Marie; Hodgkins, Elizabeth; Mansour, Abdelmoneim; DiCosty, Utami; McCall, Scott; Carmichael, James; Carson, Ben; Carter, Justin
This study assessed the influence of a topical ectoparasiticide (dinotefuran-permethrin-pyriproxyfen, DPP, Vectra® 3D, Ceva Animal Health) combined with a macrocyclic lactone (milbemycin oxime, MBO, Interceptor®, Virbac) on transmission of heartworm L3 from mosquitoes to dogs and subsequent development of worms in treated dogs exposed to infected mosquitoes. Thirty-two beagle dogs were allocated to four groups of eight: Group 1, untreated controls; Group 2, treated topically with DPP on Day 0; Group 3, treated orally with MBO on Day 51; and Group 4, treated with DPP on Day 0 and MBO on Day 51. Dogs were exposed under sedation for 1 h to Dirofilaria immitis (JYD-34)-infected Aedes aegypti on Days 21 and 28. At the end of each exposure, mosquitoes were classified as live, moribund, or dead and engorged or non-engorged. Live or moribund mosquitoes were incubated for daily survival assessment for 3 days. Mosquitoes were dissected before and after exposure to estimate the number of L3 transmitted to each dog. Dogs were necropsied 148 to 149 days postinfection. A total of 418 mosquitoes fed on the 16 dogs in Groups 1 and 3, while only 6 fed on the 16 DPP-treated dogs in Groups 2 and 4. Mosquito anti-feeding (repellency) effect in Groups 2 and 4 was 98.1 and 99.1%, respectively. The estimated numbers of L3 transmitted to controls, DPP-treated, MBO-treated and DPP + MBO-treated dogs were 76, 2, 78, and 1, respectively. No heartworms were detected in any of the DPP + MBO-treated dogs (100% efficacy), while 8 out of 8 were infected in the control group (range, 21-66 worms per dog), 8 out of 8 were infected in the MBO-treated group (58% efficacy), and 3 out of 8 were infected in the DPP-treated group (96% efficacy). DPP repelled and killed most mosquitoes that were capable of transmitting heartworm L3 to dogs. The "Double Defense" protocol of DPP + MBO had better efficacy for protecting dogs against heartworm transmission and infection than MBO alone. This added
Audouze, Karine; Taboureau, Olivier; Grandjean, Philippe
The need to prevent developmental brain disorders has led to an increased interest in efficient neurotoxicity testing. When an epidemic of microcephaly occurred in Brazil, Zika virus infection was soon identified as the likely culprit. However, the pathogenesis appeared to be complex, and a larvi......The need to prevent developmental brain disorders has led to an increased interest in efficient neurotoxicity testing. When an epidemic of microcephaly occurred in Brazil, Zika virus infection was soon identified as the likely culprit. However, the pathogenesis appeared to be complex......). Especially in an acute situation like the microcephaly epidemic, where little toxicity documentation is available, new and innovative alternative methods, whether in vitro or in silico, must be considered. We have developed a network-based model using an integrative systems biology approach to explore...
Kuhn, Louise; Aldrovandi, Grace M; Sinkala, Moses; Kankasa, Chipepo; Mwiya, Mwiya; Thea, Donald M
We reviewed the potential impact of new WHO criteria for antiretroviral therapy using data from 1025 HIV-infected women and infants followed for 24 months in Lusaka, Zambia. The new criteria require initiating therapy among 68% of pregnant women and, if fully effective, would prevent 92% of maternal deaths and 88% of perinatal and postnatal infections. Using CD4 cell count below 350 cells/microl, irrespective of clinical stage, is more efficient and stricter CD4 cutoffs would be counter productive.
Kozlowski Lynn T
Full Text Available Abstract Background Recommendations about precautionary behaviors are a key part of public health responses to infectious disease threats such as the 2009 H1N1 pandemic. Individuals' interpretation of recommendations, willingness to comply, and factors predicting willingness were examined. Methods A telephone survey of adult residents of New York State was conducted (N = 807. Respondents reported how they interpreted recommendations, willingness to engage in recommended actions, risk perceptions for H1N1 infection, and perceived efficacy of recommendations. Demographic characteristics were used to calculate sampling weights to obtain population-representative estimates. Results There was substantial variability in interpretation of preventive actions. Willingness to engage in preventive actions also varied substantially; vaccination willingness was substantially lower than other preventive actions. No pattern of demographic characteristics consistently predicted willingness. Perceived efficacy was associated with willingness for all recommendations, and perceived severity was associated with willingness for some recommendations. Conclusions Results suggest that individual interpretation of actions differ widely. The results suggest that current recommendations are not clear to laypeople and are open to different interpretations. These varying interpretations should be considered in crafting public health messages about precautionary behaviors.
Claus, F; Ried, W
The colonization with Methicillin-resistant Staphylococcus aureus (MRSA) imposes a risk on the patient herself as well as on other patients and on healthcare professionals because, in the case of an infection, substantial health problems will arise. Moreover, additional costs for health care will occur as well. This paper examines the incentives of German rehabilitation centers to implement prevention measures in order to avert MRSA transmissions and infections. Relying on a decision tree analysis, the expected healthcare cost per capita is calculated for the 3 strategies general screening, risk-based screening, both upon admission, and no screening at all. The values of the relevant parameters are identified by a review of the published literature. From the perspective of a rehabilitation center, undertaking no screening at all minimizes the expected cost of treatment while the first strategy causes the highest cost. This ordering is robust with respect to multivariate sensitivity analyses. In Germany, rehabilitation centers currently are not reimbursed for the implementation of additional prevention measures against MRSA. Hence, as our analysis demonstrates, the financial incentive to implement MRSA screening turns out to be rather weak. This could well be inefficient for society because a substantial part of the benefit arising on other agents is not taken into account. Our results can be used to indicate changes in the remuneration system that would provide rehabilitation centers with an appropriate incentive for MRSA prevention. Moreover, hygiene regulations enacted recently such as the change in the Infection Prevention Act or the Medical Hygiene regulations emphasize the significance of an appropriate hygiene regimen, thus fostering MRSA prevention. © Georg Thieme Verlag KG Stuttgart · New York.
Seyed Ramin Radfar
Full Text Available Background: Identifying factors, which influence health behaviors is critical to designing appropriate and effective preventive programs. Human immunodeficiency virus (HIV transmission is highly related to people behaviors and understanding factors influencing healthy behaviors among Iranian people living with HIVs (PLHIVs/acquired immunodeficiency syndrome (AIDS is very important to tailor an effective response to HIV/AIDS epidemic. Methods: This study was conducted as a qualitative study by methods of focus group discussion and in-depth interview in six provinces of Iran with 64 PLHIVs to determine factors influence engagement in positive prevention. Results: Knowledge and education, feelings of responsibility and positive prevention practices were identified as the primary domains of engagement. These domains were found to be influenced by feelings of ostracism and frustration, poverty, barriers to disclosure of HIV status, access to and utilization of drug abuse treatment services and antiretroviral therapy, adherence to treatment, age, religiousness, sex work, singleness, and incarceration. Conclusions: Designing new interventions and updating current interventions directed toward the aforementioned factors should be addressed by responsible Iranian authorities in order to have a national effective response on the HIV/AIDS epidemic.
Radfar, Seyed Ramin; Sedaghat, Abbas; Banihashemi, Arash Tehrani; Gouya, Mohammadmehdi; Rawson, Richard A
Identifying factors, which influence health behaviors is critical to designing appropriate and effective preventive programs. Human immunodeficiency virus (HIV) transmission is highly related to people behaviors and understanding factors influencing healthy behaviors among Iranian people living with HIVs (PLHIVs)/acquired immunodeficiency syndrome (AIDS) is very important to tailor an effective response to HIV/AIDS epidemic. This study was conducted as a qualitative study by methods of focus group discussion and in-depth interview in six provinces of Iran with 64 PLHIVs to determine factors influence engagement in positive prevention. Knowledge and education, feelings of responsibility and positive prevention practices were identified as the primary domains of engagement. These domains were found to be influenced by feelings of ostracism and frustration, poverty, barriers to disclosure of HIV status, access to and utilization of drug abuse treatment services and antiretroviral therapy, adherence to treatment, age, religiousness, sex work, singleness, and incarceration. Designing new interventions and updating current interventions directed toward the aforementioned factors should be addressed by responsible Iranian authorities in order to have a national effective response on the HIV/AIDS epidemic.
Full Text Available BACKGROUND: The glycan-targeting C-type DC-SIGN lectin receptor is implicated in the transmission of the human immunodeficiency virus (HIV by binding the virus and transferring the captured HIV-1 to CD4(+ T lymphocytes. Carbohydrate binding agents (CBAs have been reported to block HIV-1 infection. We have now investigated the potent mannose-specific anti-HIV CBA griffithsin (GRFT on its ability to inhibit the capture of HIV-1 to DC-SIGN, its DC-SIGN-directed transmission to CD4(+ T-lymphocytes and the role of the three carbohydrate-binding sites (CBS of GRFT in these processes. FINDINGS: GRFT inhibited HIV-1(IIIB infection of CEM and HIV-1(NL4.3 infection of C8166 CD4(+ T-lymphocytes at an EC50 of 0.059 and 0.444 nM, respectively. The single mutant CBS variants of GRFT (in which a key Asp in one of the CBS was mutated to Ala were about ∼20 to 60-fold less potent to prevent HIV-1 infection and ∼20 to 90-fold less potent to inhibit syncytia formation in co-cultures of persistently HIV-1 infected HuT-78 and uninfected C8166 CD4(+ T-lymphocytes. GRFT prevents DC-SIGN-mediated virus capture and HIV-1 transmission to CD4(+ T-lymphocytes at an EC50 of 1.5 nM and 0.012 nM, respectively. Surface plasmon resonance (SPR studies revealed that wild-type GRFT efficiently blocked the binding between DC-SIGN and immobilized gp120, whereas the point mutant CBS variants of GRFT were ∼10- to 15-fold less efficient. SPR-analysis also demonstrated that wild-type GRFT and its single mutant CBS variants have the capacity to expel bound gp120 from the gp120-DC-SIGN complex in a dose dependent manner, a property that was not observed for HHA, another mannose-specific potent anti-HIV-1 CBA. CONCLUSION: GRFT is inhibitory against HIV gp120 binding to DC-SIGN, efficiently prevents DC-SIGN-mediated transfer of HIV-1 to CD4(+ T-lymphocytes and is able to expel gp120 from the gp120-DC-SIGN complex. Functionally intact CBS of GRFT are important for the optimal action of
Halken, S; Høst, A
, breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation...... populations. These theories remain to be documented in proper, controlled and prospective studies. Breastfeeding and the late introduction of solid foods (>4 months) is associated with a reduced risk of food allergy, atopic dermatitis, and recurrent wheezing and asthma in early childhood. In all infants....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....
Ayoub, H H; Abu-Raddad, L J
Egypt has launched a hepatitis C virus (HCV) treatment programme using direct-acting antivirals (DAAs). Our aim was to assess the impact of five plausible programme scale-up and sustainability scenarios for HCV treatment as prevention in Egypt. We developed and analysed a mathematical model to assess programme impact using epidemiologic, programming and health economics measures. The model was parametrized with current and representative natural history, HCV prevalence and programme data. HCV incidence in Egypt is declining, but will persist at a considerable level for decades unless controlled by interventions. Across the five programme scenarios, 1.75-5.60 million treatments were administered by 2030. Reduction in incidence (annual number of new infections) by 2030 ranged between 29% and 99%, programme-attributed reduction in incidence rate (new infections per susceptible person per year) ranged between 18% and 99%, number of infections averted ranged between 42 393 and 469 599, and chronic infection prevalence reached as low as 2.8%-0.1%. Reduction in incidence rate year by year hovered around 7%-15% in the first decade of the programme in most scenarios. Treatment coverage in 2030 ranged between 24.9% and 98.8%, and number of treatments required to avert one new infection ranged between 9.5 and 12.1. Stipulated targets for HCV by 2030 could not be achieved without scaling-up treatment to 365 000 per year and sustaining it for a decade. In conclusion, DAA scale-up will have an immense and immediate impact on HCV incidence in Egypt. Elimination by 2030 is feasible if sufficient resources are committed to programme scale-up and sustainability. HCV treatment as prevention is a potent and effective prevention approach. © 2017 The Authors. Journal of Viral Hepatitis Published by John Wiley & Sons Ltd.
Guttman, Miklos; Wales, Thomas E.; Whittington, Dale; Engen, John R.; Brown, Jeffery M.; Lee, Kelly K.
Hydrogen/deuterium exchange (HDX) mass spectrometry (MS) for protein structural analysis has been adopted for many purposes, including biopharmaceutical development. One of the benefits of examining amide proton exchange by mass spectrometry is that it can readily resolve different exchange regimes, as evidenced by either binomial or bimodal isotope patterns. By careful analysis of the isotope pattern during exchange, more insight can be obtained on protein behavior in solution. However, one must be sure that any observed bimodal isotope patterns are not artifacts of analysis and are reflective of the true behavior in solution. Sample carryover and certain stationary phases are known as potential sources of bimodal artifacts. Here, we describe an additional undocumented source of deuterium loss resulting in artificial bimodal patterns for certain highly charged peptides. We demonstrate that this phenomenon is predominantly due to gas-phase proton exchange between peptides and bulk solvent within the initial stages of high-transmission conjoined ion guides. Minor adjustments of the ion guide settings, as reported here, eliminate the phenomenon without sacrificing signal intensity. Such gas-phase deuterium loss should be appreciated for all HDX-MS studies using such ion optics, even for routine studies not focused on interpreting bimodal spectra.
Cecchini, Diego M; Martinez, Marina G; Morganti, Laura M; Rodriguez, Claudia G
We conducted a retrospective study in a general hospital in Buenos Aires, Argentina (2009-2015) aimed at evaluating outcomes in HIV-infected pregnant women (HIPW), who were prescribed raltegravir (RAL)-containing antiretroviral therapy (ART). A total of 239 HIPW were enrolled in our study; among them 31 received RAL (12.9%) at different clinical stages: i) intensification (INS): addition of RAL to current ART because of detectable antepartum viral load, 13 (41.9%); ii) late presenter (LP): standard ART + RAL as fourth drug, 15 (48.4%); iii) treatment of resistant-HIV: 3 (9.7%). Median gestational age at RAL initiation was 34 weeks and median exposure was 30 days. In INS-group, median viral load (VL) decrease was 1.48 log 10 . In LP-group, median VL decline was 2.15 log 10. No clinical adverse events or maternal intolerance attributable to RAL were observed. Elective cesarean section was done in 51.7%; mild elevation of transaminases was observed in 35% of neonates. No vertical transmission was documented.
Diego M. Cecchini
Full Text Available We conducted a retrospective study in a general hospital in Buenos Aires, Argentina (2009-2015 aimed at evaluating outcomes in HIV-infected pregnant women (HIPW, who were prescribed raltegravir (RAL- containing antiretroviral therapy (ART. A total of 239 HIPW were enrolled in our study; among them 31 received RAL (12.9% at different clinical stages: i intensification (INS: addition of RAL to current ART because of detectable antepartum viral load, 13 (41.9%; ii late presenter (LP: standard ART + RAL as fourth drug, 15 (48.4%; iii treatment of resistant-HIV: 3 (9.7%. Median gestational age at RAL initiation was 34 weeks and median exposure was 30 days. In INS-group, median viral load (VL decrease was 1.48 log10. In LPgroup, median VL decline was 2.15 log10. No clinical adverse events or maternal intolerance attributable to RAL were observed. Elective cesarean section was done in 51.7%; mild elevation of transaminases was observed in 35% of neonates. No vertical transmission was documented.
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
Ramamoorthy, Sheela; Sanakkayala, Neelima; Vemulapalli, Ramesh; Jain, Neeta; Lindsay, David S; Schurig, Gerhardt S; Boyle, Stephen M; Sriranganathan, Nammalwar
Bovine abortions caused by the apicomplexan parasite Neospora caninum have been responsible for severe economic losses to the cattle industry. Infected cows either experience abortion or transmit the parasite transplacentally at a rate of up to 95%. Neospora caninum vaccines that can prevent vertical transmission and ensure disruption in the life cycle of the parasite greatly aid in the management of neosporosis in the cattle industry. Brucella abortus strain RB51, a commercially available vaccine for bovine brucellosis, can also be used as a vector to express plasmid-encoded proteins from other pathogens. Neospora caninum protective antigens MIC1, MIC3, GRA2, GRA6 and SRS2 were expressed in strain RB51. Female C57BL/6 mice were vaccinated with a recombinant strain RB51 expressing N. caninum antigen or irradiated tachyzoites, boosted 4 weeks later and then bred. Antigen-specific IgG, IFN-gamma and IL-10 were detected in vaccinated pregnant mice. Vaccinated mice were challenged with 5 x 10(6)N. caninum tachyzoites between days 11-13 of pregnancy. Brain tissue was collected from pups 3 weeks after birth and examined for the presence of N. caninum by real-time PCR. The RB51-MIC3, RB51-GRA6, irradiated tachyzoite vaccine, pooled strain RB51-Neospora vaccine, RB51-MIC1 and RB51-SRS2 vaccines elicited approximately 6-38% protection against vertical transmission. However, the differences in parasite burden in brain tissue of pups from the control and vaccinated groups were highly significant for all groups. Thus, B. abortus strain RB51 expressing the specific N. caninum antigens induced substantial protection against vertical transmission of N. caninum in mice.
Zhang, Lei; Gui, Xi-en; Teter, Caroline; Zhong, Hairong; Pang, Zhiyong; Ding, Lixiong; Li, Fengliang; Zhou, Yun; Zhang, Ling
Combined immunization with hepatitis B immunoglobulin (HBIG) plus hepatitis B vaccine (HB vaccine) can effectively prevent perinatal transmission of hepatitis B virus (HBV). With the universal administration of HB vaccine, anti-HBs conferred by HB vaccine can be found increasingly in pregnant women, and maternal anti-HBs can be passed through the placenta. This study was designed to evaluate the effect of hepatitis B immunization on preventing mother-to-infant transmission of HBV and on the immune response of infants towards HB vaccine. From 2008 to 2013, a prospective study was conducted in 15 centers in China. HBsAg-positive pregnant women and their infants aged 8-12 months who completed immunoprophylaxis were enrolled in the study and tested for HBV markers (HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc). Antepartum administration of HBIG to HBsAg-positive women was based on individual preference. HBsAg-negative pregnant women and their infants of 7-24 months old who received HB vaccines series were enrolled and tests of their HBV markers were performed. 1202 HBsAg-positive mothers and their infants aged 8-12 months were studied and 40 infants were found to be HBsAg positive with the immunoprophylaxis failure rate of 3.3%. Infants with immunoprophylaxis failure were all born to HBeAg-positive mothers of HBV-DNA ≥6 log₁₀copies/ml. Among infants of HBeAg-positive mothers, immunoprophylaxis failure rate in vaccine plus HBIG group, 7.9% (29/367), was significantly lower than the vaccine-only group, 16.9% (11/65), p=0.021; there was no significant difference in the immunoprophylaxis failure rate whether or not antepartum HBIG was given to the pregnant woman, 10.3% (10/97) vs 9.0% (30/335), p=0.685. Anti-HBs positive rate was 56.3% (3883/6899) among HBsAg-negative pregnant women and anti-HBs positive rate was 94.2% in cord blood of anti-HBs-positive mothers. After completing the HB vaccine series, anti-HBs positive rate among infants with maternal anti
McDonald, Karalyn; Kirkman, Maggie
This paper explores HIV-positive women's accounts of their use and non-use of treatments for the prevention of mother-to-child transmission. In-depth interviews were conducted in 2001 with 34 HIV-positive women who were diagnosed during their childbearing years. This paper reports on the 16 women who gave birth after being diagnosed with HIV. Some women reported experiencing debilitating side-effects of antiretroviral (ARV) therapy, and all were aware that the history of HIV therapy was not one of clear, consistent and benevolent effectiveness. It was evident that women wanted the best outcomes for themselves and their babies. Women represented their role vis-a-vis their children as encompassing protection against a medical fraternity that insisted on the use of ARV and prophylaxis without acknowledging the mothers' concerns about toxicity. From the women's perspective, it made sense not to let their babies become experimental subjects when long-term effects were unknown. To maximise the benefit of ARV therapy to mothers and babies, thereby reducing the risk of vertical transmission, it is imperative to understand a woman's explanation of what therapy means to her, and advisable to presume that she wants the best for her baby. Such an approach will facilitate better communication and encourage clinicians and patients to work towards a shared goal.
Wind-Rotolo, Megan; Durand, Christine; Cranmer, Lisa; Reid, Alison; Martinson, Neil; Doherty, Meg; Jilek, Benjamin L.; Kagaayi, Joseph; Kizza, Allan; Pillay, Visva; Laeyendecker, Oliver; Reynolds, Steven J.; Eshleman, Susan H.; Lau, Bryan; Ray, Stuart C.; Siliciano, Janet D.; Quinn, Thomas C.; Siliciano, Robert F.
Background Intrapartum single-dose nevirapine decreases mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) but promotes nevirapine resistance. Although resistant viruses fade to undetectable levels in plasma, they may persist as stably integrated proviruses within the latent reservoir in resting CD4+ T cells, potentially complicating future treatment. Methods Blood samples were collected from 60 women from South Africa and Uganda >6 months after they had received single-dose nevirapine. To selectively analyze the stable latent form of HIV-1, resting CD4+ T cells were isolated and activated in the presence of reverse-transcriptase inhibitors and integrase inhibitors, which allows for the specific isolation of viruses produced by cells with stably integrated proviral DNA. These viruses were then analyzed for nevirapine resistance. Results Although only a small number of latently infected cells were present in each blood sample (mean, 162 cells), nevirapine resistance mutations (K103N and G190A) were detected in the latent reservoir of 4 (8%) of 50 evaluable women. Conclusions A single dose of nevirapine can establish antiretroviral resistance within the latent reservoir. This results in a potentially lifelong risk of reemergence of nevirapine-resistant virus and highlights the need for strategies to prevent transmission that do not compromise successful future treatment. PMID:19338474
Peng, Zhuoxin; Wang, Shengnan; Xu, Biao; Wang, Weibing
To identify the barriers to and enablers of the prevention of mother-to-child transmission (PMTCT) of HIV program in China. A systematic review of the existing literature regarding barriers to and enablers of the implementation of the PMTCT program in China was performed. The checklist from the SURE guidelines (Supporting the Use of Research Evidence) was used to synthesize the barriers and enablers (supporting strategies) and to analyze their relationships. The HIV testing rate, vertical transmission rate, and antiretroviral treatment (ART) acceptance rate among HIV-infected women and their infants was also extracted from the included studies to assess the effectiveness of the enablers. Initially 794 publications were identified, and ultimately 14 articles were included. Eighteen types of barrier and nine types of supportive strategy were identified, mainly at the level of social and political issues, healthcare recipients, healthcare providers, and the healthcare system. Based on government-oriented multi-sector cooperation, enablers in China have included community-hospital-family promotion, comprehensive financial support for service recipients, free HIV testing at marriage registration, the opt-out model, and the one-to-one service model. Experience in China suggests that the government's role in coordination and the acceptability and accessibility of the service should be the primary concerns in regard to the PMTCT project. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.
Chi, Benjamin H; Stringer, Jeffrey S A; Moodley, Dhayendre
Considerable advances have been made in the effort to prevent mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa. Clinical trials have demonstrated the efficacy of antiretroviral regimens to interrupt HIV transmission through the antenatal, intrapartum, and postnatal periods. Scientific discoveries have been rapidly translated into health policy, bolstered by substantial investment in health infrastructure capable of delivering increasingly complex services. A new scientific agenda is also emerging, one that is focused on the challenges of effective and sustainable program implementation. Finally, global campaigns to "virtually eliminate" pediatric HIV and dramatically reduce HIV-related maternal mortality have mobilized new resources and renewed political will. Each of these developments marks a major step in regional PMTCT efforts; their convergence signals a time of rapid progress in the field, characterized by an increased interdependency between clinical research, program implementation, and policy. In this review, we take stock of recent advances across each of these areas, highlighting the challenges--and opportunities--of improving health services for HIV-infected mothers and their children across the region.
Yang, Jiajia; Yao, Yang; Wang, Ling; Yang, Chunxiao; Wang, Faqi; Guo, Jie; Wang, Zhiyun; Yang, Zhuo; Ming, Dong
Neuronal gastrin-releasing peptide (GRP) has been proved to be an important neuromodulator in the brain and involved in a variety of neurological diseases. Whether GRP could attenuate cognition impairment induced by vascular dementia (VD) in rats, and the mechanism of synaptic plasticity and GRP's action on synaptic efficiency are still poorly understood. In this study, we first investigated the effects of GRP on glutamatergic transmission with patch-clamp recording. We found that acute application of GRP enhanced the excitatory synaptic transmission in hippocampal CA1 neurons via GRPR in a presynaptic mechanism. Secondly, we examined whether exogenous GRP or its analogue neuromedin B (NMB) could prevent VD-induced cognitive deficits and the mechanism of synaptic plasticity. By using Morris water maze, long-term potentiation (LTP) recording, western blot assay and immunofluorescent staining, we verified for the first time that GRP or NMB substantially improved the spatial learning and memory abilities in VD rats, restored the impaired synaptic plasticity and was able to elevate the expression of synaptic proteins, synaptophysin (SYP) and CaMKII, which play pivotal roles in synaptic plasticity. These results suggest that the facilitatory effects of GRP on glutamate release may contribute to its long-term action on synaptic efficacy which is essential in cognitive function. Our findings present a new entry point for a better understanding of physiological function of GRP and raise the possibility that GRPR agonists might ameliorate cognitive deficits associated with neurological diseases. Copyright © 2016 Elsevier Inc. All rights reserved.
Radhika, A G; Chawla, Sonia; Bhaskaran, Sruthi
Prevention of Parent To Child Transmission (PPTCT) of HIV/AIDS is an integral component of AIDS control programme. PPTCT is an ongoing programme since last 15 years. The aim of the study was to evaluate the reduction in the burden of disease in newborn and infants by prevention of parents to child transmission of HIV/AIDS. This retrospective study was conducted at Department of Obstetrics and Gynecology in a tertiary care hospital of Delhi from May 2002 to May 2015. The data was collected from records of maternal details registered at PPTCT clinic as well as list of infants undergoing Early Infant Diagnosis (EID) recorded in the standard format as per instructions from National AIDS Control Organization (NACO) of India. The Programme performance was assessed against performance indicators stated by NACO, India. Evaluation was done by dividing study period into two halves of seven years each. Out of 2,52,447 new antenatal case registration, overall, 43% received pretest of which, 91% were tested. Antenatal seropositivity rate varied from 0.1%-0.25%. Of 243 seropositive antenatal women 187 partners tested positive. While 25 women opted for MTP, 15 had still births. There were 17 neonatal deaths at 3-12 months attributable to respiratory infections and diarrheal diseases. Operative delivery rates declined from 50% to 31% over the years. Most women opted for breast feeding. The lost to follow up rate of newborns was quite high with details of only 43.5% being available at 18 months of infant's age. A total of three infants tested HIV positive at 18 months of age. The study highlights the practical aspects of policy implementation and operational issues involved in low resource country.
Schuster, Roseanne C; McMahon, Devon E; Young, Sera L
Despite significant biomedical and policy advances, 199,000 infants and young children in sub-Saharan Africa (SSA) became infected with HIV in 2013, indicating challenges to implementation of these advances. To understand the nature of these challenges, we sought to (1) characterize the barriers and facilitators that health workers encountered delivering prevention of vertical transmission of HIV (PVT) services in SSA and (2) evaluate the use of theory to guide PVT service delivery. The PubMed and CINAHL databases were searched using keywords barriers, facilitators, HIV, prevention of vertical transmission of HIV, health workers, and their synonyms to identify relevant studies. Barriers and facilitators were coded at ecological levels according to the Determinants of Performance framework. Factors in this framework were then classified as affecting motivation, opportunity, or ability, per the Motivation-Opportunity-Ability (MOA) framework in order to evaluate domains of health worker performance within each ecological level. We found that the most frequently reported challenges occurred within the health facility level and spanned all three MOA domains. Barriers reported in 30% or more of studies from most proximal to distal included those affecting health worker motivation (stress, burnout, depression), patient opportunity (stigma), work opportunity (poor referral systems), health facility opportunity (overburdened workload, lack of supplies), and health facility ability (inadequate PVT training, inconsistent breastfeeding messages). Facilitators were reported in lower frequencies than barriers and tended to be resolutions to challenges (e.g., quality supervision, consistent supplies) or responses to an intervention (e.g., record systems and infrastructure improvements). The majority of studies did not use theory to guide study design or implementation. Interventions addressing health workers' multiple ecological levels of interactions, particularly the health
de Andrade, Solange Dourado; Sabidó, Meritxell; Marcelo Monteiro, Wuelton; Canellas, Luiz; Prazeres, Vania; Schwartz Benzaken, Adele
The purpose of the study was to estimate rates of mother-to-child transmission (MTCT) of HIV in the Amazonas, Brazil, and to identify the associated factors. This was a retrospective cohort study of 1210 children born to HIV-infected women between 1999 and 2011 and enrolled before age of 18 months in a reference HIV/AIDS pediatrics service in Manaus. We used multivariable logistic regression to assess the effect of maternal, obstetric and prophylactic interventions on MTCT of HIV. Ten children were excluded because of undocumented maternal HIV status. Among 1200 children, 163 (13.6%) were lost to follow-up. We included in the analysis 1037 children with known HIV status. Of those, 68 children were HIV infected, resulting in a MTCT rate of 6.6% [95% confidence interval (CI): 5.3-8.3]. Among mothers, 76.1% had received antiretroviral therapy during pregnancy, 59.3% elective caesarean, and 9.7% were breastfed. Factors associated with lower odds of MTCT of HIV were antiretroviral therapy during pregnancy [odds ratio (OR): 0.26; 95% CI: 0.12-0.58], elective caesarean (OR: 0.48; 95% CI: 0.23-0.98) and with MTCT: being breastfed (OR: 4.56; 95% CI: 2.19-9.50). Transmission decreased from 7.5% in 2007-2008 to 3.2% in 2011, while breastfeeding decreased from 30.8% in 1999-2000 to 3.9% in 2011-2012. The HIV rate of MTCT is still high in the Amazonas and challenges for its prevention prevail including lost to follow-up and gaps in critical strategies such as antiretroviral use during pregnancy. More efforts are needed to increase the number of women and babies who successfully complete the prevention of MTCT cascade and work toward elimination of MTCT of HIV.
Popoola, Victor O; Budd, Alicia; Wittig, Sara M; Ross, Tracy; Aucott, Susan W; Perl, Trish M; Carroll, Karen C; Milstone, Aaron M
To characterize the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections in a level IIIC neonatal intensive care unit (NICU) and identify barriers to MRSA control. Retrospective cohort study in a university-affiliated NICU with an MRSA control program including weekly nares cultures of all neonates and admission nares cultures for neonates transferred from other hospitals or admitted from home. Medical records were reviewed to identify neonates with NICU-acquired MRSA colonization or infection between April 2007 and December 2011. Compliance with hand hygiene and an MRSA decolonization protocol were monitored. Relatedness of MRSA strains were assessed using pulsed-field gel electrophoresis (PFGE). Of 3,536 neonates, 74 (2.0%) had a culture grow MRSA, including 62 neonates with NICU-acquired MRSA. Nineteen of 74 neonates (26%) had an MRSA infection, including 8 who became infected before they were identified as MRSA colonized, and 11 of 66 colonized neonates (17%) developed a subsequent infection. Of the 37 neonates that underwent decolonization, 6 (16%) developed a subsequent infection, and 7 of 14 (50%) that remained in the NICU for 21 days or more became recolonized with MRSA. Using PFGE, there were 14 different strain types identified, with USA300 being the most common (31%). Current strategies to prevent infections-including active identification and decolonization of MRSA-colonized neonates-are inadequate because infants develop infections before being identified as colonized or after attempted decolonization. Future prevention efforts would benefit from improving detection of MRSA colonization, optimizing decolonization regimens, and identifying and interrupting reservoirs of transmission.
Benjamin J Cowling
Full Text Available There are sparse data on whether non-pharmaceutical interventions can reduce the spread of influenza. We implemented a study of the feasibility and efficacy of face masks and hand hygiene to reduce influenza transmission among Hong Kong household members.We conducted a cluster randomized controlled trial of households (composed of at least 3 members where an index subject presented with influenza-like-illness of <48 hours duration. After influenza was confirmed in an index case by the QuickVue Influenza A+B rapid test, the household of the index subject was randomized to 1 control or 2 surgical face masks or 3 hand hygiene. Households were visited within 36 hours, and 3, 6 and 9 days later. Nose and throat swabs were collected from index subjects and all household contacts at each home visit and tested by viral culture. The primary outcome measure was laboratory culture confirmed influenza in a household contact; the secondary outcome was clinically diagnosed influenza (by self-reported symptoms. We randomized 198 households and completed follow up home visits in 128; the index cases in 122 of those households had laboratory-confirmed influenza. There were 21 household contacts with laboratory confirmed influenza corresponding to a secondary attack ratio of 6%. Clinical secondary attack ratios varied from 5% to 18% depending on case definitions. The laboratory-based or clinical secondary attack ratios did not significantly differ across the intervention arms. Adherence to interventions was variable.The secondary attack ratios were lower than anticipated, and lower than reported in other countries, perhaps due to differing patterns of susceptibility, lack of significant antigenic drift in circulating influenza virus strains recently, and/or issues related to the symptomatic recruitment design. Lessons learnt from this pilot have informed changes for the main study in 2008.ClinicalTrials.gov NCT00425893 HKClinicalTrials.com HKCTR-365.
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
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
Full Text Available We examined uptake of prevention of mother-to-child HIV transmission (PMTCT services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa.A cross-sectional survey was conducted among 4-8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants' dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated.Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4% received some form of maternal and infant antiretroviral treatment. More than a third (34.9% of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5-3.3 as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2% of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001. A third (33.8% of infant HIV infections were attributable to dropout in one or more steps in the cascade.A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake
Stevens, C.E.; Taylor, P.E.; Tong, M.J.; Toy, P.T.; Vyas, G.N.; Nair, P.V.; Weissman, J.Y.; Krugman, S.
A yeast-recombinant hepatitis B vaccine was licensed recently by the Food and Drug administration and is now available. To assess the efficacy of the yeast-recombinant vaccine, the authors administered the vaccine in combination with hepatitis B immune globulin to high-risk newborns. If infants whose mothers were positive for both hepatitis B surface antigen and the e antigen receive no immunoprophylaxis, 70% to 90% become infected with the virus, and almost all become chronic carriers. Among infants in this study who received hepatitis B immune globulin at birth and three 5- + g doses of yeast-recombinant hepatitis B vaccine, only 4.8% became chronic carriers, a better than 90% level of protection and a rate that is comparable with that seen with immune globulin and plasma-derived hepatitis B vaccine. Hepatitis surface antigen and antibodies were detected by radioimmunoassay. These data suggest that, in this high-risk setting, the yeast-recombinant vaccine is as effective as the plasma-derived vaccine in preventing hepatitis B virus infection and the chronic carrier state
Michel, G; Vallée, D; Thuret, I; Chambost, H; Tamalet, C; de Boisse, P; Leclaire, M; Farnarier, C; Kaplanski, S; Perrimond, H
Twenty-four perinatally HIV infected children received early treatment as soon as the diagnosis of viral contamination was established. In 13 cases (group 1), this diagnosis was based on a viremia and/or antigenemia during the first 6 months of life. In 11 cases (group 2), children were more than 15 months-old and had a positive HIV antibody test. Therapy included azidothymidine (AZT, 400 mg/m2/d) and the prevention of secondary infectious complications with intravenous immunoglobulin and cotrimoxazole. With a median follow-up of 26 months, we reported no case of severe secondary infection and no case of encephalopathy. Hematological side effects of AZT were rarely observed. Only one patient developed anemia. In all other cases, the only hematological abnormality was macrocytosis of red blood cells. Before treatment, the mean value of T4 cells age-adjusted count was 96, 86 and 91%, respectively, for groups 1, 2 and the entire study group. At the time of analysis, these values were 64, 62 and 63% respectively. This decrease was statistically significant for group 1 and for the entire study group, but did not reach statistical significance for group 2. These data show that AZT is probably insufficient as a long-term therapy for HIV infected children. Other therapeutic approaches need to be developed in the future, notably the combination of anti-retroviral drugs.
Monteiro, João Filipe G; Marshall, Brandon D L; Escudero, Daniel; Sosa-Rubí, Sandra G; González, Andrea; Flanigan, Timothy; Operario, Don; Mayer, Kenneth H; Lurie, Mark N; Galárraga, Omar
Mexico has a concentrated HIV epidemic, with male sex workers constituting a key affected population. We estimated annual HIV cumulative incidence among male sex workers' partners, and then compared incidence under three hypothetical intervention scenarios: improving condom use; and scaling up HIV treatment as prevention, considering current viral suppression rates (CVS, 60.7 %) or full viral suppression among those treated (FVS, 100 %). Clinical and behavioral data to inform model parameterization were derived from a sample (n = 79) of male sex workers recruited from street locations and Clínica Condesa, an HIV clinic in Mexico City. We estimated annual HIV incidence among male sex workers' partners to be 8.0 % (95 % CI: 7.3-8.7). Simulation models demonstrated that increasing condom use by 10 %, and scaling up HIV treatment initiation by 50 % (from baseline values) would decrease the male sex workers-attributable annual incidence to 5.2, 4.4 % (CVS) and 3.2 % (FVS), respectively. Scaling up the number of male sex workers on ART and implementing interventions to ensure adherence is urgently required to decrease HIV incidence among male sex workers' partners in Mexico City.
Lee, Donghoon; Park, Sang Min
To tackle the high prevalence of Hepatitis B virus (HBV) infection in North Korea, it is essential that birth doses of HBV vaccines should be administered within 24 hours of birth. As the country fails to provide a Timely Birth Dose (TBD) of HBV vaccine, the efforts of reducing the high prevalence of HBV have been significantly hampered. To examine the cost-effectiveness of vaccination strategies to prevent perinatal transmission of HBV in North Korea, we established a decision tree with a Markov model consisting of selective, universal, and the country's current vaccination program against HBV. The cost-effectiveness analysis was performed from societal and payer's perspectives and evaluated by Disability Adjusted Life Year (DALY). The results suggest that introducing the universal vaccination would prevent 1,866 cases of perinatal infections per 100,000 of the birth cohort of 2013. Furthermore, 900 cases of perinatal infections per 100,000 could be additionally averted if switching to the selective vaccination. The current vaccination is a dominated strategy both from the societal and payer's perspective. The Incremental Cost-Effectiveness Ratio (ICER) between universal and selective vaccination is $267 from the societal perspective and is reported as $273 from the payer's perspective. Based on the assumption that the 2012 Gross Domestic Product (GDP) per capita in North Korea, $582.6 was set for cost-effectiveness criteria, the result of this study indicates that selective vaccination may be a highly cost-effective strategy compared to universal vaccination.
Full Text Available BACKGROUND:Traditional birth attendants (TBAs assist most deliveries in Nigeria. Knowing and understanding all issues surrounding HIV/AIDS and Prevention of Mother-To-Child Transmission of HIV (PMTCT can help them to protect themselves and others. This study aimed to assess the knowledge and practice of PMTCT amongst TBAs in Lagos, Nigeria. METHODS: This was a cross-sectional survey. Multistage sampling method was used to select 108 registered TBAs in 2 local governments areas who were interviewed using a pre-tested questionnaire. RESULTS: All the respondents were aware of HIV but their awareness of PMTCT specifically was not as high. Only 8.3% of the respondents had good level of knowledge about HIV and PMTCT and up to 13% of them claimed to be able to cure HIV using native remedies. The practices of HIV counseling of patients and referral of patients for HIV testing were low and higher levels of knowledge positively influenced these practices significantly (p < 0.05. They were also deficient in certain measures to prevent infection of patients and themselves. CONCLUSION: Most of the TBAs did not have adequate knowledge and practice of PMTCT illustrating the need for periodic PMTCT training for TBAs.
Barbara A. Hanrahan
Full Text Available Background: When new guidelines for existing programmes are introduced, it is often the clinicians tasked with the execution of the guidelines who bear the brunt of the changes. Frequently their opinions are not sought. In this study, the researcher interviewed registered nurses working in the field of the prevention of mother-to-child transmission (PMTCT of human immunodeficiency virus (HIV to gain an understanding of their perspectives on the changes introduced to the guidelines. The guideline changes in 2014 were to move from the World Health Organization (WHO Option B to Option B + which prescribes lifelong antiretroviral therapy (ART for all HIV-positive pregnant women regardless of CD4 cell count. Objective: To determine what the registered nurses’ perspectives are on the PMTCT programme as implemented at four PHC facilities in the Limpopo Province. Method: For this qualitative investigation, a descriptive research design was implemented. The data were collected during semi-structured interviews with nurses from four primary healthcare facilities in the Limpopo Province of South Africa. Data were analysed using thematic analysis. Results: Challenges preventing effective implementation (e.g. increased workloads, viz. staff shortages; poor planning of training; equipment and medication shortages and long lead times; poor patient education were identified. Conclusion: In spite of the successes of the PMTCT programme, considerable challenges still prevail; lack of patient education, poor facilities management and staff shortages could potentially influence the implementation of the PMTCT guidelines negatively.
Motlagabo G. Matseke
Full Text Available Male partner involvement (MPI can contribute to the success of programs aimed at preventing mother-to-child transmission (PMTCT of HIV. However, the definition and measures of MPI differ according to context. This study utilized secondary cross-sectional data to investigate the prevalence and determinants of MPI among 463 male partners of HIV-infected pregnant women in rural South Africa. Results indicated that 44.1% of male partners reported involvement in most or all specified male partner involvement activities (i.e., scores of 7 to 9. Descriptive, correlation and multiple linear-regression analyses were conducted. Positive predictors of MPI included relationship status, own HIV status, awareness of female partner’s positive HIV status, female partner’s desire to have more children, having family planning discussions with provider, condom use to prevent HIV and sexually transmitted infections (STIs, and partner reasoning skills. Negative predictors included partner verbal aggression. Overall, although MPI is low, the study underlines important information that could be used to develop interventions aimed at improving maternal and infant health in PMTCT programs in South Africa.
Cláudio Santos Ferreira
Full Text Available It is recognized that breast feeding is an alternative means of transmission of Chagas disease. However, thermal treatment of milk can prevent this occurrence. As domestic microwave ovens are becoming commonplace, the efficacy of microwave thermal treatment in inactivating Trypanosoma cruzi trypomastigotes in human milk was tested. Human milk samples infected with T. cruzi trypomastigotes (Y strain from laboratory-infected mice, were heated to 63 °C in a domestic microwave oven (2 450 MHz, 700 W. Microscopical and serological examinations demonstrated that none of the animals inoculated orally or intraperitoneally with infected milk which had been treated, got the infection, while those inoculated with untreated, infected milk, became infected. It was concluded that the simple treatment prescribed, which can easily be done at home, was effective in inactivating T. cruzi trypomastigotes contained in human milk.A amamentação é reconhecidamente um modo alternativo de transmissão da doença de Chagas. Entretanto, o tratamento térmico do leite pode evitar tal acidente. Por ser atualmente comum o uso doméstico de fornos de microondas, projetou-se um experimento para avaliar a eficácia do tratamento térmico do leite por microondas na inativação de formas de Trypanosoma cruzi contidas no leite materno. Acrescentaram-se, a amostras de leite humano, tripomastigotas de T. cruzi (cepa Y provenientes de camundongos infectados em laboratório. Essas amostras foram aquecidas a 63 ºC (sete minutos, 45% de potência em forno de microondas doméstico (2 450 MHz, 700 W. Exames microscópicos e sorológicos dos animais inoculados, por via oral ou intraperitoneal, com leite infectado e tratado, foram negativos. Os resultados dos inoculados com leite infectado e não tratado foram positivos. Concluiu-se que este é um processo simples e eficaz para inativar tripomastigotas contidos em leite, podendo facilmente ser executado em ambiente doméstico.
Stringer, Jeffrey S. A.; Sinkala, Moses; Stout, Julia P.; Goldenberg, Robert L.; Acosta, Edward P.; Chapman, Victoria; Kumwenda-Phiri, Rosemary; Vermund, Sten H.
Summary Universal nevirapine (NVP) therapy (provision of the drug without HIV testing) has been suggested as potentially superior to targeted NVP therapy (provision of the drug to seropositive patients identified through voluntary HIV counseling and testing [VCT]) for perinatal HIV prevention in low-resource, high-prevalence settings. The authors postulated that uptake (the proportion of women who accept the strategy when offered) may be higher for universal therapy, since it does not require a woman to learn her serostatus; they further postulated that adherence (the proportion of women who actually ingest the NVP tablet at labor onset) may be higher for targeted therapy, since knowledge of serostatus could motivate better adherence. Two clinics in Lusaka, Zambia were assigned to provide either the targeted or universal strategy. Halfway through the study period, the approach offered at each clinic was crossed over. Adherence was assessed by liquid chromatographic assay for NVP of cord blood. Regarding uptake, 1524 pregnant women were offered participation, and 1025 (67%) accepted. Of 694 women offered enrollment in the universal strategy, 496 (71%) accepted; of 830 women offered enrollment in the targeted strategy, 529 (64%) accepted (p < .01). Uptake was similar at both clinics for the universal strategy: 250 of 339 (74%) at clinic A and 246 of 355 (69%) at clinic B (p [H11505] .2), but differed significantly between clinics for the targeted strategy: 229 of 316 (72%) at clinic A and 300 of 514 (58%) at clinic B (RR, 1.51; 95% CI, 1.23, 1.86). Increased uptake correlated with having been offered the universal rather than the targeted strategy (AOR, 1.5; 95% CI, 1.1, 2.1), attendance at clinic A (AOR, 1.4; 95% CI, 1.01, 2.0), and maternal report of a prior fetal or infant death (AOR, 1.6; 95% CI, 1.1, 2.5). Regarding adherence, in the universal strategy, 40 of 103 women (39%) were nonadherent compared with 25 of 98 women (26%) in the targeted strategy (RR, 1
Brown, B J; Oladokun, R E; Osinusi, K
To evaluate breastfeeding and weaning practices associated socio-demographic factors and knowledge about mother-to-child transmission of HIV among mothers in Ibadan. A cross sectional survey was conducted among 513 mothers of children aged 6- 24 months, attending infant welfare clinics. Data collection was by a structured questionnaire, which was supplemented by focus group discussions to further explore some of the issues covered in the survey. Breast-feeding rate was 99.4%, the duration of which ranged from 1-22 months with a median of 14 months among those who had stopped breastfeeding. Only 145 (28.3%) mothers breastfed their babies exclusively for six months and 259(50.8%) initiated breastfeeding within one hour of birth; both were associated with at least secondary level of education. The main obstacle to exclusive breastfeeding was the belief that water is required to quench thirst in babies. Expression of breast milk was not favoured by majority of the mothers (68%) most of whom felt that the milk would get contaminated. Wet nursing was rarely practiced (0.4%). Most of the mothers, 436 (85%) were aware that HIV could be transmitted through breast milk but the attitude towards a mother who did not breast feed was negative in 96.8% ofrespondents. Adherence to recommended infant feeding options for HIV-exposed infants are likely to be faced with challenges in a culture where breastfeeding is the norm and exclusive breastfeeding rate is low. There is need for counseling and health education on prevention of mother-to-child transmission of HIV.
Kalichman, Seth C; Cherry, Chauncey; Kalichman, Moira O; Eaton, Lisa A; Kohler, James J; Montero, Catherine; Schinazi, Raymond F
We conducted a randomized clinical trial to test a mobile health behavioral intervention designed to enhance HIV treatment as prevention (B-TasP) by simultaneously increasing combination antiretroviral therapies (cART) adherence and improving the sexual health of people living with HIV. A cohort of sexually active men (n = 383) and women (n = 117) living with HIV were enrolled. Participants were baseline assessed and randomized to either (1) B-TasP adherence and sexual health intervention or (2) general health control intervention. Outcome measures included HIV RNA viral load, cART adherence monitored by unannounced pill counts, indicators of genital tract inflammation, and sexual behaviors assessed over 12 months. Eighty-six percent of the cohort was retained for 12-month follow-up. The B-TasP intervention demonstrated significantly lower HIV RNA, OR = 0.56, P = 0.01, greater cART adherence, Wald χ = 33.9, P = 0.01, and fewer indicators of genital tract inflammation, Wald χ = 9.36, P = 0.05, over the follow-up period. Changes in sexual behavior varied, with the B-TasP intervention showing lower rates of substance use in sexual contexts, but higher rates of condomless sex with non-HIV positive partners occurred in the context of significantly greater beliefs that cART reduces HIV transmission. Theory-based mobile health behavioral interventions can simultaneously improve cART adherence and sexual health in people living with HIV. Programs aimed to eliminate HIV transmission by reducing HIV infectiousness should be bundled with behavioral interventions to maximize their impact and increase their chances of success.
VanDeusen, Adam; Paintsil, Elijah; Agyarko-Poku, Thomas; Long, Elisa F
Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana. A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios. HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses. Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.
Dicko, Alassane; Roh, Michelle E; Diawara, Halimatou; Mahamar, Almahamoudou; Soumare, Harouna M; Lanke, Kjerstin; Bradley, John; Sanogo, Koualy; Kone, Daouda T; Diarra, Kalifa; Keita, Sekouba; Issiaka, Djibrilla; Traore, Sekou F; McCulloch, Charles; Stone, Will J R; Hwang, Jimee; Müller, Olaf; Brown, Joelle M; Srinivasan, Vinay; Drakeley, Chris; Gosling, Roly; Chen, Ingrid; Bousema, Teun
Primaquine and methylene blue are gametocytocidal compounds that could prevent Plasmodium falciparum transmission to mosquitoes. We aimed to assess the efficacy and safety of primaquine and methylene blue in preventing human to mosquito transmission of P falciparum among glucose-6-phosphate dehydrogenase (G6PD)-normal, gametocytaemic male participants. This was a phase 2, single-blind, randomised controlled trial done at the Clinical Research Centre of the Malaria Research and Training Centre (MRTC) of the University of Bamako (Bamako, Mali). We enrolled male participants aged 5-50 years with asymptomatic P falciparum malaria. G6PD-normal participants with gametocytes detected by blood smear were randomised 1:1:1:1 in block sizes of eight, using a sealed-envelope design, to receive either sulfadoxine-pyrimethamine and amodiaquine, sulfadoxine-pyrimethamine and amodiaquine plus a single dose of 0·25 mg/kg primaquine, dihydroartemisinin-piperaquine, or dihydroartemisinin-piperaquine plus 15 mg/kg per day methylene blue for 3 days. Laboratory staff, investigators, and insectary technicians were masked to the treatment group and gametocyte density of study participants. The study pharmacist and treating physician were not masked. Participants could request unmasking. The primary efficacy endpoint, analysed in all infected patients with at least one infectivity measure before and after treatment, was median within-person percentage change in mosquito infectivity 2 and 7 days after treatment, assessed by membrane feeding. This study is registered with ClinicalTrials.gov, number NCT02831023. Between June 27, 2016, and Nov 1, 2016, 80 participants were enrolled and assigned to the sulfadoxine-pyrimethamine and amodiaquine (n=20), sulfadoxine-pyrimethamine and amodiaquine plus primaquine (n=20), dihydroartemisinin-piperaquine (n=20), or dihydroartemisinin-piperaquine plus methylene blue (n=20) groups. Among participants infectious at baseline (54 [68%] of 80), those in the
Full Text Available The rectum is particularly vulnerable to HIV transmission having only a single protective layer of columnar epithelium overlying tissue rich in activated lymphoid cells; thus, unprotected anal intercourse in both women and men carries a higher risk of infection than other sexual routes. In the absence of effective prophylactic vaccines, increasing attention is being given to the use of microbicides and preventative antiretroviral (ARV drugs. To prevent mucosal transmission of HIV, a microbicide/ARV should ideally act locally at and near the virus portal of entry. As part of an integrated rectal microbicide development programme, we have evaluated rectal application of the nucleotide reverse transcriptase (RT inhibitor tenofovir (PMPA, 9-[(R-2-(phosphonomethoxy propyl] adenine monohydrate, a drug licensed for therapeutic use, for protective efficacy against rectal challenge with simian immunodeficiency virus (SIV in a well-established and standardised macaque model.A total of 20 purpose-bred Indian rhesus macaques were used to evaluate the protective efficacy of topical tenofovir. Nine animals received 1% tenofovir gel per rectum up to 2 h prior to virus challenge, four macaques received placebo gel, and four macaques remained untreated. In addition, three macaques were given tenofovir gel 2 h after virus challenge. Following intrarectal instillation of 20 median rectal infectious doses (MID50 of a noncloned, virulent stock of SIVmac251/32H, all animals were analysed for virus infection, by virus isolation from peripheral blood mononuclear cells (PBMC, quantitative proviral DNA load in PBMC, plasma viral RNA (vRNA load by sensitive quantitative competitive (qc RT-PCR, and presence of SIV-specific serum antibodies by ELISA. We report here a significant protective effect (p = 0.003; Fisher exact probability test wherein eight of nine macaques given tenofovir per rectum up to 2 h prior to virus challenge were protected from infection (n = 6 or had
In this podcast, CDCâs 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.
Gourlay, Annabelle; Birdthistle, Isolde; Mburu, Gitau; Iorpenda, Kate; Wringe, Alison
Objectives To investigate and synthesize reasons for low access, initiation and adherence to antiretroviral drugs by mothers and exposed babies for prevention of mother-to-child transmission (PMTCT) of HIV in sub-Saharan Africa. Methods A systematic literature review was conducted. Four databases were searched (Medline, Embase, Global Health and Web of Science) for studies conducted in sub-Saharan Africa from January 2000 to September 2012. Quantitative and qualitative studies were included that met pre-defined criteria. Antiretroviral (ARV) prophylaxis (maternal/infant) and combination antiretroviral therapy (ART) usage/registration at HIV care and treatment during pregnancy were included as outcomes. Results Of 574 references identified, 40 met the inclusion criteria. Four references were added after searching reference lists of included articles. Twenty studies were quantitative, 16 were qualitative and eight were mixed methods. Forty-one studies were conducted in Southern and East Africa, two in West Africa, none in Central Africa and one was multi-regional. The majority (n=25) were conducted before combination ART for PMTCT was emphasized in 2006. At the individual-level, poor knowledge of HIV/ART/vertical transmission, lower maternal educational level and psychological issues following HIV diagnosis were the key barriers identified. Stigma and fear of status disclosure to partners, family or community members (community-level factors) were the most frequently cited barriers overall and across time. The extent of partner/community support was another major factor impeding or facilitating the uptake of PMTCT ARVs, while cultural traditions including preferences for traditional healers and birth attendants were also common. Key health-systems issues included poor staff-client interactions, staff shortages, service accessibility and non-facility deliveries. Conclusions Long-standing health-systems issues (such as staffing and service accessibility) and community
Muñoz-González, Sara; Sordo, Yusmel; Pérez-Simó, Marta; Suárez, Marisela; Canturri, Albert; Rodriguez, Maria Pilar; Frías-Lepoureau, María Teresa; Domingo, Mariano; Estrada, Mario Pablo; Ganges, Llilianne
Here we evaluated the effect of double vaccination with a novel subunit marker vaccine candidate based in the CSFV E2 glycoprotein fused to the porcine CD154 to prevent CSFV vertical transmission. A lentivirus-based gene delivery system was used to obtain a stable recombinant HEK 293 cell line for the expression of E2 fused to porcine CD154 molecule. Six pregnant sows were distributed in two groups and at 64days of gestation animals numbered 1-4 (group 1) were vaccinated via intramuscular inoculation with 50μg of E2-CD154 subunit vaccine. Animals from group 2 (numbered 5 and 6, control animals) were injected with PBS. Seventeen days later sows from group 1 were boosted with the same vaccine dose. Twenty-seven days after the first immunization, the sows were challenged with a virulent CSFV Margarita strain and clinical signs were registered. Samples were collected during the experiment and at necropsy to evaluate immune response and virological protection. Between 14 and 18days after challenge, the sows were euthanized, the foetuses were obtained and samples of sera and tissues were collected. E2-CD154 vaccinated animals remained clinically healthy until the end of the study; also, no adverse reaction was shown after vaccination. An effective boost effect in the neutralizing antibody response after the second immunization and viral challenge was observed and support the virological protection detected in these animals after vaccination. Protection against CSFV vertical transmission was found in the 100% of serums samples from foetus of vaccinated sows. Only two out of 208 samples (0.96%) were positive with Ct value about 36 corresponding to one tonsil and one thymus, which may be non-infective viral particles. Besides, its DIVA potential and protection from vertical transmission, the novel CSFV E2 bound to CD154 subunit vaccine, is a promising alternative to the live-attenuated vaccine for developing countries. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available Abstract Background Uptake of and adherence to the prevention of mother to child transmission of HIV (PMTCT interventions are a challenge to most women if there is no male partner involvement. Organizations which include the National AIDS Council and the Zimbabwe AIDS Prevention Project- University of Zimbabwe have been working towards mobilizing men for couple HIV testing and counseling (HTC in antenatal care (ANC. In 2013, Midlands province had 19 % males who were tested together with their partners in ANC, an increase by 9 % from 2011. However, this improvement was still far below the national target, hence this study was conducted to determine the associated factors. Methods A1:1 unmatched case control study was conducted. A case was a man who did not receive HIV testing and counseling together with his pregnant wife in ANC in Midlands province from January to June 2015. A control was a man who received HIV testing and counseling together with his pregnant wife in ANC in Midlands province from January to June 2015. Simple random sampling was used to select 112 cases and 112 controls. Epi Info statistical software was used to analyze data. Written informed consent was obtained from each study participant. Results Independent factors that predicted male involvement in PMTCT were: having been previously tested as a couple (aOR 0.22, 95 % CI = 0.12, 0.41 and having time to visit the clinic (aOR 0.41, 95 % CI = 0.21, 0.80. Being afraid of knowing one’s HIV status (aOR 2.22, 95 % CI = 1.04, 4.76 was independently associated with low male involvement in PMTCT. Conclusion Multiple factors were found to be associated with male involvement in PMTCT. Routine PMTCT educational campaigns in places where men gather, community based couple HTC and accommodating the working class during weekends are essential in fostering male involvement in PMTCT thereby reducing HIV transmission to the baby.
Amoran Olorunfemi E
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
Cláudio Santos FERREIRA
Full Text Available Although admittedly transmission of Trypanosoma cruzi infection through breastfeeding is a rare event, it involves serious risks. To test the effectiveness of pasteurization in preventing this mode of infection, three sets of samples of human milk were tested: a - contaminated with T. cruzi and pasteurized; b - contaminated with T. cruzi and non-pasteurized; c - non-contaminated and pasteurized. Samples from all sets were orally and intraperitoneally administered to 90 BALB/c mice. The animals inoculated with contaminated, non-pasteurized samples, got the infection. Controls and the animals inoculated with contaminated and pasteurized milk were not infected. The hypothesis was accepted that pasteurization inactivates T. cruzi trypomastigotes.A amamentação é modo alternativo de transmitir-se a doença de Chagas. Embora admitida como evento raro, a infecção por esta via é preocupante. Para evitá-la é sugerida a pasteurização. Separaram-se para o ensaio três conjuntos de amostras de leite humano: a - contaminadas por Trypanosoma cruzi e pasteurizadas; b - contaminadas por T. cruzi e não pasteurizadas; c - não contaminadas e pasteurizadas. Frações dos três conjuntos foram inoculadas por vias oral e intraperitoneal em 90 camundongos BALB/c. Os animais inoculados com leite contaminado e não pasteurizado infectaram-se. Os controles e os inoculados com leite contaminado e pasteurizado não se infectaram. Aceitou-se a hipótese de a pasteurização ter inativado as formas tripomastigotas de T. cruzi em suspensão no leite.
Mohamed M.A. Zeinhom
Full Text Available A total of 150 samples of raw milk, 75 each of farm and market milk were collected from different farms and supermarkets in Beni-Suef Governorate, in addition to 30 stool samples from milk handlers and 25 milker's hand swabs were examined for the presence of Escherichia coli, E. coli O157:H7, Salmonella, Aeromonas and Yersinia. Isolates were identified biochemically and serologically. The obtained results revealed that E. coli was detected in a percentage of 26.7% and 16% in the examined raw market and bulk farm milk respectively, while in stool and hand swabs samples were 16.6% and 16%, respectively. E. coli O157:H7 and Salmonella spp. failed to be detected in any of the examined samples. Additionally, 45% and 16.7% of the recovered E. coli strains from the examined raw market and farm milk samples were enteropathogenic O166, while 55% and 83.3 were untypable, respectively. On the other hand 60% of human stool samples isolates were O 148 and 40% of the isolates were untypable, while 100% of the hand swab isolates were untypable. The results also exhibits isolation rate of Aeromonas hydrophila in a percentage of 24%, 13.3%, 10% and 16% from market milk, farm milk samples, stool and hand swabs respectively. While Yersinea enterocolitica represent 3.3% in the stool samples only. The public health significance of isolated strains as well as suggested control measures were discussed.
Thomson, Kerry A; Telfer, Barbara; Opondo Awiti, Patricia; Munge, Jane; Ngunga, Mathew; Reid, Anthony
Within the first year of implementation, 43% of women who tested HIV positive at their first antenatal care visit were no longer retained and being followed in the free prevention of mother to child transmission (PMTCT) of HIV program offered by the Kenyan Ministry of Health and Médecins Sans Frontières in the informal settlement of Kibera, Nairobi. This study aimed to explore barriers to enrolling and remaining engaged in PMTCT services throughout the pregnancy and postpartum periods. Qualitative data from 31 focus group discussions and 35 in-depth interviews across six stakeholder groups that included women, men, and PMTCT service providers were analyzed. Using an inductive exploratory approach, four researchers coded the data and identified key themes. Five themes emerged from the data that may influence attrition from PMTCT service in this setting: 1) HIV in the context of Kibera, 2) knowledge of HIV status, 3) knowledge of PMTCT, 4) disclosure of HIV status, and 5) male partner support for PMTCT services. A new HIV diagnosis during pregnancy immediately triggered an ongoing risk assessment of perceived hazards in the home, community, and clinic environments that could occur as a result of female participation in PMTCT services. Male partners were a major influence in this risk assessment, but were generally unaware of PMTCT services. To preserve relationships with male partners, meet community expectations of womanhood, and maintain confidentiality while following recommendations of healthcare providers, women had to continuously weigh the risks and benefits of PMTCT services and interventions. Community-based HIV testing and PMTCT education, male involvement in antenatal care, and counseling customized to assist each woman in her own unique risk assessment, may improve uptake of and retention in care and optimize the HIV prevention benefit of PMTCT interventions.
Full Text Available AI Olugbenga-Bello,1 WO Adebimpe,2 FF Osundina,3 ST Abdulsalam3 1Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Ladoke Akintola University of Technology (LAUTECH, Osogbo, Osun State, Nigeria; 2Department of Community Medicine, Osun State University, Osogbo, Osun State, Nigera; 3Department of Community Medicine, Ladoke Akintola University of Technology (LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria Introduction: The fastest growing group of adults living with human immunodeficiency virus (HIV, is women. As more women contract the virus, the number of children infected in utero, intra-partum, and during breastfeeding has been growing. This study assessed the knowledge and attitude of women of child bearing age towards the prevention of mother-to-child-transmission (PMTCT of HIV. Materials and methods: This is a descriptive cross sectional survey of 420 women of the reproductive age group (15–49 years selected using a multistage sampling technique. Data were obtained using interviewer-administered, pretested, semistructured questionnaires. The data were analyzed using the Statistical Package for Social Sciences (SPSS software version 15. Results: A high level of awareness about HIV/acquired immunodeficiency syndrome (AIDS was observed among the respondents (99.8%. The knowledge about MTCT and PMTCT of HIV was high, 92.1% and 91.4%, respectively. However, a significant portion (71.27% of the study population had poor attitudes towards PMTCT of HIV. Conclusion: Despite the high level of awareness of HIV/AIDS, and good knowledge about MTCT and PMTCT of HIV/AIDS among the respondents, the attitude towards PMTCT is poor. There is need for the involvement of the stakeholders in bridging the gap between knowledge and attitude of prevention of MTCT of HIV among women. Keywords: HIV/AIDS, PMTCT, women, perception, knowledge, attitude
Jane-Francis K T Akoachere
Full Text Available Buruli ulcer (BU is a neglected tropical disease affecting the skin, tissues and in some cases the bones, caused by the environmental pathogen Mycobacterium ulcerans (M. ulcerans. Its mode of transmission is still elusive. Delayed treatment may cause irreversible disabilities with consequent social and economic impacts on the victim. Socio-cultural beliefs, practices and attitudes in endemic communities have been shown to influence timely treatment causing disease management, prevention and control a great challenge. An assessment of these factors in endemic localities is important in designing successful intervention strategies. Considering this, we assessed the knowledge, attitude and practices regarding BU in three endemic localities in the South West region, Cameroon to highlight existing misconceptions that need to be addressed to enhance prompt treatment and facilitate effective prevention and control.A cross-sectional study was executed in three BU endemic health districts. Using qualitative and quantitative approaches we surveyed 320 randomly selected household heads, interviewed BU patients and conducted three focus group discussions (FGDs to obtain information on awareness, beliefs, treatment, and attitudes towards victims. The influence of socio-demographic factors on these variables was investigated.Respondents (84.4% had a good knowledge of BU though only 65% considered it a health problem while 49.4% believed it is contagious. Socio-demographic factors significantly (P<0.05 influenced awareness of BU, knowledge and practice on treatment and attitudes towards victims. Although the majority of respondents stated the hospital as the place for appropriate treatment, FGDs and some BU victims preferred witchdoctors/herbalists and prayers, and considered the hospital as the last option. We documented beliefs about the disease which could delay treatment.Though we are reporting a high level of knowledge of BU, there exist fallacies about
Ramirez-Ferrero, Eric; Lusti-Narasimhan, Manjula
Despite ample evidence documenting the positive impact of men on the prevention of mother-to-child transmission (PMTCT) and other sexual and reproductive health programs, men's engagement remains very low. This paper examines the current level and nature of male involvement and identifies opportunities for the advancement of men's constructive engagement in PMTCT and sexual and reproductive health. Conceptual and policy barriers have encouraged the inadvertent exclusion of men from PMTCT and other reproductive health services. The historic institutionalization of reproductive health as women's health has generally resulted in health services that are not welcoming of men and has undermined efforts to engage couples. This paper argues that to maximize the health outcomes of PMTCT and sexual and reproductive health programs for women and men, we must move beyond seeing men as simply "facilitating factors" that enable women to access health-care services. Men need to instead be recognized as a constituent part of reproductive health policy and practice. The paper proposes strategies for policy makers and program leaders to engage men and couples to foster communication and shared decision-making. This approach can both help to achieve health goals and engender more equitable relationships between men and women. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.
Augustin R.M. Amboko
Full Text Available Background: The Democratic Republic of Congo (DRC implemented a prevention of mother-to-child transmission (PMTCT of HIV infection programme in maternal, newborn and child health (MNCH services in 2001 with nurses as key personnel. To date there is no informationin the DRC and specifically in Kinshasa with respect to compliance with PMTCT national guidelines.Aim: The study aimed at describing nurses’ compliance with the PMTCT national guidelines in selected PMTCT sites of Kinshasa.Methods: A descriptive cross-sectional study was conducted in Kinshasa with 76 nurses in 18 selected PMTCT sites. The nurses’ compliance with PMTCT national guidelines was assessed using a healthcare provider self-reporting questionnaire developed by the researchers.Results: The study showed that the mean score of nurses’ compliance with PMTCT nationalg uidelines was 74% (95% CI: 69% – 78% which progressively decreased and was significantly different across different MNCH services (p = 0.025. With respect to categories of PMTCT recommendations, nurses were compliant with those related to education in labour and delivery, and antenatal services. Sociodemographic characteristics such as training, length of service and category of nurses did not influence nurses’ compliance score.Conclusion: These findings showed that nurses were noncompliant with PMTCT national guidelines, with the score level being 80% or more in the three MNCH services/units. Improvement of nurses’ ‘compliance with the PMTCT national guidelines requires effective monitoring of full integration of PMTCT as routine activities in MNCH care.
Amos Kankponang Laar, PhD
Full Text Available Background: Developed by the World Health Organization (WHO and partners, the correct adaptation and implementation of the global guidelines on prevention of mother-to-child transmission (PMTCT of HIV is critical. This study explored the challenges that health workers face implementing WHO’s PMTCT guidelines, and the experiences of HIV-positive clients receiving these services. Methods: We interacted with 14 health professionals, and 16 PMTCT clients through in-depth interviews. Four of seven PMTCT sites within the Accra Metropolis were purposively included. Interviews were tape-recorded, transcribed, analyzed, and then sorted into themes. Results: Health workers had challenges translating PMTCT guidelines into useful messages for their clients. Their counselling was often prescriptive. Counselors identified inadequate in-service training as a key reason for their outdated and inconsistent messages. HIV-positive clients exhibited general knowledge about the importance of doing exclusive breast-feeding for the first six months of life. Clients had confidence in antiretroviral for PMTCT. However, deeply rooted socio-cultural practices and the attitudes of counselors remain challenges to clients. Conclusions and Global Health Implications: Counselors require refresher training which addresses, among other things, long-held socio-cultural practices. Publicizing these challenges will prod policy makers and program implementers to develop strategies that address the challenges both locally and globally.
Tynan, Anna; Vallely, Lisa; Kupul, Martha; Neo, Ruthy; Fiya, Voletta; Worth, Heather; Kariwiga, Grace; Mola, Glen D L; Kaldor, John; Kelly-Hanku, Angela
Prevention of parent-to-child transmission (PPTCT) of HIV is a highly complex package of interventions, which spans services in both maternal and child health programmes. In Papua New Guinea (PNG), a commitment to ensure that all pregnant women and their partners have access to the full range of PPTCT interventions exists; however, efforts to increase access and utilisation of PPTCT remain far from optimal. The aim of this paper is to examine health care worker (HCW) perception of health system factors impacting on the performance of PPTCT programmes. Sixteen interviews were undertaken with HCWs involved in the PPTCT programme. Application of the WHO 6 building blocks of a health system was applied, and further thematic analysis was conducted on the data with assistance from the analysis software NVivo. Broken equipment, problems with access to medication and supplies, and poorly supported workforce were reported as barriers for implementing a successful PPTCT programme. The absence of central coordination of this complex, multistaged programme was also recognised as a key issue. The study findings highlight an important need for investment in appropriately trained and supported HCWs and integration of services at each stage of the PPTCT programme. Lessons from the PPTCT experience in PNG may inform policy discussions and considerations in other similar contexts. Copyright © 2017 John Wiley & Sons, Ltd.
Peña, Anamaría; Cerón, Inés; Budnik, Isolda; Barttlet, Diego; Cataldo, Karma; Fernández, Ana M; Ramírez, Anamaría; Lasso, Martín
Antiretroviral therapy (ART) has shown to be an effective measure in decreasing HIV vertical transmission (VT). Nevertheless, it is not free from adverse effects in the newborn: risk of prematurity, low birth weight, metabolic disorders, among others. Despite the importance of the subject, there are few national data that analyze the problem. We performed a retrospective analysis of a cohort of HIV positive mother/child binomial, followed between 1995 and 2010. Ninety-four pregnancies and 96 children (2 twin pregnancies) were analyzed. The rate of VT was 2.1%. Adverse effects attributed to ART were found on 85.4% of the newborn; highlighting the presence of anemia (70.8%) and several metabolic disorders [elevated lactate without acidosis (29.2%), lactic acidosis (12.5%), hyperkalemia (14.6%), metabolic acidosis (9.4%)]. Maternal exposure to protease inhibitors proved to be an independent risk factor for the development of metabolic disorders in newborns (OR 0.15 [0.04-0.48], p < 0.01). In our series, ART was effective in reducing the VT, however exposed newborns showed a high frequency of adverse effects, so it is advisable to implement programs for monitoring these patients to prevent sequelae.
Elias Asfaw Zegeye
Full Text Available Economic analyses of patients’ costs are pertinent to improve effective healthcare services including the prevention of mother-to-child HIV/AIDS transmission (PMTCT. This study assessed the direct and non-direct medical costs borne by pregnant women attending PMTCT services in urban (high-HIV prevalence and rural (low-HIV prevalence settings, in Ethiopia. Patient-level direct medical costs and direct non-medical data were collected from HIV-positive pregnant women in six regions. The cost estimation was classified as direct medical (service fee, drugs and laboratory and direct non-medical (food, transportation and accommodation. The mean direct medical expense per patient per year was Ethiopian birr (ETB 746 (US$ 38 in the urban settings, as compared to ETB 368 (US$ 19 in the rural settings. On average, a pregnant woman from urban and rural catchments incurred direct non-medical costs of ETB 6,435 (US$ 327 and ETB 2,154 (US$ 110 per year, respectively. On average, non-medical costs of friend/relative/guardian were ETB 2,595 (US$ 132 and ETB 2,919 (US$ 148.39 in the urban and rural settings, respectively. Although the PMTCT service is provided free of charge, HIV-positive pregnant women and infant pairs still face a substantial amount of out-of-pocket spending due to direct medical and non-medical costs.
Schlech, W.F. III
The route or mechanism of transmission of Listeria monocytogenes from its rural veterinary reservoir to newborn and older human populations has been obscure. Anecdotal reports of milk-borne infection from cows with Listeria mastitis have been published, but intensive investigations of small outbreaks of L. monocytogenes infections in humans have not supported a gastrointestinal mode of infection. Several recent studies, however, strongly suggest this possibility, and case-control studies of epidemic listeriosis in the Canadian Maritime provinces in 1981 documented an association between ingestion of uncooked vegetables and the development of illness (p = 0.02). In that study, coleslaw from a regional producer which was distributed throughout the Maritimes was considered to be the vehicle of transmission. Cabbage, the raw product in the production of coleslaw, was contaminated at a farm prior to arrival at the plant. Contamination occurred through fertilization with raw manure from a flock of sheep known to harbor L. monocytogenes. Therefore, an indirect link was established between Listeria monocytogenes infection of sheep on a cabbage farm and subsequent development of invasive listeriosis in humans. This study supports findings from other epidemiologic studies of human listeriosis and is consistent with results of investigations into the mode of transmission of natural and laboratory-acquired listeriosis in animals. 34 references.
Gouveia, Pedro Alves da Cruz; da Silva, Gerlane Alves Pontes; de Albuquerque, Maria de Fatima Pessoa Militão
Mother-to-child transmission of HIV (MTCT) is the major form of acquiring the disease among children. The loss to follow-up (LTF) of mothers and their children is a problem that affects the effectiveness of programs for the prevention of mother-to-child transmission (PMTCT). The aim of this study is to identify risk factors associated with the LTF of HIV-exposed children in the state of Pernambuco, Brazil. A retrospective cohort study was carried out with 1200 HIV-exposed children born between 2000 and 2009, registered up to the age of 2 months in a public health PMTCT program. Children were considered LTF if they did not return for scheduled visits to monitor infection status. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for LTF. A total of 185 children (15.4%; CI: 95%: 13.4-17.4%) met the case definition of LTF before the determination of serological HIV status. Risk factors independently associated with LTF were mother-child pairs who reside in rural and remote areas (OR 1.86; 95% CI: 1.30-2.66) and mothers who use illicit drugs (OR 1.8; 95% CI: 1.08-3.0). Initiation of the PMTCT during pregnancy was a protective factor for LTF (OR 0.69; 95% CI: 0.49-0.96). The decentralization of support services for HIV-exposed children to other cities in the state seems to be crucial for the accurate monitoring of outcomes. It is also important to introduce additional measures addressing mothers who are drug users so that they remain in the program: an intensive follow-up program that actively searches for absentee mother-child pairs, support from social services and treatment for drug-dependency. The findings of this study highlight the importance of diagnosing mothers as early as possible in order to conduct a more complete follow-up period of the children. Solving the above-mentioned problems is a challenge, which must be overcome so as to improve the quality of PMTCT.
Schuster, Roseanne C; de Sousa, Octávio; Rivera, Jacqueline; Olson, Rebecca; Pinault, Delphine; Young, Sera L
Performance-based incentives (PBIs) have garnered global attention as a promising strategy to improve healthcare delivery to vulnerable populations. However, literature gaps in the context in which an intervention is implemented and how the PBIs were developed exist. Therefore, we (1) characterized the barriers and promoters to prevention of vertical transmission of HIV (PVT) service delivery in rural Mozambique, where the vertical transmission rate is 12 %, and (2) assessed the appropriateness for a PBI's intervention and application to PVT. We conducted 24 semi-structured interviews with nurses, volunteers, community health workers, and traditional birth attendants about the barriers and promoters they experienced delivering PVT services. We then explored emergent themes in subsequent focus group discussions (n = 7, total participants N = 92) and elicited participant perspectives on PBIs. The ecological motivation-opportunity-ability framework guided our iterative data collection and thematic analysis processes. The interviews revealed that while all health worker cadres were motivated intrinsically and by social recognition, they were dissatisfied with low and late remuneration. Facility-based staff were challenged by factors across the rest of the ecological levels, primarily in the opportunity domain, including the following: poor referral and record systems (work mandate), high workload, stock-outs, poor infrastructure (facility environment), and delays in obtaining patient results and donor payment discrepancies (administrative). Community-based cadres' opportunity challenges included lack of supplies, distance (work environment), lack of incorporation into the health system (administration), and ability challenges of incorrect knowledge (health worker). PBIs based on social recognition and that enable action on intrinsic motivation through training, supervision, and collaboration were thought to have the most potential for targeting improvements
Full Text Available OBJECTIVE: We assessed the 18-month effectiveness of short-course (sc antiretroviral peripartum regimens combined with alternatives to prolonged breastfeeding to prevent mother-to-child transmission (MTCT of HIV-1 in Abidjan, Côte d'Ivoire. METHODOLOGY: HIV-1 infected pregnant women received from >/=32-36 weeks of gestation scZidovudine (ZDV+/-Lamivudine (3TC+single-dose Nevirapine (sdNVP at delivery within the ANRS 1201/1202 DITRAME-Plus cohort (2001-2003. Neonates received a sdNVP+7-day ZDV prophylaxis. Two infant-feeding interventions were systematically offered free of charge: formula-feeding or exclusive shortened breastfeeding with early cessation from four months. The reference group was the ANRS 049a DITRAME cohort (1994-2000 exposed to scZDV from 36 weeks, then to prolonged breastfeeding. Pediatric HIV infection was defined by a positive plasma HIV-1 RNA at any age, or if aged >/=18 months, a positive HIV-1 serology. Turnbull estimates of cumulative transmission risks (CTR and effectiveness (HIV-free survival were compared by exposure group using a Cox model. FINDINGS: Among 926 live-born children enrolled, 107 (11.6% were HIV-infected at 18 months. CTRs were 22.3% (95% confidence interval[CI]:16-30% in the 238 ZDV long-term breastfed reference group, 15.9% (CI:10-27% in the 169 ZDV+sdNVP shortened breastfed group; 9.4% (CI:6-14% in the 195 ZDV+sdNVP formula-fed group; 6.8% (CI:4-11% in the 198 ZDV+3TC+sdNVP shortened breastfed group, and 5.6% (CI:2-10% in the 126 ZDV+3TC+sdNVP formula-fed group. Each combination had a significantly higher effectiveness than the ZDV long-term breastfed group except for ZDV+sdNVP shortened breastfed children, ranging from 51% (CI:20-70% for ZDV+sdNVP formula fed children to 63% (CI:40-80% for ZDV+3TC+NVPsd shortened breastfed children, after adjustment for maternal eligibility for antiretroviral therapy (ART, home delivery and low birth-weight. Substantial MTCT risk reductions are reachable in Africa
Nagot, Nicolas; Kankasa, Chipepo; Meda, Nicolas; Hofmeyr, Justus; Nikodem, Cheryl; Tumwine, James K; Karamagi, Charles; Sommerfelt, Halvor; Neveu, Dorine; Tylleskär, Thorkild; Van de Perre, Philippe
Postnatal transmission of HIV-1 through breast milk remains an unsolved challenge in many resource-poor settings where replacement feeding is not a safe alternative. WHO now recommends breastfeeding of infants born to HIV-infected mothers until 12 months of age, with either maternal highly active antiretroviral therapy (HAART) or peri-exposure prophylaxis (PEP) in infants using nevirapine. As PEP, lamivudine showed a similar efficacy and safety as nevirapine, but with an expected lower rate of resistant HIV strains emerging in infants who fail PEP, and lower restrictions for future HIV treatment. Lopinavir/ritonavir (LPV/r) is an attractive PEP candidate with presumably higher efficacy against HIV than nevirapine or lamivudine, and a higher genetic barrier to resistance selection. It showed an acceptable safety profile for the treatment of very young HIV-infected infants. The ANRS 12174 study aims to compare the risk of HIV-1 transmission during and safety of prolonged infant PEP with LPV/r (40/10 mg twice daily if 2-4 kg and 80/20 mg twice daily if >4 kg) versus Lamivudine (7,5 mg twice daily if 2-4 kg, 25 mg twice daily if 4-8 kg and 50 mg twice daily if >8 kg) from day 7 until one week after cessation of BF (maximum 50 weeks of prophylaxis) to prevent postnatal HIV-1 acquisition between 7 days and 50 weeks of age. The ANRS 12174 study is a multinational, randomised controlled clinical trial conducted on 1,500 mother-infant pairs in Burkina Faso, South Africa, Uganda and Zambia. We will recommend exclusive breastfeeding (EBF) until 26th week of life and cessation of breastfeeding at a maximum of 49 weeks in both trial arms.HIV-uninfected infants at day 7 (± 2 days) born to HIV-1 infected mothers not eligible for HAART who choose to breastfeed their infants.The primary endpoint is the acquisition of HIV-1 (as assessed by HIV-1 DNA PCR) between day 7 and 50 weeks of age. Secondary endpoints are safety (including resistance, adverse events and growth) until 50
Full Text Available Abstract Background Postnatal transmission of HIV-1 through breast milk remains an unsolved challenge in many resource-poor settings where replacement feeding is not a safe alternative. WHO now recommends breastfeeding of infants born to HIV-infected mothers until 12 months of age, with either maternal highly active antiretroviral therapy (HAART or peri-exposure prophylaxis (PEP in infants using nevirapine. As PEP, lamivudine showed a similar efficacy and safety as nevirapine, but with an expected lower rate of resistant HIV strains emerging in infants who fail PEP, and lower restrictions for future HIV treatment. Lopinavir/ritonavir (LPV/r is an attractive PEP candidate with presumably higher efficacy against HIV than nevirapine or lamivudine, and a higher genetic barrier to resistance selection. It showed an acceptable safety profile for the treatment of very young HIV-infected infants. The ANRS 12174 study aims to compare the risk of HIV-1 transmission during and safety of prolonged infant PEP with LPV/r (40/10 mg twice daily if 2-4 kg and 80/20 mg twice daily if >4 kg versus Lamivudine (7,5 mg twice daily if 2-4 kg, 25 mg twice daily if 4-8 kg and 50 mg twice daily if >8 kg from day 7 until one week after cessation of BF (maximum 50 weeks of prophylaxis to prevent postnatal HIV-1 acquisition between 7 days and 50 weeks of age. Methods The ANRS 12174 study is a multinational, randomised controlled clinical trial conducted on 1,500 mother-infant pairs in Burkina Faso, South Africa, Uganda and Zambia. We will recommend exclusive breastfeeding (EBF until 26th week of life and cessation of breastfeeding at a maximum of 49 weeks in both trial arms. HIV-uninfected infants at day 7 (± 2 days born to HIV-1 infected mothers not eligible for HAART who choose to breastfeed their infants. The primary endpoint is the acquisition of HIV-1 (as assessed by HIV-1 DNA PCR between day 7 and 50 weeks of age. Secondary endpoints are safety (including resistance
Systematic review on tuberculosis transmission on aircraft and update of the European Centre for Disease Prevention and Control risk assessment guidelines for tuberculosis transmitted on aircraft (RAGIDA-TB).
Kotila, Saara M; Payne Hallström, Lara; Jansen, Niesje; Helbling, Peter; Abubakar, Ibrahim
As a setting for potential tuberculosis (TB) transmission and contact tracing, aircraft pose specific challenges. Evidence-based guidelines are needed to support the related-risk assessment and contact-tracing efforts. In this study evidence of TB transmission on aircraft was identified to update the Risk Assessment Guidelines for TB Transmitted on Aircraft (RAGIDA-TB) of the European Centre for Disease Prevention and Control (ECDC). Electronic searches were undertaken from Medline (Pubmed), Embase and Cochrane Library until 19 July 2013. Eligible records were identified by a two-stage screening process and data on flight and index case characteristics as well as contact tracing strategies extracted. The systematic literature review retrieved 21 records. Ten of these records were available only after the previous version of the RAGIDA guidelines (2009) and World Health Organization guidelines on TB and air travel (2008) were published. Seven of the 21 records presented some evidence of possible in-flight transmission, but only one record provided substantial evidence of TB transmission on an aircraft. The data indicate that overall risk of TB transmission on aircraft is very low. The updated ECDC guidelines for TB transmission on aircraft have global implications due to inevitable need for international collaboration in contract tracing and risk assessment.
Cui, Fuqiang; Luo, Huiming; Wang, Fuzhen; Zheng, Hui; Gong, Xiaohong; Chen, Yuansheng; Wu, Zhenhua; Miao, Ning; Kane, Mark; Hennessey, Karen; Hadler, Stephen C; Hutin, Yvan J; Liang, Xiaofeng; Yang, Weizhong
Mother to Child Transmission (MTCT) has remained a leading cause of HBV infection in China, accounting for 40% of total infections. Providing hepatitis B vaccine (HepB) to all infants within 24h of birth (Timely Birth Dose, TBD), and subsequent completion of at least 3 vaccine doses is key to preventing perinatal HBV infection. In 2002, with the financial support of the Global Alliance on Vaccine and Immunization (GAVI) targeted to Western region and 223 poverty-affected counties in Central region, hepatitis B vaccine was provided for free. In 2010, we evaluated the China GAVI project in terms of its activities to prevent perinatal infections. The objectives of the evaluation were to (1) measure achievements in the China GAVI project in terms of TBD coverage, and (2) describe practices for HBsAg screening of pregnant women and HBIG use outside the GAVI China project. We used the methods recommended by WHO to select a cluster sample of health care facilities for the purpose of an injection safety assessment. We stratified China into three regions based on economic criteria, and selected eight counties with a probability proportional to population size in each region. In each selected county, we selected (a) 10 townships at random among the list of townships of the county and (b) the one county level hospital. In each hospital, we abstracted 2002 through 2009 records to collect information regarding birth cohorts, hospitals deliveries, vaccine management, hepatitis B vaccination delivery, HBsAg screening practices and results, and HBIG administration. In addition, in all hospitals, we abstracted records regarding the delivery of TBD. We visited 244 facilities in the three regions, including 24 county hospitals and 220 township hospitals. We reviewed 837,409 birth summary records, 699,249 for infants born at county or township hospitals. Hospital delivery rates increased from 58% in 2002 to 93% in 2009. Surveyed TBD coverage increased from 60% in 2002 to 91% in 2009
He, Yan; Luo, Yan; Ding, Yi-ling; Zheng, Yu-huang; Li, Jing; Huang, Jian; Li, Jie-min
To identify the effect of highly active anti-retroviral therapy (HAART) on prevention of mother to child transmission (PMTCT) of HIV and on infant growth and development. A total of 16 HIV-infected women or pregnant women selected in this study received HAART before or 18 - 24 weeks after pregnancy. The treatment included taking Zidovudine (AZT) 0.3 g each time, twice a day, Lamivudine (3TC) 0.3 g each time, once a day and Nevirapine (NVP) 0.2 g each time, twice a day or Efavirenz (EFV) 0.6 g each time, once a day, as well as labor intervention and artificial feeding. The growth index for 17 infants from HIV-infected mothers (experimental group) and 16 normal infants (control group) were observed for 18 months. Neonatal hemoglobin (Hb), liver and kidney function, serum iron and calcium were detected at neonatal period and at 12(th) month, respectively. All the pregnant women were in good conditions and had tolerance with HAART. The birth weight, length and Apgar score of the newborns in the experimental group were (3.5 ± 0.9) kg, (54.2 ± 3.8) cm and 7 - 10 scores respectively, however those in the control group were (3.6 ± 0.8) kg, (55.6 ± 3.6) cm and 8 - 10 scores (t(weight) = 1.01, t(length) = 6.98, P > 0.05). Weight and length of infants in experimental group were (9.36 ± 1.8) kg and (76.3 ± 2.7) cm at 12(th) month, while those in control group were (9.86 ± 2.5) kg and (76.8 ± 2.9) cm (t(weight) = 0.83, t(length) = 1.00, P > 0.05). The level of Hb in experimental group was (126.2 ± 16.7) g/L, and was (148.6 ± 20.5) g/L in control group (t = -5.89, P = 0.11). At 12(th) month, the levels of Hb and the total bilirubin (TB) were (125.9 ± 19.8) g/L and (11.7 ± 3.5) µmol/L in experimental group; and those in the control group were (130.1 ± 18.7) g/L and (13.2 ± 3.7) µmol/L (t(Hb) = -3.82, t(TB) = -2.14, P > 0.05). Serum iron and calcium were (25.4 ± 5.7) µmol/L and (26.4 ± 7.2) µmol/L at neonatal period and were (2.3 ± 0.6) mol/L and (2.8 ± 0
Full Text Available Abstract Background Mother-to-child transmission of HIV (MTCT accounts for over 95% of all paediatric HIV infections worldwide. Several studies have shown that male participation in the antenatal care of their spouses together with couple counselling and testing for HIV, increases use of the interventions for HIV prevention. The prevention programme of MTCT (PMTCT was launched in Uganda in 2000 and Mbale in 2002. Less than 10% of the pregnant women accepted antenatal HIV testing at Mbale Regional Referral Hospital in 2003; couple counselling and testing for HIV was low. Therefore, we conducted the study to determine the level of male involvement and identify its determinants in the PMTCT programme. Methods A cross-sectional survey of 388 men aged 18 years or more, whose spouses were attending antenatal care at Mbale Regional Referral Hospital, was conducted in Mbale district, Eastern Uganda. A male involvement index was constructed based on 6 questions. The survey was complemented by eight focus group discussions and five in-depth interviews. Results The respondents had a median age of 32 years (inter-quartile range, IQR: 28-37. The majority (74% had a low male involvement index and only 5% of men accompanied their spouses to the antenatal clinic. Men who had attained secondary education were more likely to have a high male involvement index (OR: 1.9, 95% CI: 1.1-3.3 than those who had primary or no formal education. The respondents, whose occupation was driver (OR: 0.3, 95% CI: 0.1-0.7 or those who had fear of disclosure of their HIV sero-status results to their spouses (OR: 0.4, 95% CI: 0.2-0.8, were less likely to have a high male involvement index. Barriers to male involvement in the PMTCT programme were related to both the poor health system, to socio-economic factors and to cultural beliefs. Conclusions Structural and cultural barriers to men's involvement in the PMTCT programme in Mbale district were complex and interrelated. Community
Mutabazi, Jean Claude; Zarowsky, Christina; Trottier, Helen
The global scale-up of Prevention of mother-to-child transmission (PMTCT) services is credited for a 52% worldwide decline in new HIV infections among children between 2001 and 2012. However, the epidemic continues to challenge maternal and paediatric HIV control efforts in Sub Saharan Africa (SSA), with repercussions on other health services beyond those directly addressing HIV and AIDS. This systematised narrative review describes the effects of PMTCT programs on other health care services and the implications for improving health systems in SSA as reported in the existing articles and scientific literature. The following objectives framed our review:To describe the effects of PMTCT on health care services and systems in SSA and assess whether the PMTCT has strengthened or weakened health systems in SSATo describe the integration of PMTCT and its extent within broader programs and health systems. Articles published in English and French over the period 1st January 2007 (the year of publication of WHO/UNICEF guidelines on global scale-up of the PMTCT) to 31 November 2016 on PMTCT programs in SSA were sought through searches of electronic databases (Medline and Google Scholar). Articles describing the impact (positive and negative effects) of PMTCT on other health care services and those describing its integration in health systems in SSA were eligible for inclusion. We assessed 6223 potential papers, reviewed 225, and included 57. The majority of selected articles offered arguments for increased health services utilisation, notably of ante-natal care, and some evidence of beneficial synergies between PMTCT programs and other health services especially maternal health care, STI prevention and early childhood immunisation. Positive and negative impact of PMTCT on other health care services and health systems are suggested in thirty-two studies while twenty-five papers recommend more integration and synergies. However, the empirical evidence of impact of PMTCT
Julio S G Montaner
Full Text Available 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.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.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%.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 Therapy Guidelines offer a unique opportunity to
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.
Katoba, Juliet; Hangulu, Lydia; Mashamba-Thompson, Tivani Phosa
Point-of-care (POC) testing has been shown to help improve healthcare access in resource-limited settings. However, there is paucity of evidence on accessibility of POC testing for prevention of mother-to-child transmission (PMTCT) in resource-limited settings. We propose to conduct a systematic scoping review to map the evidence on POC testing services for PMTCT. A scoping review framework, proposed by Arksey and O'Malley, will guide the study. A comprehensive literature search will be performed in the following electronic databases: PubMed, Science Direct, Cochrane Central, Google Scholar and databases within EBSCOhost (Medline and CINAHL). The primary research articles published in peer-reviewed journals and grey articles addressing our question will be included. One reviewer will conduct title screening and the results will be exported to endnote library. Two independent reviewers will perform abstract, then full article screening in parallel. The same process shall be employed to extract data from eligible studies. Data analysis will involve a narrative summary of included studies and thematic content analysis aided by NVIVO software V.11. The mixed methods assessment tool will be used to assess the quality of studies that will be included. Ethical approval is not applicable to this study. The study findings will be disseminated through publication in a peer-reviewed journal and presentations at conferences related to syphilis, HIV, PMTCT, bacterial infections and POC diagnostics. CRD42017056267. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
El-Karaksy, Hanaa M; Mohsen, Lamiaa M; Saleh, Doa'a A; Hamdy, Mona S; Yassin, Noha A; Farouk, Mohamed; Salit, Mohamed E; El-Shabrawi, Mortada H
To identify possible maternal risk factors for hepatitis B virus (HBV) acquisition and assess the efficacy of immunoprophylaxis given to infants born to hepatitis B virus surface antigen (HBsAg) positive mothers. Screening of 2000 pregnant females was carried out using rapid test and confirmed by enzyme immunoassay. A questionnaire consisting of 20 questions about the possible risk factors for acquisition of HBV infection was filled for every pregnant HBsAg positive female in addition to at least 2 pregnant HBsAg negative females for each positive case. Infants of HBsAg positive women were offered passive and active immunoprophylaxis within the 1st 48 h after birth, in addition to 2nd and 3rd doses of HBV vaccine after 1 and 6 mo respectively. Infants were tested for HBsAg and hepatitis B surface antibodies (HBsAb) at six months of age. HBsAg was confirmed positive in 1.2% of tested pregnant women. Risk factors significantly associated with HBV positivity were; history of injections (OR = 5.65), history of seeking medical advice in a clinic (OR = 7.02), history of hospitalization (OR = 6.82), history of surgery (OR = 4) and family history of hepatitis (OR = 3.89) (P < 0.05). Dropout rate was 28% for HBsAg women whose rapid test was not confirmed and could not be reached to provide immunoprophylaxis for thier newborns. Immunoprophylaxis failure was detected in only one newborn (3.7%) who tested positive for HBsAg at 6 mo of age; and vaccine failure (seronegative to HBsAb after 4 doses of the vaccine) was detected in another one (3.7%). The success rate of the immunoprophylaxis regimen was 92.6%. This pilot study shows that a successful national program for prevention of perinatal transmission of HBV needs to be preceded by an awareness campaign to avoid a high dropout rate.
Li, Yang; Zhu, Liping; Du, Li; Qu, Lingxiao; Jiang, Weili; Xu, Biao
Maternal syphilis is a health threat to both the pregnant women and the children. This study aimed to delineate the longitudinal trend of maternal syphilis and burden of associated adverse pregnant outcomes (APOs) in Shanghai from 2001 to 2015; and to evaluate the effects of preventing mother-to-child transmission (PMTCT) of syphilis in Shanghai with regard to service coverage and APOs averted. PMTCT program of syphilis has been implemented since 2001. Municipal and national PMTCT surveillance data were used in analysis. By using WHO estimation model, the burden of associated APOs and APOs averted were estimated. The differences in access to antenatal care and PMTCT services between resident and non-resident pregnant women were analyzed. The prevalence of seropositivity for maternal syphilis in Shanghai ranged from 0.20% to 0.38% during 2001-2015. The treatment rate varied from 69.8% to 96.8% and remained 83.6% in 2015. Under the PMTCT program, 2163 APOs had been averted during the 15-year period, including 852(39.4%) early fetal loss/stillbirth, 356(16.4%) neonatal death, 190(8.8%) prematurity or low birth weight, and 765(35.4%) clinical evidence of congenital syphilis. Compared with the residents, the non-resident pregnant women had a higher prevalence of syphilis (1.2‰ vs. 2.5‰) and contributed to 81.7% of the syphilis associated APOs in 2015. Screening of maternal syphilis has reached a full coverage both in residents and non-residents. Large numbers of APOs has been averted attributing to the PMTCT program. More attentions should be paid to those vulnerable non-resident pregnant women and tailored interventions including health education, PMTCT promotion and point of care should be given to maximize the effects of PMTCT in Shanghai.
Motlatso G. Mlambo
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.
Full Text Available BACKGROUND: Multidrug antiretroviral (ARV regimens including HAART and short-course dual antiretroviral (sc-dARV regimens were introduced in 2004 to improve Prevention of Mother-to-Child Transmission (PMTCT in Cameroon. We assessed the effectiveness of these regimens from 6-10 weeks and 12 months of age, respectively. METHODOLOGY/FINDINGS: We conducted a retrospective cohort study covering the period from October 2004 to March 2008 in a reference hospital in Cameroon. HIV-positive pregnant women with CD4 or = 37 weeks, women received sd-NVP during labour [regimen 4]. Infants received sd-NVP plus ZDV and 3TC for 7 days or 30 days. Early diagnosis (6-10 weeks was done, using b-DNA and subsequently RT-PCR. We determined early MTCT rate and associated risk factors using logistic regression. The 12-month HIV-free survival was assessed using Cox regression. Among 418 mothers, 335 (80% received multidrug ARV regimens (1, 2, and 3 and MTCT rate with multidrug regimens was 6.6% [95%CI: 4.3-9.6] at 6 weeks, without any significant difference between regimens. Duration of mother's ARV regimen < 4 weeks [OR = 4.7, 95%CI: 1.3-17.6], mother's CD4 < 350 cells/mm(3 [OR = 6.4, 95%CI: 1.8-22.5] and low birth weight [OR = 4.0, 95%CI: 1.4-11.3] were associated with early MTCT. By 12 months, mixed feeding [HR = 8.7, 95%CI: 3.6-20.6], prematurity [HR = 2.3, 95%CI: 1.2-4.3] and low birth weight were associated with children's risk of progressing to infection or death. CONCLUSIONS: Multidrug ARV regimens for PMTCT are feasible and effective in routine reference hospital. Early initiation of ARV during pregnancy and proper obstetrical care are essential to improve PMTCT.
Alinane Linda Nyondo
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
Andrea L Ciaranello
Full Text Available 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.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.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.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.
Nyondo, Alinane Linda; Muula, Adamson Sinjani; Chimwaza, Angela Faith
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. The objective of this study was to identify strategies that may promote MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. 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. 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. 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 consultations with men should continue to achieve higher levels
Mate, Kedar S; Ngubane, Gugu; Barker, Pierre M
QUALITY PROBLEM AND ASSESSMENT: In South Africa (SA), non-governmental organizations (NGOs) have a major role in the provision of health services, but they often compete for funding and influence rather than collaborate. The National Department of Health (NDOH) sought to coordinate existing non-governmental organizations (NGOs) to optimize the prevention of mother-to-child HIV transmission (PMTCT) at scale. We describe how a group of NGO and government partners were brought together to jointly develop the 'Accelerated Plan' (A-Plan) to improve PMTCT services at health-care facilities in SA. The A-Plan used four main principles of large-scale change to align the network of NGO partners and NDOH: setting targets and improving data, simplifying processes and facilitating local execution, building networks and enabling coordination. In the first 6 months of the project, six NGO partners were engaged and the program reached 161 facilities. The program spontaneously spread from five planned subdistricts to nine subdistricts and produced a package of tested interventions to assist in scale-up of the PMTCT program elsewhere. Districts reported high levels of provider engagement in the initiative. In the 6-month project period, a total of 676 health-care workers and managers were trained in quality improvement methods and tools. Coverage of seven key processes in the PMTCT program was tracked on a monthly basis within each subdistrict. We found that a network model for the A-plan could successfully recruit key stakeholders into a strong partnership leading to rapid scale-up of a life-saving public health intervention.
Serradell, Marianela C; Saura, Alicia; Rupil, Lucia L; Gargantini, Pablo R; Faya, Marcela I; Furlan, Paulina J; Lujan, Hugo D
Giardia lamblia is a human intestinal parasite and one of the most frequent enteric pathogen of companion animals. Clinical manifestations of giardiasis, such as diarrhoea, anorexia, weight loss and lethargy, have been associated with Giardia infections in both domestic and farm animals. A few anti-parasitic drugs are routinely used to treat giardiasis, but re-infections are common and drug-resistant strains have already been reported. Unfortunately, efficient vaccines against Giardia are not available. Giardia undergoes antigenic variation; through this mechanism, parasites can avoid the host’s immune defenses, causing chronic infections and/or re-infections. Antigenic variation is characterised by a continuous switch in the expression of members of a homologous family of genes encoding surface antigens. In a previous report, we indicated that in Giardia, the mechanism responsible for the exchange of variant-specific surface proteins (VSPs) involves the RNA interference (RNAi) pathway. From a repertoire of ~200 VSP genes, only one is expressed on the surface of single trophozoites; however, RNAi machinery disruption generates trophozoites that express the complete VSP repertoire. We also demonstrated that gerbils orally immunised with VSPs isolated from these altered parasites showed high levels of protection. Here we tested this vaccine in cats and dogs, and found that it is highly efficient in preventing new infections and reducing chronic giardiasis in domestic animals both in experimental and natural infections. Remarkably, immunisation of dogs in a highly endemic area strongly decreased the percentage of infected children in the community, suggesting that this vaccine would block the zoonotic transmission of the disease. PMID:29263857
Odeny, Thomas A; Bukusi, Elizabeth A; Cohen, Craig R; Yuhas, Krista; Camlin, Carol S; McClelland, R Scott
Many sub-Saharan African countries report high postpartum loss to follow-up of mother-baby pairs. We aimed to determine whether interactive text messages improved rates of clinic attendance and early infant HIV testing in the Nyanza region of Kenya. Parallel-group, unblinded, randomized controlled trial. HIV-positive pregnant women at least 18 years old and enrolled in the prevention of mother-to-child transmission of HIV programme were randomized to receive either text messages (SMS group, n = 195) or usual care (n = 193). Messages were developed using formative focus group research informed by constructs of the Health Belief Model. The SMS group received up to eight text messages before delivery (depending on gestational age), and six messages postpartum. Primary outcomes included maternal postpartum clinic attendance and virological infant HIV testing by 8 weeks postpartum. The primary analyses were intention-to-treat. Of the 388 enrolled women, 381 (98.2%) had final outcome information. In the SMS group, 38 of 194 (19.6%) women attended a maternal postpartum clinic compared to 22 of 187 (11.8%) in the control group (relative risk 1.66, 95% confidence interval 1.02-2.70). HIV testing within 8 weeks was performed in 172 of 187 (92.0%) infants in the SMS group compared to 154 of 181 (85.1%) in the control group (relative risk 1.08, 95% confidence interval 1.00-1.16). Text messaging significantly improved maternal postpartum visit attendance, but overall return rates for these visits remained low. In contrast, high rates of early infant HIV testing were achieved in both arms, with significantly higher testing rates in the SMS compared to the control infants.
Persaud, Deborah; Bedri, Abubaker; Ziemniak, Carrie; Moorthy, Anitha; Gudetta, Berhanu; Abashawl, Aida; Mengistu, Yohannes; Omer, Saad B; Isehak, Abdulhamid; Kumbi, Solomon; Adamu, Rahel; Lulseged, Sileshi; Ashworth, Roxann; Hassen, Elham; Ruff, Andrea
Nevirapine resistance mutations arise commonly following single or extended-dose nevirapine (ED-NVP) prophylaxis to prevent mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), but decay within 6-12 months of single-dose exposure. Use of ED-NVP prophylaxis in infants is expected to rise, but data on decay of nevirapine resistance mutations in infants in whom ED-NVP failed remain limited. We assessed, in Ethiopian infants participating in the Six-Week Extended Nevirapine (SWEN) Trial, the prevalence and persistence of nevirapine resistance mutations at 6 and 12 months following single-dose or up to 6 weeks of ED-NVP, and correlated their presence with the timing of infection and the type of resistance mutations. Standard population genotyping followed by high-throughput cloning were done on dried blood spot samples collected during the trial. More infants who received ED-NVP had nevirapine resistance detected by standard population genotyping (high frequencies) at age 6 months compared with those who received single-dose nevirapine (SD-NVP) (58% of 24 vs. 26% of 19, respectively; p = 0.06). Moreover, 56% of ED-NVP-exposed infants with nevirapine resistance at age 6 months still had nevirapine resistance mutations present at high frequencies at age 1 year. Infants infected before 6 weeks of age who received either SD- or ED-NVP were more likely to have Y181C or K103N; these mutations were also more likely to persist at high frequencies through 1 year of age. HIV-infected infants in whom ED-NVP prophylaxis fails are likely to experience delayed clearance of nevirapine-resistant virus in the first year of life, which in turn places them at risk for early selection of multidrug-resistant HIV after initial therapy with nonnucleoside reverse transcriptase inhibitor-based regimens.
Ijumba, Petrida; Doherty, Tanya; Jackson, Debra; Tomlinson, Mark; Sanders, David; Persson, Lars-Åke
In 2001, South Africa began implementing the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. This programme included distribution of free formula milk for infants up to 6 months of age at all public health facilities. Effective from 1 January 2011, KwaZulu-Natal became the first province to phase out free formula milk from its PMTCT programme. On 23 August 2011, the South African National Department of Health adopted promotion of exclusive breastfeeding as the national infant feeding strategy and made a decision to withdraw free formula milk from the PMTCT programme. To explore the perceptions and understanding of households at community level on the policy decision to phase out free formula milk from the PMTCT programme in South Africa. An exploratory qualitative study was conducted amongst women enrolled in a community randomized trial known as Good Start III. Focus group discussions were held with grandmothers, fathers and teenage mothers; and in-depth interviews were performed with HIV-positive and HIV-negative mothers. Data were analysed using thematic analysis. Identified themes included: (1) variations in awareness and lack of understanding of the basis for the policy change, (2) abuse of and dysfunctional policy as perceived reasons for policy change and (3) proposed strategies for communicating the policy change. There is an urgent need to develop a multifaceted communication strategy clearly articulating the reasons for the infant feeding policy change and promoting the new breastfeeding strategy. The communication strategy should take into account inputs from the community. With a supportive environment and one national infant feeding strategy, South Africa has an opportunity to reverse years of poor infant feeding practices and to improve the health of all children in the country.
Economic and social factors are some of the most common barriers preventing women from accessing maternal and newborn child health (MNCH) and prevention of mother-to-child transmission (PMTCT) services: a literature review.
hIarlaithe, Micheal O; Grede, Nils; de Pee, Saskia; Bloem, Martin
Support to health programming has increasingly placed an emphasis on health systems strengthening. Integration of prevention of mother-to-child transmission (PMTCT) and maternal and newborn child health (MNCH) services has been one of the areas where there has been a shift from a siloed to a more integrated approach. The scale-up of anti-retroviral therapy has made services increasingly available while also bringing them closer to those in need. However, addressing supply side issues around the availability and quality of care at the health centre level alone cannot guarantee better results without a more explicit focus on access issues. Access to PMTCT care and treatment services is affected by a number of barriers which influence decisions of women to seek care. This paper reviews published qualitative and quantitative studies that look at demand side barriers to PMTCT services and proposes a categorisation of these barriers. It notes that access to PMTCT services as well as eventual uptake and retention in PMTCT care starts with access to MNCH in general. While poverty often prevents women, regardless of HIV status, from accessing MNCH services, women living with HIV who are in need of PMTCT services face an additional set of PMTCT barriers. This review proposes four categories of barriers to accessing PMTCT: social norms and knowledge, socioeconomic status, physiological status and psychological conditions. Social norms and knowledge and socioeconomic status stand out. Transport is the most frequently mentioned socioeconomic barrier. With regard to social norms and knowledge, non-disclosure, stigma and partner relations are the most commonly cited barriers. Some studies also cite physiological barriers. Barriers related to social norms and knowledge, socioeconomic status and physiology can all be affected by the mental and psychological state of the individual to create a psychological barrier to access. Increased coverage and uptake of PMTCT services can be
Wellford, W.H.; Sutley, N.H.
In this article the authors discuss the need for predictable and fair access to transmission facilities in order to ensure competitive generation of power. They propose that the Federal Energy Regulatory Commission should regulate transmission to prevent a utility from gaining a competitive advantage in electricity generation markets, the incorporation of transmission access into every bidding program under state jurisdiction, and requirement of transmission rates, terms and conditions for all in-state utilities be included in the request for proposal
Siedner, Mark J; Musinguzi, Nicholas; Tsai, Alexander C; Muzoora, Conrad; Kembabazi, Annet; Weiser, Sheri D; Bennett, John; Hunt, Peter W; Martin, Jeffrey N; Haberer, Jessica E; Bangsberg, David R
Suppressive antiretroviral therapy (ART) substantially decreases HIV transmission in clinical research settings. We sought to measure the frequency and correlates of periods of transmission risk among individuals taking ART during multiple years of observation in rural, southwestern Uganda. Observational cohort study. We collected sexual behavior and viral load data in a Ugandan cohort of people living with HIV/AIDS from the time of ART initiation. We defined each 90-day visit as a potential transmission period if HIV-1 RNA was more than 400 copies/ml and the participant reported sexual transmission risk behavior, defined as unprotected sexual contact with at least 1 HIV-uninfected partners or partners of unknown serostatus in the prior 90 days. We evaluated data from 463 individuals on ART over a median 3.5 years of observation and 5293 total study visits. During that time, over half (259, 56%) had detectable viremia or reported sexual transmission risk behavior at least once. However, only 23 (5%) had both simultaneously, at 28 (Transmission sexual behavior was reported at 6% of visits with detectable viremia. In multivariable regression modeling, correlates of transmission risk periods included younger age, lower CD4 cell count, low household asset ownership and increased internalized stigma. Although detectable viremia and/or sexual transmission risk behavior occurred in over half of individuals, ART reduced periods of HIV transmission risk by over 90% during up to 6 years of observation time. These findings provide further support for provision of ART, along with interventions to promote long-term adherence, to reduce HIV transmission in HIV-endemic settings.
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
Nyondo, Alinane Linda; Choko, Augustine Talumba; Chimwaza, Angela Faith; Muula, Adamson Sinjani
Introduction 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...
Full Text Available ObjectiveTo evaluate the efficacy and safety of telbivudine given from the 12th week of gestation in preventing mother-to-infant transmission of hepatitis B virus (HBV in pregnant women with high HBV DNA load. MethodsEighty pregnant women (at 12 weeks of gestation with chronic hepatitis B, who had a HBV DNA load higher than 1.0×107 copies/ml, were enrolled. The patients were divided into two groups according to their personal preferences: treatment group (n=38 and control group (n=42. The treatment group received oral telbivudine (600 mg once daily until 12 weeks after delivery and was administered compound glycyrrhizin for liver protection, while the control group was given compound glycyrrhizin for liver protection alone. All infants in both groups were vaccinated with hepatitis B immunoglobulin (200 IU and HBV vaccine (20 μg after birth. The mother-to-infant transmission of HBV was indicated by the presence of HBsAg and HBV DNA in infants at 7 months after birth. The HBV DNA levels in these women were measured, and the positive rate of HBsAg in infants was determined. The difference in positive rate of HBsAg was analyzed by chi-square test; the between-group comparison was analyzed by group t(t′-test, and the before-after comparison was analyzed by paired t-test. ResultsThe treatment group showed significantly decreased HBV DNA and alanine aminotransferase levels before delivery. The HBV DNA load of treatment group dropped rapidly after 2 weeks of treatment and then decreased slowly until delivery. The treatment group had significantly decreased HBV DNA levels beforedelivery and at 12 weeks after delivery (t=29.15, P＜0.01; t=40.06, P＜0.01, but the control group showed no significant changes (P＞0.05. The treatment group had significantly lower HBV DNA levels than the control group before delivery and at 12 weeks after delivery (P＜0.01. No infants in the treatment group were HBV-positive, versus a positive rate of 14.3% in the
Mirkuzie Alemnesh H
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
Jennings, Larissa; Ong'ech, John; Simiyu, Rogers; Sirengo, Martin; Kassaye, Seble
Community-based mobile phone programs can complement gaps in clinical services for prevention of mother-to-child transmission (PMTCT) of HIV in areas with poor infrastructure and personnel shortages. However, community and health worker perceptions on optimal mobile phone communication for PMTCT are underexplored. This study examined what specific content and forms of mobile communication are acceptable to support PMTCT. Qualitative methods using focus groups and in-depth interviews were conducted in two district hospitals in Nyanza Province, Kenya. A total of 45 participants were purposefully selected, including HIV-positive women enrolled in PMTCT, their male partners, community health workers, and nurses. Semi-structured discussion guides were used to elicit participants' current mobile phone uses for PMTCT and their perceived benefits and challenges. We also examined participants' views on platform design and gender-tailored short message service (SMS) messages designed to improve PMTCT communication and male involvement. Most participants had access to a mobile phone and prior experience receiving and sending SMS, although phone sharing was common among couples. Mobile phones were used for several health-related purposes, primarily as voice calls rather than texts. The perceived benefits of mobile phones for PMTCT included linking with health workers, protecting confidentiality, and receiving information and reminders. Men and women considered the gender-tailored SMS as a catalyst for improving PMTCT male involvement and couples' communication. However, informative messaging relayed safely to the intended recipient was critical. In addition, health workers emphasized the continual need for in-person counseling coupled with, rather than replaced by, mobile phone reinforcement. For all participants, integrated and neutral text messaging provided antenatally and postnatally was most preferred, although not all topics or text formats were equally acceptable. Given
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
Antunes, Francisco; Zindoga, Pereira; Gomes, Perpétua; Augusto, Orvalho; Mahumane, Isabel; Veloso, Luís; Valadas, Emília; Camacho, Ricardo
Background 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. Objectives 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. Methods 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. Results 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). Conclusions 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. PMID:26161559
Pereira, Gerson Fernando Mendes; Sabidó, Meritxell; Caruso, Alessandro; Benzaken, Adele Schwartz
In Brazil, due to the rapid increase in programmes for the prevention of mother-to-child transmission (PMTCT), routine programme data are widely available. The objective of this study was to assess the utility of programmatic data to replace HIV surveillance based on the antenatal care (ANC) surveillance survey (SS). We analysed ANC SS data from 219 maternity service clinics. PMTCT variables were extracted from the ANC SS data collection form, which allowed us to capture and compare the ANC SS data and PMTCT HIV test results for each pregnant woman who completed the ANC SS. Both the PMTCT programme and the ANC SS tested for HIV using sequential ELISA and western blot for confirmation. We assessed the completeness (% missing) of the PMTC data included in the ANC SS. Of the 36,713 pregnant women who had ANC SS HIV tests performed, 30,588 also underwent PMTCT HIV testing. The HIV prevalence rate from routine PMTCT testing was 0.36%, compared to 0.38% from the ANC SS testing (relative difference -0.05%; absolute difference -0.02%). The relative difference in prevalence rates between pregnant women in northern Brazil and pregnant women central-west Brazil was -0.98 and 0.66, respectively. Of the 29,856 women who had HIV test results from both the PMTCT and ANC SS, the positive percent agreement of the PMTCT versus the surveillance test was 84.1% (95% confidence interval [CI]: 74.8-91.0), and the negative percent agreement was 99.9% (95% CI: 99.9-100.0). The PMTCT HIV testing uptake was 86.4%. The ANC SS HIV prevalence was 0.33% among PMTCT non-refusers and 0.59% among refusers, with a percent bias of -10.80% and a differential prevalence ratio of 0.56. Syphilis and HIV testing results were complete in 98% and 97.6% of PMTCT reports, respectively. The reported HIV status for the women at clinic entry was missing. Although there were consistent HIV prevalence estimates from the PMTCT data and the ANC SS, the overall positive percent agreement of 84.1% falls below the
Rempis, Eva M; Schnack, Alexandra; Decker, Sarah; Braun, Vera; Rubaihayo, John; Tumwesigye, Nazarius Mbona; Busingye, Priscilla; Harms, Gundel; Theuring, Stefanie
While most Sub-Saharan African countries are now implementing the WHO-recommended Option B+ protocol for prevention of vertical HIV transmission, there is a lack of knowledge regarding the influence of Option B+ exposure on adverse birth outcomes (ABOs). Against this background, we assessed ABOs among delivering women in Western Uganda. A cross-sectional, observational study was performed within a cohort of 412 mother-newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of stillbirth, pre-term delivery, and small size for gestational age (SGA) was analysed, looking for influencing factors related to HIV-status, antiretroviral drug exposure and duration, and other sociodemographic and clinical parameters. Among 302 HIV-negative and 110 HIV-positive women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in 28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no significant association was found with stillbirth (OR 0.48, p = 0.55), pre-term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to seronegative women. Women enrolled on antiretroviral therapy (ART) before conception (n = 38) had no different risk for ABOs than women on Option B+ or HIV-negative women. Identified risk factors for stillbirth included lack of formal education, poor socio-economic status, long travel distance, hypertension and anaemia. Pre-term delivery risk was increased with poor socio-economic status, primiparity, Malaria and anaemia. The occurrence of SGA was influenced by older age and Malaria. In our study, women on Option B+ showed no difference in ABOs compared to HIV-negative women and to women on ART. We identified several non-HIV/ART-related influencing factors, suggesting an urgent need for improving early risk assessment mechanisms in antenatal care through better screening and triage systems. Our results are encouraging with regard to continued universal scale-up of Option B+ and ART programmes.
Naburi, Helga; Mujinja, Phares; Kilewo, Charles; Orsini, Nicola; Bärnighausen, Till; Manji, Karim; Biberfeld, Gunnel; Sando, David; Geldsetzer, Pascal; Chalamila, Guerino; Ekström, Anna Mia
Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV (i.e., lifelong antiretroviral treatment for all pregnant and breastfeeding mothers living with HIV) was initiated in Tanzania in 2013. While there is evidence that this policy has benefits for the health of the mother and the child, Option B+ may also increase the workload for health care providers in resource-constrained settings, possibly leading to job dissatisfaction and unwanted workforce turnover. From March to April 2014, a questionnaire asking about job satisfaction and turnover intentions was administered to all nurses at 36 public-sector health facilities offering antenatal and PMTCT services in Dar es Salaam, Tanzania. Multivariable logistic regression models were used to identify factors associated with job dissatisfaction and intention to quit one's job. Slightly over half (54%, 114/213) of the providers were dissatisfied with their current job, and 35% (74/213) intended to leave their job. Most of the providers were dissatisfied with low salaries and high workload, but satisfied with workplace harmony and being able to follow their moral values. The odds of reporting to be globally dissatisfied with one's job were high if the provider was dissatisfied with salary (adjusted odds ratio (aOR) 5.6, 95% CI 1.2-26.8), availability of protective gear (aOR 4.0, 95% CI 1.5-10.6), job description (aOR 4.3, 95% CI 1.2-14.7), and working hours (aOR 3.2, 95% CI 1.3-7.6). Perceiving clients to prefer PMTCT Option B+ reduced job dissatisfaction (aOR 0.2, 95% CI 0.1-0.8). The following factors were associated with providers' intention to leave their current job: job stability dissatisfaction (aOR 3.7, 95% CI 1.3-10.5), not being recognized by one's superior (aOR 3.6, 95% CI 1.7-7.6), and poor feedback on the overall unit performance (aOR 2.7, 95% CI 1.3-5.8). Job dissatisfaction and turnover intentions are comparatively high among nurses in Dar es Salaam's public-sector maternal care
Improving knowledge and behaviours related to the cause, transmission and prevention of Tuberculosis and early case detection: a descriptive study of community led Tuberculosis program in Flores, Indonesia
Full Text Available Abstract Background The community’s awareness of Tuberculosis (TB and delays in health care seeking remain important issues in Indonesia despite the extensive efforts of community-based TB programs delivered by a non-government organisation (NGO. This study explored the knowledge and behaviours in relation to TB and early diagnosis before and after an asset-based intervention designed to improve these issues. Methods Six villages in Flores, Indonesia were purposively selected to participate in this study. Three villages served as intervention villages and the other three villages provided a comparison group. Data collection included interviews, group discussions, observations, field notes and audit of records. Results In total, 50 participants across six villages were interviewed and three group discussions were conducted in the intervention villages supplemented by 1 – 5 h of observation during monthly visits. Overall, participants in all villages had limited knowledge regarding the cause and transmission of TB before the intervention. The delay in health seeking behaviour was mainly influenced by ignorance of TB symptoms. Health care providers also contributed to delayed diagnosis by ignoring the symptoms of TB suspects at the first visit and failing to examine TB suspects with sputum tests. Stigmatisation of TB patients by the community was reported, although this did not seem to be common. Early case detection was less than 50 % in four of the six villages before the asset-based intervention. Knowledge of TB improved after the intervention in the intervention villages alongside improved education activities. Early case detection also increased in the intervention villages following this intervention. The behaviour changes related to prevention of TB were also obvious in the intervention villages but not the comparison group. Conclusion This small project demonstrated that an asset-based intervention can result in positive changes in
Callie A Scott
Full Text Available BACKGROUND: Zambia adopted Option A for prevention of mother-to-child transmission of HIV (PMTCT in 2010 and announced a move to Option B+ in 2013. We evaluated the uptake, outcomes, and costs of antenatal, well-baby, and PMTCT services under routine care conditions in Zambia after the adoption of Option A. METHODS: We enrolled 99 HIV-infected/HIV-exposed (index mother/baby pairs with a first antenatal visit in April-September 2011 at four study sites and 99 HIV-uninfected/HIV-unexposed (comparison mother/baby pairs matched on site, gestational age, and calendar month at first visit. Data on patient outcomes and resources utilized from the first antenatal visit through six months postpartum were extracted from site registers. Costs in 2011 USD were estimated from the provider's perspective. RESULTS: Index mothers presented for antenatal care at a mean 23.6 weeks gestation; 55% were considered to have initiated triple-drug antiretroviral therapy (ART based on information recorded in site registers. Six months postpartum, 62% of index and 30% of comparison mother/baby pairs were retained in care; 67% of index babies retained had an unknown HIV status. Comparison and index mother/baby pairs utilized fewer resources than under fully guideline-concordant care; index babies utilized more well-baby resources than comparison babies. The average cost per comparison pair retained in care six months postpartum was $52 for antenatal and well-baby services. The average cost per index pair retained was $88 for antenatal, well-baby, and PMTCT services and increased to $185 when costs of triple-drug ART services were included. CONCLUSIONS: HIV-infected mothers present to care late in pregnancy and many are lost to follow up by six months postpartum. HIV-exposed babies are more likely to remain in care and receive non-HIV, well-baby care than HIV-unexposed babies. Improving retention in care, guideline concordance, and moving to Option B+ will result in
Bull, Sheana; Thomas, Deborah Sk; Nyanza, Elias C; Ngallaba, Sospatro E
The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention
Peltzer, Karl; Weiss, Stephen M; Soni, Manasi; Lee, Tae Kyoung; Rodriguez, Violeta J; Cook, Ryan; Alcaide, Maria Luisa; Setswe, Geoffrey; Jones, Deborah L
We evaluate the impact of clinic-based PMTCT community support by trained lay health workers in addition to standard clinical care on PMTCT infant outcomes. In a cluster randomized controlled trial, twelve community health centers (CHCs) in Mpumalanga Province, South Africa, were randomized to have pregnant women living with HIV receive either: a standard care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; n = 357), or an enhanced intervention (EI) condition of SC PMTCT plus the "Protect Your Family" intervention (EI; 6 CHCs; n = 342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions and those in the EI, four antenatal and two postnatal PMTCT plus "Protect Your Family" sessions led by trained lay health workers. Maternal PMTCT and HIV knowledge were assessed. Infant HIV status at 6 weeks postnatal was drawn from clinic PCR records; at 12 months, HIV status was assessed by study administered DNA PCR. Maternal adherence was assessed by dried blood spot at 32 weeks, and infant adherence was assessed by maternal report at 6 weeks. The impact of the EI was ascertained on primary outcomes (infant HIV status at 6 weeks and 12 months and ART adherence for mothers and infants), and secondary outcomes (HIV and PMTCT knowledge and HIV transmission related behaviours). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention on study outcomes. In all, 699 women living with HIV were recruited during pregnancy (8-24 weeks), and assessments were completed at baseline, at 32 weeks pregnant (61.7%), and at 6 weeks (47.6%), 6 months (50.6%) and 12 months (59.5%) postnatally. Infants were tested for HIV at 6 weeks and 12 months, 73.5% living infants were tested at 6 weeks and 56.7% at 12 months. There were no significant differences between SC and EI on infant HIV status at 6 weeks and at 12 months, and no
Gimbel, Sarah; Voss, Joachim; Mercer, Mary Anne; Zierler, Brenda; Gloyd, Stephen; Coutinho, Maria de Joana; Floriano, Florencia; Cuembelo, Maria de Fatima; Einberg, Jennifer; Sherr, Kenneth
The objective of the prevention of Mother-to-Child Transmission (pMTCT) cascade analysis tool is to provide frontline health managers at the facility level with the means to rapidly, independently and quantitatively track patient flows through the pMTCT cascade, and readily identify priority areas for clinic-level improvement interventions. Over a period of six months, five experienced maternal-child health managers and researchers iteratively adapted and tested this systems analysis tool for pMTCT services. They prioritized components of the pMTCT cascade for inclusion, disseminated multiple versions to 27 health managers and piloted it in five facilities. Process mapping techniques were used to chart PMTCT cascade steps in these five facilities, to document antenatal care attendance, HIV testing and counseling, provision of prophylactic anti-retrovirals, safe delivery, safe infant feeding, infant follow-up including HIV testing, and family planning, in order to obtain site-specific knowledge of service delivery. Seven pMTCT cascade steps were included in the Excel-based final tool. Prevalence calculations were incorporated as sub-headings under relevant steps. Cells not requiring data inputs were locked, wording was simplified and stepwise drop-offs and maximization functions were included at key steps along the cascade. While the drop off function allows health workers to rapidly assess how many patients were lost at each step, the maximization function details the additional people served if only one step improves to 100% capacity while others stay constant. Our experience suggests that adaptation of a cascade analysis tool for facility-level pMTCT services is feasible and appropriate as a starting point for discussions of where to implement improvement strategies. The resulting tool facilitates the engagement of frontline health workers and managers who fill out, interpret, apply the tool, and then follow up with quality improvement activities. Research on
Hofer, Cristina Barroso; Egger, Matthias; Davies, Mary-Ann; Frota, Ana Cristina Cisne; de Oliveira, Ricardo Hugo; Abreu, Thalita Fernandes; Araújo, Lúcia Evangelista; Witthlin, Bernardo Bastos; Carvalho, Alice Weber; Cordeiro, Janaína Rivas; Lima, Giulia Pasqualini; Keiser, Olivia
To describe the cascade of care to HIV mother-to-child transmission (PMTCT) in a Rio de Janeiro reference paediatric clinic and evaluate the main factors possibly associated with HIV transmission. Data on antenatal care (ANC), perinatal and neonatal assistance to HIV-infected and HIV-exposed but uninfected children assisted in the clinic from 1996 to 2013 were collected. The cascade of care was graphically demonstrated, and possible factors associated with HIV infection were described using regression models for bivariate and multivariate analysis. We imputed missing values of explanatory variables for the final model. A total of 989 children were included in the analysis: 211 were HIV and 778 HEU. Graphically, the HIV PMTCT cascade of care improved from 1996/2000 to the later periods, but not from 2001/2006 to 2007/2013. The main factor independently associated with the HIV infection over time was breastfeeding. In the period 1996/2000, the lack of antiretroviral use during labour was associated HIV transmission. While in 2001/2007, other modes of delivery but elective Caesarean section, and lack of maternal antiretroviral use during ANC were associated with HIV transmission. In the last period, the main factor associated with transmission was the lack of maternal ANC. The HIV PMTCT cascade improved over time, but HIV vertical transmission remains a problem, and better access to ANC is needed. © 2017 John Wiley & Sons Ltd.
Full Text Available Abstract Background Hepatitis B virus (HBV infection is endemic in China; perinatal transmission is the main source of chronic HBV infection. Simultaneous administration of hepatitis B immune globulin (HBIG and hepatitis B vaccine is highly effective to prevent perinatal transmission of HBV; however, the effectiveness also depends on full adherence to the recommended protocols in daily practice. In the present investigation, we aimed to identify gaps in immunoprophylaxis of perinatal transmission of HBV between recommendations and routine practices in Jiangsu Province, China. Methods Totally 626 children from 6 cities and 8 rural areas across Jiangsu Province, China, born from February 2003 to December 2004, were enrolled; 298 were born to mothers with positive hepatitis B surface antigen (HBsAg and 328 were born to HBsAg-negative mothers. Immunoprophylactic measures against hepatitis B were retrospectively reviewed for about half of the children by checking medical records or vaccination cards and the vaccine status was validated for most of children. Results Of 298 children born to HBV carrier mothers, 11 (3.7% were HBsAg positive, while none of 328 children born to non-carrier mothers was HBsAg positive (P Conclusions There are substantial gaps in the prevention of perinatal HBV infection between the recommendations and routine practices in China, which highlights the importance of full adherence to the recommendations to eliminate perinatal HBV infection in the endemic regions.
Full Text Available OBJECTIVE: To assess school teachers' level of knowledge on prevention of viral hepatitis (VH. MATERIAL AND METHODS: A cross-sectional study was conducted in three cities of Brazil, from August to November of 1999. The sample was composed of 360 subjects: 334 women and 26 men, 81 (22.5% from Belém, 123 (34.2% from Natal and 156 (43.3% from Rio de Janeiro. Cultural differences in knowledge were identified using a questionnaire to classify, according to semantic content, categories of transmission and preventive practices. Responses were scored as right or wrong. Data were tabulated and analyzed using EPIINFO 6.04 and open answers were classified according to semantic content. Comparison of the answer frequencies between cities was done through the chi-square test. RESULTS: Transmission category (TC (n=837 answers and prevention category (PC (n=771 answers "food-and waterborne" transmission items were the most frequently mentioned (40%. For TC, "food-and waterborne" answers were followed by "bloodborne" (16%, "inadequate knowledge" (9%, "possible causes of hepatic disease" (9%, and "sexual transmission" (7% answers. For PC items, "food-and waterborne" answers were followed by "general aspects of prevention" (13%, "immunization" (9%, "quality of health services" (8% and "sexual prevention" (5% items. "Right" scores for transmission mechanisms and prevention practices varied from zero to 80%. CONCLUSIONS: Study findings suggest that investments should be made to disseminate appropriate knowledge on VH prevention, mainly addressing sexual transmission and intravenous drug use.OBJETIVO: Evaluar los conocimientos y prácticas de profesores escolares en la prevención de hepatitis viral. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio transversal en tres ciudades de Brasil, de agosto a noviembre de 1999. La muestra estuvo constituida por 360 sujetos: 334 mujeres y 26 hombres, 81 (22.5% de Belém, 123 (34.2% de Nataly 156 (43.3% de Río de Janeiro. Se
Bradford, J.; Wilson, L.; Thon, S.; Millar, N.
This session on transmission issues focused on the role that transmission plays in electricity markets and the importance of getting the market structure right in terms of generation divestiture with buy back contracts, demand side responsive programs, transmission upgrades and long term contracts. The difficulties of distinguishing between market power and scarcity were examined along with some of the complications that ensue if transmission experiences congestion, as exemplified by the August 2003 blackout in eastern North America. The presentations described the best ways to handle transmission issues, and debated whether transmission should be deregulated or follow market forces. Issues of interconnections and reliability of connections were also debated along with the attempt to integrate renewables into the grid. Some presentations identified what new transmission must be built and what must be done to ensure that transmission gets built. The challenges and business opportunities for transmission in Alberta were discussed with reference to plans to invest in new infrastructure, where it is going outside of the province and how it works with other jurisdictions. Manitoba's Conawapa Hydro Project and its 2000 MW tie line to Ontario was also discussed. Some examples of non-optimal use of interconnections in Europe were also discussed in an effort to learn from these mistakes and avoid them in Canada. tabs., figs
Hahné, Susan; van den Hoek, Anneke; Baayen, Dorothé; van der Sande, Marianne; de Melker, Hester; Boot, Hein
Background: In the Netherlands, different hepatitis B vaccination schedules have been used for children born to HBV-infected mothers. All schedules included a birth dose of hepatitis B immunoglobuline (HBIg). We assessed determinants of perinatal HBV transmission and determinants of anti-HBs titers
Kissin, Dmitry M; Mandel, Michele G; Akatova, Natalia; Belyakov, Nikolay A; Rakhmanova, Aza G; Voronin, Evgeny E; Volkova, Galina V; Yakovlev, Alexey A; Jamieson, Denise J; Vitek, Charles; Robinson, Joanna; Miller, William C; Hillis, Susan
The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission. 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. 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<0.0001). Programmatic improvements led to increased uptake of the following clinical services from 2004 to 2008 (all P<0.01): initiation of antiretroviral prophylaxis at ≤28 weeks gestation (IDUs 44%-54%, non-IDUs 45%-72%), monitoring of immunologic (IDUs 48%-64%, non-IDUs 58%-80%) and virologic status (IDUs 8%-58%, non-IDUs 10%-75%), dual/triple antiretroviral prophylaxis (IDUs 9%-44%, non-IDUs 14%-59%). After initial increase from 5.3% (95% confidence interval [CI] 3.5%-7.8%) in 2004 to 8.5% (CI 6.1%-11.7%) in 2005 (P<0.05), perinatal HIV transmission decreased to 5.3% (CI 3.4%-8.3%) in 2006, and 3.2% (CI 1.7%-5.8%) in 2007 (P for trend<0.05). However, the proportion of women without prenatal care and without HIV testing before labor and delivery remained unchanged. 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.
First update of the International Xenotransplantation Association consensus statement on conditions for undertaking clinical trials of porcine islet products in type 1 diabetes--Chapter 5: recipient monitoring and response plan for preventing disease transmission.
Denner, Joachim; Tönjes, Ralf R; Takeuchi, Yasu; Fishman, Jay; Scobie, Linda
Xenotransplantation of porcine cells, tissues, and organs may be associated with the transmission of porcine microorganisms to the human recipient. A previous, 2009, version of this consensus statement focused on strategies to prevent transmission of porcine endogenous retroviruses (PERVs). This version addresses potential transmission of all porcine microorganisms including monitoring of the recipient and provides suggested approaches to the monitoring and prevention of disease transmission. Prior analyses assumed that most microorganisms other than the endogenous retroviruses could be eliminated from donor animals under appropriate conditions which have been called "designated pathogen-free" (DPF) source animal production. PERVs integrated as proviruses in the genome of all pigs cannot be eliminated in that manner and represent a unique risk. Certain microorganisms are by nature difficult to eliminate even under DPF conditions; any such clinically relevant microorganisms should be included in pig screening programs. With the use of porcine islets in clinical trials, special consideration has to be given to the presence of microorganisms in the isolated islet tissue to be used and also to the potential use of encapsulation. It is proposed that microorganisms absent in the donor animals by sensitive microbiological examination do not need to be monitored in the transplant recipient; this will reduce costs and screening requirements. Valid detection assays for donor and manufacturing-derived microorganisms must be established. Special consideration is needed to preempt potential unknown pathogens which may pose a risk to the recipient. This statement summarizes the main achievements in the field since 2009 and focus on issues and solutions with microorganisms other than PERV. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Jones Philip H
Full Text Available Abstract Background APOBEC3 proteins are host factors that restrict infection by retroviruses like HIV, MMTV, and MLV and are variably expressed in hematopoietic and non-hematopoietic cells, such as macrophages, lymphocytes, dendritic, and epithelia cells. Previously, we showed that APOBEC3 expressed in mammary epithelia cells function to limit milk-borne transmission of the beta-retrovirus, mouse mammary tumor virus. In this present study, we used APOBEC3 knockout mice and their wild type counterpart to query the role of APOBEC3 in sexual transmission of LP-BM5 MLV – the etiological agent of murine AIDs (mAIDs. Results We show that mouse APOBEC3 is expressed in murine genital tract tissues and gametes and that genital tract tissue of APOBEC3-deficient mice are more susceptible to infection by LP-BM5 virus. APOBEC3 expressed in genital tract tissues most likely plays a role in decreasing virus transmission via the sexual route, since mice deficient in APOBEC3 gene have higher genitalia and seminal plasma virus load and sexually transmit the virus more efficiently to their partners compared to APOBEC3+ mice. Moreover, we show that female mice sexually infected with LP-BM5 virus transmit the virus to their off-spring in APOBEC3-dependent manner. Conclusion Our data indicate that genital tissue intrinsic APOBEC3 restricts genital tract infection and limits sexual transmission of LP-BM5 virus.
Transmissibility is the defining characteristic of infectious diseases. Quantifying transmission matters for understanding infectious disease epidemiology and designing evidence-based disease control programs. Tracing individual transmission events can be achieved by epidemiological investigation coupled with pathogen typing or genome sequencing. Individual infectiousness can be estimated by measuring pathogen loads, but few studies have directly estimated the ability of infected hosts to transmit to uninfected hosts. Individuals' opportunities to transmit infection are dependent on behavioral and other risk factors relevant given the transmission route of the pathogen concerned. Transmission at the population level can be quantified through knowledge of risk factors in the population or phylogeographic analysis of pathogen sequence data. Mathematical model-based approaches require estimation of the per capita transmission rate and basic reproduction number, obtained by fitting models to case data and/or analysis of pathogen sequence data. Heterogeneities in infectiousness, contact behavior, and susceptibility can have substantial effects on the epidemiology of an infectious disease, so estimates of only mean values may be insufficient. For some pathogens, super-shedders (infected individuals who are highly infectious) and super-spreaders (individuals with more opportunities to transmit infection) may be important. Future work on quantifying transmission should involve integrated analyses of multiple data sources.
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.
Samuel, Reshmi; Paredes, Roger; Parboosing, Raveen; Moodley, Pravi; Singh, Lavanya; Naidoo, Anneta; Gordon, Michelle
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. © 2015 Wiley Periodicals, Inc.
Carneiro-Proietti, A. B. F.; Amaranto-Damasio, M. S.; Leal-Horiguchi, C. F.; Bastos, R. H. C.; Seabra-Freitas, G.; Borowiak, D. R.; Ribeiro, M. A.; Proietti, F. A.; Ferreira, A. S. D.; Martins, M. L.
Although human T-cell lymphotropic viruses (HTLV-1/2) were described over 30 years ago, they are relatively unknown to the public and even to healthcare personnel. Although HTLV-1 is associated with severe illnesses, these occur in only approximately 10% of infected individuals, which may explain the lack of public knowledge about them. However, cohort studies are showing that a myriad of other disease manifestations may trouble infected individuals and cause higher expenditures with healthcare. Testing donated blood for HTLV-1/2 started soon after reliable tests were developed, but unfortunately testing is not available for women during prenatal care. Vertical transmission can occur before or after birth of the child. Before birth, it occurs transplacentally or by transfer of virus during cesarean delivery, but these routes of infection are rare. After childbirth, viral transmission occurs during breastfeeding and increases with longer breastfeeding and high maternal proviral load. Unlike the human immunodeficiency virus types 1 and 2, HTLV is transmitted primarily through breastfeeding and not transplacentally or during delivery. In this study, we review what is currently known about HTLV maternal transmission, its prevention, and the gaps still present in the understanding of this process. PMID:25232474
Tugal, Dogan A; Tugal, Osman
This updated second edition provides working answers to today's critical questions about designing and managing all types of data transmission systems and features a new chapter on local area networks (LANs...
Fraser, Hannah; Martin, Natasha K; Brummer-Korvenkontio, Henrikki
(NSP) across Europe over the next 10 years. METHODS: We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST and NSP coverage from 11 European settings. We parameterized a HCV transmission model to setting-specific data that projects chronic HCV prevalence and incidence...... in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100pyrs or less in 10 years. Moderate...
Carmone, Andy; Bomai, Korai; Bongi, Wayaki; Frank, Tarua Dale; Dalepa, Huleve; Loifa, Betty; Kiromat, Mobumo; Das, Sarthak; Franke, Molly F.
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. PMID:25172429
Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review
Wilbroda H. Ngidi
Full Text Available Background: Prevention of mother-to-child transmission (PMTCT of HIV is a life-saving public health intervention. Sub-Saharan African (SSA countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV.Aim: To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy.Methods: Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included ‘Sub-Saharan African countries’, ‘implementation strategies’, ‘interventions to bridge implementation gap’, ‘prevention of mother-to-child transmission of HIV’ and ‘closing implementation gap’.Results: Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1 health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance; (2 health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision; as well as (3 community-level strategies (community health workers, technology use – mHealth, family-centred approaches, male involvement, culturally appropriate interventions.Conclusion: There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency.
João Paulo Queiroz Farias
Full Text Available OBJETIVO: avaliar as atitudes e conhecimento dos obstetras das maternidades públicas da cidade de Salvador (MPS sobre as recomendações do Ministério da Saúde para a profilaxia da transmissão vertical do vírus humano da imunodeficiência (HIV e terapia antiretroviral em gestantes. Avaliou-se também a influência das condições de trabalho, disponibilidade da testagem rápida e da terapia antiretroviral em relação à aplicação destas recomendações. MÉTODOS: realizou-se um estudo de corte transversal entre agosto e novembro de 2005, envolvendo 129/152 (85% dos obstetras de todas as MPS. Utilizou-se como instrumento um questionário anônimo, estruturado e auto-explicativo, com questões sobre as características da população, condições de trabalho e disponibilidade de insumos, conhecimento e atitudes relacionadas ao aconselhamento e testagem para o HIV e condutas com as pacientes (uso da zidovudina (AZT, reconhecimento de fatores de risco, escolha e manejo da via de parto e cuidados no puerpério. RESULTADOS: dos obstetras, 69% referiram conhecer integralmente as recomendações do Ministério da Saúde; 90,7% concordaram com a solicitação compulsória da testagem rápida para o HIV; 63,6% escolheram a cesariana para via de parto; 38% contra-indicaram o parto por via vaginal; 37,5% recomendaram isolamento das pacientes soropositivas e 58,1% indicaram laqueadura tubária. A maioria (90% dos sujeitos referiram a existência de fatores prejudiciais à aplicabilidade das recomendações, sendo que os mais apontados foram a realização inadequada e a indisponibilidade das informações do pré-natal na admissão. Embora a testagem rápida estivesse disponível, apenas um terço dos entrevistados afirmou que o resultado estava sempre disponível em tempo hábil. CONCLUSÕES: algumas atitudes relacionadas à assistência à gestante com HIV foram discordantes das recomendações do Ministério da Saúde. Na opinião dos
Gregg, K; Riddell, K P; Chen, S H; Galik, P K; Xiang, T; Guerra, T; Marley, M S; Polejaeva, I; Givens, M D
The objective was to assess the risk of transmission of bovine viral diarrhea virus (BVDV) through embryo production via somatic cell nuclear transfer (SCNT), with oocytes obtained from persistently infected (PI) donors. Using ultrasound-guided follicular aspiration following superstimulation, oocytes were obtained from five female beef cattle, including three that were PI and two that were negative for BVDV. In the three PI cattle, seven aspirations yielded 32 oocytes (PI-1: three aspirations yielding six oocytes; PI-2: two aspirations yielding 14 oocytes; and PI-3: two aspirations yielding 12 oocytes). The oocyte recovery rate was better in negative control cattle, with 32 oocytes obtained from the two cattle in a single superstimulation and aspiration session. Oocytes were processed individually for SCNT, evaluated, and tested for BVDV. Nearly all (31/32) oocytes from the three PI donors were positive for BVDV by PCR, with detected viral RNA copy number ranging from 1 to 1.1 x 10(5). The proportion of oocytes acceptable for SCNT embryo production (based on oocyte quality and maturation status) was only 16 to 35% from PI donors, but was 81% from control donors. Therefore, routine testing of unacceptable (discarded) oocytes could be an effective approach to identify batches that might contain infected oocytes from PI donors. Identification and removal of high-risk batches of oocytes would minimize the risk of BVDV transmission through SCNT embryo production.
Langley, Cheri; Barbee, Anita P.; Antle, Becky; Christensen, Dana; Archuleta, Adrian; Sar, Bibhuti K.; Karam, Eli; van Zyl, Riaan; Cunningham, Michael R.; Borders, Kevin
To ensure that "Reducing the Risk," a successful teen pregnancy prevention education curriculum, remains relevant for today's youth, covers all information youth need to know in order to make better choices, and is delivered in a standardized way, adaptations were made and enhancements were added. This article describes results of a…
Chagomerana, Maganizo B; Miller, William C; Tang, Jennifer H; Hoffman, Irving F; Mthiko, Bryan C; Phulusa, Jacob; John, Mathias; Jumbe, Allan; Hosseinipour, Mina C
Effective antiretroviral therapy during pregnancy minimizes the risk of vertical HIV transmission. Some women present late in their pregnancy for first antenatal visit; whether these women achieve viral suppression by delivery and how suppression varies with time on ART is unclear. We conducted a prospective cohort study of HIV-infected pregnant women initiating antiretroviral therapy for the first time at Bwaila Hospital in Lilongwe, Malawi from June 2015 to November 2016. Multivariable Poisson models with robust variance estimators were used to estimate risk ratios (RR) and 95% confidence intervals (CI) of the association between duration of ART and both viral load (VL) ≥1000 copies/ml and VL ≥40 copies/ml at delivery. Of the 252 women who had viral load testing at delivery, 40 (16%) and 78 (31%) had VL ≥1000 copies/ml and VL ≥40 copies/ml, respectively. The proportion of women with poor adherence to ART was higher among women who were on ART for ≤12 weeks (9/50 = 18.0%) than among those who were on ART for 13-35 weeks (18/194 = 9.3%). Compared to women who were on ART for ≤12 weeks, women who were on ART for 13-20 weeks (RR = 0.52; 95% CI: 0.36-0.74) or 21-35 weeks (RR = 0.26; 95% CI: 0.14-0.48) had a lower risk of VL ≥40 copies/ml at delivery. Similar comparisons for VL ≥1000 copies/ml at delivery showed decrease in risk although not significant for those on ART 13-20 weeks. Longer duration of ART during pregnancy was associated with suppressed viral load at delivery. Early ANC attendance in pregnancy to facilitate prompt ART initiation for HIV-positive women is essential in the effort to eliminate HIV vertical transmission.
Catherine A Pruszynski
Full Text Available Aedes aegypti is a container-inhabiting mosquito and a vector of dengue, chikungunya, and Zika viruses. In 2009 several cases of autochthonous dengue transmission were reported in Key West, Florida, USA prompting a comprehensive response to control A. aegypti. In Key West, larvae of this mosquito develop in containers around human habitations which can be numerous and labor intensive to find and treat. Aerial applications of larvicide covering large areas in a short time can be an efficient and economical method to control A. aegypti. Bacillus thuringiensis israelensis (Bti is a bacterial larvicide which is highly target specific and appropriate for wide area spraying over urban areas, but to date, there are no studies that evaluate aerial spraying of Bti to control container mosquitoes like A. aegypti.This paper examines the effectiveness of aerial larvicide applications using VectoBac® WG, a commercially available Bti formulation, for A. aegypti control in an urban setting in the USA. Droplet characteristics and spray drop deposition were evaluated in Key West, Florida, USA. The mortality of A. aegypti in containers placed under canopy in an urban environment was also evaluated. Efficacy of multiple larvicide applications on adult female A. aegypti population reduction was compared between an untreated control and treatment site.Droplet characteristics showed that small droplets can penetrate through dense canopy to reach small containers. VectoBac WG droplets reached small containers under heavy canopy in sufficient amounts to cause > 55% mortality on all application days and >90% mortality on 3 of 5 application days while controls had 50%. Aerial larvicide applications using VectoBac WG can cover wide areas in a short period of time and can be effective in controlling A. aegypti and reducing A. aegypti-borne transmission in urban areas similar to Key West, Florida, USA.
Pruszynski, Catherine A; Hribar, Lawrence J; Mickle, Robert; Leal, Andrea L
Aedes aegypti is a container-inhabiting mosquito and a vector of dengue, chikungunya, and Zika viruses. In 2009 several cases of autochthonous dengue transmission were reported in Key West, Florida, USA prompting a comprehensive response to control A. aegypti. In Key West, larvae of this mosquito develop in containers around human habitations which can be numerous and labor intensive to find and treat. Aerial applications of larvicide covering large areas in a short time can be an efficient and economical method to control A. aegypti. Bacillus thuringiensis israelensis (Bti) is a bacterial larvicide which is highly target specific and appropriate for wide area spraying over urban areas, but to date, there are no studies that evaluate aerial spraying of Bti to control container mosquitoes like A. aegypti. This paper examines the effectiveness of aerial larvicide applications using VectoBac® WG, a commercially available Bti formulation, for A. aegypti control in an urban setting in the USA. Droplet characteristics and spray drop deposition were evaluated in Key West, Florida, USA. The mortality of A. aegypti in containers placed under canopy in an urban environment was also evaluated. Efficacy of multiple larvicide applications on adult female A. aegypti population reduction was compared between an untreated control and treatment site. Droplet characteristics showed that small droplets can penetrate through dense canopy to reach small containers. VectoBac WG droplets reached small containers under heavy canopy in sufficient amounts to cause > 55% mortality on all application days and >90% mortality on 3 of 5 application days while controls had treated sites was >50%. Aerial larvicide applications using VectoBac WG can cover wide areas in a short period of time and can be effective in controlling A. aegypti and reducing A. aegypti-borne transmission in urban areas similar to Key West, Florida, USA.
Khan, Salah Uddin; Gurley, Emily S.; Hossain, M. Jahangir; Nahar, Nazmun; Sharker, M. A. Yushuf; Luby, Stephen P.
Background Drinking raw date palm sap is a risk factor for human Nipah virus (NiV) infection. Fruit bats, the natural reservoir of NiV, commonly contaminate raw sap with saliva by licking date palm’s sap producing surface. We evaluated four types of physical barriers that may prevent bats from contacting sap. Methods During 2009, we used a crossover design and randomly selected 20 date palm sap producing trees and observed each tree for 2 nights: one night with a bamboo skirt intervention applied and one night without the intervention. During 2010, we selected 120 trees and randomly assigned four types of interventions to 15 trees each: bamboo, dhoincha (local plant), jute stick and polythene skirts covering the shaved part, sap stream, tap and collection pot. We enrolled the remaining 60 trees as controls. We used motion sensor activated infrared cameras to examine bat contact with sap. Results During 2009 bats contacted date palm sap in 85% of observation nights when no intervention was used compared with 35% of nights when the intervention was used [psap when the skirt did not entirely cover the sap producing surface. Therefore, in 2010 we requested the sap harvesters to use larger skirts. During 2010 bats contacted date palm sap [2% vs. 83%, psap in trees with bamboo (psap during one night (7%) with the jute stick skirt (psap producing areas of a tree effectively prevented bat-sap contact. Community interventions should promote applying these skirts to prevent occasional Nipah spillovers to human. PMID:22905160
Colombini, Manuela; Stöckl, Heidi; Watts, Charlotte; Zimmerman, Cathy; Agamasu, Enyonam; Mayhew, Susannah H
Despite the biomedical potential to eliminate vertical HIV transmission, drug adherence to short regimens is often sub-optimal. To inform future programmes, we reviewed evidence on the factors influencing maternal and infant drug adherence to preventing MTCT drug regimens at delivery in sub-Saharan Africa. A literature review yielding 14 studies on adherence to drug regimes among HIV-positive pregnant women and mothers in sub-Saharan Africa was conducted. Rates of maternal adherence to preventive drug regimens at time of delivery varied widely across sites between 35 and 93.5%. Factors most commonly associated with low adherence to antiretroviral therapy (ARV) prophylaxis for preventing MTCT at the health system level include giving birth at home, quality and timing of HIV testing and counselling, and late distribution of nevirapine (NVP). Socio-demographic and demand-side factors include fear of stigma, lack of male involvement, fear of partner's reaction to disclosure, few antenatal (ANC) visits, young age and lack of education. With the implementation of the newly published WHO guidelines recommending triple-drug ARV regimen during pregnancy and breastfeeding for all women with HIV, it is important that women are able to adhere to recommended drug regimens. Service improvements should include clear and timely communication with women about the benefits of combined regimens and greater emphasis on patient confidentiality. Efforts must be made to help women overcome barriers that reduce adherence, such as financial logistical challenges, social stigma and women's fear of violence.
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
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
Avaliação da prevenção da transmissão vertical do HIV em Belo Horizonte, MG, Brasil Evaluación de la prevención de la transmisión vertical del VIH en Belo Horizone, MG, Brasil Prevention evaluation of HIV vertical transmission in Belo Horizonte, MG, Brazil
Francisco Carlos Felix Lana
Full Text Available A pesquisa teve como objetivo analisar o pré-natal ofertado na rede básica de saúde do Distrito Leste do município de Belo Horizonte e as ações direcionadas à prevenção da transmissão vertical do HIV. Foi discutida a permanência de taxas significativas de transmissão do HIV na vigência de tecnologias adequadas para a sua prevenção. Por meio de uma análise descritiva e univariada, que abordou os bancos de dados Sisprenatal e Sinan, identificou-se entraves que se relacionam diretamente a problemas observados na captação precoce de gestantes e na instituição da terapêutica em tempo adequado. O envolvimento dos gestores e a capacitação dos profissionais envolvidos é essencial para o correto direcionamento de ações que possibilitem a prevenção efetiva da transmissão vertical do HIV.Este trabajo de investigación tuve como objetivo analizar la atención prenatal de la red básica del Distrito Este del municipio de Belo Horizonte y las acciones que buscan prevenir la transmisión del VIH de madre a hijo. Se discutió el porqué de las altas tasas de transmisión vertical de dicho virus cuando hay tecnologías adecuadas para su prevención. Se realizó un análisis descriptivo y univariado de información de los bancos de datos Sisprenatal y Sinan. Se identificaron obstáculos para los problemas observados en la captación temprana de embarazadas y en la institución de la terapéutica en tiempo adecuado. El compromiso de los gestores y la capacitación de los profesionales son esenciales para orientar acciones de prevención efectiva de la transmisión vertical del VIH.The study had as objective to analyze the prenatal care services offered by the East District's primary healthcare network of the city of Belo Horizonte as well as actions for the prevention of vertical transmission of HIV. It discussed the still significant rates of transmission of HIV in the presence of appropriate technologies for its prevention. Barriers
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Döring, G; Ulrich, M; Müller, W; Bitzer, J; Schmidt-Koenig, L; Münst, L; Grupp, H; Wolz, C; Stern, M; Botzenhart, K
Pseudomonas aeruginosa was isolated from sinks of washing basins, showers, toilets and bathtubs, from the personnel and patients of a mixed infectious disease ward in a German children's hospital during a prospective 4-week epidemiological study. 81% of all sinks were contaminated with P. aeruginosa strains. Upon entering the hospital, all personnel hand cultures were P. aeruginosa-negative. However, during duty, 42.5% of the personnel members carried different P. aeruginosa strains on their hands. Detection of P. aeruginosa strains in sinks preceding the isolation of identical genotypes from personnel hands suggested a transmission route from sinks to hands. Opening of water taps generated aerosols containing P. aeruginosa sink organisms which contaminated hands during hand washing. Survival times of various P. aeruginosa strains in aerosols was dependent on strain characteristics, light and humidity, and t 1/2 differed between 3-76 min. Heating of washing basin sinks to 70 degrees C with a new, safe and inexpensive device inhibited bacterial growth in sinks, generation of P. aeruginosa aerosols, and resulted in hand cultures negative for P. aeruginosa after washing.
Márcia Maria Ferrairo Janini Dal Fabbro
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%.
Outcomes and linkage to chronic care of HIV exposed infants among health centers and hospitals in Amhara Region, Ethiopia: implications to prevention of mother-to-child transmission of HIV program: a cross sectional study.
Kebede, Zemene Tigabu; Taye, Belaynew Wasie
Numerous challenges exist in provision of prevention of mother-to-child transmission of HIV (PMTCT) such as linking HIV exposed infants (HEI) and their mothers to chronic cares services, and tackling loss to follow up. Limited evidence exists in Ethiopian setting that explains the persisting high HIV infection rate among HEIs and extent of linkage to chronic care. The study assessed the proportion of HIV infection; children linked to chronic care and determinants of HIV infection among HEI in Northern Ethiopia. This institution-based cross-sectional study was conducted in health centers and hospitals of Amhara Region. A total of 484 HEI-mother pairs selected by multistage random sampling were included in the study. Data were collected from PMTCT and anti-retroviral therapy (ART) clinics using pre-tested and structured questionnaires. Quantitative data were entered in Epi Info version 7.0 and exported to SPSS 20.0 for analysis. A total of 484 mother-infant pairs with a response rate of 92.4% were included in the analysis. About 94.2% of infants and women were linked to chronic care follow-up sometime after the diagnosis. The proportion of HIV infection was 12.4%. Antenatal care attendance had a significant association with HIV infection among HEI (p care that increased institutional delivery, leads to timely initiation and high uptake of PMTCT to reduce the vertical transmission of HIV infection and meet national targets.
Knowledge, perception about antiretroviral therapy (ART) and prevention of mother-to-child-transmission (PMTCT) and adherence to ART among HIV positive women in the Ashanti Region, Ghana: a cross-sectional study.
Boateng, Daniel; Kwapong, Golda Dokuaa; Agyei-Baffour, Peter
Mother-to-Child Transmission (MTCT) has been identified as the greatest means of HIV infection among children. Adherence to antiretroviral drugs is necessary to prevent drug resistance and MTCT of HIV among HIV positive women. However, there is a gap in clients' knowledge, attitudes and perceptions of antiretroviral therapy (ART) and Prevention of Mother-To-Child Transmission (PMTCT) which influence their decision to adhere to ART. The study was a descriptive cross-sectional employing both qualitative and quantitative methods. The study involved 229 HIV positive women in reproductive age (18 - 49 years) and had been on ART for at least six months. Fourteen health workers were also included in the qualitative study. Respondents were selected from three ART centers in the Kumasi Metropolis through systematic random sampling from August to November 2011. HIV positive women who had consistently missed two or more ART appointments within the previous two months were classified as defaulters. Data was analyzed with SPSS 19 and STATA 11. Logistic regression was run to assess the odds ratios at 95% confidence level. The ART defaulter rate was 27% and clients had good knowledge about ART and PMTCT. More than 90% of the HIV positive women had inadequate knowledge about ART and PMTCT and these women were more likely to default ART (OR = 3.5; 95% CI = 1.89, 6.21). The educational background of HIV positive women did not have significant influence on their knowledge of ART and PMTCT. Mothers, knowledge and understanding of ART and PMTCT could influence their adherence to ART. Educational interventions which target the understanding of both the literate and illiterate women in society are necessary to develop positive behaviors and enhance adherence to ART.
Safety and effectiveness of antiretroviral drugs during pregnancy, delivery and breastfeeding for prevention of mother-to-child transmission of HIV-1: the Kesho Bora Multicentre Collaborative Study rationale, design, and implementation challenges.
To evaluate strategies to reduce HIV-1 transmission through breastfeeding, a multicentre study including a nested randomized controlled trial was implemented in five research sites in West, East and South Africa (The Kesho Bora Study). The aim was to optimize the use of antiretroviral (ARV) drugs during pregnancy, delivery and breastfeeding to prevent mother-to-child transmission of HIV-1 (PMTCT) and to preserve the health of the HIV-1-infected mother. The study included long-term ARV treatment for women with advanced disease, and short-course ARV prophylaxis stopped at delivery for women with early disease. Women with intermediate disease participated in a randomized controlled trial to compare safety and efficacy of triple-ARV prophylaxis prolonged during breastfeeding with short-course ARV prophylaxis stopped at delivery. Between January 2005 and August 2008 a total of 1140 women were enrolled. This paper describes the study design, interventions and protocol amendments introduced to adapt to evolving scientific knowledge, international guidelines and availability of ARV treatment. The paper highlights the successes and challenges during the conduct of the trial. The Kesho Bora Study included one of the few randomized controlled trials to assess safety and efficacy of ARV prophylaxis continued during breastfeeding and the only randomized trial to assess maternal prophylaxis started during pregnancy. The findings have been important for informing international and national guidelines on MTCT prevention in developing countries where, due to poverty, lack of reliable and affordable supply of replacement feed and stigma associated with HIV/AIDS, HIV-infected women have little or no option other than to breastfeed their infants. (ISRCTN71468401). Copyright © 2010 Elsevier Inc. All rights reserved.
Rashid, Mahamud-ur; George, Christine Marie; Monira, Shirajum; Mahmud, Toslim; Rahman, Zillur; Mustafiz, Munshi; Saif-Ur-Rahman, K. M.; Parvin, Tahmina; Bhuyian, Sazzadul Islam; Zohura, Fatema; Begum, Farzana; Biswas, Shwapon Kumar; Akhter, Shamima; Zhang, Xiaotong; Sack, David; Sack, R. Bradley; Alam, Munirul
Household members of cholera patients are at a 100 times higher risk of cholera infections than the general population because of shared contaminated drinking water sources and secondary transmission through poor household hygiene practices. In this study, we investigated the bactericidal concentration of free chlorine required to inactivate Vibrio cholerae in household drinking water in Dhaka, Bangladesh. In laboratory experiments, we found that the concentrations of free chlorine required to inactivate 105 colony-forming units (CFU)/mL of V. cholerae serogroups O1 and O139 were 0.1 mg/L and 0.2 mg/L, respectively. The concentration of free chlorine generated by a single chlorine tablet (sodium dichloroisocyanurate [33 mg]) after a 30-minute reaction time in a 10-L sealed vessel containing Dhaka city municipal supply water was 1.8 mg/L; and the concentration declined to 0.26 mg/L after 24 hours. In field measurements, water collected from 165 households enrolled in a randomized controlled trial (RCT) of a chlorine and handwashing with soap intervention (Cholera-Hospital-Based-Intervention-for-7-Days[CHoBI7]), we observed significantly higher free chlorine concentrations in the 82 intervention arm households (mean = 1.12 mg/L, standard deviation [SD] = 0.52, range = 0.07–2.6 mg/L) compared with the 83 control households (0.017 mg/L, SD = 0.01, range = 0–0.06 mg/L) (P water in households of cholera patients in Dhaka city. This result is consistent with the findings from the RCT of CHoBI7 which found that this intervention led to a significant reduction in symptomatic cholera infections among household members of cholera patients and no stored drinking water samples with detectable V. cholerae. PMID:27698273
Lipscomb, I P; Pinchin, H E; Collin, R; Harris, K; Keevil, C W
Regulations recommend the routine application of biochemical tests, such as the Ninhydrin or Biuret tests, to confirm the efficacy of hospital sterile service department (SSD) washer-disinfector cycles in removing proteinaceous material, particularly with respect to prions. The effectiveness of these methods relies on both the effective sampling of the instruments and the sensitivity of the tests employed. Two commercially available contamination assessment tests were evaluated for their sensitivity to ME7 brain homogenate on surgical-grade stainless steel surfaces. Controls were visualized by the application of episcopic differential interference contrast/Epi-fluorecence microscopy (EDIC/EF) combined with the sensitive fluorescent reagent, SYPRO Ruby, which has been shown previously to rapidly visualize and assess low levels of contamination on medical devices. The Ninhydrin test displayed a minimum level of detection observed by 75% of volunteers (MLD(75)) of 9.25 microg [95% confidence interval (95% CI) 8.6-10.0 microg]. The Biuret test provided better sensitivity, with a MLD(75) of 6.7 microg (95% CI 5.4-8.2 microg). However, much lower concentrations of proteinaceous soiling (pg) were visualized using the EDIC/EF microscopy method. From these findings, it is clear that these approved colorimetric tests of cleaning are relatively insensitive. This investigation demonstrates how large amounts (up to 6.5 microg) of proteinaceous brain contamination could remain undetected and the instruments deemed clean using such methods. The application of more sensitive cleanliness evaluation methods should be applied to reduce the risk of iatrogenic transmission of prion disease in 'high-risk' instruments such as neurosurgical devices.
Medidas de prevenção da transmissão vertical do HIV empregadas por mães de crianças o positivas Medidas de prevención de la transmisión vertical del VIH empleadas por madres de niños seropositivos HIV vertical transmission preventive measurements used by mothers of seropositive children
Aline da Fonseca Leal
.Objective. To analyze HIV vertical transmission preventive measurements used by mothers of HIV positive children who were supported by the Specialized Attention Service (EAS of the municipality of Pelotas, Rio Grande do sul (Brazil. Methodology. Qualitative research with descriptive and exploratory approach. Data were collected through semi structured interviews applied to five mothers of HIV positive children. The analysis of the information was made through thematic categorization. Results. It was observed that the main factor that hampers HIV vertical transmission preventive measurements was the healthcare staff omission to order the HIV test. Most of the surveyed mothers showed knowledge about the disease and its preventive measurements. Conclusion. There is a need to train health care professionals in the diffusion of preventive measurements to improve prenatal attention.
Adegbehingbe, Stella M; Paul-Ebhohimhen, Virginia; Marais, Debbie
The rate of mother-to-child transmission of HIV, occurring during pregnancy, delivery/labour and breastfeeding, still remains high in Sub-Saharan Africa (SSA). The World Health Organization recommends HIV infected mothers exclusively breastfeed their infants, unless replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS). Health care workers are responsible for providing counselling to mothers on the risks and benefits of infant feeding options allowing mothers to make an 'informed choice', but this role is challenging and mostly subjective. The aim of this study was to develop and content validate an AFASS assessment tool that could be used for infant feeding counselling in SSA. An AFASS assessment tool was developed based on the evidence and tools available regarding why replacement feeding is not AFASS in SSA (15 questions). Fifty seven experts involved in PMTCT programmes in five SSA countries were approached to participate as members of the Delphi expert panel (purposive sampling and snowballing). A web-based survey, utilising a 4-point Likert scale, was employed to gain consensus (>75% agreement) from the expert panel following the Delphi technique. A final panel of 15 experts was obtained. Thirteen of the 15 questions in the tool achieved consensus agreement. Experts suggested some additional questions, and that double-barrelled questions were split. Consensus was achieved regarding the applicability and appropriateness of the tool within a SSA context. Experts all agreed that the tool will be useful for the purpose for which it was designed. Suggestions made by the expert panel were incorporated into the revised tool. The findings of this study confirm that this AFASS counselling tool may be appropriate and useful for SSA. Ideally the revised tool should be tested by providers of infant feeding advice with the aim of adoption into routine PMTCT programmes in SSA. Within the context of the 2010 WHO guidelines which advocate a
Adegbehingbe Stella M
Full Text Available Abstract Background The rate of mother-to-child transmission of HIV, occurring during pregnancy, delivery/labour and breastfeeding, still remains high in Sub-Saharan Africa (SSA. The World Health Organization recommends HIV infected mothers exclusively breastfeed their infants, unless replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS. Health care workers are responsible for providing counselling to mothers on the risks and benefits of infant feeding options allowing mothers to make an ‘informed choice’, but this role is challenging and mostly subjective. The aim of this study was to develop and content validate an AFASS assessment tool that could be used for infant feeding counselling in SSA. Methods An AFASS assessment tool was developed based on the evidence and tools available regarding why replacement feeding is not AFASS in SSA (15 questions. Fifty seven experts involved in PMTCT programmes in five SSA countries were approached to participate as members of the Delphi expert panel (purposive sampling and snowballing. A web-based survey, utilising a 4-point Likert scale, was employed to gain consensus (>75% agreement from the expert panel following the Delphi technique. Results A final panel of 15 experts was obtained. Thirteen of the 15 questions in the tool achieved consensus agreement. Experts suggested some additional questions, and that double-barrelled questions were split. Consensus was achieved regarding the applicability and appropriateness of the tool within a SSA context. Experts all agreed that the tool will be useful for the purpose for which it was designed. Suggestions made by the expert panel were incorporated into the revised tool. Conclusions The findings of this study confirm that this AFASS counselling tool may be appropriate and useful for SSA. Ideally the revised tool should be tested by providers of infant feeding advice with the aim of adoption into routine PMTCT programmes in SSA
Uma concepção popular sobre a esquistossomose mansônica: os modos de transmissão e prevenção na perspectiva de gênero A popular concept of schistosomiasis mansoni: modes of transmission and prevention in the perspective of gender differences
Ceci V. Noronha
Full Text Available Estudo sobre as concepções e práticas populares acerca da transmissão e prevenção das parasitoses, com ênfase para a esquistossomose mansônica. Explora a existência de um sistema popular de cuidados de saúde que mescla elementos da biomedicina e da medicina tradicional como forma de compreender e manejar os fenômenos de saúde/doença. Descreve as diferenças entre morbidade e sexo/gênero na concepção dos sujeitos entrevistados. Apresenta o discurso popular sobre as parasitoses, discutindo as dificuldades das ações de controle. Considera as contradições entre hábitos e valores culturais e as medidas de controle conhecidas, criticando a imprecisão das ações educativas nos programas oficiais de intervenção.This is a study on popular ideas, beliefs and practices concerning the transmission and prevention of parasitic diseases, specifically schistosomiasis mansoni. The author explored the existence of a popular belief system within the health care system, combining elements from biomedicine and folk medicine for the understanding and management of the health/disease phenomenon. The study describes the differences in perception of morbidity and gender among the interviewwees. Finally, the study presents popular discourse on parasitic diseases and discusses diffculties with control measures. It considers the contradiction between cultural values and habits and conventional control measures, critically assessing the lack of precision in health education measures under government prevention programs.
Thomas Obinchemti Egbe
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.
Soka, Moses J; Choi, Mary J; Baller, April; White, Stephen; Rogers, Emerson; Purpura, Lawrence J; Mahmoud, Nuha; Wasunna, Christine; Massaquoi, Moses; Abad, Neetu; Kollie, Jomah; Dweh, Straker; Bemah, Philip K; Christie, Athalia; Ladele, Victor; Subah, Oneychachi C; Pillai, Satish; Mugisha, Margaret; Kpaka, Jonathan; Kowalewski, Stephen; German, Emilio; Stenger, Mark; Nichol, Stuart; Ströher, Ute; Vanderende, Kristin E; Zarecki, Shauna Mettee; Green, Hugh Henry W; Bailey, Jeffrey A; Rollin, Pierre; Marston, Barbara; Nyenswah, Tolbert G; Gasasira, Alex; Knust, Barbara; Williams, Desmond
-PCR varies by individual and might be associated with age. By combining behavioural counselling and laboratory testing, the Men's Health Screening Program helps male Ebola virus disease survivors understand their individual risk and take appropriate measures to protect their sexual partners. World Health Organization and the US Centers for Disease Control and Prevention. ©2016 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
Platt, Lucy; Minozzi, Silvia; Reed, Jennifer; Vickerman, Peter; Hagan, Holly; French, Clare; Jordan, Ashly; Degenhardt, Louisa; Hope, Vivian; Hutchinson, Sharon; Maher, Lisa; Palmateer, Norah; Taylor, Avril; Bruneau, Julie; Hickman, Matthew
To estimate the effects of needle and syringe programmes (NSP) and opioid substitution therapy (OST), alone or in combination, for preventing acquisition of hepatitis C virus (HCV) in people who inject drugs (PWID). Systematic review and meta-analysis. Bibliographic databases were searched for studies measuring concurrent exposure to current OST (within the last 6 months) and/or NSP and HCV incidence among PWID. High NSP coverage was defined as regular NSP attendance or ≥ 100% coverage (receiving sufficient or greater number of needles and syringes per reported injecting frequency). Studies were assessed using the Cochrane risk of bias in non-randomized studies tool. Random-effects models were used in meta-analysis. We identified 28 studies (n = 6279) in North America (13), United Kingdom (five), Europe (four), Australia (five) and China (one). Studies were at moderate (two), serious (17) critical (seven) and non-assessable risk of bias (two). Current OST is associated with 50% [risk ratio (RR) =0.50, 95% confidence interval (CI) = 0.40-0.63] reduction in HCV acquisition risk, consistent across region and with low heterogeneity (I 2 = 0, P = 0.889). Weaker evidence was found for high NSP coverage (RR = 0.79, 95% CI = 0.39-1.61) with high heterogeneity (I 2 = 77%, P = 0.002). After stratifying by region, high NSP coverage in Europe was associated with a 56% reduction in HCV acquisition risk (RR = 0.44, 95% CI = 0.24-0.80) with low heterogeneity (I 2 = 12.3%, P = 0.337), but not in North America (RR = 1.58, I 2 = 89.5%, P = Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria, the evidence on OST and combined OST/NSP is low quality, while NSP is very low. Opioid substitution therapy reduces risk of hepatitis C acquisition and is strengthened in combination with needle and syringe programmes (NSP). There is weaker evidence for the impact of needle syringe programmes alone, although stronger evidence
Rodger, Alison J; Phillips, Andrew; Speakman, Andrew; Gilson, Richard; Fisher, Martin; Wilkins, Ed; Anderson, Jane; Johnson, Margaret; O'Connell, Rebecca; Collins, Simon; Elford, Jonathan; Sherr, Lorraine; Lampe, Fiona C
To assess if a strategy of early ART to prevent HIV transmission is acceptable to ART naïve people with HIV with high CD4 counts. ASTRA is a UK multicentre, cross sectional study of 3258 HIV outpatients in 2011/12. A self-completed questionnaire collected sociodemographic, behavioral and health data, and attitudes to ART; CD4 count was recorded from clinical records. ART naïve participants with CD4 ≥350 cells/µL (n = 281) were asked to agree/disagree/undecided with the statements (i) I would want to start treatment now if this would slightly reduce my risk of getting a serious illness, and (ii) I would want to start treatment now if this would make me less infectious to a sexual partner, even if there was no benefit to my own health. Participants were 85% MSM, 76% white, 11% women. Of 281 participants, 49.5% and 45.2% agreed they would start ART for reasons (i) and (ii) respectively; 62.6% agreed with either (i) or (ii); 12.5% agreed with neither; 24.9% were uncertain. Factors independently associated (pactive. A strategy of starting ART at high CD4 counts is likely to be acceptable to the majority of HIV-diagnosed individuals. Almost half with CD4 >350 would start ART to reduce infectiousness, even if treatment did not benefit their own health. However a significant minority would not like to start ART either for modest health benefit or to reduce infectivity. Any change in approach to ART initiation must take account of individual preferences. Transmission models of potential benefit of early ART should consider that ART uptake may be lower than that seen with low CD4 counts.
Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa: A systematic literature review.
Gumede-Moyo, Sehlulekile; Filteau, Suzanne; Munthali, Tendai; Todd, Jim; Musonda, Patrick
To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets. Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU). Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants. Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa.
Interventions to significantly improve service uptake and retention of HIV-positive pregnant women and HIV-exposed infants along the prevention of mother-to-child transmission continuum of care: systematic review.
Vrazo, Alexandra C; Firth, Jacqueline; Amzel, Anouk; Sedillo, Rebecca; Ryan, Julia; Phelps, B Ryan
Despite the success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programmes, low uptake of services and poor retention pose a formidable challenge to achieving the elimination of vertical HIV transmission in low- and middle-income countries. This systematic review summarises interventions that demonstrate statistically significant improvements in service uptake and retention of HIV-positive pregnant and breastfeeding women and their infants along the PMTCT cascade. Databases were systematically searched for peer-reviewed studies. Outcomes of interest included uptake of services, such as antiretroviral therapy (ART) such as initiation, early infant diagnostic testing, and retention of HIV-positive pregnant and breastfeeding women and their infants. Interventions that led to statistically significant outcomes were included and mapped to the PMTCT cascade. An eight-item assessment tool assessed study rigour. CRD42017063816. Of 686 citations reviewed, 11 articles met inclusion criteria. Ten studies detailed maternal outcomes and seven studies detailed infant outcomes in PMTCT programmes. Interventions to increase access to antenatal care (ANC) and ART services (n = 4) and those using lay cadres (n = 3) were most common. Other interventions included quality improvement (n = 2), mHealth (n = 1), and counselling (n = 1). One study described interventions in an Option B+ programme. Limitations included lack of HIV testing and counselling and viral load monitoring outcomes, small sample size, geographical location, and non-randomized assignment and selection of participants. Interventions including ANC/ART integration, family-centred approaches, and the use of lay healthcare providers are demonstrably effective in increasing service uptake and retention of HIV-positive mothers and their infants in PMTCT programmes. Future studies should include control groups and assess whether interventions developed in the context of earlier 'Options' are
This review summarizes pertinent data and opinions regarding the potential hazard of disease transmission through cryopreserved and banked embryos in liquid nitrogen (LN). Special attention is given to the survival of pathogens in LN, new vitrification methods, sterility of LN, risks associated with the use of straws and cryovials, and LN dewars including dry shippers. It was experimentally demonstrated that cross-contamination between LN and embryos may occur, when infectious agents are present in LN and embryos are not protected by a sealed container. It is important, therefore, to prevent direct contact of embryos with LN during cryopreservation and their banking. This includes the usage of hermetically sealed, high-quality, shatter-proof freezing containers and/or the application of a secondary enclosure such as "double bagging or straw in straw." A periodic disinfection of cryo-dewars should be considered as an additional precaution to diminish the potential for inadvertent cross-contamination. It might be advisable to use separate LN dewars to quarantine embryos derived from infected donors of valuable genotype or from unknown health status, extinction-threatened species. Nevertheless, in summary, it has been concluded that over 25 yr with no direct evidence of disease transmission by transferred cryopreserved human and animal embryos, that the present cryopreservation technology is sanitary sound, with the stipulation that biocontainment measures recommended by the International Embryo Transfer Society (IETS) and the World Organization for Animal Health - Office International des Epizooties (OIE), are strictly followed. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.
Acceptability and feasibility of infant-feeding options: experiences of HIV-infected mothers in the World Health Organization Kesho Bora mother-to-child transmission prevention (PMTCT) trial in Burkina Faso.
Cames, Cécile; Saher, Aisha; Ayassou, Kossiwavi A; Cournil, Amandine; Meda, Nicolas; Simondon, Kirsten Bork
In Burkina Faso, prolonged breastfeeding with introduction of ritual fluids from birth is a deep-seated norm. We explored HIV-infected mothers' views and experiences of the acceptability and feasibility of the World Health Organization's recommended infant-feeding options within a mother-to-child-transmission prevention trial. A qualitative study was conducted on 17 formula-feeding and 19 breastfeeding mothers, from a larger cohort of 51 eligible HIV-infected women, consenting to participate in separate focus group discussions in early post-partum. Mothers opted for breastfeeding essentially out of fear of family rejection. Most of them were afraid of denigration for disrespecting tradition if they formula-fed or being suspected of HIV infection. Achieving exclusive breastfeeding remained a difficult challenge as they engaged in a continuous struggle with close elders to avoid fluid feeding. Additional stress and fatigue were fed by their perception of a high transmission risk through breast milk. Exclusive formula-feeding seemed easier to implement, especially as formula was provided free of charge. Formula-feeding mothers more frequently had a supportive partner, a strong personality and lived in better socio-economic conditions than breastfeeding mothers (76% had education and electricity supply vs. 42%, respectively). Exclusive breastfeeding for the first 6 months remains the most appropriate option for many HIV-infected mothers in sub-Saharan Africa. Its acceptability and feasibility urgently need to be improved by promoting it as the best feeding option for all infants. Other crucial interventions are the promotion of voluntary counselling and testing for couples, and greater partner involvement in infant-feeding counselling.
Alemayehu, M T; Haidar, J
Antenatal care (ANC) is an entry point for the prevention of mother-to-child transmission (PMTCT), particularly when a man accompanies his spouse for voluntary counselling and testing (VCT), even though this seldom happens in Ethiopia. To study the role of male partners in improving PMTCT/ANC, which is essential to prevent HIV/AIDS transmission in this country. Our study focused on identifying barriers for the low involvement in PMTCT/ANC among male partners whose spouses received ANC. A total of 422 male partners in Goba town, Oromia regional state, Ethiopia, were recruited in September - October 2014 and enrolled by a systematic sampling method. A facility-based cross-sectional study and two focus group discussions (FGDs) were conducted. Binary logistic regression and odds ratios were calculated to ascertain sociodemographic and other important information compared with the outcome variable and PMTCT/ANC, while the findings of the FGDs were grouped according to the emerging themes and analysed manually by means of a thematic approach. The percentage of male partners (22.7%) accompanying their spouses for HIV testing and counselling at antenatal clinics improved three-fold when an invitation letter was introduced as a new initiative to increase male participation. Individuals in the age group 15 - 29 years (adjusted odds ratio (AOR) 5.4, 95% confidence interval (CI) 1.66 - 17.85), and whose duration of marriage was ˂5 years (AOR 5.6, 95% CI 1.83 - 17.30), were more likely to be tested than their referent groups. Men without a higher education (AOR 0.1, 95% CI 0.02 - 0.50), who disagreed with legal enforcement (AOR 0.1, 95% CI 0.07 - 0.32), were less likely to be tested, while those who did not notify their partners (AOR 8.4, 95% CI 1.92 - 37.12) were more likely to use the service. Being busy, proxy testing, fears of testing HIV-positive, neglecting the importance of VCT, and inadequate knowledge about the PMTCT/ANC programme were other barriers that came to the
M T Alemayehu
Full Text Available Background. Antenatal care (ANC is an entry point for the prevention of mother-to-child transmission (PMTCT, particularly when a man accompanies his spouse for voluntary counselling and testing (VCT, even though this seldom happens in Ethiopia. Objective. To study the role of male partners in improving PMTCT/ANC, which is essential to prevent HIV/AIDS transmission in this country. Our study focused on identifying barriers for the low involvement in PMTCT/ANC among male partners whose spouses received ANC. Methods. A total of 422 male partners in Goba town, Oromia regional state, Ethiopia, were recruited in September - October 2014 and enrolled by a systematic sampling method. A facility-based cross-sectional study and two focus group discussions (FGDs were conducted. Binary logistic regression and odds ratios were calculated to ascertain sociodemographic and other important information compared with the outcome variable and PMTCT/ANC, while the findings of the FGDs were grouped according to the emerging themes and analysed manually by means of a thematic approach. Results. The percentage of male partners (22.7% accompanying their spouses for HIV testing and counselling at antenatal clinics improved three-fold when an invitation letter was introduced as a new initiative to increase male participation. Individuals in the age group 15 - 29 years (adjusted odds ratio (AOR 5.4, 95% confidence interval (CI 1.66 - 17.85, and whose duration of marriage was ˂5 years (AOR 5.6, 95% CI 1.83 - 17.30, were more likely to be tested than their referent groups. Men without a higher education (AOR 0.1, 95% CI 0.02 - 0.50, who disagreed with legal enforcement (AOR 0.1, 95% CI 0.07 - 0.32, were less likely to be tested, while those who did not notify their partners (AOR 8.4, 95% CI 1.92 - 37.12 were more likely to use the service. Being busy, proxy testing, fears of testing HIV-positive, neglecting the importance of VCT, and inadequate knowledge about the PMTCT
Schoeneborn, Dennis; Trittin, Hannah
Purpose – Extant research on corporate social responsibility (CSR) communication primarily relies on a transmission model of communication that treats organizations and communication as distinct phenomena. This approach has been criticized for neglecting the formative role of communication...... in the emergence of organizations. This paper seeks to propose to reconceptualize CSR communication by drawing on the “communication constitutes organizations” (CCO) perspective. Design/methodology/approach – This is a conceptual paper that explores the implications of switching from an instrumental...... are stabilized by various non-human entities that “act” on their behalf. Accordingly, CSR communication should also take into account non-human agency and responsibility. Originality/value – This paper links the literature on CSR communication to broader debates in organizational communication studies and...
Weber, Immo; Mallick, Bert; Schild, Matthias; Kareth, Sabine; Puchta, Ralph; van Eldik, Rudi
Alumina deposition on platinum grading electrodes in high voltage direct current (HVDC) transmission modules is an unsolved problem that has been around for more than three decades. This is due to the unavoidable corrosion of aluminum heat sinks that causes severe damage to electrical power plants and losses in the range of a million Euro range per day in power outage. Simple experiments in a representative HV test setup showed that aluminates at concentrations even below 10(-8) mol L(-1) can deposit on anodes through neutralization by protons produced in de-ionized water (κ≤0.15 μS cm(-1)) at 20-35 kV (8 mA) per electrode. In this otherwise electrolyte-poor aqueous environment, the depositions are formed three orders of magnitude below the critical precipitation concentration at pH 7! In the presence of an inert electrolyte such as TMAT (tetramethylammonium-p-toluenesulfonate), at a concentration level just above that of the total dissolved aluminum, no deposition was observed. Deposition can be also prevented by doping with CO2 gas at a concentration level that is magnitudes lower than that of the dissolved aluminum. From an overview of aqueous aluminum chemistry, the mystery of the alumina deposition process and its inhibition by CO2 is experimentally resolved and fully explained by field accumulation and repulsion models in synergism with acid-base equilibria. The extraordinary size of the alumina depositions is accounted for in terms of proton tunneling through "hydrated" alumina, which is supported by quantum chemical calculations. As a consequence, pulse-purging with pure CO2 gas is presented as a technical solution to prevent the deposition of alumina. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
Shan, Duo; Sun, Jiangping; Khoshnood, Kaveh; Fu, Jeannia; Duan, Song; Jiang, Chengqin; Zhang, Yan; Bulterys, Marc; Guo, Haoyan; Sante, Michael; Liu, Hui; Hu, Yiyun
The burden of HIV/AIDS in China has been disproportionately concentrated in Yunnan Province, where in Dehong prefecture, the HIV prevalence rate among pregnant women reached 1.3% in 2003, a rate that is indicative of a generalized epidemic. Since then, there have been extensive efforts to expand prevention to reduce mother-to-child transmission (MTCT) in this high-prevalence region. These intensified MTCT reduction efforts and their impact on MTCT are yet to be examined. We described the changes in access to HIV screening and antiretroviral therapy (ART) among pregnant women from 2005 to 2010 in this region and the corresponding reduction in MTCT over this period. Between 2005 and 2010, the annual number of pregnant women screened for HIV in Dehong Prefecture more than doubled. The proportion of pregnant women screened for HIV rose from an estimated 15-20% to 99.8%, and the proportion of HIV-infected pregnant women receiving ART increased from 63% to 99%. We estimate that the proportion of children born with HIV to HIV-infected mothers decreased from 15.4% to 7.2% over this period. Sustained low-level MTCT following comprehensive interventions in this region is encouraging. Over the last decade, comprehensive PMTCT efforts, coupled with national and local government policy support in this area appear to be effective.
Ngambi, Peslie G; Kalungia, Aubrey C; Law, Michael R; Kalemeera, Francis; Truter, IIse; Godman, Brian; Munkombwe, Derick
The 2016 World Health Organization (WHO) consolidated guideline recommends lifelong antiretroviral therapy (ART) for all HIV-infected pregnant and breastfeeding women for preventing mother-to-child HIV transmission (PMTCT). Ambiguity remains about the cost-effectiveness of this strategy in resource-limited developing countries. Areas covered: We reviewed model-based studies on the cost-effectiveness of lifelong ART (formerly Option B+) relative to previous WHO guidelines for PMTCT. Our search using PubMed, Medline and Google Scholar for articles on Option B+ resulted in the final inclusion of seven studies published between 2012 and 2016. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to assess the quality of reporting. Outcomes of interest, which included infant infections averted, maternal quality and length of life, and the Incremental Cost Effectiveness Ratio (ICER), were used in comparing cost-effectiveness. Expert commentary: Despite most model-based studies favouring lifelong ART (Option B+) in terms of its cost-effectiveness in comparison to Options A and B, inclusiveness of the evidence remains weak for generalization. This is largely because setting specificity for providing lifelong ART to all pregnant and breastfeeding women may differ significantly in each setting. Consequently, future cost-effectiveness studies should be robust, setting-specific, and endeavor to assess the willingness and ability to pay of each setting.
Wangwe, P J T; Nyasinde, M; Charles, D S K
Children living with HIV worldwide majority are infected through mother to child transmission of HIV (MTCT) acquired during pregnancy. Knowledge, attitude and behavioral changes are pivot tools towards success of any interventions. To determine the effectiveness of counseling on HIV done in primary health facilities (PHF), level of knowledge gained and attitude changes towards PMTCT. A cross sectional study assessing pregnant women's knowledge and their attitude towards PMTCT was conducted in Temeke district from October 2010 to Jan 2011 using a structured questionnaire. A total of 383 antenatal attendees were referred to Temeke district for management after counselled and tested for HIV in PHFs. Majority (86.9%) had primary education and good knowledge on MTCT. Correct timing of ARVs prophylaxis (15.7%) as preventive measures for MTCT was poor. Education and employment were associated with good knowledge on MTCT of HIV. Women had positive attitudes towards HIV counseling and testing, but stigma was a barrier to disclosure of one's serostatus. There is knowledge gap in routine PMTCT counseling among antenatal attendees in our PHFs. Effective counseling on PMTCT in the PHFs will bridge the identified knowledge gap and help in reduction of pediatric HIV.
Effectiveness of counseling at primary health facilities: level of knowledge of antenatal attendee and their attitude on Prevention of Mother to Child Transmission of HIV in primary health facilities in Dar es Salaam, Tanzania.
Wangwe, P J T; Nyasinde, M; Charles, D S K
Children living with HIV worldwide majority are infected through mother to child transmission of HIV (MTCT) acquired during pregnancy. Knowledge, attitude and behavioral changes are pivot tools towards success of any interventions. To determine the effectiveness of counseling on HIV done in primary health facilities (PHF), level of knowledge gained and attitude changes towards PMTCT. A cross sectional study assessing pregnant women's knowledge and their attitude towards PMTCT was conducted in Temeke district from October 2010 to Jan 2011 using a structured questionnaire. A total of 383 antenatal attendees were referred to Temeke district for management after counselled and tested for HIV in PHFs. Majority (86.9%) had primary education and good knowledge on MTCT. Correct timing of ARVs prophylaxis (15.7%) as preventive measures for MTCT was poor. Education and employment were associated with good knowledge on MTCT of HIV. Women had positive attitudes towards HIV counseling and testing, but stigma was a barrier to disclosure of one's serostatus. There is knowledge gap in routine PMTCT counseling among antenatal attendees in our PHFs. Effective counseling on PMTCT in the PHFs will bridge the identified knowledge gap and help in reduction of pediatric HIV.
Potter, Dara; Goldenberg, Robert L; Chao, Ann; Sinkala, Moses; Degroot, Alain; Stringer, Jeffrey S A; Bulterys, Marc; Vermund, Sten H
The implementation of disease-specific research or service programs may have an ancillary beneficial or harmful impact on routine clinical services. We reviewed the records of 5801 first visits to 22 antenatal clinics from 1997 to 2004 in Lusaka, Zambia and examined documented syphilis rapid plasma reagin (RPR) screening and syphilis treatment before and after implementation of research and/or service programs in prevention of mother-to-child (PMTCT) HIV transmission. Compared with before PMTCT program implementation, the prevalence odds ratios (PORs) and 95% confidence intervals (CIs) for documented RPR screening were 0.9 (0.7 to 1.1) after implementation of research, 0.7 (0.6 to 0.8) after service, and 2.5 (2.1 to 3.0) after research and service programs. Documented RPR screening was improved after implementation of PMTCT research and service were operating simultaneously and not with research or service alone. Health policy makers and researchers should plan explicitly for how the targeted HIV programs, service, and/or research can have a broader primary care impact.
Bedri, Abubaker; Gudetta, Berhanu; Isehak, Abdulhamid; Kumbi, Solomon; Lulseged, Sileshi; Mengistu, Yohannes; Bhore, Arvind V; Bhosale, Ramesh; Varadhrajan, Venkat; Gupte, Nikhil; Sastry, Jayagowri; Suryavanshi, Nishi; Tripathy, Srikanth; Mmiro, Francis; Mubiru, Michael; Onyango, Carolyne; Taylor, Adrian; Musoke, Philippa; Nakabiito, Clemensia; Abashawl, Aida; Adamu, Rahel; Antelman, Gretchen; Bollinger, Robert C; Bright, Patricia; Chaudhary, Mohammad A; Coberly, Jacqueline; Guay, Laura; Fowler, Mary Glenn; Gupta, Amita; Hassen, Elham; Jackson, J Brooks; Moulton, Lawrence H; Nayak, Uma; Omer, Saad B; Propper, Lidia; Ram, Malathi; Rexroad, Vivian; Ruff, Andrea J; Shankar, Anita; Zwerski, Sheryl
serious adverse events during the study (p=0.54). Although a 6-week regimen of daily nevirapine might be associated with a reduction in the risk of HIV transmission at 6 weeks of age, the lack of a significant reduction in the primary endpoint-risk of HIV transmission at 6 months-suggests that a longer course of daily infant nevirapine to prevent HIV transmission via breast milk might be more effective where access to affordable and safe replacement feeding is not yet available and where the risks of replacement feeding are high. US National Institutes of Health; US National Institute of Allergy and Infectious Diseases; Fogarty International Center.
Staphylococcus aureus is a major pathogen in nosocomial infections. Up to 30% of UCI related infections are caused by S. aureus. In this thesis we explore both clinical and molecular aspects of patient-to-patient transmission of S. aureus. We performed a European ICU study exploring infection prevention measures and their influence on transmission. We developed a experimental transmission model in animals, showing a difference in spread and colonization persistence between MSSA and MRSA. Next...
effective approach for prevention and control of transfusion-transmissible infections (TTIs). Also, it has been documented that sub-standard test kits are mostly used in resource limited settings for transfusion related diagnosis. However, the role of ...
Wilson Aparecido Silva
there are few studies describing young male vulnerability to HIV. A study was carried out aiming at developing a STD/AIDS prevention program for junior professional soccer players. METHODS: Study participants were twenty-five junior soccer players of a major league professional team of the city of Campinas, Brazil. There were 2 segments. In segment 1, participants were given a self-administered questionnaire covering sociodemographic data, sexual behavior, specific gender-related behaviors, condom use, HIV/AIDS knowledge and prevention, and sports associated exposure risk. In segment 2, 17 sessions of group dynamics were carried out. Many forms of expression (speech, writing, pictures, and videos were encouraged to grasp participants' thoughts on STD/AIDS-related matters. RESULTS: Participants showed good knowledge on HIV transmission but they were poorly informed on reproduction and STDs. Unwanted pregnancy is their main concern. As for condom use, 73% consistently used condoms with casual partners (73%, and only 27% consistently used them with regular partners. Also, 58% considered risky to have HIV-positive players among them. CONCLUSIONS: Young players do not consider themselves vulnerable despite their chances of HIV infection and unwanted pregnancy. They have poor knowledge about the human body and reproductive health. Soccer milieu as well as other sports milieus create great opportunities for prevention programs, where they may have a multiplier effect since athletes are often regarded as role models for children and youngsters.
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
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
Correlation between knowledge on transmission and prevention of HIV/STI and proficiency in condom use among male migrants from Africa and Middle East evaluated by a Condom Use Skills score using a wooden penile model.
Zoboli, Fabio; Martinelli, Domenico; Di Stefano, Mariantonietta; Fasano, Massimo; Prato, Rosa; Santantonio, Teresa Antonia; Fiore, Jose' Ramòn
Migrants in Italy are prevalently young adults, with a higher risk of sexual transmitted infections (STI) and HIV infection. Promoting consistent as well as correct use of condoms could reduce failure rate due to their improper use. The aim of our study was to evaluate Condom Use Skills among a migrant population recently landed in Italy, hosted in a government center for asylum seekers. The study sample was composed of 80 male migrants. Sanitary trained interviewers submitted a questionnaire to participants to investigate age, provenience, marital status, educational level and knowledge about transmission and prevention of HIV/STI. Then, we assessed participants' level of condom use skill with the Condom Use Skills (CUS) measure by using a wooden penile model. The interviewer filled in a checklist and assigned 1 point for correct demonstration of each behavior that may prevent condom failure during sex. Participants' median age was 26 years and the sample was composed of 54 migrants from sub-Saharan Africa and 26 from Middle East. Most of them were married, with a lower middle level of education, up to 8 or 5 years. Half of the sample achieved the highest score in the questionnaire and our CUS showed a large number of people with middle high score classes. The Spearman's rho was 0.30, therefore answers to the questionnaire and CUS score appeared correlated (p level of education (p = 0.001), and a higher score in the questionnaire (p level of CUS between single or married men and between African and Middle Asian migrants of the sample. Our study shows that educational level influences the quality of knowledge and awareness about STI/AIDS and contribute to correct condom use. Since the half of participants had a low educational level and linguistic problems, the risk of missing campaigns messages or misunderstanding informative materials increases. Direct observation of condom-application on penile model may offer realistic assessment of application skills in
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.
Full Text Available 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.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+.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.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.
Migrant women living with HIV in Europe: are they facing inequalities in the prevention of mother-to-child-transmission of HIV?: The European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) study group in EuroCoord.
Favarato, G; Bailey, H; Burns, F; Prieto, L; Soriano-Arandes, A; Thorne, C
In pregnancy early interventions are recommended for prevention of mother-to-child-transmission (PMTCT) of HIV. We examined whether pregnant women who live with HIV in Europe and are migrants encounter barriers in accessing HIV testing and care. Four cohorts within the European Pregnancy and Paediatric HIV Cohort Collaboration provided data for pooled analysis of 11 795 pregnant women who delivered in 2002-12 across ten European countries. We defined a migrant as a woman delivering in a country different from her country of birth and grouped the countries into seven world regions. We compared three suboptimal PMTCT interventions (HIV diagnosis in late pregnancy in women undiagnosed at conception, late anti-retroviral therapy (ART) start in women diagnosed but untreated at conception and detectable viral load (VL) at delivery in women on antenatal ART) in native and migrant women using multivariable logistic regression models. Data included 9421 (79.9%) migrant women, mainly from sub-Saharan Africa (SSA); 4134 migrant women were diagnosed in the current pregnancy, often (48.6%) presenting with CD4 count <350 cells/µl. Being a migrant was associated with HIV diagnosis in late pregnancy [OR for SSA vs. native women, 2.12 (95% CI 1.67, 2.69)] but not with late ART start if diagnosed but not on ART at conception, or with detectable VL at delivery once on ART. Migrant women were more likely to be diagnosed in late pregnancy but once on ART virological response was good. Good access to antenatal care enables the implementation of PMTCT protocols and optimises both maternal and children health outcomes generally. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
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.
Nyondo, Alinane Linda; Choko, Augustine Talumba; Chimwaza, Angela Faith; Muula, Adamson Sinjani
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.
Thomas A Odeny
Full Text Available 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.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.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.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 improving postpartum PMTCT retention and infant
Fink, S.; Porter, K.; Mudd, C.; Rogers, J.
The report presents transmission cost allocation methodologies for reliability transmission projects, generation interconnection, and economic transmission projects for all Regional Transmission Organizations.
Impact of approaches in improving male partner involvement in the prevention of mother-to-child transmission (PMTCT) of HIV on the uptake of PMTCT services in sub-Saharan Africa: a protocol of a systematic review and meta-analysis
Takah, Noah F; Kennedy, Iain T R; Johnman, Cathy
Introduction Several studies have reported approaches used in improving the delivery of prevention of mother-to-child transmission (PMTCT) of HIV services through the involvement of male partners, but evidence from a systematic review is limited. We aim at determining the impact of male partner involvement on PMTCT in sub-Saharan Africa. Methods and analysis This will be a systematic review of published literature. Interventional and observational studies on male involvement in PMTCT carried ...
Sexualidade na terceira idade: medidas de prevenção para doenças sexualmente transmissíveis e AIDS Sexualidad en la tercera edad: medidas de prevención de enfermedades de transmisión sexual y SIDA Sexuality in the elderly: prevention methods for sexually transmissible illnesses and AIDS
Manoela Busato Mottin Maschio
Full Text Available O objetivo deste estudo foi identificar as medidas de prevenção que os idosos estão utilizando para à prevenção das Doenças Sexualmente Transmissíveis e Síndrome da Imunodeficiência Adquirida. A pesquisa foi de caráter prospectivo, quantitativo e descritivo com uma amostragem intencional, realizada com 98 idosos. Foi aplicado um questionário com perguntas abertas e fechadas, relacionadas à vida sexual dos idosos frequentadores de uma instituição que desenvolve programas para a melhoria da qualidade de vida dos idosos no município de Curitiba, Paraná. Dos entrevistados 43%, relatam fazer uso de alguma medida de prevenção. A realização de programas de prevenção voltados para o atendimento de pessoas com 50 anos ou mais, deve estar atenta às questões de sexualidade no envelhecimento. Os idosos devem ser vistos como indivíduos que possuem desejos, necessidades sexuais e que fazem projetos para o futuro.El objetivo de este estudio es identificar medidas que los ancianos están utilizando para la prevención de enfermedades de transmisión sexual y el Enfermedades de Transmisión Sexual Síndrome de Inmunodeficiencia Adquirida. La encuesta fue de carácter prospectivo y cuantitativo con una muestra intencional, realizado con 98 personas de edad avanzada. Se aplicó un cuestionario con preguntas abiertas y cerradas, relacionadas con la vida sexual de los visitantes mayores de una institución que desarrolla programas para la mejora de la calidad de vida de las personas mayores en la ciudad de Curitiba, Paraná, Brasil. De los 43% de los encuestados informaron que usan de alguna medida de prevención. La ejecución de los programas de prevención se centró en la atención de personas mayores de 50 años o más, deben de estar atentos a las cuestiones de la sexualidad en el envejecimiento. Los ancianos deben ser vistos como individuos que tienen necesidades sexuales y deseos, que hacen proyectos para el futuro.This study aimed
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.
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.
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
Carlson, Jonathan M; Schaefer, Malinda; Monaco, Daniela C; Batorsky, Rebecca; Claiborne, Daniel T; Prince, Jessica; Deymier, Martin J; Ende, Zachary S; Klatt, Nichole R; DeZiel, Charles E; Lin, Tien-Ho; Peng, Jian; Seese, Aaron M; Shapiro, Roger; Frater, John; Ndung'u, Thumbi; Tang, Jianming; Goepfert, Paul; Gilmour, Jill; Price, Matt A; Kilembe, William; Heckerman, David; Goulder, Philip J R; Allen, Todd M; Allen, Susan; Hunter, Eric
Heterosexual transmission of HIV-1 typically results in one genetic variant establishing systemic infection. We compared, for 137 linked transmission pairs, the amino acid sequences encoded by non-envelope genes of viruses in both partners and demonstrate a selection bias for transmission of residues that are predicted to confer increased in vivo fitness on viruses in the newly infected, immunologically naïve recipient. Although tempered by transmission risk factors, such as donor viral load, genital inflammation, and recipient gender, this selection bias provides an overall transmission advantage for viral quasispecies that are dominated by viruses with high in vivo fitness. Thus, preventative or therapeutic approaches that even marginally reduce viral fitness may lower the overall transmission rates and offer long-term benefits even upon successful transmission. Copyright © 2014, American Association for the Advancement of Science.
Background: Knowledge about the modes of transmission and preventive measures of malaria are important preceding factors for the acceptance and use of proven control tools by the community. Objective: To assess knowledge, attitude and practices (KAP) about modes of malaria transmission and preventive methods in ...
Full Text Available OBJECTIVES: To describe the effectiveness of a program designed to reduce the rate of mother-to-child transmission (MTCT of HIV at the primary HIV testing and treatment center in Haiti between 1999 and 2004. METHODS: All pregnant, HIV-positive women who attended the major HIV testing and treatment clinic in Port-au-Prince, Haiti, between March 1999 and December 2004 were asked to participate in an MTCT prevention program. Of the 650 women who participated, 73.3% received zidovudine (AZT, 2.9% received nevirapine (NVP, and 10.1% received triple-drug therapy when it became available in 2003 and if clinical/laboratory indications were met. Approximately 13.8% received no antiretroviral medication. All participants received cotrimoxazole prophylaxis and infant formula for their children. Kaplan-Meier survival analysis and the log rank test were used to evaluate program impact on child survival. RESULTS: Complete data were available for 348 mother-infant pairs who completed the program to prevent MTCT of HIV. The rate of MTCT in the study was 9.2% (95% CI: 6.14-12.24, in contrast to the historical mother-to-child transmission rate of 27% in Haiti. HIV-positive infants were less likely to survive than HIV-negative infants at 18 months of follow-up (χ2 = 19.06, P OBJETIVOS: Describir la eficacia de un programa diseñado para reducir la tasa de transmisión del VIH de madre a hijo (TMH en el principal centro de diagnóstico y tratamiento de esa infección en Haití entre 1999 y 2004. MÉTODOS: Se invitó a participar en un programa para la prevención de la TMH a todas las embarazadas positivas al VIH que asistían a la clínica principal de diagnóstico y tratamiento de la infección por el VIH en Puerto Príncipe, Haití, entre marzo de 1999 y diciembre de 2004. De las 650 mujeres que participaron, 73,3% recibieron zidovudina (AZT, 2,9% nervirapine (NVP y 10,1% tripleterapia cuando esta se hizo disponible en 2003 y cumplían los indicadores cl
This podcast reports on the transmission of TB from elephants to humans. Dr. Rendi Murphree, Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention and Vanderbilt University Visiting Scholar, discusses the recent elephant-to-human transmission of tuberculosis at an elephant refuge in Tennessee. Created: 2/23/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Date Released: 2/23/2011.
Didem Cemile Yesilirmak
Conclusion: Results suggest that EGF supplementation in newborn rats leads to a significant increase in intestinal mucosal proliferation and a significant decrease in bilirubin elimination. These data suggest that EGF possibly increases intestinal bilirubin absorption and may have a role in development of breast milk jaundice. Further studies are needed to confirm this hypothesis.
Evaluating the effectiveness of selected community-level interventions on key maternal, child health, and prevention of mother-to-child transmission of HIV outcomes in three countries (the ACCLAIM Project): a study protocol for a randomized controlled trial.
Woelk, Godfrey B; Kieffer, Mary Pat; Walker, Damilola; Mpofu, Daphne; Machekano, Rhoderick
Efforts to scale up and improve programs for prevention of mother-to-child transmission of HIV (PMTCT) have focused primarily at the health facility level, and limited attention has been paid to defining an effective set of community interventions to improve demand and uptake of services and retention. Many barriers to PMTCT are also barriers to pregnancy, childbirth, and postnatal care faced by mothers regardless of HIV status. Demand for maternal and child health (MCH) and PMTCT services can be limited by critical social, cultural, and structural barriers. Yet, rigorous evaluation has shown limited evidence of effectiveness of multilevel community-wide interventions aimed at improving MCH and HIV outcomes for pregnant women living with HIV. We propose to assess the effect of a package of multilevel community interventions: a social learning and action component, community dialogues, and peer-led discussion groups, on the demand for, uptake of, and retention of HIV positive pregnant/postpartum women in MCH/PMTCT services. This study will undertake a three-arm randomized trial in Swaziland, Uganda, and Zimbabwe. Districts/regions (n = 9) with 45 PMTCT-implementing health facilities and their catchment areas (populations 7,300-27,500) will be randomly allocated to three intervention arms: 1) community leader engagement, 2) community leader engagement with community days, or 3) community leader engagement with community days and male and female community peer groups. The primary study outcome is HIV exposed infants (HEIs) returning to the health facility within 2 months for early infant diagnosis (EID) of HIV. Secondary study outcomes include gestational age of women attending for first antenatal care, male partners tested for HIV, and HEIs receiving nevirapine prophylaxis at birth. Changes in community knowledge, attitudes, practices, and beliefs on MCH/PMTCT will be assessed through household surveys. Implementation of the protocol necessitated changes in the
Fischer, Robert; Jürgens, Gunter; Najork, Rolf; Pollak, Burkhard
This book presents