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Sample records for preventing hiv transmission

  1. Preventing Mother-to-Child Transmission of HIV

    Science.gov (United States)

    ... 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 ...

  2. Effectiveness of condoms in preventing HIV transmission.

    Science.gov (United States)

    Pinkerton, S D; Abramson, P R

    1997-05-01

    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.

  3. Immunotherapies to Prevent Mother-to-Child Transmission of HIV

    OpenAIRE

    Hicar, Mark D.

    2013-01-01

    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...

  4. Prevention of Prenatal HIV Transmission in Kazakhstan | Trumova ...

    African Journals Online (AJOL)

    . 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 ...

  5. Prevention of vertical transmission of HIV in Denmark

    DEFF Research Database (Denmark)

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

    2008-01-01

    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

  6. Prevention of vertical transmission of HIV in Denmark

    DEFF Research Database (Denmark)

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

    2008-01-01

    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...

  7. Prevention of Mother-to-Child Transmission of HIV data ...

    African Journals Online (AJOL)

    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 ...

  8. Prevention of Mother-to-Child Transmission of HIV data ...

    African Journals Online (AJOL)

    2014-08-21

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-01-01

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

  10. [Prevention of HIV transmission (vertical, occupational and non-occupational)].

    Science.gov (United States)

    Azkune, Harkaitz; Ibarguren, Maialen; Camino, Xabier; Iribarren, José Antonio

    2011-10-01

    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.

  11. Nurturing the Continuum of HIV Testing, Treatment and Prevention Matrix Cascade in Reducing HIV Transmission.

    Science.gov (United States)

    Yah, Clarence S

    2017-11-01

    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

  12. HIV Transmission

    Science.gov (United States)

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

  13. Antenatal prevention of mother to child transmission of HIV

    African Journals Online (AJOL)

    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 ...

  14. When prevention of mother-to-child HIV transmission fails: preventing pretreatment drug resistance in African children

    NARCIS (Netherlands)

    Inzaule, Seth C.; Hamers, Raph L.; Calis, Job; Boerma, Ragna; Sigaloff, Kim; Zeh, Clement; Mugyenyi, Peter; Akanmu, Sulaimon; Rinke de Wit, Tobias F.

    2018-01-01

    : 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.

  15. Misconceptions about HIV prevention and transmission in Botswana ...

    African Journals Online (AJOL)

    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 ...

  16. Preventing HIV Transmission in Chinese Internal Migrants: A Behavioral Approach

    Science.gov (United States)

    Erasmus, Vicki; Sun, Xinying; Shi, Yuhui; Richardus, Jan Hendrik

    2014-01-01

    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

  17. Vertical transmission of HIV from mother to child in sub-Saharan Africa: modes of transmission and methods for prevention.

    Science.gov (United States)

    Santmyire, B R

    2001-05-01

    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.

  18. Eliminating Perinatal HIV Transmission

    Centers for Disease Control (CDC) Podcasts

    2012-11-26

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

  19. The Impact of Prevention of Mother to Child Transmission of HIV ...

    African Journals Online (AJOL)

    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 ...

  20. Condoms for the prevention of HIV transmission: cultural dimensions.

    Science.gov (United States)

    Potts, M; Short, R V

    1989-01-01

    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.

  1. HIV prevention is not enough: child survival in the context of prevention of mother to child HIV transmission.

    Science.gov (United States)

    Kuhn, Louise; Sinkala, Moses; Thea, Don M; Kankasa, Chipepo; Aldrovandi, Grace M

    2009-12-11

    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.

  2. An update on multipurpose prevention technologies for the prevention of HIV transmission and pregnancy.

    Science.gov (United States)

    Friend, David R

    2016-01-01

    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.

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

    Science.gov (United States)

    Haire, Bridget; Kaldor, John

    2015-12-01

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

  4. Effectiveness of the prevention of mother-to-child HIV transmission in Bahia, Brazil.

    Science.gov (United States)

    Patricio, Fátima Rejane Lemos; Rutherford, George Williams; Barreto, José Henrique Silva; Rodamilans, Cynthia; Badaró, Roberto

    2015-01-01

    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.

  5. Topical application of entry inhibitors as "virustats" to prevent sexual transmission of HIV infection

    Directory of Open Access Journals (Sweden)

    Root Michael

    2008-12-01

    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

  6. Prevention of vertical transmission of HIV-1 in resource-limited settings.

    Science.gov (United States)

    Coutsoudis, Anna; Kwaan, Leith; Thomson, Mairi

    2010-10-01

    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.

  7. Antiretroviral pre-exposure prophylaxis prevents vaginal transmission of HIV-1 in humanized BLT mice.

    Directory of Open Access Journals (Sweden)

    Paul W Denton

    2008-01-01

    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.

  8. Positive prevention: reducing HIV transmission among people living with HIV/AIDS

    National Research Council Canada - National Science Library

    Kalichman, Seth C

    2005-01-01

    ... 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,...

  9. Preventing HIV transmission through blockade of CCR5: rationale, progress and perspectives.

    Science.gov (United States)

    Hartley, Oliver; Martins, Elsa; Scurci, Ilaria

    2018-01-29

    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.

  10. Risk of HIV transmission within marriage in rural China: implications for HIV prevention at the family level.

    Science.gov (United States)

    Liu, Hongjie; Detels, Roger; Li, Xiaoming; Stanton, Bonita; Hu, Zhi; Yang, Hongmei

    2005-07-01

    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.

  11. [Prevention of HIV transmission - what is desirable? What is feasible?].

    Science.gov (United States)

    Escobar Pinzón, L C; Sweers, H

    2007-04-01

    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.

  12. Prevention of mother to child transmission of HIV in Burkina Faso: breastfeeding and wet nursing.

    Science.gov (United States)

    Nacro, Boubacar; Barro, Makoura; Gaudreault, Suzanne; Dao, Blami

    2010-06-01

    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.

  13. Highly active antiretroviral treatment as prevention of HIV transmission: review of scientific evidence and update.

    Science.gov (United States)

    Granich, Reuben; Crowley, Siobhan; Vitoria, Marco; Smyth, Caoimhe; Kahn, James G; Bennett, Rod; Lo, Ying-Ru; Souteyrand, Yves; Williams, Brian

    2010-07-01

    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.

  14. Effectiveness of a project to prevent HIV vertical transmission in the Republic of Congo.

    Science.gov (United States)

    Bisio, Francesca; Masini, Giulia; Blasi Vacca, Elisabetta; Calzi, Anna; Cardinale, Francesco; Bruzzone, Bianca; Bruzzi, Paolo; Viscoli, Claudio

    2013-08-01

    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.

  15. HIV sexual transmission risk among serodiscordant couples: assessing the effects of combining prevention strategies.

    Science.gov (United States)

    Lasry, Arielle; Sansom, Stephanie L; Wolitski, Richard J; Green, Timothy A; Borkowf, Craig B; Patel, Pragna; Mermin, Jonathan

    2014-06-19

    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.

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

    Directory of Open Access Journals (Sweden)

    Ricardo Kuchenbecker

    2015-09-01

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

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

    Directory of Open Access Journals (Sweden)

    William Kilembe

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

  18. Knowledge of HIV Serodiscordance, Transmission, and Prevention among Couples in Durban, South Africa

    Science.gov (United States)

    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

    2015-01-01

    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

  19. Prevention of mother to child transmission of HIV/AIDS in Eritrea: the ...

    African Journals Online (AJOL)

    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 ...

  20. Prevention of mother-to-child transmission of HIV guidelines: Nurses ...

    African Journals Online (AJOL)

    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 ...

  1. An interactive multimedia program to prevent HIV transmission in men with intellectual disability.

    Science.gov (United States)

    Wells, Jennifer; Clark, Khaya; Sarno, Karen

    2014-05-01

    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).

  2. Stakeholders’ perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi

    OpenAIRE

    Nyondo, Alinane Linda; Chimwaza, Angela Faith; Muula, Adamson Sinjani

    2014-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Osoti A

    2014-07-01

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

  4. Scaling up Prevention of Mother to Child Transmission of HIV ...

    African Journals Online (AJOL)

    LFU). Most women (85.7%) had highly active antiretroviral therapy (HAART) and vaginal delivery (98%). Perinatal mortality rate was 66/1000 births and 95.3% of exposed infants had negative HIV-DNA polymerase reaction test at 6 weeks of life ...

  5. [Neonatal outcomes of prevention of vertical HIV transmission; 15 years of experience in a non-university HIV centre].

    Science.gov (United States)

    Veen, Christa A; van Kasteren, Marjo E E; Fiedeldeij, Cora A; Kuipers, Marien H J; van Dijken, Pim J; Obihara, Charles C

    2014-01-01

    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.

  6. Prevention of mother to child transmission of HIV: evaluation of a pilot programme in a district hospital in rural Zimbabwe.

    Science.gov (United States)

    Perez, Freddy; Orne-Gliemann, Joanna; Mukotekwa, Tarisai; Miller, Anna; Glenshaw, Monica; Mahomva, Agnes; Dabis, François

    2004-11-13

    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

  7. Narrative review: antiretroviral therapy to prevent the sexual transmission of HIV-1.

    Science.gov (United States)

    Cohen, Myron S; Gay, Cynthia; Kashuba, Angela D M; Blower, Sally; Paxton, Lynn

    2007-04-17

    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.

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

    Science.gov (United States)

    Manji, A; Peña, R; Dubrow, R

    2007-09-01

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

  9. Preventing perinatal HIV transmission - nowisthe time to act!

    African Journals Online (AJOL)

    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 ...

  10. [From the apprehension of sexually transmissible diseases to the prevention of HIV].

    Science.gov (United States)

    Deniaud, F; Melman, C

    2002-03-09

    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

  11. HIV transmission and retention in care among HIV-exposed children enrolled in Malawi's prevention of mother-to-child transmission programme.

    Science.gov (United States)

    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

    2017-09-04

    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.

  12. Interpretation of indeterminate HIV-1 PCR results are influenced by changing vertical transmission prevention regimens.

    Science.gov (United States)

    Maritz, Jean; Maharaj, Jayshree Narvin; Cotton, Mark Frederic; Preiser, Wolfgang

    2017-10-01

    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.

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

    Science.gov (United States)

    Tshitenge, Stephane; Citeya, Andre; Ganiyu, Adewale

    2014-09-18

    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.

  14. Planning for pre-exposure prophylaxis to prevent HIV transmission: challenges and opportunities

    Science.gov (United States)

    2010-01-01

    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

  15. HIV Prevention

    Science.gov (United States)

    ... Abroad Treatment Basic Statistics Get Tested Find an HIV testing site near you. Enter ZIP code or city Follow HIV/AIDS CDC HIV CDC HIV/AIDS See RSS | ... Collapse All Is abstinence the only 100% effective HIV prevention option? Yes. Abstinence means not having oral, ...

  16. [Preventing the transmission of HIV-1 from mother to child in Africa in the year 2000].

    Science.gov (United States)

    Castetbon, K; Leroy, V; Spira, R; Dabis, F

    2000-01-01

    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

  17. Effectiveness of interventions to prevent mother-to-child transmission of HIV in Southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Merdekios B

    2011-11-01

    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

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

    Directory of Open Access Journals (Sweden)

    Peters Ronald J

    2005-03-01

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

  19. The Rectal Mucosa and Condomless Receptive Anal Intercourse in HIV Negative MSM: Implications for HIV Transmission and Prevention

    Science.gov (United States)

    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.

    2016-01-01

    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

  20. INTEGRATING THE ROLES OF STAKEHOLDERS IN PREVENTING THE HIV/AIDS TRANSMISSION IN EAST JAVA, INDONESIA

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    Toetik Koesbardiati

    2017-08-01

    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.

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

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    Andrea Hauser

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

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

    Science.gov (United States)

    Hauser, Andrea; Sewangi, Julius; Mbezi, Paulina; Dugange, Festo; Lau, Inga; Ziske, Judith; Theuring, Stefanie; Kuecherer, Claudia; Harms, Gundel; Kunz, Andrea

    2012-01-01

    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

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

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    Stephane Tshitenge

    2014-01-01

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

  4. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda.

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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

    2006-01-02

    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.

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

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    Paul W Denton

    2010-01-01

    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.

  6. HIV Prevention

    Centers for Disease Control (CDC) Podcasts

    2012-02-01

    Dr. Kevin Fenton, Director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, talks about steps people can take to protect their health from HIV.  Created: 2/1/2012 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 2/1/2012.

  7. [Consensus statement on monitoring of HIV: pregnancy, birth, and prevention of mother-to-child transmission].

    Science.gov (United States)

    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

    2014-05-01

    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.

  8. 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.

    Science.gov (United States)

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

    2015-01-01

    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.

  9. The contribution of family planning towards the prevention of vertical HIV transmission in Uganda.

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    Wolfgang Hladik

    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.

  10. Effectiveness of semen washing to prevent HIV transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis

    Science.gov (United States)

    Zafer, Maryam; Horvath, Hacsi; Mmeje, Okeoma; van der Poel, Sheryl; Semprini, Augusto; Rutherford, George; Brown, Joelle

    2015-01-01

    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

  11. Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis.

    Science.gov (United States)

    Zafer, Maryam; Horvath, Hacsi; Mmeje, Okeoma; van der Poel, Sheryl; Semprini, Augusto E; Rutherford, George; Brown, Joelle

    2016-03-01

    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.

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

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    Mirkuzie Alemnesh H

    2012-12-01

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

  13. Sexual risk behavior, sexually transmitted infections, and HIV transmission risks in HIV-positive men who have sex with men (MSM) - approaches for medical prevention.

    Science.gov (United States)

    Esser, Stefan; Krotzek, Judith; Dirks, Henrike; Scherbaum, Norbert; Schadendorf, Dirk

    2017-04-01

    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.

  14. Prevention of mother-to-child transmission of HIV type 1: the role of neonatal and infant prophylaxis.

    Science.gov (United States)

    Hurst, Stacey A; Appelgren, Kristie E; Kourtis, Athena P

    2015-02-01

    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.

  15. Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive.

    Science.gov (United States)

    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

    2018-02-01

    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.

  16. HIV drug resistance in infants increases with changing prevention of mother-to-child transmission regimens.

    Science.gov (United States)

    Poppe, Lisa K; Chunda-Liyoka, Catherine; Kwon, Eun H; Gondwe, Clement; West, John T; Kankasa, Chipepo; Ndongmo, Clement B; Wood, Charles

    2017-08-24

    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.

  17. Pooled individual data analysis of 5 randomized trials of infant nevirapine prophylaxis to prevent breast-milk HIV-1 transmission.

    Science.gov (United States)

    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

    2013-01-01

    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.

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

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    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

  19. Community voices: barriers and opportunities for programmes to successfully prevent vertical transmission of HIV identified through consultations among people living with HIV.

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    Anderson, Ginna; Caswell, Georgina; Edwards, Olive; Hsieh, Amy; Hull, Beri; Mallouris, Christoforos; Mason, Naisiadet; Nöstlinger, Christiana

    2012-07-11

    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

  20. Integration of prevention of mother-to-child HIV transmission into maternal health services in Senegal.

    Science.gov (United States)

    Cisse, C

    2017-06-01

    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

  1. Reductions in Transmission Risk Behaviors in HIV-Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project

    Science.gov (United States)

    Gasiorowicz, Mari; Llanas, Michelle R.; DiFranceisco, Wayne; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Hoxie, Neil J.; Reiser, William J.; Vergeront, James M.

    2005-01-01

    Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV…

  2. Executive summary of the Consensus Statement on monitoring HIV: pregnancy, birth, and prevention of mother-to-child transmission.

    Science.gov (United States)

    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

    2014-05-01

    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.

  3. Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis

    Science.gov (United States)

    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

    2016-01-01

    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

  4. Assessment of Prevention of Mother-to-Child Transmission HIV Services in the Bantey Meanchey Province in Cambodia.

    Science.gov (United States)

    Sau, Mealiny Sokun; Balamane, Maya; Lurie, Mark; Harwell, Joseph; Welle, Emily; Mean, Chhivun; Cu-Uvin, Susan

    2016-07-01

    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.

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

    Science.gov (United States)

    Essien, Ekere J; Meshack, Angela F; Peters, Ronald J; Ogungbade, Gbadebo O; Osemene, Nora I

    2005-01-01

    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

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

    Science.gov (United States)

    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

    2012-12-01

    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.

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

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    Lígia Mara Dolce de Lemos

    2012-12-01

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

  8. Challenges faced by health workers in implementing the prevention of mother-to-child HIV transmission (PMTCT) programme in Uganda.

    Science.gov (United States)

    Nuwagaba-Biribonwoha, H; Mayon-White, R T; Okong, P; Carpenter, L M

    2007-09-01

    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.

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

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    Adriana S. Duran

    2006-02-01

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

  10. [Prevention of vertical HIV-1 transmission in a tertiary care public hospital in Buenos Aires, Argentina].

    Science.gov (United States)

    Cecchini, Diego; Martinez, Marina; Astarita, Viviana; Nieto, Claudia; Giesolauro, Rafael; Rodriguez, Claudia

    2011-09-01

    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.

  11. Antiretroviral therapy for prevention of HIV transmission: potential role for people who inject drugs in Central Asia.

    Science.gov (United States)

    McNairy, Margaret L; Deryabina, Anna; Hoos, David; El-Sadr, Wafaa M

    2013-11-01

    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.

  12. Preventing HIV Transmission Among Partners of HIV-Positive Male Sex Workers in Mexico City: A Modeling Study.

    Science.gov (United States)

    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

    2015-09-01

    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.

  13. Mobile Health Intervention to Reduce HIV Transmission: A Randomized Trial of Behaviorally Enhanced HIV Treatment as Prevention (B-TasP).

    Science.gov (United States)

    Kalichman, Seth C; Cherry, Chauncey; Kalichman, Moira O; Eaton, Lisa A; Kohler, James J; Montero, Catherine; Schinazi, Raymond F

    2018-05-01

    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.

  14. Interim outcomes for a community-based program to prevent perinatal HIV transmission.

    Science.gov (United States)

    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

    1995-06-01

    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.

  15. The accessibility of HIV-infected Poor Women to the Prevention of Mother to Child Transmission Service in Surakarta Indonesia

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    Argyo Demartoto

    2016-12-01

    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.

  16. Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa: evaluation of a two-tiered approach.

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    Besigin Tonwe-Gold

    2007-08-01

    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

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

    Science.gov (United States)

    Ambia, Julie; Mandala, Justin

    2016-01-01

    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

  18. Women's decision-making and uptake of services to prevent mother-to-child HIV transmission in Zambia.

    Science.gov (United States)

    Ford, Catherine; Chibwesha, Carla J; Winston, Jennifer; Jacobs, Choolwe; Lubeya, Mwansa Ketty; Musonda, Patrick; Stringer, Jeffrey S A; Chi, Benjamin H

    2018-04-01

    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.

  19. Barriers to men's participation in antenatal and prevention of mother-to-child HIV transmission care in Cameroon, Africa.

    Science.gov (United States)

    Nkuoh, Godlove N; Meyer, Dorothy J; Tih, Pius M; Nkfusai, Joseph

    2010-01-01

    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.

  20. Prevention of perinatal HIV I transmission by protease inhibitor based triple drug antiretroviral therapy versus nevirapine as single dose at the time of delivery.

    Science.gov (United States)

    Bendle, Meenakshi; Bajpai, Smrati; Choudhary, Ashwini; Pazare, Amar

    2012-12-01

    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.

  1. Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda

    NARCIS (Netherlands)

    Kuznik, Andreas; Lamorde, Mohammed; Hermans, Sabine; Castelnuovo, Barbara; Auerbach, Brandon; Semeere, Aggrey; Sempa, Joseph; Ssennono, Mark; Ssewankambo, Fred; Manabe, Yukari C.

    2012-01-01

    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

  2. The utility of the new generation of humanized mice to study HIV-1 infection: transmission, prevention, pathogenesis, and treatment

    Directory of Open Access Journals (Sweden)

    Rowan Mark R

    2011-08-01

    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

  3. Delivery Unit Costs for Antiretroviral Treatment and Prevention of Mother-to-Child-Transmission of HIV

    Science.gov (United States)

    Galárraga, Omar; Wirtz, Veronika J.; Figueroa-Lara, Alejandro; Santa-Ana-Tellez, Yared; Coulibaly, Ibrahima; Viisainen, Kirsi; Medina-Lara, Antonieta; Korenromp, Eline L.

    2013-01-01

    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

  4. Progress in prevention of mother-to-child transmission of HIV infection in Ukraine: results from a birth cohort study

    Directory of Open Access Journals (Sweden)

    Pilipenko Tatyana

    2009-04-01

    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.

  5. Engineering a segmented dual-reservoir polyurethane intravaginal ring for simultaneous prevention of HIV transmission and unwanted pregnancy.

    Directory of Open Access Journals (Sweden)

    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.

  6. Engineering a Segmented Dual-Reservoir Polyurethane Intravaginal Ring for Simultaneous Prevention of HIV Transmission and Unwanted Pregnancy

    Science.gov (United States)

    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.

    2014-01-01

    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

  7. Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: The One Stop Clinic model.

    Directory of Open Access Journals (Sweden)

    Anna Gamell

    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

  8. HIV Risk and Prevention

    Science.gov (United States)

    ... Prevention VIH En Español Get Tested Find an HIV testing site near you. Enter ZIP code or city Follow HIV/AIDS CDC HIV CDC HIV/AIDS See RSS | ... Email Updates on HIV Syndicated Content Website Feedback HIV Risk and Prevention Recommend on Facebook Tweet Share ...

  9. 4. CRIMINALISING HIV TRANSMISSION

    African Journals Online (AJOL)

    Esem

    Method: A comprehensive analysis of both global and. Zambianpublications, legislation and case laws was conducted. Results: Proponents of criminalisation of HIV transmission argue that criminalization would serve as a deterrent to the culprit and others to engage in prohibited conduct in future while the opponents argue ...

  10. HIV disclosure, sexual negotiation and male involvement in prevention-of-mother-to-child-transmission in South Africa.

    Science.gov (United States)

    Villar-Loubet, Olga M; Bruscantini, Laura; Shikwane, Molatelo Elisa; Weiss, Stephen; Peltzer, Karl; Jones, Deborah L

    2013-01-01

    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.

  11. Cascade of access to interventions to prevent HIV mother to child transmission in the metropolitan area of Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Elaine S. Pires Araujo

    2014-05-01

    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.

  12. Cost-effectiveness analysis of infant feeding strategies to prevent mother-to-child transmission of HIV in South Africa.

    Science.gov (United States)

    Maredza, Mandy; Bertram, Melanie Y; Saloojee, Haroon; Chersich, Matthew F; Tollman, Stephen M; Hofman, Karen J

    2013-09-01

    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.

  13. The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability.

    Science.gov (United States)

    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

    2017-12-01

    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.

  14. The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

    Science.gov (United States)

    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.

    2017-01-01

    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

  15. Transitioning from antenatal surveillance surveys to routine HIV testing: a turning point in the mother-to-child transmission prevention programme for HIV surveillance in Brazil.

    Science.gov (United States)

    Pereira, Gerson Fernando Mendes; Sabidó, Meritxell; Caruso, Alessandro; Benzaken, Adele Schwartz

    2017-07-05

    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

  16. Pursuing ethical coherence in the prevention of vertical transmission of HIV: justice and injustice in Option B.

    Science.gov (United States)

    Hodson, Nathan; Bewley, Susan

    2017-07-01

    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.

  17. Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners.

    Science.gov (United States)

    Kamarulzaman, Adeeba; Reid, Stewart E; Schwitters, Amee; Wiessing, Lucas; El-Bassel, Nabila; Dolan, Kate; Moazen, Babak; Wirtz, Andrea L; Verster, Annette; Altice, Frederick L

    2016-09-10

    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.

  18. Prevention of mother to child transmission of HIV/AIDS in Eritrea: the ...

    African Journals Online (AJOL)

    ) of HIV/AIDS in Eritrea where skilled care delivery is ... before the introduction of PMTCT in 2002, while the prospective study followed up children born to pregnant HIV positive .... HIV testing a routine antenatal care investigation, combination ...

  19. Cascade of access to interventions to prevent HIV mother to child transmission in the metropolitan area of Rio de Janeiro, Brazil.

    Science.gov (United States)

    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

    2014-01-01

    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.

  20. Implementation of prevention of mother-to-child transmission of HIV programme through private hospitals of Delhi--policy implications.

    Science.gov (United States)

    Gupta, A K; Garg, C R; Joshi, B C; Rawat, N; Dabla, V; Gupta, A

    2015-01-01

    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.

  1. Transmission of chimeric HIV by mating in conventional mice: prevention by pre-exposure antiretroviral therapy and reduced susceptibility during estrus

    Directory of Open Access Journals (Sweden)

    Eran Hadas

    2013-09-01

    Heterosexual transmission accounts for the majority of new human immunodeficiency virus (HIV cases worldwide. The current approach to investigate HIV heterosexual transmission in animals involves application of virus stock to the vaginal surface, a method that does not reproduce the physiological conditions of vaginal intercourse that influence the rate of transmission. We have previously described efficient infection of conventional mice using EcoHIV/NL4-3 and EcoHIV/NDK, chimeric HIV molecular clones constructed to express all HIV structural and regulatory genes except envelope, which is replaced by a rodent-tropic envelope gene. Here we investigated whether EcoHIV/NDK-infected male mice transmit virus to females during coitus, and the sensitivity of this transmission to HIV pre-exposure prophylaxis and the estrus state. Our general approach was to allow mating between EcoHIV/NDK-infected male mice and uninfected females for 1–7 nights. At 1–6 weeks after mating, mice were euthanized and virus burdens were measured by quantitative PCR (qPCR amplification of HIV RNA or DNA in peritoneal macrophages, inguinal lymph node cells, spleen cells or vas deferens, or by ELISA for antibodies to HIV Gag. We found that 70–100% of female mice mated to EcoHIV/NDK-infected males acquired infection. Pericoital treatment of females with either 2′,3′-dideoxcytidine (ddC or tenofovir largely prevented their EcoHIV/NDK infection by mating (P<0.05 and P<0.003, respectively. In males, T cells were dispensable for virus transmission. The rate of EcoHIV/NDK sexual transmission to females in estrus declined sharply (P=0.003 but their infection by injection was unaffected, indicating that the local environment in the female reproductive tract influences susceptibility to HIV. We conclude that this system of EcoHIV/NDK transmission during mouse mating reproduces key features of heterosexual transmission of HIV in humans and can be used to investigate its biology and control.

  2. Sexual Practices, Fertility Intentions, and Awareness to Prevent Mother-to-Child Transmission of HIV Among Infected Pregnant Women at the Yaounde Central Hospital.

    Science.gov (United States)

    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

    2016-06-01

    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.

  3. 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

    NARCIS (Netherlands)

    Prabawanti, Ciptasari

    2015-01-01

    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

  4. Stakeholders' perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi.

    Science.gov (United States)

    Nyondo, Alinane Linda; Chimwaza, Angela Faith; Muula, Adamson Sinjani

    2014-07-07

    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

  5. Stakeholders’ perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi

    Science.gov (United States)

    2014-01-01

    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

  6. Prevention of mother-to-child transmission of HIV: Postpartum adherence to Option B+ until 18 months in Western Uganda.

    Science.gov (United States)

    Decker, Sarah; Rempis, Eva; Schnack, Alexandra; Braun, Vera; Rubaihayo, John; Busingye, Priscilla; Tumwesigye, Nazarius Mbona; Harms, Gundel; Theuring, Stefanie

    2017-01-01

    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.

  7. Prevention of mother-to-child transmission of HIV: Postpartum adherence to Option B+ until 18 months in Western Uganda.

    Directory of Open Access Journals (Sweden)

    Sarah Decker

    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.

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

    Science.gov (United States)

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

    2015-09-01

    Male participation in the prevention of mother-to-child transmission (PMTCT) of HIV has been determined as one of the key factors in sub-Saharan African countries, but its realization is challenging because of male-related and institutional factors. The purpose of this study is two-fold: first, we explored the views of Luba-Kasai men, living in Zambia in the Lusaka Province, on the factors that encourage, inconvenience or inhibit them in accompanying their wives to the antenatal clinic and their ideas to improve their experience. Secondly, the study considered their knowledge of the PMTCT program and how such knowledge conformed to the Zambian National Protocol Guidelines Integrated PMTCT of HIV /: AIDS. Twenty-one interviews were analyzed using qualitative inductive content analysis. The National Protocol Guidelines Integrated PMTCT of HIV/AIDS were analyzed using the deductive content analysis. The encouraging factors that emerged were involvement in the program, the time of delivery, love and care, and also the suspicion of corruption. The inconveniencing factors were the arrangements and working culture of the clinic, together with stigma and guilt. A lack of motivation, fear of death, socioeconomic circumstances and again the arrangements and working culture at the clinic were held as inhibiting factors. The ideas to remove inconvenient factors were maintaining a spiritual outlook on life, education, interaction, a good mood and a sense of meaningfulness. Considering such male views and paying attention to minorities in the development of national PMTCT of HIV Programs may enhance male participation in the process. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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

    DEFF Research Database (Denmark)

    Ndondoki, Camille; Dicko, Fatoumata; Ahuatchi Coffie, Patrick

    2014-01-01

    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....

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

    DEFF Research Database (Denmark)

    Gammeltoft, Tine; Rasch, Vibeke; Bui, Kim Chi

    2012-01-01

    '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...

  11. Health workers' views on quality of prevention of mother-to-child transmission and post-natal care for HIV-infected women and their children

    NARCIS (Netherlands)

    Nguyen, T.A.; Oosterhoff, P.; Yen, P.N.; Hardon, A.; Wright, P.

    2009-01-01

    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

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

    Science.gov (United States)

    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

    2011-10-27

    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.

  13. Effects of patient load and travel distance on HIV transmission in rural China: Implications for treatment as prevention.

    Directory of Open Access Journals (Sweden)

    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.

  14. 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

    Directory of Open Access Journals (Sweden)

    Muluye Dagnachew

    2012-03-01

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

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    children between 1 June 1994 and 30 June 2008. Results We identified 210 HIV-infected women with 255 pregnancies, ranging from 7 per year in 1995 to 39 per year in 2006. Thirty per cent of the women were Caucasian and 51% were Black African. Knowledge of HIV status before pregnancy increased from 8% (four...... or after delivery and did not receive prophylactic ART. Conclusions The annual number of HIV pregnancies increased fivefold during this 14-year period and substantial changes in pregnancy management were seen. No woman treated according to the national guidelines, i.e. ART before week 22, intravenous...

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  17. Identification of Nevirapine-Resistant HIV-1 in the Latent Reservoir after Single-Dose Nevirapine to Prevent Mother-to-Child Transmission of HIV-1

    Science.gov (United States)

    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.

    2009-01-01

    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

  18. Role of the carbohydrate-binding sites of griffithsin in the prevention of DC-SIGN-mediated capture and transmission of HIV-1.

    Directory of Open Access Journals (Sweden)

    Bart Hoorelbeke

    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

  19. Mother-to-child Transmission of HIV From 1999 to 2011 in the Amazonas, Brazil: Risk Factors and Remaining Gaps in Prevention Strategies.

    Science.gov (United States)

    de Andrade, Solange Dourado; Sabidó, Meritxell; Marcelo Monteiro, Wuelton; Canellas, Luiz; Prazeres, Vania; Schwartz Benzaken, Adele

    2016-02-01

    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.

  20. Health workers' views on quality of prevention of mother-to-child transmission and postnatal care for HIV-infected women and their children

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    Hardon Anita

    2009-05-01

    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

  1. Effectiveness of self instructional module on awareness about prevention and transmission of HIV/AIDS among bachelor level management students in selected colleges at Bangalore, India

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    Tara Ramtel

    2017-01-01

    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

  2. Prevention of mother-to-child transmission of HIV programme: South ...

    African Journals Online (AJOL)

    The 6-week polymerase chain reaction (PCR) baby test uptake was 81% (239 out of 296 live babies). Of those tested, 2.9% (95% CI 1.3 - 6.2) tested HIV positive. Conclusion. Despite challenges faced by PMTCT providers in a resource-constrained setting, this state-aided hospital provides a comprehensive and integrated ...

  3. Effectiveness of ART and condom use for prevention of sexual HIV transmission in serodiscordant couples: a systematic review and meta-analysis.

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    Huixin Liu

    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.

  4. Female perspectives of male partners’ inclusion in the prevention of mother-to-child HIV transmission programme in KwaZulu-Natal

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    Mondli Miya

    2016-02-01

    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.

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

    Science.gov (United States)

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

    2015-01-01

    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

  6. Risk adapted transmission prophylaxis to prevent vertical HIV-1 transmission: effectiveness and safety of an abbreviated regimen of postnatal oral zidovudine.

    Science.gov (United States)

    Neubert, Jennifer; Pfeffer, Maren; Borkhardt, Arndt; Niehues, Tim; Adams, Ortwin; Bolten, Mareike; Reuter, Stefan; Stannigel, Hans; Laws, Hans-Juergen

    2013-01-24

    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.

  7. A national review of vertical HIV transmission.

    Science.gov (United States)

    Forbes, John C; Alimenti, Ariane M; Singer, Joel; Brophy, Jason C; Bitnun, Ari; Samson, Lindy M; Money, Deborah M; Lee, Terry C K; Lapointe, Normand D; Read, Stanley E

    2012-03-27

    Prevention of vertical HIV transmission has evolved significantly in Canada over the last two decades. The aim of this analysis is to describe the surveillance programme used, rate of vertical HIV transmission and changing epidemiology of HIV-affected pregnancies in Canada. National perinatal HIV surveillance programme. From 1990, annual retrospective data was collected on demographic and clinical characteristics of HIV-infected mothers and their infants referred to 22 participating sites across Canada either before/during pregnancy or within 3 months after delivery. Factors impacting HIV transmission and demographic features were explored. Two thousand, six hundred and ninety-two mother-infant pairs were identified. The overall rate of vertical HIV transmission was 5.2%, declining to 2.9% since 1997. The rate of transmission for mothers who received HAART was 1%, and 0.4% if more than 4 weeks of HAART was given. Forty percent of women delivered by caesarean section, with no difference in transmission rate compared with vaginal delivery for women treated with HAART (1.4 vs. 0.6%, P = 0.129) but significant risk reduction for those who did not receive HAART (3.8 vs. 10.3%, P = 0.016). Black women were the largest group; proportions of black and aboriginal women increased significantly over time (P Vertical HIV transmission in Canada has decreased dramatically for women treated with HAART therapy. All pregnant women should be evaluated for HIV infection and programmes expanded to reach vulnerable populations including aboriginal, immigrant and IDU women.

  8. Male Partners’ Involvement in the Prevention of Mother-to-Child Transmission of HIV and Associated Factors in Arba Minch Town and Arba Minch Zuria Woreda, Southern Ethiopia

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    Marelign Tilahun

    2015-01-01

    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.

  9. Exploring the relevance of male involvement in the prevention of mother to child transmission of HIV services in Blantyre, Malawi.

    Science.gov (United States)

    Nyondo, Alinane Linda; Chimwaza, Angela Faith; Muula, Adamson Sinjani

    2014-10-30

    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.

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

    Science.gov (United States)

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

    2016-09-19

    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.

  11. Review of prevention of mother –to – child transmission of HIV ...

    African Journals Online (AJOL)

    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 ...

  12. Knowledge and practice of prevention of mother-to-child transmission of HIV among traditional birth attendants in Lagos State, Nigeria

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    Mobolanle Balogun

    2010-04-01

    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.

  13. Risk Factors for HIV Transmission and Barriers to HIV Disclosure: Metropolitan Atlanta Youth Perspectives

    OpenAIRE

    Camacho-Gonzalez, Andres F.; Wallins, Amy; Toledo, Lauren; Murray, Ashley; Gaul, Zaneta; Sutton, Madeline Y.; Gillespie, Scott; Leong, Traci; Graves, Chanda; Chakraborty, Rana

    2016-01-01

    Youth carry the highest incidence of HIV infection in the United States. Understanding adolescent and young adult (AYA) perspectives on HIV transmission risk is important for targeted HIV prevention. We conducted a mixed methods study with HIV-infected and uninfected youth, ages 18–24 years, from Atlanta, GA. We provided self-administered surveys to HIV-infected and HIV-uninfected AYAs to identify risk factors for HIV acquisition. By means of computer-assisted thematic analyses, we examined t...

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

    Science.gov (United States)

    Carmone, Andy; Bomai, Korai; Bongi, Wayaki; Frank, Tarua Dale; Dalepa, Huleve; Loifa, Betty; Kiromat, Mobumo; Das, Sarthak; Franke, Molly F.

    2014-01-01

    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

  15. Vertical transmission of HIV-an update.

    Science.gov (United States)

    Lala, Mamatha M; Merchant, Rashid H

    2010-11-01

    One of the greatest successes in AIDS research to date has by far been the discovery of successful interventions that interrupt the transmission of HIV from mother to child. It is however important to note that these successes have occurred largely in countries with great resources and the least burden of perinatal transmission of HIV. In the developing world wherein currently 95% of vertical transmission of HIV occurs, it is highly condemnable that still every minute an infected infant is said to be born in spite of the fact that vertical transmission is largely preventable, mainly because translating knowledge into practice is not always possible or feasible; This has led to a continuous growing numbers of children with HIV, thereby making pediatric HIV a looming problem rapidly draining the already burdened health care system of these countries. It is the need of the hour to appropriately address the challenges to achieve zero percent transmission of HIV from an infected mother to her child thereby giving a hope for an AIDS-free new generation worldwide.

  16. 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

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    Malaju Marelign

    2012-05-01

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

  17. A Qualitative Study of Barriers to Effectiveness of Interventions to Prevent Mother-to-Child Transmission of HIV in Arba Minch, Ethiopia

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    Adebola Adedimeji

    2012-01-01

    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.

  18. HIV-1 Early Infant Diagnosis is an Effective Indicator of the Prevention of Mother-to-Child Transmission Program Performance: Experience from Cameroon.

    Science.gov (United States)

    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

    2015-01-01

    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.

  19. Lopinavir/Ritonavir versus Lamivudine peri-exposure prophylaxis to prevent HIV-1 transmission by breastfeeding: the PROMISE-PEP trial Protocol ANRS 12174.

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    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

    2012-10-06

    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

  20. Lopinavir/Ritonavir versus Lamivudine peri-exposure prophylaxis to prevent HIV-1 transmission by breastfeeding: the PROMISE-PEP trial Protocol ANRS 12174

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    Nagot Nicolas

    2012-10-01

    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

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

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    Johri Mira

    2011-02-01

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

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

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    Sinkala Moses

    2008-12-01

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

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

    Science.gov (United States)

    Walter, Jan; Kuhn, Louise; Kankasa, Chipepo; Semrau, Katherine; Sinkala, Moses; Thea, Donald M; Aldrovandi, Grace M

    2008-12-30

    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.

  4. Perception on prevention of mother-to-child-transmission (PMTCT of HIV among women of reproductive age group in Osogbo, Southwestern Nigeria

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    Olugbenga-Bello AI

    2013-07-01

    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

  5. Nevirapine Pharmacokinetics and Safety in Neonates Receiving Combination Antiretroviral Therapy for Prevention of Vertical HIV Transmission.

    Science.gov (United States)

    Lau, Elaine; Brophy, Jason; Samson, Lindy; Kakkar, Fatima; Campbell, Douglas M; Yudin, Mark H; Murphy, Kellie; Seto, Winnie; Colantonio, David; Read, Stanley E; Bitnun, Ari

    2017-04-15

    Nevirapine (NVP)-based combination antiretroviral therapy is routinely prescribed to infants deemed at high risk of vertical HIV infection in our centers. We evaluated NVP pharmacokinetics and safety of this regimen. Neonates were recruited prospectively between September 2012 and April 2015 or enrolled retrospectively if treated similarly before prospective study initiation. NVP was dosed at 150 mg/m daily for 14 days, then twice daily for 14 days. NVP levels were drawn at weeks 1, 2, and 4 [target trough (NVP-T): 3-8 mg/L]. Thirty-three neonates were included (23 prospectively). Median gestational age (GA) and birth weight were 38 weeks (32-41 weeks) and 2.9 kg (1.5-4.2 kg), respectively. Median NVP-Ts were 8.2 mg/L (1.6-25.1 mg/L), 3.5 mg/L (1.6-6.8 mg/L), and 4.3 mg/L (0.1-19.9 mg/L) at weeks 1, 2, and 4, respectively. The proportions with therapeutic NVP-T were 42%, 61%, and 73% at these same timepoints. Median apparent oral clearance (CL/F) increased from 0.05 L·kg·h (0.01-0.50 L·kg·h) at week 2 to 0.18 L·kg·h (0.01-0.78 L·kg·h) at week 4. Increased drug exposure [area under the curve (AUCτ)] correlated with younger GA (r = 0.459, P = 0.032) and lower birth weight (r = 0.542, P = 0.009). The most common adverse events potentially attributable to combination antiretroviral therapy were transient asymptomatic hyperlactatemia (26%), anemia (24.7%), and neutropenia (22.1%). Treatment dose NVP was generally well-tolerated and associated with normalization of trough levels over time in most cases without dose adjustment. Lower empiric dosing is recommended for infants <34 weeks of GA. Routine therapeutic drug monitoring may not be required for infants ≥34 weeks of GA.

  6. Behaviors Influencing Human Immunodeficiency Virus Transmission in the Context of Positive Prevention among People Living with HIV/Acquired Immunodeficiency Syndrome in Iran: A Qualitative Study

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    Seyed Ramin Radfar

    2014-01-01

    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.

  7. Behaviors Influencing Human Immunodeficiency Virus Transmission in the Context of Positive Prevention among People Living with HIV/Acquired Immunodeficiency Syndrome in Iran: A Qualitative Study.

    Science.gov (United States)

    Radfar, Seyed Ramin; Sedaghat, Abbas; Banihashemi, Arash Tehrani; Gouya, Mohammadmehdi; Rawson, Richard A

    2014-08-01

    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.

  8. [Maternal-fetal transmission of HIV].

    Science.gov (United States)

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

    1995-02-01

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

  9. Antiretroviral drug regimens to prevent mother-to-child transmission of HIV: a review of scientific, program, and policy advances for sub-Saharan Africa.

    Science.gov (United States)

    Chi, Benjamin H; Stringer, Jeffrey S A; Moodley, Dhayendre

    2013-06-01

    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.

  10. The outcome of prevention of mother to child transmission (PMTCT) of HIV infection programme in Nnewi, southeast Nigeria.

    Science.gov (United States)

    Ikechebelu, J I; Ugboaja, J O; Kalu, S O; Ugochukwu, E F

    2011-01-01

    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.

  11. 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.

    Science.gov (United States)

    Kebede, Zemene Tigabu; Taye, Belaynew Wasie

    2016-01-01

    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.

  12. Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV services in Kibera, Kenya: Barriers to engaging and remaining in care.

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    Thomson, Kerry A; Telfer, Barbara; Opondo Awiti, Patricia; Munge, Jane; Ngunga, Mathew; Reid, Anthony

    2018-01-01

    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.

  13. Understanding HIV transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy: an information--motivation--behavioral skills model analysis.

    Science.gov (United States)

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

    2013-08-01

    The current study applied the Information-Motivation-Behavioral Skills (IMB) model (Fisher & Fisher, 1992; Fisher & Fisher, 1993) to identify factors associated with human immunodeficiency virus (HIV) transmission risk behavior among HIV-infected South Africans receiving antiretroviral therapy (ART), a population of considerable significance for curtailing, or maintaining, South Africa's generalized HIV epidemic. HIV prevention information, HIV prevention motivation, HIV prevention behavioral skills, and HIV transmission risk behavior were assessed in a sample of 1,388 South Africans infected with HIV and receiving ART in 16 clinics in KwaZulu-Natal, South Africa. Findings confirmed the assumptions of the IMB model and demonstrated that HIV prevention information and HIV prevention motivation work through HIV prevention behavioral skills to affect HIV transmission risk behavior in this population. Subanalyses confirmed these relationships for HIV transmission risk behavior overall and for HIV transmission risk behavior with partners perceived to be HIV-negative or HIV-status unknown. A consistent pattern of gender differences showed that for men, HIV prevention information and HIV prevention motivation may have direct links with HIV preventive behavior, whereas for women, the effect of HIV prevention motivation works through HIV prevention behavioral skills to affect HIV preventive behavior. These IMB model-based findings suggest directions for HIV prevention interventions with South African men and women living with HIV and on ART as an important component of overall strategies to contain South Africa's generalized HIV epidemic. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  14. A cluster randomized controlled trial of lay health worker support for prevention of mother to child transmission of HIV (PMTCT) in South Africa.

    Science.gov (United States)

    Peltzer, Karl; Weiss, Stephen M; Soni, Manasi; Lee, Tae Kyoung; Rodriguez, Violeta J; Cook, Ryan; Alcaide, Maria Luisa; Setswe, Geoffrey; Jones, Deborah L

    2017-12-16

    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

  15. Factors Associated with Male Partner Involvement in Programs for the Prevention of Mother-to-Child Transmission of HIV in Rural South Africa

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    Motlagabo G. Matseke

    2017-11-01

    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.

  16. HIV transmission during paediatric health care in sub- Saharan ...

    African Journals Online (AJOL)

    Health care systems in sub-Saharan Africa are challenged not only to improve care for the increasing number of HIV-infected children, but also to prevent transmission of HIV to other children and health care workers through contaminated medical procedures and needlestick accidents. HIV-infected children aged to 1 year ...

  17. The HIV-1 transmission bottleneck

    OpenAIRE

    Kariuki, Samuel Mundia; Selhorst, Philippe; Ari?n, Kevin K.; Dorfman, Jeffrey R.

    2017-01-01

    It is well established that most new systemic infections of HIV-1 can be traced back to one or a limited number of founder viruses. Usually, these founders are more closely related to minor HIV-1 populations in the blood of the presumed donor than to more abundant lineages. This has led to the widely accepted idea that transmission selects for viral characteristics that facilitate crossing the mucosal barrier of the recipient?s genital tract, although the specific selective forces or advantag...

  18. Scale up use of family planning services to prevent maternal transmission of HIV among discordant couples: a cross-sectional study within a resource-limited setting

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    Kuete M

    2016-10-01

    Full Text Available Martin Kuete,1,2 HongFang Yuan,1 Aude Laure Tchoua Kemayou,2 Emmanuel Ancel Songo,2 Fan Yang,1 XiuLan Ma,1 ChengLiang Xiong,1 HuiPing Zhang1 1Obstetrics and Gynecology, Reproductive Center, Family Planning and Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China; 2Main Maternity of Obstetrics and Gynecology, Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon Background: Integration of family planning services (FPS into human immunodeficiency virus (HIV care for HIV-infected women is an important aspect of the global prevention of mother-to-child transmission (PMTCT strategy. We assessed the integration of FPS into routine care of HIV-infected mothers by evaluating the uptake and barriers of contraception and PMTCT services. Methods: We conducted an interventional study using the interrupted time series approach in the health care facilities located in Yaounde, Cameroon. First, structured questionnaires related to family planning use, PMTCT services use, and infection risk of the sexual partner were administered to the first trimester pregnant women who were HIV infected and living with uninfected partners. Second, 2 weeks before the delivery date, the women were interviewed according to the prior counseling interventions received, in order to assess their behavior on FPS, antiretroviral therapy (ART use, delivery option, and infant nourishment to be adopted. P-values below 0.05 were considered statistically significant in the statistical analyses. Results: Of 94 HIV-infected women, 69% were stable couples. Only 13% of women had attended FPS before conception. Although the vast majority were knowledgeable about modern and traditional contraception methods, only 19% had experienced effective contraceptive methods. However, 66% preferred condom use, 45% having three children still expressed a desire to conceive, while 44% reported

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

    Directory of Open Access Journals (Sweden)

    Lawani LO

    2014-03-01

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

  20. Potential impact of new WHO criteria for antiretroviral treatment for prevention of mother-to- child HIV transmission.

    Science.gov (United States)

    Kuhn, Louise; Aldrovandi, Grace M; Sinkala, Moses; Kankasa, Chipepo; Mwiya, Mwiya; Thea, Donald M

    2010-06-01

    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.

  1. 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.

    Science.gov (United States)

    Favarato, G; Bailey, H; Burns, F; Prieto, L; Soriano-Arandes, A; Thorne, C

    2018-02-01

    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.

  2. HIV-positive women in Australia explain their use and non-use of antiretroviral therapy in preventing mother-to-child transmission.

    Science.gov (United States)

    McDonald, Karalyn; Kirkman, Maggie

    2011-05-01

    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.

  3. Barriers and enablers of the prevention of mother-to-child transmission of HIV/AIDS program in China: a systematic review and policy implications.

    Science.gov (United States)

    Peng, Zhuoxin; Wang, Shengnan; Xu, Biao; Wang, Weibing

    2017-02-01

    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.

  4. The role of drugs in HIV prevention

    Science.gov (United States)

    Kembaren, T.

    2018-03-01

    WHO reports 36.7 million people are living with Human Immunodeficiency Virus (HIV) worldwide by 2016 with about 1.8 million new infections each year. It will be a specific health problem for the world in both developed and developing countries so it is necessary strategies to reduce HIV transmission to the community. HIV transmission in people with risk factors is largely determined by the amount of virus in the blood of people who are the source of infection. Antiretroviral (ARV) therapy has long been used in HIV patients, which serves to suppress viral replication so that the patient’s immunity increases; opportunistic infections are resolved and prolong the lifespan and lower transmission rates. In the HIV Prevention Trials Network (HPTN) study 052 there was a 96% reduction in transmission in earlier antiretroviral. ARV is also used in the prevention of transmission in people exposed to HIV virus that is Postexposure Prophylaxis as well as in people at risk before exposure (Pre-exposure Prophylaxis). Three prevention strategies with the provision of ARV is expected to be guided as a means of prevention of transmission in addition to behavioral changes has long been declared since the beginning of the HIV epidemic.

  5. Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana.

    Science.gov (United States)

    VanDeusen, Adam; Paintsil, Elijah; Agyarko-Poku, Thomas; Long, Elisa F

    2015-03-18

    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.

  6. Prevention of HIV infection by passive immunization with HIV immunoglobulin

    NARCIS (Netherlands)

    Prince, A. M.; Reesink, H.; Pascual, D.; Horowitz, B.; Hewlett, I.; Murthy, K. K.; Cobb, K. E.; Eichberg, J. W.

    1991-01-01

    The use of a human immunodeficiency virus (HIV) immune globulin (HIVIG) in prevention of HIV infection in chimpanzees was investigated in the hope of ultimate application to interruption of vertical transmission. In previous experiments, no protection was observed when relatively high challenge

  7. Economic Costs of Patients Attending the Prevention of Mother-to- Child Transmission of HIV/AIDS (PMTCT Services in Ethiopia: Urban-Rural Settings

    Directory of Open Access Journals (Sweden)

    Elias Asfaw Zegeye

    2016-08-01

    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.

  8. The impact of comprehensive prevention of mother-to-child HIV transmission in Dehong prefecture, Yunnan province, 2005-2010: a hard-hit area by HIV in Southern China.

    Science.gov (United States)

    Shan, Duo; Sun, Jiangping; Khoshnood, Kaveh; Fu, Jeannia; Duan, Song; Jiang, Chengqin; Zhang, Yan; Bulterys, Marc; Guo, Haoyan; Sante, Michael; Liu, Hui; Hu, Yiyun

    2014-03-01

    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.

  9. (ajst) transmission dynamics of hiv/aids

    African Journals Online (AJOL)

    ABSTRACT: This paper examines the transmission dynamics of HIV/AIDS with screening using ... HIV/AIDS. Also, the effect of non-linear incidence parameters showed that transmission dynamics of. HIV/AIDS will be lowered when infectives after becoming aware of their ...... vertical transmission of the disease and mode of.

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

    OpenAIRE

    Nyondo, Aliane Linda; Sinjani Muula, Adamson; Faith Chimwaza, Angela

    2013-01-01

    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...

  11. Influence of Chitosan Swelling Behaviour on Controlled Release of Tenofovir from Mucoadhesive Vaginal Systems for Prevention of Sexual Transmission of HIV

    Science.gov (United States)

    Notario-Pérez, Fernando; Martín-Illana, Araceli; Cazorla-Luna, Raúl; Ruiz-Caro, Roberto; Bedoya, Luis-Miguel; Tamayo, Aitana; Rubio, Juan; Veiga, María-Dolores

    2017-01-01

    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

  12. Influence of Chitosan Swelling Behaviour on Controlled Release of Tenofovir from Mucoadhesive Vaginal Systems for Prevention of Sexual Transmission of HIV.

    Science.gov (United States)

    Notario-Pérez, Fernando; Martín-Illana, Araceli; Cazorla-Luna, Raúl; Ruiz-Caro, Roberto; Bedoya, Luis-Miguel; Tamayo, Aitana; Rubio, Juan; Veiga, María-Dolores

    2017-02-21

    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.

  13. Influence of Chitosan Swelling Behaviour on Controlled Release of Tenofovir from Mucoadhesive Vaginal Systems for Prevention of Sexual Transmission of HIV

    Directory of Open Access Journals (Sweden)

    Fernando Notario-Pérez

    2017-02-01

    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.

  14. Dynamic characteristic analysis of mother to child transmission of HIV in India

    Directory of Open Access Journals (Sweden)

    A. S. Kadi

    2014-01-01

    Full Text Available In this study, a mathematical model of HIV/AIDS mother to child transmission to analyze the effectiveness of prevention of HIV mother to child transmission programmes has been presented. The result reveals that prevention of HIV mother to child transmission programmes focusing only on biological transmission cannot control the increase of the HIV mother to child transmission in India. Hence, to control the HIV MTCT epidemic in India, in spite of strengthening the PMTCT programmes to reduce transmission rates, effective measures should be taken to prevent HIV infection in women of reproductive ages. Since the overall HIV MTCT epidemic is dependent on the HIV incidence in women of reproductive age group, the integration of pediatric HIV model with a detailed model of adult HIV would be investigated in future studies in order to model these dynamics more accurately.

  15. A comprehensive review of the barriers and promoters health workers experience in delivering prevention of vertical transmission of HIV services in sub-Saharan Africa.

    Science.gov (United States)

    Schuster, Roseanne C; McMahon, Devon E; Young, Sera L

    2016-01-01

    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

  16. Uptake, outcomes, and costs of antenatal, well-baby, and prevention of mother-to-child transmission of HIV services under routine care conditions in Zambia.

    Directory of Open Access Journals (Sweden)

    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

  17. [HIV infection in the child after materno-fetal transmission: early treatment with azidothymidine and prevention of secondary infectious complications].

    Science.gov (United States)

    Michel, G; Vallée, D; Thuret, I; Chambost, H; Tamalet, C; de Boisse, P; Leclaire, M; Farnarier, C; Kaplanski, S; Perrimond, H

    1992-01-01

    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.

  18. Antiretroviral Therapy Containing Raltegravir to Prevent Mother-to-Child Transmission of HIV in Infected Pregnant Women.

    Science.gov (United States)

    Cecchini, Diego M; Martinez, Marina G; Morganti, Laura M; Rodriguez, Claudia G

    2017-05-31

    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.

  19. Antiretroviral therapy containing raltegravir to prevent mother-to-child transmission of HIV in infected pregnant women

    Directory of Open Access Journals (Sweden)

    Diego M. Cecchini

    2017-06-01

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Texting improves testing: a randomized trial of two-way SMS to increase postpartum prevention of mother-to-child transmission retention and infant HIV testing.

    Science.gov (United States)

    Odeny, Thomas A; Bukusi, Elizabeth A; Cohen, Craig R; Yuhas, Krista; Camlin, Carol S; McClelland, R Scott

    2014-09-24

    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.

  2. Knowledge and attitudes about HIV infection and prevention of ...

    African Journals Online (AJOL)

    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.

  3. HIV transmission. Selection bias at the heterosexual HIV-1 transmission bottleneck.

    Science.gov (United States)

    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

    2014-07-11

    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.

  4. Future of phylogeny in HIV prevention.

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    Brenner, Bluma G; Wainberg, Mark A

    2013-07-01

    The success of the HIV Prevention Trials Network 052 trial has led to revisions in HIV-1 treatment guidelines. Antiretroviral therapy may reduce the risk of HIV-1 transmissions at the population level. The design of successful treatment as prevention interventions will be predicated on a comprehensive understanding of the spatial, temporal, and biological dynamics of heterosexual men who have sex with men and intravenous drug user epidemics. Viral phylogenetics can capture the underlying structure of transmission networks based on the genetic interrelatedness of viral sequences and cluster networks that could not be otherwise identified. This article describes the phylogenetic expansion of the Montreal men who have sex with men epidemic over the last decade. High rates of coclustering of primary infections are associated with 1 infection leading to 13 onward transmissions. Phylogeny substantiates the role of primary and recent stage infection in transmission dynamics, underlying the importance of timely diagnosis and immediate antiretroviral therapy initiation to avert transmission cascades.

  5. Vertical HIV transmission should be excluded from criminal prosecution.

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    Csete, Joanne; Pearshouse, Richard; Symington, Alison

    2009-11-01

    Prevention of mother-to-child transmission of HIV (PMTCT) is an important part of global and national responses to HIV and AIDS. In recent years, many countries have adopted laws to criminalise HIV transmission and exposure. Many of these laws are broadly written and have provisions that enable criminal prosecution of vertical transmission in some circumstances. Even if prosecutions have not yet materialised, the use of these laws against HIV-positive pregnant women could compound the stigma already faced by them and have a chilling effect on women's utilisation of prevention of mother-to-child transmission programmes. Although criminal laws targeting HIV transmission have often been proposed and adopted with the intent of protecting women, such laws may disadvantage women instead. Criminal laws on HIV transmission and exposure should be reviewed and revised to ensure that vertical transmission is explicitly excluded as an object of criminal prosecution. Scaling up PMTCT services and ensuring that they are affordable, accessible, welcoming and of good quality is the most effective strategy for reducing vertical transmission of HIV and should be the primary strategy in all countries.

  6. Factors associated with male involvement in the prevention of mother to child transmission of HIV, Midlands Province, Zimbabwe, 2015 - a case control study

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    Annamercy Makoni

    2016-04-01

    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.

  7. 18-month effectiveness of short-course antiretroviral regimens combined with alternatives to breastfeeding to prevent HIV mother-to-child transmission.

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    Valériane Leroy

    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

  8. Situation analysis of the existing infant feeding pattern at the commencement of the prevention of mother to child transmission (PMTCT) of HIV programme in Ibadan.

    Science.gov (United States)

    Brown, B J; Oladokun, R E; Osinusi, K

    2009-12-01

    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.

  9. Determinants of male involvement in the prevention of mother-to-child transmission of HIV programme in Eastern Uganda: a cross-sectional survey

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    Semiyaga Nulu

    2010-06-01

    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

  10. Likely stakeholders in the prevention of mother to child transmission ...

    African Journals Online (AJOL)

    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 ...

  11. Prevention of Parent to Child Transmission of HIV: Single Centre Experience of 14 years at Tertiary Care Hospital in Delhi, India.

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    Radhika, A G; Chawla, Sonia; Bhaskaran, Sruthi

    2017-08-01

    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.

  12. Comparison of Two Strategies for Administering Nevirapine to Prevent Perinatal HIV Transmission in High-Prevalence, Resource-Poor Settings

    Science.gov (United States)

    Stringer, Jeffrey S. A.; Sinkala, Moses; Stout, Julia P.; Goldenberg, Robert L.; Acosta, Edward P.; Chapman, Victoria; Kumwenda-Phiri, Rosemary; Vermund, Sten H.

    2009-01-01

    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

  13. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review

    Science.gov (United States)

    Gourlay, Annabelle; Birdthistle, Isolde; Mburu, Gitau; Iorpenda, Kate; Wringe, Alison

    2013-01-01

    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

  14. Apparent declines in the global HIV transmission rate.

    Science.gov (United States)

    Holtgrave, D R

    2009-12-01

    Estimates of global and regional HIV incidence and prevalence are helpful for gauging the state of the epidemic. However, they do not contain as much information as the HIV transmission rate for judging the potential speed of HIV spread. The HIV transmission rate can be defined as follows: for every 100 persons living with HIV, the number of HIV infections transmitted to seronegative partners in one year. Here, we estimate the transmission rate for the global epidemic for the years 2001 and 2007, and for 10 major international regions for the year 2007. The transmission rate is calculated as incidence divided by prevalence, and the quotient then multiplied by 100. Previously published and publicly available, the Joint United Nations Programme on HIV/AIDS estimates of HIV incidence and prevalence at the global and regional levels were utilized. Between 2001 and 2007, the global HIV transmission rate dropped from 10.2 to 8.2, a decrease of 19.6% in six years time. The regional estimates for 2007 ranged from 3.7 in Western and Central Europe, to 10.5 in the Middle East and Northern Africa, to 17.6 in Oceania. The global transmission rate for 2007 of 8.2 indicates that 91.8% or more of persons living with HIV are not transmitting to other persons in a given year. The 19.6% decrease in HIV transmission rate between 2001 and 2007 appears to indicate some success in global HIV prevention efforts. The range of regional estimates helps to identify areas with the potential for rapidly growing epidemics, even if the raw numbers of new infections and prevalence are low. I believe the transmission rate to be a useful statistic and recommend its further adoption.

  15. Prevention-of-Mother-To-Child-Transmission of HIV Services in Sub-Saharan Africa: A Qualitative Analysis of Healthcare Providers and Clients Challenges in Ghana

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    Amos Kankponang Laar, PhD

    2014-09-01

    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.

  16. Option B+ for prevention of vertical HIV transmission has no influence on adverse birth outcomes in a cross-sectional cohort in Western Uganda.

    Science.gov (United States)

    Rempis, Eva M; Schnack, Alexandra; Decker, Sarah; Braun, Vera; Rubaihayo, John; Tumwesigye, Nazarius Mbona; Busingye, Priscilla; Harms, Gundel; Theuring, Stefanie

    2017-03-07

    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.

  17. Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV.

    Science.gov (United States)

    Bull, Sheana; Thomas, Deborah Sk; Nyanza, Elias C; Ngallaba, Sospatro E

    2018-01-15

    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

  18. Treatment as long-term prevention: sustained reduction in HIV sexual transmission risk with use of antiretroviral therapy in rural Uganda.

    Science.gov (United States)

    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

    2014-01-14

    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.

  19. 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.

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    Vrazo, Alexandra C; Firth, Jacqueline; Amzel, Anouk; Sedillo, Rebecca; Ryan, Julia; Phelps, B Ryan

    2018-02-01

    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

  20. Toward elimination of mother-to-child transmission of HIV in South Africa: how best to monitor early infant infections within the Prevention of Mother-to-Child Transmission Program.

    Science.gov (United States)

    Sherman, Gayle G; Mazanderani, Ahmad Haeri; Barron, Peter; Bhardwaj, Sanjana; Niit, Ronelle; Okobi, Margaret; Puren, Adrian; Jackson, Debra J; Goga, Ameena Ebrahim

    2017-06-01

    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.

  1. Prevention of mother-to-child transmission of HIV guidelines: Nurses’ views at four primary healthcare facilities in the Limpopo Province

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    Barbara A. Hanrahan

    2017-06-01

    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.

  2. Risk Factors for HIV Transmission and Barriers to HIV Disclosure: Metropolitan Atlanta Youth Perspectives.

    Science.gov (United States)

    Camacho-Gonzalez, Andres F; Wallins, Amy; Toledo, Lauren; Murray, Ashley; Gaul, Zaneta; Sutton, Madeline Y; Gillespie, Scott; Leong, Traci; Graves, Chanda; Chakraborty, Rana

    2016-01-01

    Youth carry the highest incidence of HIV infection in the United States. Understanding adolescent and young adult (AYA) perspectives on HIV transmission risk is important for targeted HIV prevention. We conducted a mixed methods study with HIV-infected and uninfected youth, ages 18-24 years, from Atlanta, GA. We provided self-administered surveys to HIV-infected and HIV-uninfected AYAs to identify risk factors for HIV acquisition. By means of computer-assisted thematic analyses, we examined transcribed focus group responses on HIV education, contributors to HIV transmission, and pre-sex HIV status disclosure. The 68 participants had the following characteristics: mean age 21.5 years (standard deviation: 1.8 years), 85% male, 90% black, 68% HIV-infected. HIV risk behaviors included the perception of condomless sex (Likert scale mean: 8.0) and transactional sex (88% of participants); no differences were noted by HIV status. Qualitative analyses revealed two main themes: (1) HIV risk factors among AYAs, and (2) barriers to discussing HIV status before sex. Participants felt the use of social media, need for immediate gratification, and lack of concern about HIV disease were risk factors for AYAs. Discussing HIV status with sex partners was uncommon. Key reasons included: fear of rejection, lack of confidentiality, discussion was unnecessary in temporary relationships, and disclosure negatively affecting the mood. HIV prevention strategies for AYAs should include improving condom use frequency and HIV disclosure skills, responsible utilization of social media, and education addressing HIV prevention including the risks of transactional sex.

  3. Predictors of loss to follow-up among children registered in an HIV prevention mother-to-child transmission cohort study in Pernambuco, Brazil.

    Science.gov (United States)

    Gouveia, Pedro Alves da Cruz; da Silva, Gerlane Alves Pontes; de Albuquerque, Maria de Fatima Pessoa Militão

    2014-11-27

    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.

  4. [Prevention of vertical transmission and side effects of antiretroviral therapy in children born to HIV-positive South Eastern area of Santiago, Chile: 15-years perspective].

    Science.gov (United States)

    Peña, Anamaría; Cerón, Inés; Budnik, Isolda; Barttlet, Diego; Cataldo, Karma; Fernández, Ana M; Ramírez, Anamaría; Lasso, Martín

    2013-12-01

    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.

  5. how acceptable are the prevention of mother to child transmission

    African Journals Online (AJOL)

    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 ...

  6. Prevention of mother to child transmission (PMTCT) of human ...

    African Journals Online (AJOL)

    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: ...

  7. [Effect of highly active anti-retroviral therapy on prevention of mother to child transmission of HIV and on infant growth and development].

    Science.gov (United States)

    He, Yan; Luo, Yan; Ding, Yi-ling; Zheng, Yu-huang; Li, Jing; Huang, Jian; Li, Jie-min

    2011-10-01

    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

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

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    Thomas Obinchemti Egbe

    2016-01-01

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

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

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    Thomas A Odeny

    Full Text Available 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

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

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    Agnes Binagwaho

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

  11. Slower clearance of nevirapine resistant virus in infants failing extended nevirapine prophylaxis for prevention of mother-to-child HIV transmission.

    Science.gov (United States)

    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

    2011-08-01

    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.

  12. The impact of programs for prevention of mother-to-child transmission of HIV on health care services and systems in sub-Saharan Africa - A review.

    Science.gov (United States)

    Mutabazi, Jean Claude; Zarowsky, Christina; Trottier, Helen

    2017-01-01

    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

  13. Combining social and genetic networks to study HIV transmission in mixing risk groups

    NARCIS (Netherlands)

    Zarrabi, N.; Prosperi, M.C.F.; Belleman, R.G.; Di Giambenedetto, S.; Fabbiani, M.; De Luca, A.; Sloot, P.M.A.

    2013-01-01

    Reconstruction of HIV transmission networks is important for understanding and preventing the spread of the virus and drug resistant variants. Mixing risk groups is important in network analysis of HIV in order to assess the role of transmission between risk groups in the HIV epidemic. Most of the

  14. Bottlenecks in HIV-1 transmission: insights from the study of founder viruses

    Science.gov (United States)

    Joseph, Sarah B.; Swanstrom, Ronald; Kashuba, Angela D. M.; Cohen, Myron S.

    2016-01-01

    HIV-1 infection typically results from the transmission of a single viral variant, the transmitted/founder (T/F) virus. Studies of these HIV-1 variants provide critical information about the transmission bottlenecks and the selective pressures acting on the virus in the transmission fluid and in the recipient tissues. These studies reveal that T/F virus phenotypes are shaped by stochastic and selective forces that restrict transmission and may be targets for prevention strategies. In this Review, we highlight how studies of T/F viruses contribute to a better understanding of the biology of HIV-1 transmission and discuss how these findings affect HIV-1 prevention strategies. PMID:26052661

  15. Top Questions About HIV Prevention and Women

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    ... THE OFFICE ON WOMEN’S HEALTH Top Questions About HIV Prevention and Women The human immunodeficiency virus, or HIV, ... entry of HIV. This is Top Questions About HIV Prevention and Women 2 especially true for girls and ...

  16. Attitudes of people in the UK with HIV who Are Antiretroviral (ART) Naïve to starting ART at high CD4 counts for potential health benefit or to prevent HIV transmission.

    Science.gov (United States)

    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

    2014-01-01

    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.

  17. ORIGINAL ARTICLES The prevention of mother-to-child HIV ...

    African Journals Online (AJOL)

    ORIGINAL ARTICLES. The prevention of mother-to-child HIV transmission programme and infant feeding practices. K Hilderbrand, E Goemaere, D Coetzee. Since the first cases of HIV transmission through breast- feeding were documented, a fierce debate has raged on appropriate guidelines for infant feeding in resource- ...

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

    Science.gov (United States)

    Antunes, Francisco; Zindoga, Pereira; Gomes, Perpétua; Augusto, Orvalho; Mahumane, Isabel; Veloso, Luís; Valadas, Emília; Camacho, Ricardo

    2015-01-01

    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

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

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    Leshabari Sebalda

    2011-07-01

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

  20. Effectiveness of multidrug antiretroviral regimens to prevent mother-to-child transmission of HIV-1 in routine public health services in Cameroon.

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    Patrice Tchendjou

    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.

  1. Male Partner Risk Behaviors Are Associated With Reactive Rapid HIV Antibody Tests Among Pregnant Mexican Women: Implications for Prevention of Vertical and Sexual HIV Transmission in Concentrated HIV Epidemics.

    Science.gov (United States)

    Rivero, Estela; Kendall, Tamil

    2015-01-01

    Mexico's policies on antenatal HIV testing are contradictory, and little is known about social and behavioral characteristics that increase pregnant Mexican women's risks of acquiring HIV. We analyzed the association between risk behaviors reported by pregnant women for themselves and their male partners, and women's rapid HIV antibody test results from a large national sample. Three quarters of pregnant women with a reactive test did not report risk behaviors for themselves and one third did not report risk behaviors for themselves or their male partners. In the retrospective case-control analysis, other than reporting multiple sexual partners, reactive pregnant women reported risk behaviors did not differ from nonreactive women's behaviors. However, reactive pregnant women were significantly more likely to have reported risk behaviors for male partners. Our findings support universal offer of antenatal HIV testing and suggest that HIV prevention for women should focus on reducing risk of HIV acquisition within stable relationships. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  2. ORIGINAL ARTICLES HIV transmission during paediatric health ...

    African Journals Online (AJOL)

    ORIGINAL ARTICLES. REVIEW ARTICLE. HIV transmission during paediatric health care in sub-. Saharan Africa - risks and evidence. David Gisselquist, John J Potterat, Stuart Brody. Health care systems in sub-Saharan Africa are challenged not only to improve care for the increasing number of HIV- infected children, but ...

  3. Prevenção da transmissão vertical do HIV: atitude dos obstetras em Salvador, Brasil Prevention of HIV vertical transmission: obstetricians'atitude in Salvador, Brasil

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    João Paulo Queiroz Farias

    2008-03-01

    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

  4. Programmes for the prevention of parent-to-child transmission of HIV in Papua New Guinea: Health system challenges and opportunities.

    Science.gov (United States)

    Tynan, Anna; Vallely, Lisa; Kupul, Martha; Neo, Ruthy; Fiya, Voletta; Worth, Heather; Kariwiga, Grace; Mola, Glen D L; Kaldor, John; Kelly-Hanku, Angela

    2017-09-27

    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.

  5. Persistent misconceptions about HIV transmission among males and females in Malawi.

    Science.gov (United States)

    Sano, Yujiro; Antabe, Roger; Atuoye, Kilian Nasung; Hussey, Lucia Kafui; Bayne, Jason; Galaa, Sylvester Zackaria; Mkandawire, Paul; Luginaah, Isaac

    2016-06-07

    The prevalence of HIV in Malawi is one of the highest in sub-Saharan Africa, and misconceptions about its mode of transmission are considered a major contributor to the continued spread of the virus. Using the 2010 Malawi Demographic and Health Survey, the current study explored factors associated with misconceptions about HIV transmission among males and females. We found that higher levels of ABC prevention knowledge were associated with lower likelihood of endorsing misconceptions among females and males (OR = 0.85, p misconceptions about HIV transmission. Moreover, marital status and ethnicity were significant predictors of HIV transmission misconceptions among females but not among males. Also, household wealth quintiles, education, religion, and urban-rural residence were significantly associated with endorsing misconceptions about HIV transmission. Based on our findings, we recommend that education on HIV transmission in Malawi should integrate cultural and ethnic considerations of HIV/AIDS.

  6. HIV TRANSMISSION BREAST-FEEDING AND HIV: AN UPDATE

    African Journals Online (AJOL)

    Enrique

    2004-11-02

    Nov 2, 2004 ... feeding and will discuss factors that increase the risk of HIV transmission during breast-feeding as well as strategies that could be .... own risks. The objective of any PMTCT strategy must be to optimise overall child survival, including that of children of. HIV-uninfected women. Central to this decision is.

  7. Assessing the impact of federal HIV prevention spending on HIV testing and awareness.

    Science.gov (United States)

    Linas, Benjamin P; Zheng, Hui; Losina, Elena; Walensky, Rochelle P; Freedberg, Kenneth A

    2006-06-01

    The United States allocates more than $900 million annually for the prevention of HIV infection. We assessed the impact of this funding on HIV testing and knowledge. We linked data from the Behavioral Risk Factor Surveillance System with tracking of Centers for Disease Control and Prevention (CDC) HIV prevention funding. We developed and validated regression models of the relation between HIV prevention funding to a respondent's state and the odds that the respondent (1) had been tested for HIV, and (2) was aware of methods to prevent mother-to-child HIV transmission (MTCT). The odds of having been tested for HIV increased with increased CDC funding to states (P=.009), as did awareness of prevention of MTCT (P=.002). We estimate that CDC HIV prevention funds led to 12.8 million more people being tested for HIV between 1998 and 2003 than would have been tested had all states received funds equal to the lowest quintile of funding. Federal HIV prevention funds independently correlate with increased HIV testing and knowledge of prevention of MTCT. Proposed reductions in HIV prevention spending would likely have adverse public health consequences.

  8. 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

    OpenAIRE

    Nyondo, Alinane Linda; Choko, Augustine Talumba; Chimwaza, Angela Faith; Muula, Adamson Sinjani

    2015-01-01

    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...

  9. HIV Transmission Dynamics Among Foreign-Born Persons in the United States.

    Science.gov (United States)

    Valverde, Eduardo E; Oster, Alexandra M; Xu, Songli; Wertheim, Joel O; Hernandez, Angela L

    2017-12-15

    In the United States (US), foreign-born persons are disproportionately affected by HIV and differ epidemiologically from US-born persons with diagnosed HIV infection. Understanding HIV transmission dynamics among foreign-born persons is important to guide HIV prevention efforts for these populations. We conducted molecular transmission network analysis to describe HIV transmission dynamics among foreign-born persons with diagnosed HIV. Using HIV-1 polymerase nucleotide sequences reported to the US National HIV Surveillance System for persons with diagnosed HIV infection during 2001-2013, we constructed a genetic distance-based transmission network using HIV-TRACE and examined the birth region of potential transmission partners in this network. Of 77,686 people, 12,064 (16%) were foreign born. Overall, 28% of foreign-born persons linked to at least one other person in the transmission network. Of potential transmission partners, 62% were born in the United States, 31% were born in the same region as the foreign-born person, and 7% were born in another region of the world. Most transmission partners of male foreign-born persons (63%) were born in the United States, whereas most transmission partners of female foreign-borns (57%) were born in their same world region. These finding suggests that a majority of HIV infections among foreign-born persons in our network occurred after immigrating to the United States. Efforts to prevent HIV infection among foreign-born persons in the United States should include information of the transmission networks in which these individuals acquire or transmit HIV to develop more targeted HIV prevention interventions.

  10. Counselling at primary health facilities and level of knowledge of antenatal attendees and their attitude on prevention of Mother to Child Transmission of HIV in Dar-es salaam, Tanzania.

    Science.gov (United States)

    Wangwe, P J T; Nyasinde, M; Charles, D S K

    2013-12-01

    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.

  11. 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.

    Science.gov (United States)

    Wangwe, P J T; Nyasinde, M; Charles, D S K

    2014-03-01

    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.

  12. The Relationship between Substance Use and HIV Transmission in Peru.

    Science.gov (United States)

    Massa, Alfredo A; Rosen, Marc I

    2012-01-01

    The primary aim of this article is to review literature regarding the relationship between substance use and HIV transmission in Peru. Detailed search of published literature completed in PubMed and Google-Scholar and other local Peruvian publications. Mesh words: "Peru"; "substance-related-disorders"; "HIV"; "sexual-behavior" and their combinations. From 3921 articles, 150 were chosen for more careful review and only 26 were used for the review. No date limit was used in this review. Peruvian HIV epidemic is limited to MSM and its prevalence goes up to 33% in certain MSM-subpopulations. Transmission is mainly through sexual contact. Drug use doubled the risk for casual sex, decreased by half the chances of using condoms, increased the number of partners per year and the risk for STD's. Peruvian HIV-positive populations have higher rates drug use and using drugs have been associated with a higher prevalence of being HIV-positive. This may be also true for other populations such as pregnant women in which there is an association between drug use and HIV. Although the amount of Peruvian research in this area limits the review, there seems to be a relationship between using drugs, having risky-sexual-behaviors and being HIV positive in Peru. HIV-prevention strategies for Peruvians must address the link between sex and substance use.

  13. Do targeted HIV programs improve overall care for pregnant women?: Antenatal syphilis management in Zambia before and after implementation of prevention of mother-to-child HIV transmission programs.

    Science.gov (United States)

    Potter, Dara; Goldenberg, Robert L; Chao, Ann; Sinkala, Moses; Degroot, Alain; Stringer, Jeffrey S A; Bulterys, Marc; Vermund, Sten H

    2008-01-01

    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.

  14. 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.

    Science.gov (United States)

    Boateng, Daniel; Kwapong, Golda Dokuaa; Agyei-Baffour, Peter

    2013-01-22

    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.

  15. 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

    Directory of Open Access Journals (Sweden)

    Aline da Fonseca Leal

    2012-03-01

    .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.

  16. Exploring the use of mobile phone technology for the enhancement of the prevention of mother-to-child transmission of HIV program in Nyanza, Kenya: a qualitative study.

    Science.gov (United States)

    Jennings, Larissa; Ong'ech, John; Simiyu, Rogers; Sirengo, Martin; Kassaye, Seble

    2013-12-05

    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

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

    Directory of Open Access Journals (Sweden)

    Judith Ziske

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

  18. Job satisfaction and turnover intentions among health care staff providing services for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania.

    Science.gov (United States)

    Naburi, Helga; Mujinja, Phares; Kilewo, Charles; Orsini, Nicola; Bärnighausen, Till; Manji, Karim; Biberfeld, Gunnel; Sando, David; Geldsetzer, Pascal; Chalamila, Guerino; Ekström, Anna Mia

    2017-09-06

    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

  19. The prevention of mother-to-child transmission of HIV cascade analysis tool: supporting health managers to improve facility-level service delivery.

    Science.gov (United States)

    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

    2014-10-21

    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

  20. Prevention of Sexually Transmitted Diseases in HIV-Infected Individuals.

    Science.gov (United States)

    Quilter, Laura; Dhanireddy, Shireesha; Marrazzo, Jeanne

    2017-04-01

    Prevention of sexually transmitted infections (STIs) is an important part of the care of the HIV-infected individual. STIs have been associated with increased risk of transmission and acquisition of HIV. Among HIV-infected persons, treatment failures and high recurrence rates of some STIs are more common. Despite the recognized importance of prevention and discussion of sexual health, rates of screening for STIs are suboptimal. Moreover, rates of STIs such as syphilis continue to increase particularly in men who have sex with men (MSM). This review focuses on the most common STIs seen among HIV-infected individuals and recommendations for screening and prevention.

  1. Illness during Pregnancy and Bacterial Vaginosis are Associated with In Utero HIV-1 Transmission

    Science.gov (United States)

    Farquhar, Carey; Mbori-Ngacha, Dorothy; Overbaugh, Julie; Wamalwa, Dalton; Harris, Jennifer; Bosire, Rose; John-Stewart, Grace

    2009-01-01

    HIV-1 transmission in utero accounts for 20–30% of vertical transmission events in breastfeeding populations. In a prospective study of 463 HIV-1-infected mothers and infants, illness during pregnancy was associated with 2.6-fold increased risk of in utero HIV-1 transmission (95% CI 1.2, 5.8) and bacterial vaginosis with a 3-fold increase (95% CI 1.0–7.0) after adjusting for maternal HIV-1 viral load. Interventions targeting these novel risk factors could lead to more effective prevention of transmission during pregnancy. PMID:19952542

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

    Directory of Open Access Journals (Sweden)

    Motlatso G. Mlambo

    2014-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Alinane Linda Nyondo

    2013-12-01

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

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

    Science.gov (United States)

    Nyondo, Alinane Linda; Muula, Adamson Sinjani; Chimwaza, Angela Faith

    2013-12-16

    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

  5. A quality improvement model for the rapid scale-up of a program to prevent mother-to-child HIV transmission in South Africa.

    Science.gov (United States)

    Mate, Kedar S; Ngubane, Gugu; Barker, Pierre M

    2013-09-01

    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.

  6. Viral linkage in HIV-1 seroconverters and their partners in an HIV-1 prevention clinical trial.

    Directory of Open Access Journals (Sweden)

    Mary S Campbell

    2011-03-01

    Full Text Available Characterization of viruses in HIV-1 transmission pairs will help identify biological determinants of infectiousness and evaluate candidate interventions to reduce transmission. Although HIV-1 sequencing is frequently used to substantiate linkage between newly HIV-1 infected individuals and their sexual partners in epidemiologic and forensic studies, viral sequencing is seldom applied in HIV-1 prevention trials. The Partners in Prevention HSV/HIV Transmission Study (ClinicalTrials.gov #NCT00194519 was a prospective randomized placebo-controlled trial that enrolled serodiscordant heterosexual couples to determine the efficacy of genital herpes suppression in reducing HIV-1 transmission; as part of the study analysis, HIV-1 sequences were examined for genetic linkage between seroconverters and their enrolled partners.We obtained partial consensus HIV-1 env and gag sequences from blood plasma for 151 transmission pairs and performed deep sequencing of env in some cases. We analyzed sequences with phylogenetic techniques and developed a Bayesian algorithm to evaluate the probability of linkage. For linkage, we required monophyletic clustering between enrolled partners' sequences and a Bayesian posterior probability of ≥ 50%. Adjudicators classified each seroconversion, finding 108 (71.5% linked, 40 (26.5% unlinked, and 3 (2.0% indeterminate transmissions, with linkage determined by consensus env sequencing in 91 (84%. Male seroconverters had a higher frequency of unlinked transmissions than female seroconverters. The likelihood of transmission from the enrolled partner was related to time on study, with increasing numbers of unlinked transmissions occurring after longer observation periods. Finally, baseline viral load was found to be significantly higher among linked transmitters.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

  7. Migrant workers: a risk factor for hiv transmission

    International Nuclear Information System (INIS)

    Ikram, N.; Kamal, Q.M.; Hassan, M.U.; Tariq, H.M.; Ahmed, S.N.

    2011-01-01

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

  8. Performance-based incentives may be appropriate to address challenges to delivery of prevention of vertical transmission of HIV services in rural Mozambique: a qualitative investigation.

    Science.gov (United States)

    Schuster, Roseanne C; de Sousa, Octávio; Rivera, Jacqueline; Olson, Rebecca; Pinault, Delphine; Young, Sera L

    2016-10-07

    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

  9. Can a pill prevent HIV? Negotiating the biomedicalisation of HIV prevention.

    Science.gov (United States)

    Young, Ingrid; Flowers, Paul; McDaid, Lisa

    2016-03-01

    This article examines how biomedicalisation is encountered, responded to and negotiated within and in relation to new biomedical forms of HIV prevention. We draw on exploratory focus group discussions on pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) to examine how the processes of biomedicalisation are affected by and affect the diverse experiences of communities who have been epidemiologically framed as 'vulnerable' to HIV and towards whom PrEP and TasP will most likely be targeted. We found that participants were largely critical of the perceived commodification of HIV prevention as seen through PrEP, although this was in tension with the construction of being medical consumers by potential PrEP candidates. We also found how deeply entrenched forms of HIV stigma and homophobia can shape and obfuscate the consumption and management of HIV-related knowledge. Finally, we found that rather than seeing TasP or PrEP as 'liberating' through reduced levels of infectiousness or risk of transmission, social and legal requirements of responsibility in relation to HIV risk reinforced unequal forms of biomedical self-governance. Overall, we found that the stratifying processes of biomedicalisation will have significant implications in how TasP, PrEP and HIV prevention more generally are negotiated. © 2015 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

  10. Community Based Organizations in HIV/AIDS Prevention, Patient ...

    African Journals Online (AJOL)

    The main objective of this review is to provide a preliminary evaluation of the suitability of community-based organizations (CBOs) to contribute to HIV/AIDS prevention, care/support and control programs in Ethiopia. In order to put CBOs and programs in the context of HIV transmission and spread, the role of the Multisectoral ...

  11. Lignosulfonic acid exhibits broadly anti-HIV-1 activity--potential as a microbicide candidate for the prevention of HIV-1 sexual transmission.

    Directory of Open Access Journals (Sweden)

    Min Qiu

    Full Text Available Some secondary metabolites from plants show to have potent inhibitory activities against microbial pathogens, such as human immunodeficiency virus (HIV, herpes simplex virus (HSV, Treponema pallidum, Neisseria gonorrhoeae, etc. Here we report that lignosulfonic acid (LSA, a polymeric lignin derivative, exhibits potent and broad activity against HIV-1 isolates of diverse subtypes including two North America strains and a number of Chinese clinical isolates values ranging from 21.4 to 633 nM. Distinct from other polyanions, LSA functions as an entry inhibitor with multiple targets on viral gp120 as well as on host receptor CD4 and co-receptors CCR5/CXCR4. LSA blocks viral entry as determined by time-of-drug addiction and cell-cell fusion assays. Moreover, LSA inhibits CD4-gp120 interaction by blocking the binding of antibodies specific for CD4-binding sites (CD4bs and for the V3 loop of gp120. Similarly, LSA interacts with CCR5 and CXCR4 via its inhibition of specific anti-CCR5 and anti-CXCR4 antibodies, respectively. Interestingly, the combination of LSA with AZT and Nevirapine exhibits synergism in viral inhibition. For the purpose of microbicide development, LSA displays low in vitro cytotoxicity to human genital tract epithelial cells, does not stimulate NF-κB activation and has no significant up-regulation of IL-1α/β and IL-8 as compared with N-9. Lastly, LSA shows no adverse effect on the epithelial integrity and the junctional protein expression. Taken together, our findings suggest that LSA can be a potential candidate for tropical microbicide.

  12. Taxonomy of Caribbean Tourism Alcohol Venues: Implications for HIV Transmission*

    Science.gov (United States)

    GUILAMO-RAMOS, Vincent; JACCARD, James; MCCARTHY, Katharine; QUIÑONES, Zahira; LUSHIN, Viktor; SKINNER-DAY, Molly; PADILLA, Mark; MEISTERLIN, Leah

    2013-01-01

    Background Tourism areas represent ecologies of heightened HIV vulnerability characterized by a disproportionate concentration of alcohol venues. Limited research has explored how alcohol venues facilitate HIV transmission. Methods We spatially mapped locations of alcohol venues in a Dominican tourism town and conducted a venue-based survey of key informants (n=135) focused on three facets of alcohol venues: structural features, type of patrons, and HIV risk behaviors. Using latent class analysis, we identified evidence-based typologies of alcohol venues for each of the three facets. Focused contrasts identified the co-occurrence of classes of structural features, classes of types of patrons, and classes of HIV risk behavior, thus elaborating the nature of high risk venues. Results We identified three categories of venue structural features, three for venue patrons, and five for HIV risk behaviors. Analysis revealed that alcohol venues with the greatest structural risks (e.g., sex work on site with lack of HIV prevention services) were most likely frequented by the venue patron category characterized by high population-mixing between locals and foreign tourists, who were in turn most likely to engage in the riskiest behaviors. Conclusion Our results highlight the stratification of venue patrons into groups who engage in behaviors of varying risk in structural settings that vary in risk. The convergence of high-risk patron groups in alcohol venues with the greatest structural risk suggests these locations have potential for HIV transmission. Policymakers and prevention scientists can use these methods and data to target HIV prevention resources to identified priority areas. PMID:23478154

  13. Taxonomy of Caribbean tourism alcohol venues: implications for HIV transmission.

    Science.gov (United States)

    Guilamo-Ramos, Vincent; Jaccard, James; McCarthy, Katharine; Quiñones, Zahira; Lushin, Viktor; Skinner-Day, Molly; Padilla, Mark; Meisterlin, Leah

    2013-09-01

    Tourism areas represent ecologies of heightened HIV vulnerability characterized by a disproportionate concentration of alcohol venues. Limited research has explored how alcohol venues facilitate HIV transmission. We spatially mapped locations of alcohol venues in a Dominican tourism town and conducted a venue-based survey of key informants (n=135) focused on three facets of alcohol venues: structural features, type of patrons, and HIV risk behaviors. Using latent class analysis, we identified evidence-based typologies of alcohol venues for each of the three facets. Focused contrasts identified the co-occurrence of classes of structural features, classes of types of patrons, and classes of HIV risk behavior, thus elaborating the nature of high risk venues. We identified three categories of venue structural features, three for venue patrons, and five for HIV risk behaviors. Analysis revealed that alcohol venues with the greatest structural risks (e.g. sex work on-site with lack of HIV prevention services) were most likely frequented by the venue patron category characterized by high population-mixing between locals and foreign tourists, who were in turn most likely to engage in the riskiest behaviors. Our results highlight the stratification of venue patrons into groups who engage in behaviors of varying risk in structural settings that vary in risk. The convergence of high-risk patron groups in alcohol venues with the greatest structural risk suggests these locations have potential for HIV transmission. Policymakers and prevention scientists can use these methods and data to target HIV prevention resources to identified priority areas. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. conference report prevention of mother-to-child transmission

    African Journals Online (AJOL)

    2004-08-02

    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.

  15. Factors affecting adherence to short-course ARV prophylaxis for preventing mother-to-child transmission of HIV in sub-Saharan Africa: a review and lessons for future elimination.

    Science.gov (United States)

    Colombini, Manuela; Stöckl, Heidi; Watts, Charlotte; Zimmerman, Cathy; Agamasu, Enyonam; Mayhew, Susannah H

    2014-01-01

    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.

  16. Optimizing prevention of HIV mother to child transmission: Duration of antiretroviral therapy and viral suppression at delivery among pregnant Malawian women.

    Science.gov (United States)

    Chagomerana, Maganizo B; Miller, William C; Tang, Jennifer H; Hoffman, Irving F; Mthiko, Bryan C; Phulusa, Jacob; John, Mathias; Jumbe, Allan; Hosseinipour, Mina C

    2018-01-01

    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.

  17. HIV / AIDS: Symptoms, Diagnosis, Prevention and Treatment

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV / AIDS: Symptoms , Diagnosis, Prevention and Treatment Past Issues / ... Most people who have become recently infected with HIV will not have any symptoms. They may, however, ...

  18. 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

    Directory of Open Access Journals (Sweden)

    Francisco Carlos Felix Lana

    2010-08-01

    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

  19. Vaginal microbiota and its role in HIV transmission and infection.

    Science.gov (United States)

    Petrova, Mariya I; van den Broek, Marianne; Balzarini, Jan; Vanderleyden, Jos; Lebeer, Sarah

    2013-09-01

    The urogenital tract appears to be the only niche of the human body that shows clear differences in microbiota between men and women. The female reproductive tract has special features in terms of immunological organization, an epithelial barrier, microbiota, and influence by sex hormones such as estrogen. While the upper genital tract is regarded as free of microorganisms, the vagina is colonized by bacteria dominated by Lactobacillus species, although their numbers vary considerably during life. Bacterial vaginosis is a common pathology characterized by dysbiosis, which increases the susceptibility for HIV infection and transmission. On the other hand, HIV infections are often characterized by a disturbed vaginal microbiota. The endogenous vaginal microbiota may protect against HIV by direct production of antiviral compounds, through blocking of adhesion and transmission by ligands such as lectins, and/or by stimulation of immune responses. The potential role of probiotics in the prevention of HIV infections and associated symptoms, by introducing them to the vaginal and gastrointestinal tract (GIT), is also discussed. Of note, the GIT is a site of considerable HIV replication and CD4(+) T-cell destruction, resulting in both local and systemic inflammation. Finally, genetically engineered lactobacilli show promise as new microbicidal agents against HIV. © 2013 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

  20. Canadian consensus statement on HIV and its transmission in the context of criminal law.

    Science.gov (United States)

    Loutfy, Mona; Tyndall, Mark; Baril, Jean-Guy; Montaner, Julio Sg; Kaul, Rupert; Hankins, Catherine

    2014-05-01

    A poor appreciation of the science related to HIV contributes to an overly broad use of the criminal law against individuals living with HIV in cases of HIV nondisclosure. To promote an evidence-informed application of the law in Canada, a team of six Canadian medical experts on HIV and transmission led the development of a consensus statement on HIV sexual transmission, HIV transmission associated with biting and spitting, and the natural history of HIV infection. The statement is based on a literature review of the most recent and relevant scientific evidence (current as of December 2013) regarding HIV and its transmission. It has been endorsed by >70 additional Canadian HIV experts and the Association of Medical Microbiology and Infectious Disease Canada. Scientific and medical evidence clearly indicate that HIV is difficult to transmit during sex. For the purpose of informing the justice system, the per-act possibility of HIV transmission through sex, biting or spitting is described along a continuum from low possibility, to negligible possibility, to no possibility of transmission. This possibility takes into account the impact of factors such as the type of sexual acts, condom use, antiretroviral therapy and viral load. Dramatic advances in HIV therapy have transformed HIV infection into a chronic manageable condition. HIV physicians and scientists have a professional and ethical responsibility to assist those in the criminal justice system to understand and interpret the science regarding HIV. This is critical to prevent miscarriage of justice and to remove unnecessary barriers to evidence-based HIV prevention strategies.

  1. 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.

    Science.gov (United States)

    2011-01-01

    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.

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

    Science.gov (United States)

    Kalichman, Seth C; Cherry, Chauncey; Kalichman, Moira O; Washington, Christopher; Grebler, Tamar; Merely, Cindy; Welles, Brandi; Pellowski, Jennifer; Kegler, Christopher

    2015-01-01

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

  3. Preventing HIV/AIDS through education: the role of primary and ...

    African Journals Online (AJOL)

    Objective: This study was aimed at assessing the knowledge, opinion and practices of Nigerian primary and secondary school teachers on HIV/AIDS education. Method: A self-administered questionnaire was used to collect data on demography, knowledge of HIV transmission and prevention, training on HIV transmission ...

  4. Prospective study on the prevention of vertical transmission of HIV in Campo Grande, Mato Grosso do Sul, Brazil, from 1996 to 2001

    Directory of Open Access Journals (Sweden)

    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%.

  5. Characterizing HIV transmission networks across the United States.

    Science.gov (United States)

    Aldous, Jeannette L; Pond, Sergei Kosakovsky; Poon, Art; Jain, Sonia; Qin, Huifang; Kahn, James S; Kitahata, Mari; Rodriguez, Benigno; Dennis, Ann M; Boswell, Stephen L; Haubrich, Richard; Smith, Davey M

    2012-10-01

    Clinically, human immunodeficiency virus type 1 (HIV-1) pol sequences are used to evaluate for drug resistance. These data can also be used to evaluate transmission networks and help describe factors associated with transmission risk. HIV-1 pol sequences from participants at 5 sites in the CFAR Network of Integrated Clinical Systems (CNICS) cohort from 2000-2009 were analyzed for genetic relatedness. Only the first available sequence per participant was included. Inferred transmission networks ("clusters") were defined as ≥2 sequences with ≤1.5% genetic distance. Clusters including ≥3 patients ("networks") were evaluated for clinical and demographic associations. Of 3697 sequences, 24% fell into inferred clusters: 155 clusters of 2 individuals ("dyads"), 54 clusters that included 3-14 individuals ("networks"), and 1 large cluster that included 336 individuals across all study sites. In multivariable analyses, factors associated with being in a cluster included not using antiretroviral (ARV) drugs at time of sampling (P 350 cells/mL (P 100,000 copies/mL (P networks, women were more likely to cluster with other women (P epidemiology can be applied to study HIV transmission networks in geographically and demographically diverse cohorts. Clustering was associated with lack of ARV use and higher viral load, implying transmission may be interrupted by earlier diagnosis and treatment. Observed female and African American networks reinforce the importance of diagnosis and prevention efforts targeted by sex and race.

  6. A success story: HIV prevention for injection drug users in Rhode Island

    Directory of Open Access Journals (Sweden)

    Zaller Nickolas

    2006-12-01

    Full Text Available Abstract Background New HIV diagnoses related to injection drug use (IDU have declined in the United States. Access to clean syringes and decreasing HIV transmission among injection drug users have been HIV prevention priorities of the Rhode Island (RI HIV community. To examine trends in IDU-related new HIV diagnoses in RI, we performed a retrospective analysis of new HIV diagnoses according to HIV risk factor from 1990–2003. Results There has been an 80% absolute reduction in IDU-related new HIV diagnoses in RI coincident with IDU-specific prevention efforts. Conclusion There has been a greater decline in IDU-related new HIV diagnoses in Rhode Island compared to national data reported by the Centers for Disease Control and Prevention. We hypothesize that this dramatic decline in Rhode Island is related to extensive HIV prevention efforts targeting IDUs. Further research is needed to examine the impact of specific HIV prevention interventions for injection drug users.

  7. Seeking HIV prevention strategies for women.

    Science.gov (United States)

    Townsend, S

    1993-05-01

    Women are biologically more susceptible to HIV infection than men through heterosexual penile-vaginal intercourse, and transmission by heterosexual means seems to be increasing. The use of male condoms and partner reduction are currently recommended to reduce the risk of contracting and transmitting HIV. Women can, however, only indirectly influence these behaviors. Many face social and emotional factors which make it impossible to negotiate condom use with an unwilling partner. Scientists are therefore paying greater attention to female barrier methods such as the female condom and spermicides as potential female- controlled ways to help women avoid infection. Noncontraceptive chemical methods in the form of jellies and topical creams are being explored. Limited in vivo scientific data exists on how these methods may prevent the transmission of HIV. The female condom is a thin, plastic sheath which covers the cervix, vagina, and women's external genitalia. It has gone to clinical trials in 1700 women at 71 sites. While many women are in favor of the method, objections to its use have been voiced due to its appearance, the noise made during intercourse, slippage, how it feels during intercourse, expense, reduced sensitivity, and embarrassment. Its potential for re-use must be explored. Only inconclusive results are available on the effectiveness of spermicides. While lab and animal research show nonoxynol-9 can kill HIV, it remains to be seen how much or how often it may be used before mucosal linings become irritated and potentially facilitate the entry of HIV. Many unresolved questions about the mechanics of HIV infection remain to be answered before these methods may be fully endorsed by a wide array of scientists.

  8. 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

    Directory of Open Access Journals (Sweden)

    Firoza Haffejee

    2016-12-01

    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.

  9. Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV transmission via breastfeeding in Ethiopia, India, and Uganda: an analysis of three randomised controlled trials.

    Science.gov (United States)

    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

    2008-07-26

    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.

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

    Directory of Open Access Journals (Sweden)

    Nicoletta Casartelli

    2010-06-01

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

  11. Genetic transmission networks reveal the transmission patterns of HIV-1 CRF01_AE in China.

    Science.gov (United States)

    Li, Xiaoshan; Gao, Rong; Zhu, Kexin; Wei, Feiran; Fang, Kun; Li, Wei; Song, Yue; Ge, You; Ji, Yu; Zhong, Ping; Wei, Pingmin

    2018-03-01

    The epidemic of HIV-1 CRF01_AE has become a major public health issue in China. This study aimed to characterise the transmission patterns of genetic networks for CRF01_AE nationwide and elucidate possible opportunities for prevention. We isolated and conducted genetic transmission network analysis of all available CRF01_AE pol sequences (n=4704) from China in the Los Alamos HIV sequence database. A total of 1391 (29.6%) sequences were identified as belonging to 400 separate networks. Of men who have sex with men (MSM) in the networks, 93.8% were linked to other MSM and only 2.4% were linked to heterosexual women. However, 11.8% heterosexual women in the networks were linked to MSM. Lineages composed mainly of MSM had higher transmission than those that were mostly heterosexuals. Of the 1391 individuals in networks, 513 (36.9%) were linked to cases diagnosed in different provinces. The proportion of individuals involved in inter-province links was interrelated with the number of migrant people (Spearman's r =0.738, p =0.001). The outcome of this study could help improve our ability to understand HIV transmission among various regions and risk groups in China, and highlighted the importance of targeting MSM and migrants by prevention and intervention efforts. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. 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

    Directory of Open Access Journals (Sweden)

    Wilbroda H. Ngidi

    2017-01-01

    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.

  13. Translation of biomedical prevention strategies for HIV: prospects and pitfalls.

    Science.gov (United States)

    Vermund, Sten H; Tique, José A; Cassell, Holly M; Pask, Megan E; Ciampa, Philip J; Audet, Carolyn M

    2013-06-01

    Early achievements in biomedical approaches for HIV prevention included physical barriers (condoms), clean injection equipment (both for medical use and for injection drug users), blood and blood product safety, and prevention of mother-to-child transmission. In recent years, antiretroviral drugs to reduce the risk of transmission (when the infected person takes the medicines; treatment as prevention) or reduce the risk of acquisition (when the seronegative person takes them; preexposure prophylaxis) have proven to be efficacious. Circumcision of men has also been a major tool relevant for higher prevalence regions such as sub-Saharan Africa. Well-established prevention strategies in the control of sexually transmitted diseases and tuberculosis are highly relevant for HIV (ie, screening, linkage to care, early treatment, and contact tracing). Unfortunately, only slow progress is being made in some available HIV-prevention strategies such as family planning for HIV-infected women who do not want more children and prevention of mother-to-child HIV transmission. Current studies seek to integrate strategies into approaches that combine biomedical, behavioral, and structural methods to achieve prevention synergies. This review identifies the major biomedical approaches demonstrated to be efficacious that are now available. We also highlight the need for behavioral risk reduction and adherence as essential components of any biomedical approach.

  14. Knowledge and attitude towards mother to child transmission of HIV ...

    African Journals Online (AJOL)

    Background: HIV/AIDS is currently a major public health problem in Ethiopia and mother to child transmission (MTCT) is responsible for 90% of childhood HIV infections. The transmission of HIV from infected mothers to babies could occur during antenatal period, as well as during delivery and breastfeeding (postnatal ...

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

    Directory of Open Access Journals (Sweden)

    Aditya S Khanna

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

  16. Moral Agency and the Sexual Transmission of HIV

    Science.gov (United States)

    O'Leary, Ann; Wolitski, Richard J.

    2009-01-01

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

  17. Prevention of HIV-1 Transmission Through Breastfeeding: Efficacy and Safety of Maternal Antiretroviral Therapy Versus Infant Nevirapine Prophylaxis for Duration of Breastfeeding in HIV-1-Infected Women With High CD4 Cell Count (IMPAACT PROMISE): A Randomized, Open-Label, Clinical Trial.

    Science.gov (United States)

    Flynn, Patricia M; Taha, Taha E; Cababasay, Mae; Fowler, Mary Glenn; Mofenson, Lynne M; Owor, Maxensia; Fiscus, Susan; Stranix-Chibanda, Lynda; Coutsoudis, Anna; Gnanashanmugam, Devasena; Chakhtoura, Nahida; McCarthy, Katie; Mukuzunga, Cornelius; Makanani, Bonus; Moodley, Dhayendre; Nematadzira, Teacler; Kusakara, Bangini; Patil, Sandesh; Vhembo, Tichaona; Bobat, Raziya; Mmbaga, Blandina T; Masenya, Maysseb; Nyati, Mandisa; Theron, Gerhard; Mulenga, Helen; Butler, Kevin; Shapiro, David E

    2018-04-01

    No randomized trial has directly compared the efficacy of prolonged infant antiretroviral prophylaxis versus maternal antiretroviral therapy (mART) for prevention of mother-to-child transmission throughout the breastfeeding period. Fourteen sites in Sub-Saharan Africa and India. A randomized, open-label strategy trial was conducted in HIV-1-infected women with CD4 counts ≥350 cells/mm (or ≥country-specific ART threshold if higher) and their breastfeeding HIV-1-uninfected newborns. Randomization at 6-14 days postpartum was to mART or infant nevirapine (iNVP) prophylaxis continued until 18 months after delivery or breastfeeding cessation, infant HIV-1 infection, or toxicity, whichever occurred first. The primary efficacy outcome was confirmed infant HIV-1 infection. Efficacy analyses included all randomized mother-infant pairs except those with infant HIV-1 infection at entry. Between June 2011 and October 2014, 2431 mother-infant pairs were enrolled; 97% of women were World Health Organization Clinical Stage I, median screening CD4 count 686 cells/mm. Median infant gestational age/birth weight was 39 weeks/2.9 kilograms. Seven of 1219 (0.57%) and 7 of 1211 (0.58%) analyzed infants in the mART and iNVP arms, respectively, were HIV-infected (hazard ratio 1.0, 96% repeated confidence interval 0.3-3.1); infant HIV-free survival was high (97.1%, mART and 97.7%, iNVP, at 24 months). There were no significant differences between arms in median time to breastfeeding cessation (16 months) or incidence of severe, life-threatening, or fatal adverse events for mothers or infants (14 and 42 per 100 person-years, respectively). Both mART and iNVP prophylaxis strategies were safe and associated with very low breastfeeding HIV-1 transmission and high infant HIV-1-free survival at 24 months.

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

    NARCIS (Netherlands)

    Nguyen, T.A.; Oosterhoff, P.P.J.; Yen, P.N.; Wright, P.; Hardon, A.P.

    2008-01-01

    Background: According to Vietnamese policy, HIV-infected women should have access at least to HIV testing and Nevirapine prophylaxis, or where available, to adequate counselling, HIV infection staging, ARV prophylaxis, and infant formula. Many studies in high HIV prevalence settings have reported

  19. Transmission dynamics of HIV/AIDS with screening and non-linear ...

    African Journals Online (AJOL)

    ... measures to prevent the spreading of the infection. Numerical simulation of the model is implemented to investigate the sensitivity of certain key parameters on the transmission dynamics of HIV/AIDS with screening using non-linear incidence. Keywords: HIV/AIDS, Screening, Non-linear incidence, Reproduction number, ...

  20. AIDS-related stigma, HIV testing, and transmission risk among patrons of informal drinking places in Cape Town, South Africa.

    Science.gov (United States)

    Pitpitan, Eileen V; Kalichman, Seth C; Eaton, Lisa A; Cain, Demetria; Sikkema, Kathleen J; Skinner, Donald; Watt, Melissa H; Pieterse, Desiree

    2012-06-01

    AIDS-related stigma as a barrier to HIV testing has not been examined within the context of high at risk environments such as drinking venues. Of particular importance is whether AIDS-related stigma is associated with HIV transmission risks among people who have never been tested for HIV. We examined: (1) AIDS-related stigma as a barrier to testing, controlling for other potential barriers, and (2) whether stigma is associated with HIV risks among HIV-untested individuals. We surveyed 2,572 individuals attending informal drinking establishments in Cape Town, South Africa to assess HIV testing status, AIDS-related stigma endorsement, and HIV transmission sexual risk behavior. Endorsement of AIDS-related stigma was negatively associated with HIV lifetime testing. In addition, stigma endorsement was associated with higher HIV transmission risks. AIDS-related stigma must be addressed in HIV prevention campaigns across South Africa. Antistigma messages should be integrated with risk reduction counseling and testing.

  1. High risk behavior for HIV transmission among former injecting drug users:a survey from Indonesia

    Directory of Open Access Journals (Sweden)

    Iskandar Shelly

    2010-08-01

    Full Text Available Abstract Background Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs in Indonesia, which has a rapidly growing HIV-epidemic largely driven by injecting drug use. Methods Current and former IDUs were recruited by respondent driven sampling in an urban setting in Java, and interviewed regarding drug use and HIV risk behavior using the European Addiction Severity Index and the Blood Borne Virus Transmission Questionnaire. Drug use and HIV transmission risk behavior were compared between current IDUs and former IDUs, using the Mann-Whitney and Pearson Chi-square test. Results Ninety-two out of 210 participants (44% were self reported former IDUs. Risk behavior related to sex, tattooing or piercing was common among current as well as former IDUs, 13% of former IDUs were still exposed to contaminated injecting equipment. HIV-infection was high among former (66% and current (60% IDUs. Conclusion Former IDUs may contribute significantly to the HIV-epidemic in Indonesia, and HIV-prevention should therefore also target this group, addressing sexual and other risk behavior.

  2. 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.

    Science.gov (United States)

    Cames, Cécile; Saher, Aisha; Ayassou, Kossiwavi A; Cournil, Amandine; Meda, Nicolas; Simondon, Kirsten Bork

    2010-07-01

    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.

  3. Bloodborne transmission of Hiv/Aids in Africa: Challenges and ...

    African Journals Online (AJOL)

    HIV-2, has been described mainly in West Africa. HIV can be transmitted both in cellular and plasma components of blood. Bloodborne transmission, accounts for 3-5% of the mode of transmission worldwide.Figures for other modes of transmission are 5-10% for intravenous drug use, 5 to 10 % for the homosexual route , 70 ...

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

    Directory of Open Access Journals (Sweden)

    Annabelle Gourlay

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

  5. 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.

    Directory of Open Access Journals (Sweden)

    Matilda Ngarina

    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.

  6. Selection bias at the heterosexual HIV-1 transmission bottleneck

    Science.gov (United States)

    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

    2014-01-01

    factors, suggests that transmission is frequently characterized by many abortive transmission events in which some target cells are nonproductively infected. Moreover, for efficient transmission, some changes that favored survival in the transmitting partner are frequently discarded, resulting in overall slower evolution of HIV-1 in the population. Paradoxically, by increasing the selection bias at the transmission bottleneck, reduction of susceptibility may increase the expected fitness of breakthrough viruses that establish infection and may therefore worsen the prognosis for the newly infected partner. Conversely, preventative or therapeutic approaches that weaken the virus may reduce overall transmission rates via a mechanism that is independent from the quantity of circulating virus, and may therefore provide long-term benefits even upon breakthrough infection. PMID:25013080

  7. Panel: challenging criminal charges for HIV transmission and exposure.

    Science.gov (United States)

    Edwardh, Marlys; Adam, Barry; Joncas, Lucie; Clayton, Michaela

    2009-12-01

    Justice Edwin Cameron, of the Constitutional Court of South Africa, served as moderator. He said that this topic was particularly relevant for "an African/Canadian setting" because African countries may use Canadian developments as justification for their efforts to address HIV transmission and exposure through criminal law. Justice Cameron said that Canada is internationally perceived as a human rights-respecting state and, thus, sets an example, particularly for African nations, on how to comply with human rights issues. He added that in this particular case, however, Canada was sending the wrong message. This article contains summaries of the four presentations made during this panel. Marlys Edwardh reviews how the Supreme Court of Canada in Cuerrier interpreted the concepts of "endangering life" and "fraud". Barry Adam discusses the notion of a "duty to disclose" and how this affects HIV prevention. Lucie Joncas examines how the Supreme Court defined "fraud" in Cuerrier and describes a case before the Quebec Court of Appeal which may turn on whether the use of a condom or having a low viral load is considered not to constitute a significant risk of transmission. Finally, Michaela Clayton describes the trend in Southern African countries to adopt laws criminalizing HIV transmission or exposure, and explains that criminalization endangers women's health and lives.

  8. Use of a risk scoring tool to identify higher-risk HIV-1 serodiscordant couples for an antiretroviral-based HIV-1 prevention intervention

    OpenAIRE

    Irungu, Elizabeth M.; Heffron, Renee; Mugo, Nelly; Ngure, Kenneth; Katabira, Elly; Bulya, Nulu; Bukusi, Elizabeth; Odoyo, Josephine; Asiimwe, Stephen; Tindimwebwa, Edna; Celum, Connie; Baeten, Jared M.

    2016-01-01

    Background Antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) reduce HIV-1 transmission within heterosexual HIV-1 serodiscordant couples. Prioritizing couples at highest HIV-1 transmission risk for ART and PrEP would maximize impact and minimize costs. Methods The Partners Demonstration Project is an open-label, delivery study of integrated PrEP and ART for HIV-1 prevention among high risk HIV-1 serodiscordant couples in Kenya and Uganda. We evaluated the feasibility of using a ...

  9. Features of Maternal HIV-1 Associated with Lack of Vertical Transmission.

    Science.gov (United States)

    Ahmad, Nafees; Ahmad, Aamir N; Ahmad, Shahid N

    2017-01-01

    HIV-1 is transmitted from mother-to-child (vertical transmission) at an estimated rate of approximately 30% without any antiretroviral therapy (ART). However, administration of ART during pregnancy considerably diminishes the rate of mother-to-child transmission of HIV-1, which has become a standard of perinatal care in HIV-infected pregnant females in developed countries. Moreover, a majority of children born to HIV-infected mothers are uninfected without any ART. In addition, characteristics of HIV-1 and/or cellular factors in the mothers may play a role in influencing or preventing vertical transmission. Several studies, including from our laboratory have characterized the properties of HIV-1 from infected mothers that transmitted HIV-1 to their infants (transmitting mothers) and compared with those mothers that failed to transmit HIV-1 to their infants (non-transmitting mothers) in the absence of ART. One of the striking differences observed was that the non-transmitting mothers harbored a less heterogeneous HIV-1 population than transmitting mothers in the analyzed HIV-1 regions of p17 gag , env V3, vif and vpr . The other significant and distinctive findings were that the functional domains of HIV-1 vif and vpr proteins were less conserved in non-transmitting mothers compared with transmitting mothers. Furthermore, there were differences seen in two important motifs of HIV-1 Gag p17, including conservation of QVSQNY motif and variation in KIEEEQN motif in non-transmitting mothers compared with transmitting mothers. Several of these distinguishing properties of HIV-1 in non-transmitting mothers provide insights in developing strategies for preventing HIV-1 vertical transmission.

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

    Directory of Open Access Journals (Sweden)

    Kwasi Torpey

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

  11. Combining epidemiological and genetic networks signifies the importance of early treatment in HIV-1 transmission

    NARCIS (Netherlands)

    Zarrabi, N.; Prosperi, M.; Belleman, R.G.; Colafigli, M.; De Luca, A.; Sloot, P.M.A.

    2012-01-01

    Inferring disease transmission networks is important in epidemiology in order to understand and prevent the spread of infectious diseases. Reconstruction of the infection transmission networks requires insight into viral genome data as well as social interactions. For the HIV-1 epidemic, current

  12. Awareness and knowledge of mother-to-child transmission of HIV ...

    African Journals Online (AJOL)

    The instrument used was a questionnaire designed to assess awareness of the mothers about HIV/AIDS, evaluate their knowledge of possible routes of transmission and measures to prevent vertical transmission. The questionnaire was then pre-tested for comprehensibility, appropriateness of language, sensitivity of ...

  13. Sexual behavior and HIV transmission risk of Ugandan adults taking antiretroviral therapy: 3 year follow-up.

    Science.gov (United States)

    Apondi, Rose; Bunnell, Rebecca; Ekwaru, John Paul; Moore, David; Bechange, Stevens; Khana, Kenneth; King, Rachel; Campbell, James; Tappero, Jordan; Mermin, Jonathan

    2011-06-19

    Long-term impact of antiretroviral therapy (ART) on sexual HIV-transmission risk in Africa is unknown. We assessed sexual behavior changes and estimated HIV transmission from HIV-infected adults on ART in Uganda. Between 2003 and 2007, we enrolled and followed ART-naive HIV-infected adults in a home-based AIDS program with annual counseling and testing for cohabitating partners, participant transmission risk-reduction plans, condom distribution and prevention support for cohabitating discordant couples. We assessed participants' HIV plasma viral load and partner-specific sexual behaviors. We defined risky sex as intercourse with inconsistent/no condom use with HIV-negative or unknown serostatus partners in previous 3 months. We compared rates using Poisson regression models, estimated transmission risk using established viral load-specific transmission estimates, and documented sero-conversion rates among HIV-discordant couples. Of 928 participants, 755 (81%) had 36 months data: 94 (10%) died and 79 (9%) missing data. Sexual activity increased from 28% (baseline) to 41% [36 months (P sexually active participants, 22% reported risky sex at baseline, 8% at 6 months (P transmission risk reduced 91%, from 47.3 to 4.2/1000 person-years. Despite increased sexual activity among HIV-infected Ugandans over 3 years on ART, risky sex and estimated risk of HIV transmission remained lower than baseline levels. Integrated prevention programs could reduce HIV transmission in Africa.

  14. Advances in HIV Prevention for Serodiscordant Couples

    OpenAIRE

    Muessig, Kathryn E.; Cohen, Myron S.

    2014-01-01

    Serodiscordant couples play an important role in maintaining the global HIV epidemic. This review summarizes biobehavioral and biomedical HIV prevention options for serodiscordant couples focusing on advances in 2013 and 2014, including World Health Organization guidelines and best-evidence for couples counseling, couples-based interventions, and the use of antiviral agents for prevention. In the past few years marked advances have been made in HIV prevention for serodiscordant couples and nu...

  15. Development of an AFASS assessment and screening tool towards the prevention of mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa--a Delphi survey.

    Science.gov (United States)

    Adegbehingbe, Stella M; Paul-Ebhohimhen, Virginia; Marais, Debbie

    2012-06-06

    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

  16. Development of an AFASS assessment and screening tool towards the prevention of mother-to-child HIV transmission (PMTCT in sub-Saharan Africa - A Delphi survey

    Directory of Open Access Journals (Sweden)

    Adegbehingbe Stella M

    2012-06-01

    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

  17. 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.

    Science.gov (United States)

    Gumede-Moyo, Sehlulekile; Filteau, Suzanne; Munthali, Tendai; Todd, Jim; Musonda, Patrick

    2017-10-01

    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.

  18. Mathematical modelling informs HIV prevention policy in China ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-04-27

    Apr 27, 2016 ... IDRC-funded research is using mathematical modelling to influence local and national policies in China to reduce HIV transmission. Treatment as prevention Earlier research conducted under Modelling and controlling infectious diseases project showed that providing antiretroviral therapy (ART) to ...

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

    Directory of Open Access Journals (Sweden)

    Cicala Claudia

    2010-01-01

    4β7 is closely associated with CD4 and CCR5. Furthermore, α4β7 is ~3 times the size of CD4 on the cell surface, that makes it a prominent receptor for an efficient virus capture. gp120-α4β7 interactions mediate the activation of the adhesion-associated integrin LFA-1. LFA-1 facilitates the formation of virological synapses and cell-to-cell spread of HIV-1. gp120 binding to α4β7 is mediated by a tripeptide located in the V1/V2 domain of gp120. Of note, the V1/V2 domain of gp120 has been linked to variations in transmission fitness among viral isolates raising the intriguing possibility that gp120-α4β7 interactions may be linked to transmission fitness. Although many details remain unresolved, we hypothesize that gp120-α4β7 interactions play an important role in the very early events following sexual transmission of HIV and may have important implication in the design of vaccine strategies for the prevention of acquisition of HIV infection

  20. Antibodies for HIV prevention in young women.

    Science.gov (United States)

    Abdool Karim, Salim S; Abdool Karim, Quarraisha; Baxter, Cheryl

    2015-05-01

    Young women in sub-Saharan Africa bear a disproportionate HIV burden. They urgently require new HIV prevention approaches that they can use. This review provides an overview of the use of antiretrovirals for HIV preexposure prophylaxis (PrEP), highlighting some of the challenges with this technology and explores the potential role of mAbs for HIV prevention in women. Recent findings on the initial steps in viral entry and establishment of a productive local infectious nidus in the vaginal epithelium has provided important clues for HIV prevention in the female genital tract. Topical and oral formulations of antiretroviral drugs have been shown to prevent HIV infection in women with varying levels of success, depending principally on adherence. Further, several new broad and potent mAbs have been isolated over the last 5 years. Nonhuman primate studies demonstrate that broadly neutralizing HIV mAbs can protect rhesus macaques from simian immunodeficiency virus-HIV chimera (SHIV) infection. These findings have created newfound enthusiasm for passive immunization as a potential prevention strategy for women. If potent broadly neutralizing mAbs are effective in preventing HIV infection in women, this outcome could fill an important gap in HIV prevention technologies for young women, especially in Africa.

  1. HIV treatment as prevention: debate and commentary--will early infection compromise treatment-as-prevention strategies?

    Directory of Open Access Journals (Sweden)

    Myron S Cohen

    Full Text Available Universal HIV testing and immediate antiretroviral therapy for infected individuals has been proposed as a way of reducing the transmission of HIV and thereby bringing the HIV epidemic under control. It is unclear whether transmission during early HIV infection--before individuals are likely to have been diagnosed with HIV and started on antiretroviral therapy--will compromise the effectiveness of treatment as prevention. This article presents two opposing viewpoints by Powers, Miller, and Cohen, and Williams and Dye, followed by a commentary by Fraser.

  2. Comprehensive HIV Prevention for Transgender Persons.

    Science.gov (United States)

    Neumann, Mary Spink; Finlayson, Teresa J; Pitts, Nicole L; Keatley, JoAnne

    2017-02-01

    Transgender persons are at high risk for HIV infection, but prevention efforts specifically targeting these people have been minimal. Part of the challenge of HIV prevention for transgender populations is that numerous individual, interpersonal, social, and structural factors contribute to their risk. By combining HIV prevention services with complementary medical, legal, and psychosocial services, transgender persons' HIV risk behaviors, risk determinants, and overall health can be affected simultaneously. For maximum health impact, comprehensive HIV prevention for transgender persons warrants efforts targeted to various impact levels-socioeconomic factors, decision-making contexts, long-lasting protections, clinical interventions, and counseling and education. We present current HIV prevention efforts that reach transgender persons and present others for future consideration.

  3. Opportunity Knocks: HIV Prevention in Primary Care.

    Science.gov (United States)

    Thrun, Mark W

    2014-06-01

    Expansions in health care coverage, a comprehensive framework for HIV prevention and care, electronic medical records, and novel HIV prevention modalities create a current opportunity to change the trajectory of the HIV epidemic in the United States. HIV is increasingly disproportionately found in populations historically at higher risk, including gay men and other men who have sex with men, transgender women, injection drug users, and persons of color. This underscores the need for providers to identify persons at higher risk for HIV and assure the provision of screening and prevention services. In turn, universal screening for HIV-testing every adolescent and adult at least once in their lifetime-will increasingly be necessary to find the infrequent cases of HIV in lower risk populations. In both these domains, primary care providers will play a unique role in complementing traditional providers of HIV prevention and care services by increasing the proportion of their patients who have been screened for HIV, opening dialogues around sexual health, including asking about sexual orientation and gender identity, and prescribing antivirals as pre- and postexposure prophylaxis for their non-HIV-infected patients. Primary care providers must understand and embrace their importance along the HIV prevention and care continuum.

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

    Science.gov (United States)

    Zhu, Qian; Zhu, Peng; Zhang, Yilei; Li, Jie; Ma, Xuejun; Li, Ning; Wang, Qi; Xue, Xiujuan; Luo, Le; Li, Zizhao; Ring, Huijun Z; Ring, Brian Z; Su, Li

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Qian Zhu

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

  6. Social factors in HIV and AIDS transmission in Nigeria | Akinwale ...

    African Journals Online (AJOL)

    This paper examines social factors in HIV and AIDS transmission in Nigeria through content analysis of archival materials. Efforts deployed to stop the disastrous consequences of HIV and AIDS remain relatively unsuccessful in Nigeria. The number of persons infected with HIV has escalated despite the high rates of ...

  7. ART drugs help reduce HIV transmission, Chinese study finds ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Providing antiretroviral therapy (ART) to the HIV-positive partner in couples where only one person has HIV can reduce HIV transmission rates, at least in the short term, a Chinese study has found. Results of the study, led by IDRC Research Chair Yiming Shao, were published in the Oct. 5, 2013, issue of The Lancet.

  8. Human bite and human immune deficiency virus (HIV) transmission ...

    African Journals Online (AJOL)

    Background: The concentration of human immune deficiency virus (HIV) in the saliva of a carrier is low. As a result, human bite is not considered the traditional route of HIV infection transmission. Aim: To report a case of HIV sero-positivity following a human bite. Setting: University of Port Harcourt Teaching Hospital, Port ...

  9. Recognising and managing increased HIV transmission risk in newborns

    Directory of Open Access Journals (Sweden)

    Max Kroon

    2015-05-01

    Full Text Available Prevention of mother-to-child transmission (PMTCT programmes have improved maternalhealth outcomes and reduced the incidence of paediatric HIV, resulting in improved childhealth and survival. Nevertheless, high-risk vertical exposures remain common and areresponsible for a high proportion of transmissions. In the absence of antiretrovirals (ARVs,an 8- to 12-hour labour has approximately the same 15% risk of transmission as 18 monthsof mixed feeding. The intensity of transmission risk is highest during labour and delivery;however, the brevity of this intra-partum period lends itself to post-exposure interventions toreduce such risk. There is good evidence that infant post-exposure prophylaxis (PEP reducesintra-partum transmission even in the absence of maternal prophylaxis. Recent reports suggestthat infant combination ARV prophylaxis (cARP is more efficient at reducing intra-partumtransmission than a single agent in situations of minimal pre-labour prophylaxis. Guidelinesfrom the developed world have incorporated infant cARP for increased-risk scenarios. Incontrast, recent guidelines for low-resource settings have rightfully focused on reducingpostnatal transmission to preserve the benefits of breastfeeding, but have largely ignored thepotential of augmented infant PEP for reducing intra-partum transmissions. Minimal prelabourprophylaxis, poor adherence in the month prior to delivery, elevated maternal viralload at delivery, spontaneous preterm labour with prolonged rupture of membranes andchorioamnionitis are simple clinical criteria that identify increased intra-partum transmissionrisk. In these increased-risk scenarios, transmission frequency may be halved by combiningnevirapine and zidovudine as a form of boosted infant PEP. This strategy may be important toreduce intra-partum transmissions when PMTCT is suboptimal.

  10. Informing comprehensive HIV prevention: a situational analysis of the HIV prevention and care context, North West Province South Africa.

    Directory of Open Access Journals (Sweden)

    Sheri A Lippman

    Full Text Available Building a successful combination prevention program requires understanding the community's local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa.The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO's Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews.We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV.Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four 'themes' identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis

  11. Accurate and inaccurate HIV transmission beliefs, stigmatizing and HIV protection motivation in northern Thailand

    NARCIS (Netherlands)

    Boer, H.; Emons, P.A.A.

    2004-01-01

    We assessed the relation between accurate beliefs about HIV transmission and inaccurate beliefs about HIV transmission and emotional reactions to people with AIDS (PWA) and AIDS risk groups, stigmatizing attitudes and motivation to protect from HIV. In Chiang Rai, northern Thailand, 219 respondents

  12. Predicting HIV-1 transmission and antibody neutralization efficacy in vivo from stoichiometric parameters.

    Directory of Open Access Journals (Sweden)

    Oliver F Brandenberg

    2017-05-01

    Full Text Available The potential of broadly neutralizing antibodies targeting the HIV-1 envelope trimer to prevent HIV-1 transmission has opened new avenues for therapies and vaccines. However, their implementation remains challenging and would profit from a deepened mechanistic understanding of HIV-antibody interactions and the mucosal transmission process. In this study we experimentally determined stoichiometric parameters of the HIV-1 trimer-antibody interaction, confirming that binding of one antibody is sufficient for trimer neutralization. This defines numerical requirements for HIV-1 virion neutralization and thereby enables mathematical modelling of in vitro and in vivo antibody neutralization efficacy. The model we developed accurately predicts antibody efficacy in animal passive immunization studies and provides estimates for protective mucosal antibody concentrations. Furthermore, we derive estimates of the probability for a single virion to start host infection and the risks of male-to-female HIV-1 transmission per sexual intercourse. Our work thereby delivers comprehensive quantitative insights into both the molecular principles governing HIV-antibody interactions and the initial steps of mucosal HIV-1 transmission. These insights, alongside the underlying, adaptable modelling framework presented here, will be valuable for supporting in silico pre-trial planning and post-hoc evaluation of HIV-1 vaccination or antibody treatment trials.

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

    Science.gov (United States)

    Nguyen, Thu Anh; Oosterhoff, Pauline; Ngoc, Yen Pham; Wright, Pamela; Hardon, Anita

    2008-04-17

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

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

    Directory of Open Access Journals (Sweden)

    Wright Pamela

    2008-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Louise Kuhn

    2007-12-01

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

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

    Science.gov (United States)

    Kuhn, Louise; Sinkala, Moses; Kankasa, Chipepo; Semrau, Katherine; Kasonde, Prisca; Scott, Nancy; Mwiya, Mwiya; Vwalika, Cheswa; Walter, Jan; Tsai, Wei-Yann; Aldrovandi, Grace M; Thea, Donald M

    2007-12-26

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

  17. Modeling and Cost-Effectiveness in HIV Prevention.

    Science.gov (United States)

    Jacobsen, Margo M; Walensky, Rochelle P

    2016-02-01

    With HIV funding plateauing and the number of people living with HIV increasing due to the rollout of life-saving antiretroviral therapy, policy makers are faced with increasingly tighter budgets to manage the ongoing HIV epidemic. Cost-effectiveness and modeling analyses can help determine which HIV interventions may be of best value. Incidence remains remarkably high in certain populations and countries, making prevention key to controlling the spread of HIV. This paper briefly reviews concepts in modeling and cost-effectiveness methodology and then examines results of recently published cost-effectiveness analyses on the following HIV prevention strategies: condoms and circumcision, behavioral- or community-based interventions, prevention of mother-to-child transmission, HIV testing, pre-exposure prophylaxis, and treatment as prevention. We find that the majority of published studies demonstrate cost-effectiveness; however, not all interventions are affordable. We urge continued research on combination strategies and methodologies that take into account willingness to pay and budgetary impact.

  18. HIV prevention for indigenous people of the Amazon basin.

    Science.gov (United States)

    Linn, J G; Garnelo, L; Husaini, B A; Brown, C; Benzaken, A S; Stringfield, Y N

    2001-09-01

    This study identifies theoretically-based predictors of condom use in a sample of 251 sexually active adults recruited from Sao Gabriel da Cachoeira and six indigneous communities of the Upper Rio Negro region of Amazonas Brazil. The information-motivation-behavioral skills (IMB) model of AIDS-preventive behavior was used to describe the roles of HIV/AIDS knowledge, experiences with and attitudes toward condom use, peer influences, perceived vulnerability, monogamy and behavioral skills. A predictive path analytic model revealed significant predictors of more condom use including male gender, greater sexual HIV knowledge, positive experiences and attitudes about condom use, multiple partners, and greater behavioral skills. Results suggest that attention to behavioral skills for negotiating safer sex and instruction in the correct use of condoms are important elements in reducing high risk behaviors. Increasing the specific knowledge level of indigenous people regarding the complexities of sexual transmission of HIV is crucial and should be addressed. Heightening individuals' understanding of the limited protection of serial monogamy, and the need to conduct gender-specific training for behavior change to reduce transmission of HIV should be an additional goal of Brazilian health professionals. Obstacles to the implementation of the IMB HIV prevention program in Amazonas are noted and an alternative Brazilian HIV/AIDS prevention program is discussed.

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

    Science.gov (United States)

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

    2014-01-01

    In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported. Community-based interventions (CBIs) for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk, or already infected with, HIV. This paper evaluates the impact of CBIs on HIV knowledge, attitudes, and transmission. We included 39 studies on educational activities, counseling sessions, home visits, mentoring, women's groups, peer leadership, and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence. Our review findings suggest that CBIs to increase HIV awareness and risk reduction are effective in improving knowledge, attitudes, and practice outcomes as evidenced by the increased knowledge scores for HIV/AIDS (SMD: 0.66, 95% CI: 0.25, 1.07), protected sexual encounters (RR: 1.19, 95% CI: 1.13, 1.25), condom use (SMD: 0.96, 95% CI: 0.03, 1.58), and decreased frequency of sexual intercourse (RR: 0.76, 95% CI: 0.61, 0.96). Analysis shows that CBIs did not have any significant impact on scores for self-efficacy and communication. We found very limited evidence on community-based management for HIV infected population and prevention of mother- to-child transmission (MTCT) for HIV-infected pregnant women. Qualitative synthesis suggests that establishment of community support at the onset of HIV prevention programs leads to community acceptance and engagement. School-based delivery of HIV prevention education and contraceptive distribution have also been advocated as potential strategies to target high-risk youth group. Future studies should focus on evaluating the effectiveness of community delivery platforms for prevention of MTCT, and various emerging models of care to improve morbidity and mortality outcomes.

  20. HIV transmission among male inmates in a state prison system--Georgia, 1992-2005.

    Science.gov (United States)

    2006-04-21

    The estimated prevalence of human immunodeficiency virus (HIV) infection is nearly five times higher for incarcerated populations (2.0%) than for the general U.S. population (0.43%). In 1988, the Georgia Department of Corrections (GDC) initiated mandatory HIV testing of inmates upon entry into prison and voluntary HIV testing of inmates on request or if clinically indicated. GDC offered voluntary HIV testing to inmates annually during July 2003-June 2005 and currently offers testing to inmates on request. During July 1988-February 2005, a total of 88 male inmates were known to have had both a negative HIV test result upon entry into prison and a subsequent confirmed positive HIV test result (i.e., seroconversion) during incarceration. Of these 88 inmates, 37 (42%) had had more than one negative HIV test result before their HIV diagnosis. In October 2004, GDC and the Georgia Division of Public Health invited CDC to assist with an epidemiologic investigation of HIV risk behaviors and transmission patterns among male inmates within GDC facilities and to make HIV prevention recommendations for the prison population. This report describes the results of that investigation, which identified the following characteristics as associated with HIV seroconversion in prison: male-male sex in prison, tattooing in prison, older age (i.e., age of >26 years at date of interview), having served > or =5 years of the current sentence, black race, and having a body mass index (BMI) of inmates, highlighting the need for HIV prevention programs for this population.

  1. Incorporating Couples-Based Approaches into HIV Prevention for Gay and Bisexual Men: Opportunities and Challenges

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    Mizuno, Yuko; Smith, Dawn K.; Grabbe, Kristina; Courtenay-Quirk, Cari; Tomlinson, Hank; Mermin, Jonathan

    2016-01-01

    Thirty years after the beginning of the HIV epidemic, gay, bisexual, and other men who have sex with men (collectively called MSM) bear a disproportionate burden of HIV in the United States and continue to acquire a distressingly high number and proportion of new infections. Historically, HIV prevention for MSM has been focused on individual-level behavior change, rarely intervening with MSM as part of a couple. Yet, an estimated 33–67% of HIV infections among MSM are acquired from primary sexual partners, suggesting that work with MSM as couples could be an important contributor to prevention. Given the emergence of high impact combination HIV prevention, it is timely to consider how work with the broad variety of male couples can improve both personal and community health. Couples HIV testing and counseling for MSM is an important advance for identifying men who are unaware that they are HIV-positive, identifying HIV-discordant couples, and supporting men who want to learn their HIV status with their partner. Once men know their HIV status, new advances in biomedical prevention, which can dramatically reduce risk of HIV transmission or acquisition, allow men to make prevention decisions that can protect themselves and their partners. This paper highlights the present-day challenges and benefits of using a couples-based approach with MSM in the era of combination prevention to increase knowledge of HIV status, increase identification of HIV discordant couples to improve targeting prevention services, and support mutual disclosure of HIV status. PMID:24233328

  2. Missed opportunities for congenital syphilis and HIV perinatal transmission prevention Oportunidades perdidas en la prevención de la sífilis congénita y de la transmisión vertical del HIV Oportunidades perdidas na prevenção da sífilis congênita e da transmissão vertical do HIV

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    Celeste Souza Rodrigues

    2008-10-01

    Full Text Available OBJECTIVE: To estimate the prevalence of missed opportunities for congenital syphilis and HIV prevention in pregnant women who had access to prenatal care and to assess factors associated to non-testing of these infections. METHODS: Cross-sectional study comprising a randomly selected sample of 2,145 puerperal women who were admitted in maternity hospitals for delivery or curettage and had attended at least one prenatal care visit, in Brazil between 1999 and 2000. No syphilis and/or anti-HIV testing during pregnancy was a marker for missed prevention opportunity. Women who were not tested for either or both were compared to those who had at least one syphilis and one anti-HIV testing performed during pregnancy (reference category. The prevalence of missed prevention opportunity was estimated for each category with 95% confidence intervals. Factors independently associated with missed prevention opportunity were assessed through multinomial logistic regression. RESULTS: The prevalence of missed prevention opportunity for syphilis or anti-HIV was 41.2% and 56.0%, respectively. The multivariate analysis showed that race/skin color (non-white, schooling (OBJETIVO: Estimar la prevalencia de oportunidad de pérdida de prevención de la sífilis y el HIV entre gestantes que tuvieron acceso al pre-natal y factores asociados con la no evaluación de estos agravios. MÉTODOS: Se realizó estudio transversal con muestra aleatoria de 2.145 puérperas de Brasil, 1999 y 2000 admitidas en maternidades para parto o curetaje y que habían realizado al menos una consulta de pre-natal. La no realización del examen de prueba para sífilis y/o anti-HIV durante el embarazo fue usada como marcador para oportunidad de pérdida de prevención. Las mujeres que realizaron sólo examen de sífilis o sólo examen de anti-HIV, o que no realizaron ninguno, fueron comparadas con las que realizaron los dos (categoría de referencia. La prevalencia de oportunidad de pérdida de

  3. 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

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    Lubega M

    2013-05-01

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

  4. Evidence on the cost-effectiveness of lifelong antiretroviral therapy for prevention of mother-to-child transmission of HIV: implications for resource-limited countries in sub-Saharan Africa.

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    Ngambi, Peslie G; Kalungia, Aubrey C; Law, Michael R; Kalemeera, Francis; Truter, IIse; Godman, Brian; Munkombwe, Derick

    2017-10-01

    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.

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

    Science.gov (United States)

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

    2015-10-01

    Although the rates of vertical transmission of HIV in the developing world have improved to around 3% in countries like South Africa, resistance to antiretrovirals (ARV) used in Prevention of Mother-to-Child transmission (pMTCT) strategies may thwart such outcomes and affect the efficacy of future ARV regimens in mothers and children. This study conducted in Durban, South Africa, between 2010 and 2013 found a high rate of nevirapine (NVP) resistance among women receiving Zidovudine (AZT) from 14 weeks gestation, single dose nevirapine (sd NVP) at the onset of labor and a single dose of coformulated Tenofovir/Emtricitabine (TDF/FTC) postpartum. Using Sanger sequencing, high and intermediate levels of nevirapine (NVP) resistance were detected in 15/44 (34%) and in 1/44 (2%) of women tested, respectively. Most subjects selected the K103N mutation (22% (10/45) of all patients and 66% (10/15) of those with high-level NVP resistance). Such rate of NVP resistance is comparable to studies where only sd NVP was used. In conclusion, a post-partum single-dose TDF/FTC tail does not prevent the selection of NNRTI resistance in women receiving pre-partum ZDV and intrapartum sd NVP to prevent mother-to-child HIV-1 transmission. © 2015 Wiley Periodicals, Inc.

  6. The role of men as partners and fathers in the prevention of mother-to-child transmission of HIV and in the promotion of sexual and reproductive health.

    Science.gov (United States)

    Ramirez-Ferrero, Eric; Lusti-Narasimhan, Manjula

    2012-12-01

    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.

  7. 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.

    Science.gov (United States)

    Woelk, Godfrey B; Kieffer, Mary Pat; Walker, Damilola; Mpofu, Daphne; Machekano, Rhoderick

    2016-02-16

    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

  8. Male involvement in prevention of mother-to-child transmission of HIV in the context of partner testing in Goba town, Ethiopia: A facility-based cross-sectional study.

    Science.gov (United States)

    Alemayehu, M T; Haidar, J

    2017-09-22

    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

  9. Male involvement in prevention of mother-to-child transmission of HIV in the context of partner testing in Goba town, Ethiopia: A facility-based cross-sectional study

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    M T Alemayehu

    2017-10-01

    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

  10. Transmission of human immunodeficiency virus (HIV/HTLV-III/LAV): a review.

    Science.gov (United States)

    van der Graaf, M; Diepersloot, R J

    1986-01-01

    The literature on the transmission of human immunodeficiency virus (HIV/HTLV-III/LAV) is reviewed. HIV spreads by vertical transmission and by iatrogenic transmission (transfer of blood or blood-containing products), by infected needles among i.v. drug users and, more rarely, among health care workers, but mainly by sexual contact. In Western countries the virus is mainly spread by passive anal intercourse among homosexuals and seldom by heterosexual intercourse. In African countries, however, the virus is mainly spread by heterosexual intercourse, probably because of other, concurring sexually transmitted diseases. Some preventive measures are discussed.

  11. Reviewing the evidence on effectiveness and cost-effectiveness of HIV prevention strategies in Thailand

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    Teerawattananon Yot

    2010-07-01

    Full Text Available Abstract Background Following universal access to antiretroviral therapy in Thailand, evidence from National AIDS Spending Assessment indicates a decreasing proportion of expenditure on prevention interventions. To prompt policymakers to revitalize HIV prevention, this study identifies a comprehensive list of HIV/AIDs preventive interventions that are likely to be effective and cost-effective in Thailand. Methods A systematic review of the national and international literature on HIV prevention strategies from 1997 to 2008 was undertaken. The outcomes used to consider the effectiveness of HIV prevention interventions were changes in HIV risk behaviour and HIV incidence. Economic evaluations that presented their results in terms of cost per HIV infection averted or cost per quality-adjusted life year (QALY gained were also included. All studies were assessed against quality criteria. Results The findings demonstrated that school based-sex education plus life-skill programs, voluntary and routine HIV counselling and testing, male condoms, street outreach programs, needle and syringe programs, programs for the prevention of mother-to-child HIV transmission, male circumcision, screening blood products and donated organs for HIV, and increased alcohol tax were all effective in reducing HIV infection among target populations in a cost-effective manner. Conclusion We found very limited local evidence regarding the effectiveness of HIV interventions amongst specific high risk populations. This underlines the urgent need to prioritise health research resources to assess the effectiveness and cost-effectiveness of HIV interventions aimed at reducing HIV infection among high risk groups in Thailand.

  12. Reviewing the evidence on effectiveness and cost-effectiveness of HIV prevention strategies in Thailand.

    Science.gov (United States)

    Pattanaphesaj, Juntana; Teerawattananon, Yot

    2010-07-07

    Following universal access to antiretroviral therapy in Thailand, evidence from National AIDS Spending Assessment indicates a decreasing proportion of expenditure on prevention interventions. To prompt policymakers to revitalize HIV prevention, this study identifies a comprehensive list of HIV/AIDs preventive interventions that are likely to be effective and cost-effective in Thailand. A systematic review of the national and international literature on HIV prevention strategies from 1997 to 2008 was undertaken. The outcomes used to consider the effectiveness of HIV prevention interventions were changes in HIV risk behaviour and HIV incidence. Economic evaluations that presented their results in terms of cost per HIV infection averted or cost per quality-adjusted life year (QALY) gained were also included. All studies were assessed against quality criteria. The findings demonstrated that school based-sex education plus life-skill programs, voluntary and routine HIV counselling and testing, male condoms, street outreach programs, needle and syringe programs, programs for the prevention of mother-to-child HIV transmission, male circumcision, screening blood products and donated organs for HIV, and increased alcohol tax were all effective in reducing HIV infection among target populations in a cost-effective manner. We found very limited local evidence regarding the effectiveness of HIV interventions amongst specific high risk populations. This underlines the urgent need to prioritise health research resources to assess the effectiveness and cost-effectiveness of HIV interventions aimed at reducing HIV infection among high risk groups in Thailand.

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

    Science.gov (United States)

    Tugizov, Sharof

    2016-01-01

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

  14. HIV prevention in care and treatment settings: baseline risk behaviors among HIV patients in Kenya, Namibia, and Tanzania.

    Directory of Open Access Journals (Sweden)

    Daniel P Kidder

    Full Text Available HIV care and treatment settings provide an opportunity to reach people living with HIV/AIDS (PLHIV with prevention messages and services. Population-based surveys in sub-Saharan Africa have identified HIV risk behaviors among PLHIV, yet data are limited regarding HIV risk behaviors of PLHIV in clinical care. This paper describes the baseline sociodemographic, HIV transmission risk behaviors, and clinical data of a study evaluating an HIV prevention intervention package for HIV care and treatment clinics in Africa. The study was a longitudinal group-randomized trial in 9 intervention clinics and 9 comparison clinics in Kenya, Namibia, and Tanzania (N = 3538. Baseline participants were mostly female, married, had less than a primary education, and were relatively recently diagnosed with HIV. Fifty-two percent of participants had a partner of negative or unknown status, 24% were not using condoms consistently, and 11% reported STI symptoms in the last 6 months. There were differences in demographic and HIV transmission risk variables by country, indicating the need to consider local context in designing studies and using caution when generalizing findings across African countries. Baseline data from this study indicate that participants were often engaging in HIV transmission risk behaviors, which supports the need for prevention with PLHIV (PwP.ClinicalTrials.gov NCT01256463.

  15. HIV Prevention in Care and Treatment Settings: Baseline Risk Behaviors among HIV Patients in Kenya, Namibia, and Tanzania

    Science.gov (United States)

    Kidder, Daniel P.; Bachanas, Pam; Medley, Amy; Pals, Sherri; Nuwagaba-Biribonwoha, Harriet; Ackers, Marta; Howard, Andrea; DeLuca, Nick; Mbatia, Redempta; Sheriff, Muhsin; Arthur, Gilly; Katuta, Frieda; Cherutich, Peter; Somi, Geoffrey

    2013-01-01

    HIV care and treatment settings provide an opportunity to reach people living with HIV/AIDS (PLHIV) with prevention messages and services. Population-based surveys in sub-Saharan Africa have identified HIV risk behaviors among PLHIV, yet data are limited regarding HIV risk behaviors of PLHIV in clinical care. This paper describes the baseline sociodemographic, HIV transmission risk behaviors, and clinical data of a study evaluating an HIV prevention intervention package for HIV care and treatment clinics in Africa. The study was a longitudinal group-randomized trial in 9 intervention clinics and 9 comparison clinics in Kenya, Namibia, and Tanzania (N = 3538). Baseline participants were mostly female, married, had less than a primary education, and were relatively recently diagnosed with HIV. Fifty-two percent of participants had a partner of negative or unknown status, 24% were not using condoms consistently, and 11% reported STI symptoms in the last 6 months. There were differences in demographic and HIV transmission risk variables by country, indicating the need to consider local context in designing studies and using caution when generalizing findings across African countries. Baseline data from this study indicate that participants were often engaging in HIV transmission risk behaviors, which supports the need for prevention with PLHIV (PwP). Trial Registration ClinicalTrials.gov NCT01256463 PMID:23459196

  16. Factors associated with mother to child transmission of HIV despite overall low transmission rates in HIV-exposed infants in rural Kenya.

    Science.gov (United States)

    Okoko, Nicollate A; Owuor, Kevin O; Kulzer, Jayne L; Owino, George O; Ogolla, Irene A; Wandera, Ronald W; Bukusi, Elizabeth A; Cohen, Craig R; Abuogi, Lisa L

    2017-10-01

    Despite the availability of efficacious prevention of mother-to-child transmission (PMTCT) interventions and improved access to preventive services in many developing countries, vertical HIV transmission persists. A matched case-control study of HIV-exposed infants between January and June 2012 was conducted at 20 clinics in Kenya. Cases were HIV-infected infants and controls were exposed, uninfected infants. Conditional logistic regression analysis was conducted to determine characteristics associated with HIV infection. Forty-five cases and 45 controls were compared. Characteristics associated with HIV-infection included poor PMTCT service uptake such as late infant enrollment (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 2.6-16.7) and poor adherence to infant prophylaxis (OR: 8.3, 95%CI: 3.2-21.4). Maternal characteristics associated with MTCT included lack of awareness of HIV status (OR: 5.6, 95%CI: 2.2-14.5), failure to access antiretroviral prophylaxis (OR: 22.2, 95%CI: 5.8-84.6), and poor adherence (OR: 8.1, 95%CI: 3.7-17.8). Lack of clinic-based HIV education (OR: 7.7, 95%CI: 2.0-25.0) and counseling (OR: 8.3, 95%CI: 2.2-33.3) were reported by mothers of cases. Poor uptake of PMTCT services and a reported absence of HIV education and counseling at the clinic were associated with MTCT. More emphasis on high-quality, comprehensive PMTCT service provision are urgently needed to minimize HIV transmission to children.

  17. Combining epidemiological and genetic networks signifies the importance of early treatment in HIV-1 transmission.

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    Narges Zarrabi

    Full Text Available Inferring disease transmission networks is important in epidemiology in order to understand and prevent the spread of infectious diseases. Reconstruction of the infection transmission networks requires insight into viral genome data as well as social interactions. For the HIV-1 epidemic, current research either uses genetic information of patients' virus to infer the past infection events or uses statistics of sexual interactions to model the network structure of viral spreading. Methods for a reliable reconstruction of HIV-1 transmission dynamics, taking into account both molecular and societal data are still lacking. The aim of this study is to combine information from both genetic and epidemiological scales to characterize and analyse a transmission network of the HIV-1 epidemic in central Italy.We introduce a novel filter-reduction method to build a network of HIV infected patients based on their social and treatment information. The network is then combined with a genetic network, to infer a hypothetical infection transmission network. We apply this method to a cohort study of HIV-1 infected patients in central Italy and find that patients who are highly connected in the network have longer untreated infection periods. We also find that the network structures for homosexual males and heterosexual populations are heterogeneous, consisting of a majority of 'peripheral nodes' that have only a few sexual interactions and a minority of 'hub nodes' that have many sexual interactions. Inferring HIV-1 transmission networks using this novel combined approach reveals remarkable correlations between high out-degree individuals and longer untreated infection periods. These findings signify the importance of early treatment and support the potential benefit of wide population screening, management of early diagnoses and anticipated antiretroviral treatment to prevent viral transmission and spread. The approach presented here for reconstructing HIV-1

  18. Combining epidemiological and genetic networks signifies the importance of early treatment in HIV-1 transmission.

    Science.gov (United States)

    Zarrabi, Narges; Prosperi, Mattia; Belleman, Robert G; Colafigli, Manuela; De Luca, Andrea; Sloot, Peter M A

    2012-01-01

    Inferring disease transmission networks is important in epidemiology in order to understand and prevent the spread of infectious diseases. Reconstruction of the infection transmission networks requires insight into viral genome data as well as social interactions. For the HIV-1 epidemic, current research either uses genetic information of patients' virus to infer the past infection events or uses statistics of sexual interactions to model the network structure of viral spreading. Methods for a reliable reconstruction of HIV-1 transmission dynamics, taking into account both molecular and societal data are still lacking. The aim of this study is to combine information from both genetic and epidemiological scales to characterize and analyse a transmission network of the HIV-1 epidemic in central Italy.We introduce a novel filter-reduction method to build a network of HIV infected patients based on their social and treatment information. The network is then combined with a genetic network, to infer a hypothetical infection transmission network. We apply this method to a cohort study of HIV-1 infected patients in central Italy and find that patients who are highly connected in the network have longer untreated infection periods. We also find that the network structures for homosexual males and heterosexual populations are heterogeneous, consisting of a majority of 'peripheral nodes' that have only a few sexual interactions and a minority of 'hub nodes' that have many sexual interactions. Inferring HIV-1 transmission networks using this novel combined approach reveals remarkable correlations between high out-degree individuals and longer untreated infection periods. These findings signify the importance of early treatment and support the potential benefit of wide population screening, management of early diagnoses and anticipated antiretroviral treatment to prevent viral transmission and spread. The approach presented here for reconstructing HIV-1 transmission networks

  19. The cost-effectiveness of different feeding patterns combined with prompt treatments for preventing mother-to-child HIV transmission in South Africa: estimates from simulation modeling.

    Directory of Open Access Journals (Sweden)

    Wenhua Yu

    Full Text Available OBJECTIVES: Based on the important changes in South Africa since 2009 and the Antiretroviral Treatment Guideline 2013 recommendations, we explored the cost-effectiveness of different strategy combinations according to the South African HIV-infected mothers' prompt treatments and different feeding patterns. STUDY DESIGN: A decision analytic model was applied to simulate cohorts of 10,000 HIV-infected pregnant women to compare the cost-effectiveness of two different HIV strategy combinations: (1 Women were tested and treated promptly at any time during pregnancy (Promptly treated cohort. (2 Women did not get testing or treatment until after delivery and appropriate standard treatments were offered as a remedy (Remedy cohort. Replacement feeding or exclusive breastfeeding was assigned in both strategies. Outcome measures included the number of infant HIV cases averted, the cost per infant HIV case averted, and the cost per life year (LY saved from the interventions. One-way and multivariate sensitivity analyses were performed to estimate the uncertainty ranges of all outcomes. RESULTS: The remedy strategy does not particularly cost-effective. Compared with the untreated baseline cohort which leads to 1127 infected infants, 698 (61.93% and 110 (9.76% of pediatric HIV cases are averted in the promptly treated cohort and remedy cohort respectively, with incremental cost-effectiveness of $68.51 and $118.33 per LY, respectively. With or without the antenatal testing and treatments, breastfeeding is less cost-effective ($193.26 per LY than replacement feeding ($134.88 per LY, without considering the impact of willingness to pay. CONCLUSION: Compared with the prompt treatments, remedy in labor or during the postnatal period is less cost-effective. Antenatal HIV testing and prompt treatments and avoiding breastfeeding are the best strategies. Although encouraging mothers to practice replacement feeding in South Africa is far from easy and the advantages of

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

    Directory of Open Access Journals (Sweden)

    Ruizhong Shen

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

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

    Science.gov (United States)

    Shen, Ruizhong; Achenbach, Jenna; Shen, Yue; Palaia, Jana; Rahkola, Jeremy T; Nick, Heidi J; Smythies, Lesley E; McConnell, Michelle; Fowler, Mary G; Smith, Phillip D; Janoff, Edward N

    2015-01-01

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

  2. Expanding the role of community mobilization to accelerate progress towards ending vertical transmission of HIV in Uganda: the Networks model.

    Science.gov (United States)

    Mburu, Gitau; Iorpenda, Kate; Muwanga, Fred

    2012-07-11

    Efforts to prevent vertical transmission of HIV have gained momentum globally since the launch of the "Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive", reflecting the growing consensus that we now have low-cost, efficacious interventions that promise to end vertical transmission of HIV. Uganda is one of the 22 focus countries in the global plan and one of the 10 countries with the highest need for prevention of vertical transmission globally. In the context of current shortfalls in the prevention of vertical HIV transmission, this paper presents the results of the Networks project, a community mobilisation model implemented by the International HIV/AIDS Alliance in Uganda, and draws out the theoretical foundations and promising community mobilization practices relevant to prevention of vertical transmission. A retrospective review of the Network project's activities, documentation and evaluation was performed. The Networks project, through community mobilisation and greater involvement of people living with HIV, reached an estimated 1.3 million people with at least one health service. By clustering 750 groups of people living with HIV into larger coalitions, the project supported existing groups to amalgamate their collective strengths and skills in outreach, referral and literacy activities; and improved reach and coverage of HIV services through strengthened linkages with healthcare facilities. Our analysis of the Networks model shows that it could contribute to the prevention of vertical transmission of HIV as a replicable and sustainable community mobilisation approach. In particular, the Networks model increased the uptake of decentralized interventions for preventing vertical transmission through community referrals; promoted male involvement through peer sensitisation; and linked communities to advocacy channels for advancing maternal health and prevention of vertical HIV transmission. BY

  3. Knowledge and attitude towards mother to child transmission of HIV ...

    African Journals Online (AJOL)

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    Most studies in the US and Europe have documented transmission rates in untreated women to be between 12-30%. In contrast, transmission rates in Africa and Haiti were reported to be higher (25%-. 52%) (6). Vertical transmission of HIV can occur before (intra– uterine), during (intra-partum), or after delivery (through.

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

    Science.gov (United States)

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

    2014-12-01

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

  5. HLA-G 3' UTR haplotypes and HIV vertical transmission.

    Science.gov (United States)

    Segat, Ludovica; Catamo, Eulalia; Fabris, Annalisa; Padovan, Lara; Morgutti, Marcello; Crovella, Sergio

    2009-09-10

    We evaluated the possible association of human leukocyte antigen-G (HLA-G) 3777G>C and 14-bp deletion/insertion (D/I) polymorphisms haplotypes and combined genotypes with perinatal HIV transmission in Brazilian children. The 3777G>C polymorphism alone has no effect on HIV vertical transmission but, when linked with the D allele, exerts a positive role in the protection. Indeed, we identified the DC HLA-G haplotype as significantly associated with a protective effect towards HIV vertical transmission.

  6. HIV-positive pregnant women attending the prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services in Ethiopia: economic productivity losses across urban-rural settings.

    Science.gov (United States)

    Zegeye, Elias Asfaw; Mbonigaba, Josue; Kaye, Sylvia Blanche

    2018-06-01

    HIV/AIDS impacts significantly on pregnant women and on children in Ethiopia. This impact has a multiplier effect on household economies and on productivity losses, and is expected to vary across rural and urban settings. Applying the human capital approach to data collected from 131 respondents, this study estimated productivity losses per HIV-positive pregnant woman-infant pair across urban and rural health facilities in Ethiopia, which in turn were used to estimate the national productivity loss. The study found that the annual productivity loss per woman-infant pair was Ethiopian birr (ETB) 7,433 or United States dollar (US$) 378 and ETB 625 (US$ 32) in urban and rural settings, respectively. The mean patient days lost per year due to inpatient admission at hospitals/health centres was 11 in urban and 22 in rural health facilities. On average, urban home care-givers spent 20 (SD = 21) days annually providing home care services, while their rural counterparts spent 23 days (SD = 26). The productivity loss accounted for 16% and 7% of household income in urban and rural settings, respectively. These high and varying productivity losses require preventive interventions that are appropriate to each setting to ensure the welfare of women and children in Ethiopia.

  7. STD patients’ preferences for HIV prevention strategies

    Directory of Open Access Journals (Sweden)

    Castro JG

    2014-12-01

    Full Text Available Jose G Castro,1 Deborah L Jones,2 Stephen M Weiss2 1Infectious Diseases, Department of Medicine, 2Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, USA Abstract: The objective of this pilot study was to explore the knowledge of and preferences regarding effective biomedical interventions among high risk individuals attending a sexually transmitted diseases clinic, and to examine the effect of a brief information intervention on preference. Participants completed a baseline assessment, attended a presentation on human immunodeficiency virus (HIV prevention methods, and completed a postintervention assessment. Outcome measures included: demographics and sexual risk factors, self-perceived HIV risk, and knowledge and attitudes regarding new biomedical methods of HIV prevention. After the baseline evaluation, participants were provided with information on new biomedical prevention strategies. Participants were given the option to review the information by reading a pamphlet or by viewing a brief video containing the same information. Participants (n=97 were female (n=51 and male (n=46. At baseline, only a small minority of participants were aware of the newer biomedical strategies to prevent HIV infection. Postintervention, 40% endorsed having heard about the use of HIV medications to prevent HIV infection; 72% had heard that male circumcision can decrease the risk of acquiring HIV infection in men; and 73% endorsed knowledge of the potential role of microbicides in decreasing the risk of acquiring HIV. Following the intervention, the most preferred prevention method was male condoms, followed by preexposure prophylaxis, and microbicides. The least preferred methods were male circumcision and female condoms. This study provides preliminary information on knowledge and attitudes regarding newer biomedical interventions to protect against HIV infection. Keywords: STD clinic, biomedical HIV prevention, PrEP, male

  8. Spousal communication about HIV prevention in Kenya.

    Science.gov (United States)

    Chiao, Chi; Mishra, Vinod; Ksobiech, Kate

    2011-11-01

    High HIV rates among cohabiting couples in many African countries have led to greater programmatic emphasis on spousal communication in HIV prevention. This study examines how demographic and socioeconomic characteristics of cohabiting adults influence their dyadic communication about HIV. A central focus of this research is on how the position of women relative to their male partners influences spousal communication about HIV prevention. The authors analyze gaps in spousal age and education and females' participation in household decision making as key factors influencing spousal communication about HIV, while controlling for sexual behaviors of both partners as well as other individual and contextual factors. Data were obtained from the 2003 Kenya Demographic and Health Survey for 1,388 cohabiting couples. Information regarding spousal communication was self-reported, assessing whether both, either, or neither partner ever discussed HIV prevention with the other. Analyses showed higher levels of education for the female partner and participation in household decision making are positively associated with spousal communication about HIV prevention. With females' education and other factors controlled, couples with more educated male partners were more likely to have discussed HIV prevention than couples in which both partners have the same level of education. Spousal communication was also positively associated with household wealth status and exposure to the mass media, but couples in which male partners reported having nonspousal sex in the past year were less likely to have discussed HIV prevention with their spouses. Findings suggest HIV prevention programs should promote female empowerment and encourage male participation in sexual health discussion.

  9. The role of extra-couple HIV transmission in sub-Saharan Africa

    Science.gov (United States)

    Bellan, Steve E.; Fiorella, Kathryn J.; Melesse, Dessalegn Y.; Getz, Wayne M.; Williams, Brian G.; Dushoff, Jonathan

    2013-01-01

    Summary Background The proportion of heterosexual HIV transmission in Sub-Saharan Africa that occurs within cohabiting partnerships, as opposed to among single people, or in extra-couple relationships, is a subject of active debate. This question is of immediate importance. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is critical to targeting intervention efforts. Methods We built a mechanistic HIV transmission model using data from Demographic and Health Surveys covering 27,201 cohabiting couples from 18 sub-Saharan African countries with information on couple duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and ART coverage. We then estimated the proportion of observed infections in surveyed cohabiting couples that occurred prior to couple formation, between couple members, and through extra-couple intercourse. Findings We estimate that extra-couple transmission accounts for between 27-61% and 21-51% of all infected males and females, respectively, in surveyed couples, with the ranges given reflecting inter-country variation. We project that over the next year extra-couple transmission will account for 30-65% and 10-47% of new incident HIV infections in males and females, respectively, in cohabiting couples. Our results also suggest that the directionality of transmission within couples is largely from males to females; however, females experience a very high-risk period prior to couple formation. Interpretation Due to the large contribution of extra-couple transmission, HIV prevention interventions should target the general sexually active population, and not just serodiscordant couples. PMID:23391466

  10. Factors associated with misconceptions about HIV transmission among ever-married women in Bangladesh.

    Science.gov (United States)

    Mondal, Md Nazrul Islam; Hoque, Nazrul; Chowdhury, Md Rocky Khan; Hossain, Md Sabbir

    2015-01-01

    The human immunodeficiency virus (HIV) epidemic continues to be associated with misconceptions and misinformed opinions, which increase the risk of HIV transmission. Therefore, the present study aimed to identify the determinant factors among different socioeconomic and demographic factors affecting misconceptions about HIV transmission among ever-married women in Bangladesh. Data and necessary information of 9,272 ever-married women were extracted from the Bangladesh Demographic and Health Survey 2011. Three types of misconceptions were considered. Both bivariate and multivariate analyses were used as the statistical tools to determine the factors affecting misconceptions about HIV transmission. The results revealed that misconceptions are more prevalent among women who are older, less educated, have husbands who are less educated, live in rural areas, have poor economic conditions, and have less access to mass media. The respondent's age, education, husband's education, place of residence, wealth index, and exposure to mass media are significantly associated with the misconceptions. Finally, logistic regression analysis identified age, education, place of residence, wealth index, and exposure to mass media as significant predictors. Because socioeconomic factors are the key determinants of misconceptions about HIV transmission, intervention programs should be aimed at HIV prevention via education and awareness programs to reduce misconceptions as important parts of the prevention strategy.

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

    Ghanotakis, Elena; Peacock, Dean; Wilcher, Rose

    2012-07-11

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

  13. Absence of transmission from HIV-infected individuals with HAART to their heterosexual serodiscordant partners.

    Science.gov (United States)

    Del Romero, Jorge; Río, Isabel; Castilla, Jesús; Baza, Begoña; Paredes, Vanessa; Vera, Mar; Rodríguez, Carmen

    2015-12-01

    Further studies are needed to evaluate the level of effectiveness and durability of HAART to reduce the risk of HIV sexual transmission in serodiscordant couples having unprotected sexual practices. A cross-sectional study was conducted with prospective cohort of heterosexual HIV serodiscordant couples where the only risk factor for HIV transmission to the uninfected partner (sexual partner) was the sexual relationship with the infected partner (index case). HIV prevalence in sexual partners at enrolment and seroconversions in follow-up were compared by antiretroviral treatment in the index partner, HIV plasma viral load in index cases and sexual risk exposures in sexual partners. In each visit, an evaluation of the risks for HIV transmission, preventive counselling and screening for genitourinary infections in the sexual partner was performed, as well as the determination of the immunological and virological situation and antiretroviral treatment in the index case. At enrolment no HIV infection was detected in 202 couples where the index case was taking HAART. HIV prevalence in sexual partners was 9.6% in 491 couples where the index case was not taking antiretroviral treatment (p<0.001). During follow-up there was no HIV seroconversion among 199 partners whose index case was taking HAART, accruing 7600 risky sexual exposures and 85 natural pregnancies. Among 359 couples whose index case was not under antiretroviral treatment, over 13,000 risky sexual exposures and 5 HIV seroconversions of sexual partners were recorded. The percentage of seroconversion among couples having risky sexual intercourse was 2.5 (95% confidence interval [CI]: 1.1-5.6) when the index case did not undergo antiretroviral treatment and zero (95% CI: 0-3.2) when the index case received HAART. The risk of sexual transmission of HIV from individuals with HAART to their heterosexual partners can become extremely low. Copyright © 2014. Published by Elsevier España, S.L.U.

  14. Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand.

    Science.gov (United States)

    Thisyakorn, Usa

    2017-05-01

    In 1988, the generalised HIV/AIDS epidemic in Thailand began and in the same year the first HIV-exposed infant in Thailand was born at King Chulalongkorn Memorial Hospital, Bangkok. From the early to mid-1990s, an epidemic wave of HIV-infected women and infants occurred. Heterosexual HIV transmission, as described in the Asian Epidemic Model, was the major mode of spread in Thailand, causing an increasing number of HIV-infected pregnant women. The early and concerted multi-sectoral response of Thai society reduced the prevalence of HIV infection in pregnant women from 2% in the mid-1990s to 0.6% in 2015 and mother-to-child transmission of HIV (MTCT) from an estimated 20-40% to 1.9%. Thus, Thailand became the first Asian country to achieve the World Health Organization's (WHO) targets for the elimination of MTCT. In this narrative review, the key historic evolutions of the science and policy of prevention of mother-to-child transmission of HIV (PMTCT) in Thailand that addressed the four prongs of the recommended WHO PMTCT strategy are described, and the lessons learned are discussed.

  15. how acceptable are the prevention of mother to child transmission

    African Journals Online (AJOL)

    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 ...

  16. Improving HIV/STD Prevention in the Care of Persons Living with HIV Through a National Training Program

    Science.gov (United States)

    Burnside, Helen; Hsu, Katherine; Smock, Laura; Coury-Doniger, Patricia; Hall, Christopher; Marrazzo, Jeanne; Nagendra, Gowri; Rietmeijer, Cornelis; Rompalo, Ann; Thrun, Mark

    2014-01-01

    Abstract Persons living with HIV (PLWH) are living longer, remaining sexually active, and may continue risky sexual behaviors. As such, it is crucial for providers to ask all HIV-positive patients about behaviors related to HIV transmission and STD acquisition. The “Ask, Screen, Intervene” (ASI) curriculum was developed to increase provider knowledge, skills, and motivation to incorporate risk assessment and prevention services into the care of PLWH. The ASI curriculum was delivered to 2558 HIV-care providers at 137 sites between September 30, 2007 and December 31, 2010. Immediately post-training, participants self-reported significant gains in perceived confidence to demonstrate ASI knowledge and skills (pHIV-care providers self-reported more frequently performing ASI skills (pHIV-care providers, significantly increase self-reported capacity to incorporate HIV/STD prevention into the care of PLWH, and increase implementation of national recommendations. PMID:24428796

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

    NARCIS (Netherlands)

    Rodger, Alison J.; Cambiano, Valentina; Bruun, Tina; Vernazza, Pietro; Collins, Simon; van Lunzen, Jan; Corbelli, Giulio Maria; Estrada, Vicente; Geretti, Anna Maria; Beloukas, Apostolos; Asboe, David; Viciana, Pompeyo; Gutiérrez, Félix; Clotet, Bonaventura; Pradier, Christian; Gerstoft, Jan; Weber, Rainer; Westling, Katarina; Wandeler, Gilles; Prins, Jan M.; Rieger, Armin; Stoeckle, Marcel; Kümmerle, Tim; Bini, Teresa; Ammassari, Adriana; Gilson, Richard; Krznaric, Ivanka; Ristola, Matti; Zangerle, Robert; Handberg, Pia; Antela, Antonio; Allan, Sris; Phillips, Andrew N.; Lundgren, Jens; Pompeyo, V.; Trastoy, M.; Palacio, R.; Gutiérrez, F.; Masiá, M.; Padilla, S.; Robledano, C.; Clotet, B.; Coll, P.; Peña, J.; Estrada, V.; Rodrigo, M.; Santiago, E.; Rivero, A.; Antela, A.; Losada, E.; Lires, C.; Aguilera, A.; Gatell, J.; Guerrero, J.; Dronda, F.; Soriano, V.; Asboe, D.; Nwokolo, N.; Sewell, J.; Gilson, R.; Esteban, N.; McNamara, S.; Rodger, A.; Sturgeon, K.; Gompels, M.; Jennings, L.; Allan, S.; Leen, C.; Morris, S.; Brady, M.; Campbell, L.; Fisher, M.; Dhar, J.; O'Connell, R.; White, D.; Fox, J.; Fidler, S.; Stanley, P.; Natarajan, U.; Ghanem, M.; Ainsworth, J.; Waters, A.; Wilkins, E.; Minton, J.; Calderwood, J.; Patel, H.; Lascar, M.; Lunzen, J.; Kümmerle, T.; Fätkenheuer, G.; Rund, E.; Lehmann, C.; Krznaric, I.; Ingiliz, P.; Motsch, J.; Baumgarten, A.; Bogner, J.; Brockmeyer, N.; Stellbrink, H. J.; Jessen, H.; Rockstroh, J.; Stoeckle, M.; Battegay, M.; Weber, R.; Grube, C.; Braun, D.; Günthard, H.; Wandeler, G.; Furrer, H.; Konrad, T.; Rauch, A.; Vernazza, P.; Rasi, M.; Bernasconi, E.; Tarr, P.; Gerstoft, J.; Quist, T.; Handberg, P.; Clausen, B.; Mathiesen, L.; Oestergaard, Skejby; Stenvang, S.; Ristola, M.; Kivelä, P.; Westling, K.; Frisén, E.; Blaxhult, A.; Cortney, G.; Clumeck, N.; Vandekerckhove, L.; Prins, J.; Brinkman, K.; Verhagen, D.; Eeden, A.; Pradier, C.; Durant, J.; Serini, M.; Bréaud, S.; Raffi, F.; Pialoux, G.; Ohayon, M.; Coquelin, V.; Rieger, A.; Touzeau-Roemer, V.; Zangerle, R.; Kitchen, M.; Gisinger, M.; Sarcletti, M.; Geit, M.; Bini, T.; Comi, L.; Pandolfo, A.; Suardi, E.; Ammassari, A.; Pierro, P.; Carli, G.; Orchi, N.; Celesia, M.; Mussini, C.; Biagio, A.; Janerio, N.

    2016-01-01

    IMPORTANCE A key factor in assessing the effectiveness and cost-effectiveness of antiretroviral therapy (ART) as a prevention strategy is the absolute risk of HIV transmission through condomless sex with suppressed HIV-1 RNA viral load for both anal and vaginal sex. OBJECTIVE To evaluate the rate of

  18. Female Genital Mutilation: Potential for HIV Transmission in sub ...

    African Journals Online (AJOL)

    Secondly, the complications of FGM are well established which include Genitourinary disorders. Further, while data is limited on HIV transmission via FGM, there is biologic plausibility in suggesting that FGM may be associated with increasing prevalence of HIV in sub-Saharan Africa. This paper recommends further studies ...

  19. Attitudes towards the risk of HIV transmission in sport | Reddy ...

    African Journals Online (AJOL)

    Objective. There is a real risk of transmitting HIV through open wounds during participation in sport. The aim of this study was to investigate athlete s knowledge and attitudes towards HIV transmission in a competitive sport environment how their sporting codes, demographics, knowledge and interaction with colleagues ...

  20. Challenges in HIV vaccine research for treatment and prevention

    Directory of Open Access Journals (Sweden)

    Barbara eEnsoli

    2014-09-01

    Full Text Available Many attempts have been made or are ongoing for HIV prevention and HIV cure. Many successes are in the list, particularly for HIV drugs, recently proposed also for prevention. However, no eradication of infection has been achieved so far with any drug.Further, a residual immune dysregulation associated to chronic immune activation and incomplete restoration of B and T cell subsets, together with HIV DNA persistence in reservoirs, are still unmet needs of the highly active antiretroviral therapy (HAART, causing novel non-AIDS related diseases that account for a higher risk of death even in virologically suppressed patients. These ART unmet needs represent a problem, which is expected to increase by ART roll out. Further, in countries such as South Africa, where 6 millions of individuals are infected, ART appears unable to contain the epidemics. Regretfully, all the attempts at developing a preventative vaccine have been largely disappointing. However, recent therapeutic immunization strategies have opened new avenues for HIV treatment, which might be exploitable also for preventative vaccine approaches. For example, immunization strategies aimed at targeting key viral products responsible of virus transmission, activation and maintenance of virus reservoirs may intensify drug efficacy and lead to a functional cure providing new perspectives also for prevention and future virus eradication strategies. However, this approach imposes new challenges to the scientific community, vaccine developers and regulatory bodies, such as the identification of novel immunological and virological biomarkers to assess efficacy endpoints, taking advantage from the natural history of infection and exploiting lessons from former trials.This review will focus first on recent advancement of therapeutic strategies, then on the progresses made in preventative approaches, discussing concepts and problems for the way ahead for the development of vaccines for HIV treatment

  1. MiniCD4 microbicide prevents HIV infection of human mucosal explants and vaginal transmission of SHIV(162P3 in cynomolgus macaques.

    Directory of Open Access Journals (Sweden)

    Nathalie Dereuddre-Bosquet

    Full Text Available In complement to an effective vaccine, development of potent anti-HIV microbicides remains an important priority. We have previously shown that the miniCD4 M48U1, a functional mimetic of sCD4 presented on a 27 amino-acid stable scaffold, inhibits a broad range of HIV-1 isolates at sub-nanomolar concentrations in cellular models. Here, we report that M48U1 inhibits efficiently HIV-1(Ba-L in human mucosal explants of cervical and colorectal tissues. In vivo efficacy of M48U1 was evaluated in nonhuman primate (NHP model of mucosal challenge with SHIV(162P3 after assessing pharmacokinetics and pharmacodynamics of a miniCD4 gel formulation in sexually matured female cynomolgus macaques. Among 12 females, half were treated with hydroxyethylcellulose-based gel (control, the other half received the same gel containing 3 mg/g of M48U1, one hour before vaginal route challenge with 10 AID(50 of SHIV(162P3. All control animals were infected with a peak plasma viral load of 10(5-10(6 viral RNA (vRNA copies per mL. In animals treated with miniCD4, 5 out of 6 were fully protected from acquisition of infection, as assessed by qRT-PCR for vRNA detection in plasma, qPCR for viral DNA detection in PBMC and lymph node cells. The only infected animal in this group had a delayed peak of viremia of one week. These results demonstrate that M48U1 miniCD4 acts in vivo as a potent entry inhibitor, which may be considered in microbicide developments.

  2. Risk factors for perinatal HIV-1 transmission in pregnant women ...

    African Journals Online (AJOL)

    Objectives. To estimate the infant HIV-1 transmission rate and to evaluate risk factors for transmission in pregnant women at an Eastern Cape tertiary hospital requiring lifelong antiretroviral therapy (ART). Methods. Pregnant women who initiated lifelong ART during pregnancy and others who conceived on lifelong ART ...

  3. Intrapartum practices to limit vertical transmission of HIV | du Preez ...

    African Journals Online (AJOL)

    The need to improve health services to HIV-positive women requires a specific focus on limiting mother-to-child transmission. Vertical transmission most often takes place during the intrapartum period; hence, it is essential to alert midwives to what constitutes safe or risky intrapartum practices. Midwives in the southern ...

  4. Maternal and fetal determinants of perinatal transmission of HIV ...

    African Journals Online (AJOL)

    All effort should be geared toward identifying those positive and minimized or modify risks factors through behavior change, prompt initiation of treatment and prophylaxis for those found positive with a view to reduce the incidence of perinatal transmission. Key Words: perinatal transmission, HIV, maternal, fetal determinants, ...

  5. Socio cultural factors influencing HIV transmission among Wagogo ...

    African Journals Online (AJOL)

    A majority (95.6%) of the respondents were aware about main cause of HIV transmission as sexual intercourse, Mother to child transmission (77.6%), sharing of sharp equipments (63.2%) and Blood transfusion (20%). Majority (74.3%) of the respondents were related to agricultural activities, while 3.3% were civil servants.

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

    Science.gov (United States)

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

    2013-09-01

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

  7. Characteristics of HIV-1 discordant couples enrolled in a trial of HSV-2 suppression to reduce HIV-1 transmission: the partners study.

    Directory of Open Access Journals (Sweden)

    Jairam R Lingappa

    Full Text Available The Partners HSV-2/HIV-1 Transmission Study (Partners Study is a phase III, placebo-controlled trial of daily acyclovir for genital herpes (HSV-2 suppression among HIV-1/HSV-2 co-infected persons to reduce HIV-1 transmission to their HIV-1 susceptible partners, which requires recruitment of HIV-1 serodiscordant heterosexual couples. We describe the baseline characteristics of this cohort.HIV-1 serodiscordant heterosexual couples, in which the HIV-1 infected partner was HSV-2 seropositive, had a CD4 count >or=250 cells/mcL and was not on antiretroviral therapy, were enrolled at 14 sites in East and Southern Africa. Demographic, behavioral, clinical and laboratory characteristics were assessed.Of the 3408 HIV-1 serodiscordant couples enrolled, 67% of the HIV-1 infected partners were women. Couples had cohabitated for a median of 5 years (range 2-9 with 28% reporting unprotected sex in the month prior to enrollment. Among HIV-1 susceptible participants, 86% of women and 59% of men were HSV-2 seropositive. Other laboratory-diagnosed sexually transmitted infections were uncommon (500 relative to <350, respectively, p<0.001.The Partners Study successfully enrolled a cohort of 3408 heterosexual HIV-1 serodiscordant couples in Africa at high risk for HIV-1 transmission. Follow-up of this cohort will evaluate the efficacy of acyclovir for HSV-2 suppression in preventing HIV-1 transmission and provide insights into biological and behavioral factors determining heterosexual HIV-1 transmission.ClinicalTrials.gov NCT00194519.

  8. Hiv treatment as prevention: Models, data, and questions-towards evidence-based decision-making

    NARCIS (Netherlands)

    T. Bärnighausen (Till); Becker, S. (Stephen); A. Bendavid (Avrom); A. Bershteyn (Anna); J. Blandford (John); M-C. Boily (Marie-Claude); Burns, D. (David); V. Cambiano (Valentina); Cohen, M.S. (Myron S.); Cremin, Í. (Íde); Delva, W. (Wim); Dye, C. (Christopher); J.W. Eaton (Jeffrey); M. Egger (Matthias); C. Fraser (Christophe); Galai, N. (Noya); D. Garnett; Ghys, P.D. (Peter D.); T.B. Hallett (Timothy); Heaton, L. (Laura); C.B. Holmes (Charles ); J.A.C. Hontelez (Jan); Jewell, B. (Britta); Keiser, O. (Olivia); D.J. Klein (David); Lima, V. (Viviane); Long, E. (Elisa); Lyerla, R. (Rob); Marais, C. (Christiaan); Meng, F. (Fei); G. Meyer-Rath (Gesine); Miller, W.C. (William C.); N. Muraguri (Nicholas); B.E. Nichols (Brooke); Nigmatulina, K.R. (Karima R.); Over, M. (Mead); Padian, N. (Nancy); A. Phillips (Andrew); C. Pretorius (Carel); C. Rousseau (Christine); J.A. Salomon (Joshua A); N. Sangrujee (Nalinee); D. Serwadda; F. Tanser (Frank); Vesga, J.F. (Juan F.); K. Vickerman; Walker, D. (Damian); Wang, R. (Rui); Welte, A. (Alex); R.G. White (Richard); B. Williams (Brian); D.C. Wilson (David); Wilson, D. (David); B. Zaba (Basia)

    2012-01-01

    textabstractAntiretroviral therapy (ART) for those infected with HIV can prevent onward transmission of infection, but biological efficacy alone is not enough to guide policy decisions about the role of ART in reducing HIV incidence. Epidemiology, economics, demography, statistics, biology, and

  9. A Neglected Population: Drug-Using Women and Women's Methods of HIV/STI Prevention

    Science.gov (United States)

    Gollub, Erica L.

    2008-01-01

    Women drug users are at extremely high risk of HIV and sexually transmitted infections (STIs) from sexual transmission, but remain seriously neglected in intervention research promoting women-initiated methods of HIV/STI prevention. Sparse available data indicate a high interest and enthusiasm for women-initiated methods among these women.…

  10. Department of Defense HIV/AIDS Prevention Program (DHAPP): 2006 Annual Report

    Science.gov (United States)

    2007-01-01

    and unprotected sex; safe sex to prevent transmission of HIV/AIDS, other sexually transmitted infections, and un- wanted pregnancy; harm reduction...tary. In addition to this, the GAF has installed 6 HIV awareness billboards throughout the country and pro- duced a cassette tape with music and lyrics

  11. Antiretroviral therapy for prevention of HIV and tuberculosis: a promising intervention but not a panacea.

    Science.gov (United States)

    McNairy, Margaret L; Howard, Andrea A; El-Sadr, Wafaa M

    2013-07-01

    The demonstration of the efficacy of antiretroviral therapy (ART) for HIV prevention in heterosexual HIV serodiscordant couples has resulted in the call for widespread implementation of "Treatment as Prevention" (TasP) to confront the challenge of continued transmission of HIV. In addition, evidence of the possible effect of use of ART on decreasing the incidence of tuberculosis (TB) in persons living with HIV has also contributed further enthusiasm. Mathematical modeling studies evaluating the potential impact of TasP on the trajectory of the HIV and TB epidemics have inspired discussions about a possible future without AIDS. We present the evidence regarding the effect of ART on the incidence of HIV and TB, benefits and risks associated with embracing TasP, and the need for multicomponent prevention strategies and for further research to generate empiric data on the effect of TasP on HIV and TB at a population level.

  12. Prevention of mother-to-child transmission of HIV in Haiti Prevención de la transmisión del VIH de madre a hijo en Haití

    Directory of Open Access Journals (Sweden)

    Marie-Marcelle Deschamps

    2009-01-01

    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

  13. The risk of HIV transmission within HIV-1 sero-discordant couples appears to vary across sub-Saharan Africa

    Directory of Open Access Journals (Sweden)

    Hiam Chemaitelly

    2014-03-01

    Conclusions: Empirical measures from cohort studies appear to underestimate HIV infectiousness in SSA. The risk of HIV transmission among SDCs appears also to vary across SSA, and this may have contributed to the contrasting HIV epidemic trajectories in this continent.

  14. HIV transmission risk among HIV seroconcordant and serodiscordant couples: dyadic processes of partner selection.

    Science.gov (United States)

    Eaton, Lisa A; West, Tessa V; Kenny, David A; Kalichman, Seth C

    2009-04-01

    Selecting sex partners of the same HIV status or serosorting is a sexual risk reduction strategy used by many men who have sex with men. However, the effectiveness of serosorting for protection against HIV is potentially limited. We sought to examine how men perceive the protective benefits of factors related to serosorting including beliefs about engaging in serosorting, sexual communication, and perceptions of risk for HIV. Participants were 94 HIV negative seroconcordant (same HIV status) couples, 20 HIV serodiscordant (discrepant HIV status) couples, and 13 HIV positive seroconcordant (same HIV status) couples recruited from a large gay pride festival in the southeastern US. To account for nonindependence found in the couple-level data, we used multilevel modeling which includes dyad in the analysis. Findings demonstrated that participants in seroconcordant relationships were more likely to believe that serosorting reduces concerns for condom use. HIV negative participants in seroconcordant relationships viewed themselves at relatively low risk for HIV transmission even though monogamy within relationships and HIV testing were infrequent. Dyadic analyses demonstrated that partners have a substantial effect on an individual's beliefs and number of unprotected sex partners. We conclude that relationship partners are an important source of influence and, thus, intervening with partners is necessary to reduce HIV transmission risks.

  15. 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.

    Science.gov (United States)

    Zoboli, Fabio; Martinelli, Domenico; Di Stefano, Mariantonietta; Fasano, Massimo; Prato, Rosa; Santantonio, Teresa Antonia; Fiore, Jose' Ramòn

    2017-06-19

    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

  16. Campus HIV Prevention Strategies: Planning for Success.

    Science.gov (United States)

    Hoban, Mary T.; Ottenritter, Nan W.; Gascoigne, Jan L.; Kerr, Dianne L.

    This document presents the results of the National College Health Risk Behavior Survey (NCHRBS) conducted by the U.S. Centers for Disease Control (CDC) that pertain to HIV transmission. These results include sexual assault, alcohol and other drug use, and sexual behaviors. The survey was administered to a nationally representative random sample of…

  17. Pattern recognition receptors in HIV transmission

    NARCIS (Netherlands)

    Mesman, Annelies W.; Geijtenbeek, Teunis B.

    2012-01-01

    Dendritic cells (DCs), Langerhans cells (LCs), and macrophages are innate immune cells that reside in genital and intestinal mucosal tissues susceptible to HIV-1 infection. These innate cells play distinct roles in initiation of HIV-1 infection and induction of anti-viral immunity. DCs are potent

  18. 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

    OpenAIRE

    Takah, Noah F; Kennedy, Iain T R; Johnman, Cathy

    2016-01-01

    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 ...

  19. Factors of the HIV Transmission in Men Who Have Sex with Men in Suizhou City from 2009 to 2013

    Directory of Open Access Journals (Sweden)

    Fan Yang, MD

    2015-03-01

    Conclusions: HIV continues to spread rapidly among MSM in Suizhou City. The high-risk behavior among MSM remains a hindrance to HIV prevention. Innovative intervention approaches are essential for HIV surveillance and prevention among MSM in Suizhou City. Yang F, Shi X, He W, Wu S, Wang J, Zhao K, Yuan H, Martin K, and Zhang H. Factors of the HIV transmission in men who have sex with men in Suizhou City from 2009 to 2013. Sex Med 2015;3:24–31.

  20. The contribution of maternal HIV seroconversion during late pregnancy and breastfeeding to mother-to-child transmission of HIV

    Science.gov (United States)

    Johnson, Leigh F.; Stinson, Kathryn; Newell, Marie-Louise; Bland, Ruth M.; Moultrie, Harry; Davies, Mary-Ann; Rehle, Thomas M.; Dorrington, Rob E.; Sherman, Gayle G.

    2012-01-01

    Background The prevention of mother-to-child transmission (PMTCT) of HIV has been focused mainly on women who are HIV-positive at their first antenatal visit, but there is uncertainty regarding the contribution to overall transmission from mothers who seroconvert after their first antenatal visit and before weaning. Method A mathematical model was developed to simulate changes in mother-to-child transmission of HIV over time, in South Africa. The model allows for changes in infant feeding practices as infants age, temporal changes in the provision of antiretroviral prophylaxis and counselling on infant feeding, as well as temporal changes in maternal HIV prevalence and incidence. Results The proportion of MTCT from mothers who seroconverted after their first antenatal visit was 26% (95% CI: 22-30%) in 2008, or 15 000 out of 57 000 infections. It is estimated that by 2014, total MTCT will reduce to 39 000 per annum, and transmission from mothers seroconverting after their first antenatal visit will reduce to 13 000 per annum, accounting for 34% (95% CI: 29-39%) of MTCT. If maternal HIV incidence during late pregnancy and breastfeeding were reduced by 50% after 2010, and HIV screening were repeated in late pregnancy and at 6-week immunization visits after 2010, the average annual number of MTCT cases over the 2010-15 period would reduce by 28% (95% CI: 25-31%), from 39 000 to 28 000 per annum. Conclusion Maternal seroconversion during late pregnancy and breastfeeding contributes significantly to the paediatric HIV burden, and needs greater attention in the planning of PMTCT programmes. PMID:22193774

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

    Science.gov (United States)

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

    2016-01-01

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

  2. Faith and HIV prevention: the conceptual framing of HIV prevention among Pentecostal Batswana teenagers.

    Science.gov (United States)

    Mpofu, Elias; Nkomazana, Fidelis; Muchado, Jabulani A; Togarasei, Lovemore; Bingenheimer, Jeffrey Bart

    2014-03-05

    There is a huge interest by faith-based organizations (FBOs) in sub-Saharan Africa and elsewhere in HIV prevention interventions that build on the religious aspects of being. Successful partnerships between the public health services and FBOs will require a better understanding of the conceptual framing of HIV prevention by FBOS to access for prevention intervention, those concepts the churches of various denominations and their members would support or endorse. This study investigated the conceptual framing of HIV prevention among church youths in Botswana;--a country with one of the highest HIV prevalence in the world. Participants were 213 Pentecostal church members (67% female; age range 12 to 23 years; median age=19 years). We engaged the participants in a mixed-method inductive process to collect data on their implicit framing of HIV prevention concepts, taking into account the centrality of religion concepts to them and the moderating influences of age, gender and sexual experience. After, we analysed the data using multi-dimensional scaling (MDS) and hierarchical cluster analysis (HCA) to map the ways the church youths framed HIV prevention. The findings suggest the church youth to conceptually frame their HIV prevention from both faith-oriented and secular-oriented perspectives, while prioritizing the faith-oriented concepts based on biblical teachings and future focus. In their secular-oriented framing of HIV prevention, the church youths endorsed the importance to learn the facts about HIV and AIDS, understanding of community norms that increased risk for HIV and prevention education. However, components of secular-oriented framing of HIV prevention concepts were comparatively less was well differentiated among the youths than with faith-oriented framing, suggesting latent influences of the church knowledge environment to undervalue secular oriented concepts. Older and sexually experienced church youths in their framing of HIV prevention valued future

  3. Combining biomedical preventions for HIV: Vaccines with pre-exposure prophylaxis, microbicides or other HIV preventions

    Science.gov (United States)

    McNicholl, Janet M.

    2016-01-01

    ABSTRACT Biomedical preventions for HIV, such as vaccines, microbicides or pre-exposure prophylaxis (PrEP) with antiretroviral drugs, can each only partially prevent HIV-1 infection in most human trials. Oral PrEP is now FDA approved for HIV-prevention in high risk groups, but partial adherence reduces efficacy. If combined as biomedical preventions (CBP) an HIV vaccine could provide protection when PrEP adherence is low and PrEP could prevent vaccine breakthroughs. Other types of PrEP or microbicides may also be partially protective. When licensed, first generation HIV vaccines are likely to be partially effective. Individuals at risk for HIV may receive an HIV vaccine combined with other biomedical preventions, in series or in parallel, in clinical trials or as part of standard of care, with the goal of maximally increasing HIV prevention. In human studies, it is challenging to determine which preventions are best combined, how they interact and how effective they are. Animal models can determine CBP efficacy, whether additive or synergistic, the efficacy of different products and combinations, dose, timing and mechanisms. CBP studies in macaques have shown that partially or minimally effective candidate HIV vaccines combined with partially effective oral PrEP, vaginal PrEP or microbicide generally provided greater protection than either prevention alone against SIV or SHIV challenges. Since human CBP trials will be complex, animal models can guide their design, sample size, endpoints, correlates and surrogates of protection. This review focuses on animal studies and human models of CBP and discusses implications for HIV prevention. PMID:27679928

  4. Evaluation of factors associated with vertical HIV-1 transmission.

    Science.gov (United States)

    Rosa, Matheus Costa da; Lobato, Rubens Caurio; Gonçalves, Carla Vitola; Silva, Naylê Maria Oliveira da; Barral, Maria Fernanda Martínez; Martinez, Ana Maria Barral de; Hora, Vanusa Pousada da

    2015-01-01

    To compare the prevalence and factors associated with vertical transmission of human immunodeficiency virus 1 (HIV-1) among pregnant women treated in the periods of 1998-2004 and 2005-2011 in a reference service for the care of HIV-infected patients in southern Brazil. This was a descriptive and analytical study that used the databases of laboratories from the CD4 and STDs/AIDS Viral Load National Laboratory Network of the Brazilian Ministry of Health. HIV-1-infected pregnant women were selected after an active search for clinical information and obstetric and neonatal data from their medical records between the years of 1998 and 2011. 102 pregnant women were analyzed between 1998 and 2004 and 251 in the period between 2005 and 2011, totaling 353 children born to pregnant women with HIV-1. It was observed that the vertical transmission rate was 11.8% between 1998 and 2004 and 3.2% between 2005 and 2011 (pvertical transmission factors when comparing the two periods. It was observed a decrease in the rate of vertical transmission in recent years. According to the studied variables, is suggested that the risk factors for vertical transmission of HIV-1 were absence of antiretroviral therapy, high viral load in the pregnant women, and membrane rupture time >4h. Copyright © 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  5. HIV-1 vertical transmission in Rio Grande, Southern Brazil.

    Science.gov (United States)

    Tornatore, M; Gonçalves, C V; Mendoza-Sassi, R A; Silveira, J M; D'ávila, N E; Maas, C G; Bianchi, M S; Pinheiro, E M; Machado, E S; Soares, M A; Martinez, A M B

    2010-05-01

    The aim of this study was to determine the rate and risk factors of HIV-1 mother-to-child transmission (MTCT), the timing of transmission and the transmitted subtype in a population where subtypes B and C co-circulate. One hundred and forty-four babies born to HIV-1-infected mothers were studied. Subtype and timing of transmission were determined by a nested polymerase chain reaction of the gp41 gene. Seven children were infected (4.9%): four were infected intrautero and one intrapartum. The higher frequency of intrautero transmission was statistically significant (P = 0.001). Use of antiretrovirals (ARVs) in the three stages of gestation was a protective risk factor for MTCT (PR = 0.42; CI: 0.21-0.83; P = 0.013). A higher HIV viral load at delivery was the only independent risk factor for MTCT. Early and universal access to ARVs during pregnancy are the most important measures to decrease vertical HIV-1 transmission even in areas where HIV clade distribution differs.

  6. Maternal HIV infection and vertical transmission of pathogenic bacteria.

    Science.gov (United States)

    Cutland, Clare L; Schrag, Stephanie J; Zell, Elizabeth R; Kuwanda, Locadiah; Buchmann, Eckhardt; Velaphi, Sithembiso C; Groome, Michelle J; Adrian, Peter V; Madhi, Shabir A

    2012-09-01

    HIV-exposed newborns may be at higher risk of sepsis because of immune system aberrations, impaired maternal antibody transfer and altered exposure to pathogenic bacteria. We performed a secondary analysis of a study (clinicaltrials.gov, number NCT00136370) conducted between April 2004 and October 2007 in South Africa. We used propensity score matching to evaluate the association between maternal HIV infection and (1) vaginal colonization with bacterial pathogens; (2) vertical transmission of pathogens to the newborn; and (3) sepsis within 3 days of birth (EOS) or between 4-28 days of life (LOS). Colonization with group B Streptococcus (17% vs 23%, P = .0002), Escherichia coli (47% vs 45%, P = .374), and Klebsiella pneumoniae (7% vs 10%, P = .008) differed modestly between HIV-infected and uninfected women, as did vertical transmission rates. Maternal HIV infection was not associated with increased risk of neonatal EOS or LOS, although culture-confirmed EOS was >3 times higher among HIV-exposed infants (P = .05). When compared with HIV-unexposed, neonates, HIV-exposed, uninfected neonates (HEU) had a lower risk of EOS (20.6 vs 33.7 per 1000 births; P = .046) and similar rate of LOS (5.8 vs 4.1; P = .563). HIV-infected newborns had a higher risk than HEU of EOS (134 vs 21.5; P HIV infection was not associated with increased risk of maternal bacterial colonization, vertical transmission, EOS, or LOS. HIV-infected neonates, however, were at increased risk of EOS and LOS.

  7. Transmission of HIV-1 in the breast-feeding process.

    Science.gov (United States)

    Black, R F

    1996-03-01

    Current laboratory techniques cannot distinguish the mode of vertical transmission (intrauterine, intrapartum, or postnatal) of human immunodeficiency virus type 1 (HIV-1) from mother to infant. The ability to transmit HIV-1 via breast feeding has been established in 24 case reports, primarily involving mothers who seroconvert after delivery. Whether breast-feeding adds a notable additional risk of HIV-1 infection to the risk from pregnancy is controversial. The importance of the duration and intensity of breast-feeding in modulating the outcome of HIV transmission via breast milk also remains unclear. Factors in breast milk may play important roles in an infant's susceptibility to infection with HIV and in the expression of the virus. Pasteurization and storage enhance the intrinsic, antiviral properties of human milk. Banked human milk is pasteurized to destroy the HIV-1 virus but retains properties that may be helpful to infants of HIV-1-positive mothers in developed countries where breast-feeding is not recommended. For infants in populations where the infant mortality rate is high, the risk of death associated with HIV infection acquired via breast milk is lower than the risk associated with not being breast-fed.

  8. The Past, Present, and Future of HIV Prevention: Integrating Behavioral, Biomedical, and Structural Intervention Strategies for the Next Generation of HIV Prevention

    Science.gov (United States)

    Rotheram-Borus, Mary Jane; Swendeman, Dallas; Chovnick, Gary

    2010-01-01

    In the past 25 years, the field of HIV prevention research has been transformed repeatedly. Today, effective HIV prevention requires a combination of behavioral, biomedical, and structural intervention strategies. Risk of transmitting or acquiring HIV is reduced by consistent male and female-condom use, reductions in concurrent and/or sequential sexual and needle-sharing partners, male circumcision, and treatment with antiretroviral medications. At least 144 behavioral prevention programs have been found effective in reducing HIV transmission acts; however, scale up of these programs has not occurred outside of the United States. A series of recent failures of HIV-prevention efficacy trials for biomedical innovations such as HIV vaccines, treating herpes simplex 2 and other sexually transmitted infections, and diaphragm and microbicide barriers highlights the need for behavioral strategies to accompany biomedical strategies. This challenges prevention researchers to reconceptualize how cost-effective, useful, realistic, and sustainable prevention programs will be designed, delivered, tested, and diffused. The next generation of HIV prevention science must draw from the successes of existing evidence-based interventions and the expertise of the market sector to integrate preventive innovations and behaviors into everyday routines. PMID:19327028

  9. HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States.

    Science.gov (United States)

    Weinhardt, Lance S; Kelly, Jeffrey A; Brondino, Michael J; Rotheram-Borus, Mary Jane; Kirshenbaum, Sheri B; Chesney, Margaret A; Remien, Robert H; Morin, Stephen F; Lightfoot, Marguerita; Ehrhardt, Anke A; Johnson, Mallory O; Catz, Sheryl L; Pinkerton, Steven D; Benotsch, Eric G; Hong, Daniel; Gore-Felton, Cheryl

    2004-08-15

    Determining rates of HIV transmission risk behavior among HIV-positive individuals is a public health priority, especially as infected persons live longer because of improved medical treatments. Few studies have assessed the potential for transmission to the partners of HIV-positive persons who engage in high-risk activities. A total of 3723 HIV-infected persons (1918 men who have sex with men [MSM], 978 women, and 827 heterosexual men) were interviewed in clinics and community-based agencies in Los Angeles, Milwaukee, New York City, and San Francisco from June 2000 to January 2002 regarding sexual and drug use behaviors that confer risk for transmitting HIV. Less than one quarter of women and heterosexual men had 2 or more sexual partners, whereas 59% of MSM reported having multiple partners. Most unprotected vaginal and anal sexual activity took place in the context of relationships with other HIV-positive individuals. Approximately 19% of women, 15.6% of MSM, and 13.1% of heterosexual men engaged in unprotected vaginal or anal intercourse with partners who were HIV-negative or whose serostatus was unknown. The majority of sexually active participants disclosed their serostatus to all partners with whom they engaged in unprotected intercourse. An estimated 30.4 new infections (79.7% as a result of sexual interactions with MSM) would be expected among the sex partners of study participants during the 3-month reporting period. Eighteen percent of 304 participants who injected drugs in the past 3 months reported lending their used injection equipment to others. In addition to the more traditional approaches of HIV test counseling and of focusing on persons not infected, intensive prevention programs for persons with HIV infection are needed to stem the future spread of the virus.

  10. Impact of Population Recruitment on the HIV Epidemics and the Effectiveness of HIV Prevention Interventions.

    Science.gov (United States)

    Zhao, Yuqin; Wood, Daniel T; Kojouharov, Hristo V; Kuang, Yang; Dimitrov, Dobromir T

    2016-10-01

    Mechanistic mathematical models are increasingly used to evaluate the effectiveness of different interventions for HIV prevention and to inform public health decisions. By focusing exclusively on the impact of the interventions, the importance of the demographic processes in these studies is often underestimated. In this paper, we use simple deterministic models to assess the effectiveness of pre-exposure prophylaxis in reducing the HIV transmission and to explore the influence of the recruitment mechanisms on the epidemic and effectiveness projections. We employ three commonly used formulas that correspond to constant, proportional and logistic recruitment and compare the dynamical properties of the resulting models. Our analysis exposes substantial differences in the transient and asymptotic behavior of the models which result in 47 % variation in population size and more than 6 percentage points variation in HIV prevalence over 40 years between models using different recruitment mechanisms. We outline the strong influence of recruitment assumptions on the impact of HIV prevention interventions and conclude that detailed demographic data should be used to inform the integration of recruitment processes in the models before HIV prevention is considered.

  11. Older Americans and AIDS: Transmission Risks and Primary Prevention Research Needs.

    Science.gov (United States)

    Catania, Joseph A.; And Others

    1989-01-01

    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…

  12. The risk of HIV transmission at each step of the HIV care continuum among people who inject drugs: a modeling study.

    Science.gov (United States)

    Escudero, Daniel J; Lurie, Mark N; Mayer, Kenneth H; King, Maximilian; Galea, Sandro; Friedman, Samuel R; Marshall, Brandon D L

    2017-07-25

    not on treatment. Our results indicate the importance of early diagnosis and interventions to engage diagnosed PWID on treatment to further suppress population-level HIV transmission. Future HIV prevention research should focus on the elimination of identified and potential barriers to the testing, diagnosis, and retention of PWID on HIV treatment.

  13. Viral piracy: HIV-1 targets dendritic cells for transmission.

    Science.gov (United States)

    Lekkerkerker, Annemarie N; van Kooyk, Yvette; Geijtenbeek, Teunis B H

    2006-04-01

    Dendritic cells (DCs), the professional antigen presenting cells, are critical for host immunity by inducing specific immune responses against a broad variety of pathogens. Remarkably the human immunodeficiency virus-1 (HIV-1) subverts DC function leading to spread of the virus. At an early phase of HIV-1 transmission, DCs capture HIV-1 at mucosal surfaces and transmit the virus to T cells in secondary lymphoid tissues. Capture of the virus on DCs takes place via C-type lectins of which the dendritic cell-specific intercellular adhesion molecule-3 (ICAM-3) grabbing nonintegrin (DC-SIGN) is the best studied. DC-SIGN-captured HIV-1 particles accumulate in CD81(+) multivesicular bodies (MVBs) in DCs and are subsequently transmitted to CD4+ T cells resulting in infection of T cells. The viral cell-to-cell transmission takes place at the DC-T cell interface termed the infectious synapse. Recent studies demonstrate that direct infection of DCs contributes to the transmission to T cells at a later phase. Moreover, the infected DCs may function as cellular reservoirs for HIV-1. This review discusses the different processes that govern viral piracy of DCs by HIV-1, emphasizing the intracellular routing of the virus from capture on the cell surface to egress in the infectious synapse.

  14. Transmission and epidemiology of HIV/AIDS: a global view.

    Science.gov (United States)

    Lashley, Felissa R

    2006-09-01

    Since the first recognition of the condition that is now called AIDS, much has been learned. We now know that AIDS results from infection with HIV types 1 and 2. Advancements in approaches to treatment, in the form of new types of medications, have changed the trajectory of illness by slowing progression and decreasing the incidence of HIV-associated opportunistic infections in the millions of people living with HIV infection, particularly in developed countries. In less developed areas of the world, HIV infection looks different, in part because of the differential availability of medications and health care. This article focuses on epidemiology of HIV infection and AIDS in the United States and worldwide, and on transmission, including susceptibility factors.

  15. HIV Clients as Agents for Prevention: A Social Network Solution

    Directory of Open Access Journals (Sweden)

    Sarah Ssali

    2012-01-01

    Full Text Available HIV prevention efforts to date have not explored the potential for persons living with HIV to act as change agents for prevention behaviour in their social networks. Using egocentric social network analysis, this study examined the prevalence and social network correlates of prevention advocacy behaviours (discussing HIV in general; encouraging abstinence or condom use, HIV testing, and seeking HIV care enacted by 39 HIV clients in Uganda. Participants engaged in each prevention advocacy behaviour with roughly 50–70% of the members in their network. The strongest determinant of engaging in prevention advocacy with more of one’s network members was having a greater proportion of network members who knew one’s HIV seropositive status, as this was associated with three of the four advocacy behaviours. These findings highlight the potential for PLHA to be key change agents for HIV prevention within their networks and the importance of HIV disclosure in facilitating prevention advocacy.

  16. 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.

    Science.gov (United States)

    Nyondo, Alinane Linda; Choko, Augustine Talumba; Chimwaza, Angela Faith; Muula, Adamson Sinjani

    2015-01-01

    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.

  17. A five-year review of vertical HIV transmission in a specialized service: cross-sectional study.

    Science.gov (United States)

    Hoffmann, Izabel Cristina; Santos, Wendel Mombaque Dos; Padoin, Stela Maris de Mello; Barros, Sonia Maria Oliveira de

    2016-01-01

    Healthcare professionals need to instill the process of prevention, control and treatment of people infected with HIV into care practice. Through maintaining preventive treatment among HIV-infected pregnant women, it has been demonstrated that prophylactic antiretroviral therapy, scheduled cesarean section and the prohibition of breastfeeding significantly reduce vertical HIV transmission. This study aimed to assess the rates of vertical HIV transmission in a specialized service and identify the factors associated with it. Cross-sectional study developed at the University Hospital of Santa Maria (RS), Brazil. A cross-sectional study was conducted on a sample of 198 notification forms and medical records of HIV-positive pregnant women and exposed children. The vertical transmission rate was 2.4%, and three children had been infected by vertical HIV transmission. The statistically significant risk factor was the use of injectable drugs. Delayed reporting of pregnancy, absence of antiretroviral therapy during pregnancy, lack of proper prenatal care, incapacity to perform viral load detection tests and CD4+ T cell counts and obstetric and maternal clinical complications were reported. The vertical transmission rate was high and the recommended intervention measures were not adopted in full. Adequate prophylactic measures need to be implemented in HIV-positive pregnant women prenatally and during the antenatal, delivery and postpartum periods.

  18. HIV-1 Transmission, Replication Fitness and Disease Progression

    Directory of Open Access Journals (Sweden)

    Tasha Biesinger

    2008-01-01

    Full Text Available Upon transmission, human immunodeficiency virus type 1 (HIV-1 establishes infection of the lymphatic reservoir, leading to profound depletion of the memory CD4+T cell population despite the induction of the adaptive immune response. The rapid evolution and association of viral variants having distinct characteristics during different stages of infection, the level of viral burden, and rate of disease progression suggest a role for viral variants in this process. Here, we review the literature on HIV-1 variants and disease and discuss the importance of viral fitness for transmission and disease.

  19. Paediatric HIV and elimination of mother-to-child transmission of HIV in the ASEAN region: a call to action.

    Science.gov (United States)

    Ishikawa, Naoko; Ishigaki, Kyoko; Ghidinelli, Massimo N; Ikeda, Kazuko; Honda, Miwako; Miyamoto, Hideki; Kakimoto, Kazuhiro; Oka, Shinichi

    2011-04-01

    Recent achievements in scaling up paediatric antiretroviral therapy (ART) have changed the life of children living with HIV, who now stay healthy and live longer lives. However, as it becomes more of a chronic infection, a range of new problems have begun to arise. These include the disclosure of HIV serostatus to children, adherence to ART, long-term toxicities of antiretroviral drugs and their sexual and reproductive health, which are posing significant challenges to the existing health systems caring for children with HIV with limited resources, experiences and capacities. While intensified efforts and actions to improve care and treatment for these children are needed, it is crucial to accelerate the prevention of mother-to-child transmission (PMTCT) of HIV, which is the main cause of paediatric HIV in the ASEAN region so as to eliminate the fundamental cause of the problem. This report argues that given over 70% of women have access to at least one antenatal care visit in the region and acceptance of HIV testing after receiving counselling on PMTCT could be as high as 90%, there is an opportunity to strengthen PMTCT services and eventually eliminate new paediatric HIV infections in the ASEAN countries.

  20. Technologies for HIV prevention and care: challenges for health services.

    Science.gov (United States)

    Maksud, Ivia; Fernandes, Nilo Martinez; Filgueiras, Sandra Lucia

    2015-09-01

    This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.

  1. Quality assurance of HIV counselling and testing for the prevention ...

    African Journals Online (AJOL)

    child transmission of HIV in Rivers State, Nigeria. ... Nigerian Hospital Practice ... As the HIV/AIDS pandemic continues especially in the developing countries, the evaluation of quality and effectiveness of interventions aimed at its control ...

  2. Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs

    Directory of Open Access Journals (Sweden)

    Sarna Avina

    2012-03-01

    Full Text Available Abstract Background HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment. Results Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p Conclusions High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviors.

  3. Pattern recognition receptors in HIV transmission

    Directory of Open Access Journals (Sweden)

    Teunis B. Geijtenbeek

    2012-03-01

    Full Text Available Dendritic cells (DCs, Langerhans cells (LCs and macrophages are innate immune cells that reside in genital and intestinal mucosal tissues susceptible to HIV-1 infection. These innate cells play distinct roles in initiation of HIV-1 infection and induction of anti-viral immunity. DCs are potent migratory cells that capture HIV-1 and transfer virus to CD4+ T cells in the lymph nodes, whereas LCs have a protective anti-viral function, and macrophages function as viral reservoirs since they produce viruses over prolonged times. These differences are due to the different immune functions of these cells partly dependent on the expression of specific pattern recognition receptors. Expression of Toll-like receptors, C-type lectin receptors and cell-specific machinery for antigen uptake and processing strongly influence the outcome of virus interactions.

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

    Directory of Open Access Journals (Sweden)

    Katherine Wiegert

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

  5. A journey to HIV prevention research: From social psychology to social health via multidisciplinarity.

    Science.gov (United States)

    Kippax, Susan

    2018-03-01

    This is a personal account of my research in HIV prevention from 1984 to the present day. It demonstrates my disquiet with the individualism of psychology as a way of thinking about what was needed to prevent HIV transmission. HIV prevention requires social transformation which is produced via changes in social practices and norms of communities and networks rather than by changes in behaviours of individuals. My colleagues and I developed a 'social health' model of social transformation that involves enabling communities to modify their social practices by building on emergent community responses, responses that were identified by the use of a reflexive research methodology.

  6. Further research needed to support a policy of antiretroviral therapy as an HIV prevention initiative

    DEFF Research Database (Denmark)

    Rodger, Alison J; Bruun, Tina; Vernazza, Pietro

    2013-01-01

    The results from the HPTN 052 trial have increased the focus on use of antiretroviral therapy (ART) for prevention of HIV transmission; however, condom use also effectively prevents HIV transmission. Studies in heterosexual serodiscordant couples with viral suppression have so far only reported...... follow-up data for 330 couple-years when condoms were not being used. Data are even more limited for anal sex in men who have sex with men. Additional data on the effectiveness of ART as prevention when practicing condom-less sex is urgently needed....

  7. Multiplayer games and HIV transmission via casual encounters.

    Science.gov (United States)

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

    2017-04-01

    Population transmission models have been helpful in studying the spread of HIV. They assess changes made at the population level for different intervention strategies. To further understand how individual changes affect the population as a whole, game-theoretical models are used to quantify the decision-making process. Investigating multiplayer nonlinear games that model HIV transmission represents a unique approach in epidemiological research. We present here 2-player and multiplayer noncooperative games where players are defined by HIV status and age and may engage in casual (sexual) encounters. The games are modelled as generalized Nash games with shared constraints, which is completely novel in the context of our applied problem. Each player's HIV status is known to potential partners, and players have personal preferences ranked via utility values of unprotected and protected sex outcomes. We model a player's strategy as their probability of being engaged in a casual unprotected sex encounter (USE), which may lead to HIV transmission; however, we do not incorporate a transmission model here. We study the sensitivity of Nash strategies with respect to varying preference rankings, and the impact of a prophylactic vaccine introduced in players of youngest age groups. We also study the effect of these changes on the overall increase in infection level, as well as the effects that a potential prophylactic treatment may have on age-stratified groups of players. We conclude that the biggest impacts on increasing the infection levels in the overall population are given by the variation in the utilities assigned to individuals for unprotected sex with others of opposite HIV status, while the introduction of a prophylactic vaccine in youngest age group (15-20 yr olds) slows down the increase in HIV infection.

  8. Impact of HIV Testing and Counseling (HTC Knowledge on HIV Prevention Practices Among Traditional Birth Attendants in Nigeria

    Directory of Open Access Journals (Sweden)

    Alice Osuji

    2015-02-01

    Full Text Available Nigeria is second in the world for the number of people with HIV and has a high rate of mother-to-child transmission (MTCT. Over 60% of births in Nigeria occur outside of health care facilities, and because of this, Traditional Birth Attendants (TBAs play a significant role in maternal and child health. It is important that TBAs be knowledgeable about HIV prevention. The purpose of this study was to determine the impact of HIV testing and counseling (HTC knowledge on the HIV prevention practices among TBAs in Nigeria. Five hundred TBAs were surveyed. Chi-square and logistic regression were used to assess differences in HIV prevention practices between TBAs with and without HTC knowledge. TBAs with HTC knowledge are significantly more likely to engage in HIV prevention practices than TBAs without HTC. Prevention practices included: wearing gloves during delivery (p < 0.01, sterilization of delivery equipment (p < 0.01, participation in blood safety training (p < 0.01, and disposal of sharps (p < 0.01. As long as a high percent of births occur outside health care facilities in Nigeria, there will be a need for TBAs. Providing TBAs with HTC training increases HIV prevention practices and can be a key to improve maternal and child health.

  9. Implications of Mobility Patterns and HIV Risks for HIV Prevention Among Migrant Market Vendors in Kazakhstan

    Science.gov (United States)

    Gilbert, Louisa; Terlikbayeva, Assel; West, Brooke; Bearman, Peter; Wu, Elwin; Zhussupov, Baurzhan; Platais, Ingrida; Brisson, Anne

    2011-01-01

    Objectives. We examined the relationships between mobility characteristics and sexual risk behaviors among male and female migrant market vendors in Almaty, Kazakhstan. Methods. Participants completed a structured interview covering sociodemographics, mobility characteristics, sexual behaviors, and biomarkers for HIV, HCV, and syphilis. We used multivariate analyses to examine associations between mobility patterns and HIV risks after adjusting for sociodemographics. Results. Longer duration of a participant's last trip outside Almaty increased the odds of reporting multiple sexual partners. More frequent travel to visit family or friends was associated with multiple sexual partners and unprotected sex with steady partners. More frequent trave