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Prevention of mother to child HIV transmission
Duran,Adriana S.; Ivalo,Silvina A.; Hakim,Alejandro; Masciottra,Florencia M.; Zlatkes,Rafael; Adissi,Lelia; Neaton,James D.; Losso,Marcelo H.;
Medicina (Buenos Aires) , 2006,
Abstract: 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.
Antenatal prevention of mother to child transmission of HIV
G B Theron
South African Family Practice , 2007,
Abstract: An effective perinatal mother to child transmission (PMTCT) programme will reduce perinatal acquired HIV infections. This goal is within reach of the South African public health sector. Early antenatal attendance and knowledge of HIV status allows sufficient time to implement highly active antiretroviral therapy (HAART) or ART intervention. Both measures have been proved to be efficient to reduce MTCT of HIV. A transmission rate of 2% can be achieved with a dual therapy regimen in non-breastfeeding women. Mono therapy with single dose nevirapine (sd NVP) often fails due to the once off nature of the intervention as opposed to ample opportunity to administer zudovudine (AZT) antenatally with dual therapy. A higher CD4 threshold to initiate HAART increases the window of opportunity while women are reasonably healthy. Irrespective of the maternal disease the newborn babies receive the same ART regimen. Women requiring HAART following pregnancy with an interval of 6 months or longer since NVP exposure had the same virological response as compared to NVP na ve women. Dual or mono therapy for a second time will be as effective as with NVP na ve women. The present day routine use of ART will reduce the risk of obstetric interventions. South African Family Practice Vol. 49 (9) 2007: pp. 52-57
Improving Child survival through enhancing Prevention of Mother to Child Transmission of HIV
George F. Mkoma
Dar Es Salaam Medical Students' Journal , 2012,
Abstract: Background: Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. Effective strategies are needed for the Prevention of Mother-To-Child Transmission of HIV (PMTCT). The complete PMTCT package includes comprehensive antenatal (ANC) care, modified obstetric practices, antiretroviral therapy and infant feeding counseling and support. Aim: This article presents syntheses of evidence on the cost-effectiveness of HIV MTCT strategies for LMICs, investigates whether a maternal triple-antiretroviral regimen that was designed to maximally suppress viral load in late pregnancy and the first 6 months of lactation was safe and well-tolerated, investigates acceptability of the PMTCT programme components, and identifies structural and cultural challenges to male involvement in the reduction of MTCT. Methods: I identified articles on the use of ARVs to prevent MTCT of HIV through a comprehensive database search including PubMed and Embase. I screened the titles and abstracts from the individual database search results from year 2002-2011, pooled the potentially eligible studies, retrieved full-text articles, and then assessed whether they met the inclusion criteria. I extracted the data based on publication date, demographic characteristics and HIV transmission rates to babies. Results: The articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMICs. HIV-transmission rates among subgroups defined by maternal risk factors, including baseline CD4 cell count and viral load was 15% after 24 months, while transmission rates for those who have received ARVs was 7% for the same period. This reveals that triple-antiretroviral regimen for pregnant-women was safe and feasible. Routine testing for HIV of women at the antenatal clinic was found to be highly acceptable and appreciated by men, while other programme components, notably partner testing, condom use and the infant feeding recommendations, were met with continued resistance. The vision, goal, objectives and targets noted by Global Partners Forum will serve as a framework for WHO to support countries to focus on and prioritize the accelerated scale-up of effective and comprehensive PMTCT services. Conclusion and recommendations: Interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Deep-seated ideas about gender roles and hierarchy are major obstacles to male participation in the PMTCT programme. Empowering men to participate by creating a space within the PMTCT programme that is male friendly should be feasible and should be highly prioritized for the PMTCT programme to achieve its potential. Increased community sensitization, counseling and testing, treatment and support of women identified as HIV infected should improve acceptance of PMTCT servi
Knowledge and coverage of Prevention of Mother to Child Transmission (PMTCT) in Eritrea
A Berhane, A Tesfazio
Journal of the Eritrean Medical Association , 2006,
Abstract: Objective: To explore the level of knowledge on prevention of mother to child transmission of HIV in both men 15-54 years and women 15-49 years of age. Methods: A community-based survey was conducted in October-November 2005 in 45 sub zones of Eritrea. Data were collected using the Lot Quality Assurance Sampling (LQAS) method. Results: Although 81.8% of men 15-54 and 75.5% of women 15-49 years of age know that HIV can be transmitted from mother to the child, only 33.7 % of men and 26% of women know that the risk of transmission can be reduced. The result varies across zones and various socio-demographic characteristics. Conclusion: Although there is high awareness on the risk of HIV transmission from the mother to the child, the knowledge that the risk can be reduced is very low and extensive education for both men and women is recommended
Likely stakeholders in the prevention of mother to child transmission of HIV/AIDS in Blantyre, Malawi
Eyob Tadesse, Adamson S Muula, Humphreys Misiri
African Health Sciences , 2004,
Abstract: 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 health centers and the major referral and university teaching hospital of Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi Subjects: A total of 321 pregnant women attending ante-natal clinics Results: Antenatal women in Blantyre, Malawi obtain health information on HIV/AIDS from the radio (96.3%), health workers (82.2%), religious gatherings (66.7%), friends (54.8%) and newspapers (39.3%). The majority intend to be accompanied by own mother and sister for delivery (52.4% and 15.4% respectively). Almost all (99%) planned to breast feed with 91.8% reporting an intended breastfeeding period of at least 6 months. About 97% of married women reported desire to tell spouse in case of HIV sero-positive results while only 65.1% had ever discussed about HIV with spouse, and only 5.2% had ever attended antenatal clinic with spouse. Whether woman had ever discussed about HIV/AIDS with spouse or not did not influence desire to disclose HIV status to spouse. Conclusion: Close relatives, spouse and the media are important stakeholders in the health of pregnant women. Programs aimed at prevention of mother to child transmission of HIV should give serious consideration to these partners. Key Words: Mother-to-child transmission of HIV, anti-retrovirals African Health Sciences Vol.4(3) 2004: 155-159
Mothers' knowledge and utilization of prevention of mother to child transmission services in northern Tanzania
Falnes Eli,Tyllesk?r Thorkild,de Paoli Marina,Manongi Rachel
Journal of the International AIDS Society , 2010, DOI: 10.1186/1758-2652-13-36
Abstract: Background More than 90% of children living with HIV have been infected through mother to child transmission. The aims of our present study were to: (1) assess the utilization of the prevention of mother to child transmission (PMTCT) services in five reproductive and child health clinics in Moshi, northern Tanzania, after the implementation of routine counselling and testing; (2) explore the level of knowledge the postnatal mothers had about PMTCT; and (3) assess the quality of the counselling given. Methods This study was conducted in 2007 and 2008 in rural and urban areas of Moshi in the Kilimanjaro region of Tanzania. Mixed methods were used. We interviewed 446 mothers when they brought their four-week-old infants to five reproductive and child health clinics for immunization. On average, the urban clinics included in the study had implemented the programme two years earlier than the rural clinics. We also conducted 13 in-depth interviews with mothers and nurses, four focus group discussions with mothers, and four observations of mothers receiving counselling. Results Nearly all mothers (98%) were offered HIV testing, and all who were offered accepted. However, the counselling was hasty with little time for clarifications. Mothers attending urban antenatal clinics tended to be more knowledgeable about PMTCT than the rural attendees. Compared with previous studies in the area, our study found that PMTCT knowledge had increased and the counsellors had greater confidence in their counselling. Conclusions Routine counselling and testing for HIV at the antenatal clinics was greatly accepted and included practically every mother in this time period. However, the counselling was suboptimal due to time and resource constraints. We interpret the higher level of PMTCT knowledge among the urban as opposed to the rural attendees as a result of differences in the start up of the PMTCT programme and, thus, programme maturation. After comparison with earlier studies conducted in this setting, we conclude that when the programme has had time to get established, both its acceptance and the understanding of the topics dealt with during the counselling increases.
Prevention of mother to child transmission lay counsellors: Are they adequately trained?  [cached]
Catherine H. Thurling,Candice Harris
Curationis , 2012, DOI: 10.4102/curationis.v35i1.64
Abstract: South Africa’s high prevalence of human immunodeficiency virus (HIV) infected women requires a comprehensive health care approach to pregnancy because of the added risk of their HIV status. As a result of the shortage of health care workers in South Africa, lay counsellors play important roles in the prevention of mother to child transmission of HIV (PMTCT). There is no standardization of training of lay counsellors in South Africa, and training varies in length depending on the training organisation. The study aimed to investigate the training of lay counsellors by analysing their training curricula and interviewing lay counsellors about their perceptions of their training. A two phase research method was applied. Phase one documented an analysis of the training curricula. Phase two was semi-structured interviews with the participants. Purposive sampling was undertaken for this study. The total sample size was 13 people, with a final sample of 9 participants, determined at the point of data saturation. The research was qualitative, descriptive and contextual in design. The curricula analysed had different styles of delivery, and the approaches to learning and courses varied, resulting in inconsistent training outcomes. A need for supervision and mentorship in the working environment was also noted. The training of lay counsellors needs to be adapted to meet the extended roles that they are playing in PMTCT. The standardization of training programmes, and the incorporation of a system of mentorship in the work environment, would ensure that the lay counsellors are adequately prepared for their role in PMTCT.How to cite this article: Thurling, C.H. & Harris, C., 2012, ‘Prevention of mother to child transmission lay counsellors: Are they adequately trained?’ Curationis 35(1), Art. #64, 7 pages.http://dx.doi.org/10.4102/curationis.v35i1.64
Prevention of mother to child transmission of HIV/AIDS in Eritrea: the Eritrean experience
T Teclebirhan, A Berhane, J Mufunda, A Gebremichael
Journal of the Eritrean Medical Association , 2009,
Abstract: 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 IMCI guidelines in children presenting with diarrhea at Ghindae Hospital. Methods: The retrospective study analyzed medical records of pregnant HIV positive women and their children before the introduction of PMTCT in 2002, while the prospective study followed up children born to pregnant HIV positive women who received PMTCT from 2006 to 2008. Findings: Twenty seven and 4.8% of the children born to HIV positive women prior to and after PMTCT were HIV positive when tested for HIV using ELISA at 18 months. Conclusion: Health promotion targeted at scaling up skilled care delivery attendance can further reduce childhood morbidity and mortality from HIV/AIDS.
HIV prevention is not enough: child survival in the context of prevention of mother to child HIV transmission
Kuhn Louise,Sinkala Moses,Thea Don M,Kankasa Chipepo
Journal of the International AIDS Society , 2009, DOI: 10.1186/1758-2652-12-36
Abstract: 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.
Making it happen: prevention of mother to child transmission of HIV in rural Malawi  [cached]
Fyson Kasenga
Global Health Action , 2010, DOI: 10.3402/gha.v3i0.1882
Abstract: HIV and AIDS, in resource-limited settings, contribute to increased maternal and infant mortality where such vital indicators are already high. In these settings, babies born to HIV-positive women continue to have added risks of acquiring HIV infection and dying from it before their fifth birthdays if no interventions are employed. Prevention of mother-to-child transmission (PMTCT) is an international initiative whose implications within the local context need to be known. An operational research approach was adopted to study the demand and adherence of key components within the PMTCT Programme among women in rural Malawi. This study was carried out at Malamulo SDA Hospital in rural Malawi and employed the mixture of both quantitative and qualitative approaches. While the introduction of innovative policies in antenatal care (ANC) that has positive impact particularly on marginalised women's access to the services, negative effects are also inevitable. Marginalised women in resource-poor settings fail to deliver at the health facility due to lack of transportation, economic difficulties, gender inequalities, tradition and negative attitude of health workers. Integration of HIV testing and opt-out testing in ANC coupled with the introduction of free maternal care resulted in more women accessing maternal services and PMTCT services. It is as a result of this that institutional delivery facilitates increased adherence to antiretroviral prophylaxis and is supported by both women and the communities. The paper summarises the research conducted and elaborates on how it contributed to actions to improve staff attitude, increase male involvement in reproductive health care and discussions on how available resources can be maximised.
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