scholarly journals Challenges in Assessing Outcomes among Infants of Pregnant HIV-Positive Women Receiving ART in Uganda

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Barbara Castelnuovo ◽  
Frank Mubiru ◽  
Ivan Kalule ◽  
Shadia Nakalema ◽  
Agnes Kiragga
Keyword(s):  
Clinical Trials ◽  
Pregnant Women ◽  
Median Time ◽  
Hiv Transmission ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Hiv Positive Women

Since 2012, the WHO recommends lifelong ART with TDF+FTC/3TC+EFV for all HIV-positive pregnant and breastfeeding women (Option B-plus). In this analysis we describe the proportion of early and late transmission in mothers with high retention in Kampala, Uganda. We included 700 pregnant women from January 2012 to August 2014 with a follow-up extended to August 2016; the median age was 31 years (IQR: 26–35), 36.3% in WHO stage 3/4; median CD4 count was 447 cells/μL (IQR: 301–651) and 73.3% were already on ART for a median time of 28 (IQR: 10–57) months; 52% infants were male and median weight was 3.2 Kg (IQR: 2.5–3.5). Five hundred and sixty-five (80.7%) infants had at least one test for HIV; 22 (3.1%) infants died, all with unknown serostatus; 3 tested positive at week 6 and one additional at months 12 and 18. Two of the mothers of the 4 HIV-positive infants were ART-naïve at the time of pregnancy. We report very low documented HIV transmission comparable with those reported in clinical trials settings; however, demonstrating the efficacy of Option B-plus in terms of averted transmission in routine settings is challenging since high proportion of infants do not have documented HIV tests.

scholarly journals Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Rachel Musomba ◽  
Frank Mubiru ◽  
Shadia Nakalema ◽  
Hope Mackline ◽  
Ivan Kalule ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Older Women ◽  
First Trimester ◽  
Hiv Positive ◽  
Urban Centre ◽  
Factors Associated ◽  
Point Of Entry ◽  
Art Initiation ◽  
Hiv Positive Women

Introduction. We aim to describe the time of entry into care and factors associated with being lost to program (LTP) in pregnant women on Option B Plus in an integrated HIV and antenatal care (ANC) clinic in Uganda. Methods. We included all pregnant women enrolled into the integrated HIV-ANC clinic from January 2012 to 31st July 2014, while the follow up period extended up to October 30th 2015. LTP was defined as being out of care for ≥3 months. Results. Overall 856 women were included. Only 36.4% (86/236) of the women were enrolled in the first trimester. Overall 69 (8.1%) were LTP. In the multivariate analysis older women (HR: 0.80 per five-year increase, CI: 0.64–1.0, and P=0.060) and women on ART at the time of pregnancy (0.58, CI: 0.34–0.98, and P=0.040) were more likely not to be LTP. Among women already on ART at the time of pregnancy no factor was associated with LTP. Conclusion. Our results suggest the need for interventions to enhance prompt linkage of HIV positive women to HIV services for ART initiation and for increased retention particularly in young and ART naive women.

scholarly journals Adherence to Combination Antiretroviral Therapy among Pregnant Women Enrolled in a HIV Prevention Program in Rural North-central Nigeria

2020 ◽  
Vol 9 (1) ◽  
pp. 81-92
Author(s):  
Cedrina L. Calder ◽  
Heather O ◽  
Mohammad Tabatabai ◽  
Celia J. Maxwell ◽  
Salisha Marryshow ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Secondary Analysis ◽  
Self Report ◽  
Hiv Positive ◽  
Combination Antiretroviral Therapy ◽  
North Central ◽  
Hiv Positive Women ◽  
Mother To Child

Objective: Adherence to combination antiretroviral therapy (ART) among pregnant women is essential to attaining the goal of eliminating mother-to-child HIV transmission. The objective of this study was to determine which factors affect adherence to ART among HIV-positive women enrolled in a large prevention of mother-to-child HIV transmission (PMTCT) trial in rural north-central Nigeria. Methods: The parent study included 372 HIV-positive pregnant women enrolled in a cluster-randomized control trial conducted at 12 health facilities in Nigeria between 2013 and 2015. This secondary analysis included HIV-positive women (and their infants) from the original trial with documented adherence data (n=210, 56.5%). The primary outcome was maternal adherence to ART, determined by self-report and based on the visual analogue scale (VAS) of a validated medication adherence tool. Participants with a VAS score of ? 95% were classified as adherent. We employed multivariate logistic regression to evaluate the predictors of maternal ART adherence in the study sample. Results: Approximately 61.0% of study participants (128/210) were adherent to ART. The majority of adherent participants (62.5%, 80/128) were enrolled in the trial intervention arm. The most common cited response for non-adherence was fear of status disclosure. Adherence to ART was associated with study arm (intervention arm vs. control arm, adjusted Odds Ratio (aOR) [95% CI]: 16.95 [5.30-54.23]), maternal ethnicity (Gwari vs. Other, aOR = 0.13 [0.05-0.38]), and partner HIV status (HIV-positive vs. unknown, aOR = 3.14 [1.22-8.07]). Conclusion and Global Health Implications: Adherence to ART among a cohort of pregnant women enrolled in a PMTCT trial in rural North-Central Nigeria was associated with trial arm, maternal self- reported ethnicity, and partner

scholarly journals Community-Based Improvements to Increase Identification of Pregnant Women and Promote Linkages to Antenatal and HIV Care in Mozambique

2019 ◽  
Vol 18 ◽  
pp. 232595821985562 ◽  
Author(s):  
Kim Ethier Stover ◽  
Ram Shrestha ◽  
Isac Tsambe ◽  
Percina Paulo Mathe
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Health System Strengthening ◽  
Hiv Care ◽  
Community Group ◽  
Hiv Positive Women ◽  
Optimal Health ◽  
Community Improvement

A Community Health System Strengthening model, which mobilizes communities by applying quality improvement, was used in 39 communities around 3 health centers in Gaza Province, Mozambique, to increase identification of pregnant women and support them to attend antenatal care (ANC). This article describes the process and results. Community group representatives formed a community improvement team to spread messages about the importance of ANC, identify pregnant women, link them to the facility, and follow up. Between March 2014 and February 2015, teams identified 2020 pregnant women. Antenatal care attendance increased at all 3 centers. One health center did an additional chart review and found that postintervention, women were enrolling in care earlier in pregnancy. There were no changes in HIV testing or treatment initiation for HIV-positive women. Community-led improvement initiatives play an important role in connecting pregnant women with services to receive testing and treatment to promote optimal health and prevent HIV transmission.

scholarly journals Effect of triple drug antiretroviral therapy on CD4+ count in pregnant women with HIV and prevention of parent to child transmission

2020 ◽  
Vol 9 (11) ◽  
pp. 4462
Author(s):  
Akanksha Dwivedi ◽  
Ratan Gupta ◽  
Kailash C. Agarwal ◽  
Kumari U. Rani
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Cd4 Count ◽  
Hiv Positive ◽  
P Value ◽  
New Delhi ◽  
Child Transmission ◽  
Nicu Admission ◽  
A Prospective Study

Background: India has moved from single drug Antiretroviral Therapy (ART) in 2002 to triple drug ART in 2013 to prevent parent to child transmission of HIV. The aim of the study was to know the effects of triple drug ART on maternal CD4+ count and prevention of HIV transmission to baby along with its adherence, side effects and pregnancy outcome.Methods: A prospective study wsas done in Safdarjung Hospital, New Delhi on 40 HIV positive pregnant women who received single dose combination of triple drug ART. CD4+ count, LFT and KFT were done before beginning of ART and repeated after 6 months of ART. The infants received nevirapine prophylaxis and HIV status was determined by DBS PCR at 6 weeks.Results: The median CD4+ count was 317 and 397 pre and post ART for 6 months respectively (p value<0.001. Low birth weight (LBW) was seen in 43.59% which was statistically significant but confounded as 76.4% of these babies were preterm. 23.08% of babies had an APGAR of < 7 at 1 minute, out of which 77.7% were preterm. Nine out of 39 infants (one had abortion) needed NICU admission. Only one baby (2.56%) was HIV positive who died at 4 months of age due to pneumonia. There was no defaulter and no statistically significant changes in LFT and KFT after 6 months of ART.Conclusions: Triple drug ART offers greater convenience improves fetomaternal outcome and minimize the risk of HIV transmission from mother to child.

The Bio/Necropolitics of ACTG 076: Lessons from Pregnant Women of Colour Living with HIV for Treatment for Prevention in the Twenty-first Century

Somatechnics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 233-253
Author(s):  
Eli Manning
Keyword(s):  
Hiv Transmission ◽  
Ethical Dilemmas ◽  
Hiv Treatment ◽  
First Century ◽  
Hiv Positive ◽  
Treatment As Prevention ◽  
People Living With Hiv ◽  
Hiv Positive Women ◽  
Aids Clinical Trials ◽  
Living With Hiv

Since the pharmaceutical turn, using HIV treatment to prevent transmission is increasingly common. Treatment as Prevention®, or TasP, has relied on HIV treatment to prevent HIV transmission, targeting people living with HIV. However, TasP is predicated on troublesome heterosexist, classist, and racist medical practices borrowed from various times and spaces that enact biopolitical and necropolitical relations. This paper discusses the debate surrounding the first clinical trial that used HIV treatment to prevent transmission from woman-to-foetus. The 1994 landmark AIDS Clinical Trials Group 076 study laid the groundwork for using HIV treatment to prevent HIV transmission, the essential precursor to TasP. By examining the concerns of HIV positive women of colour and other AIDS activists, we are able to understand the ethical dilemmas and practical consequences that still haunt today's game-changing uses of HIV treatment for prevention and to see how biopolitics and necropolitics persist in TasP.

Factors influencing utilization of postpartum CD4 count testing by HIV-positive women not yet eligible for antiretroviral treatment

AIDS Care ◽  
2011 ◽  
Vol 23 (3) ◽  
pp. 322-329 ◽  
Author(s):  
Kate P. Gilles ◽  
Chifundo Zimba ◽  
Innocent Mofolo ◽  
Emily Bobrow ◽  
Gloria Hamela ◽  
...  
Keyword(s):  
Antiretroviral Treatment ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Factors Influencing ◽  
Hiv Positive Women

Antiretroviral Therapy in Pregnant Women

2019 ◽  
pp. 281-286
Author(s):  
William R. Short ◽  
Jason J. Schafer
Keyword(s):  
Clinical Trials ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Pediatric Aids ◽  
Women Living With Hiv ◽  
Pivotal Study ◽  
Aids Clinical Trials ◽  
Living With Hiv ◽  
Mother To Child ◽  
Over Time

Upon completion of this chapter, the reader should be able to describe the appropriate management of antiretrovirals for pregnant women living with HIV. Over time, research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission (MTCT) of HIV. In 1994, a pivotal study in the field of HIV medicine, the Pediatric AIDS Clinical Trials Group 076, demonstrated that the use of zidovudine (ZDV) monotherapy during pregnancy substantially reduced the risk of HIV transmission to infants by 67% (...

scholarly journals Perencanaan Memiliki Anak pada Wanita dengan HIV Positif di Kota Semarang

2019 ◽  
Vol 14 (2) ◽  
pp. 108
Author(s):  
Nastiti Bandari Pratiwi ◽  
Zahroh Shaluhiyah ◽  
Antono Suryoputro
Keyword(s):  
Pregnant Women ◽  
Quantitative Research ◽  
Qualitative Data ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Cross Sectional ◽  
Cd4 Cell Count ◽  
Hiv Positive Women ◽  
Women With Hiv ◽  
Fertile Women

Background: Pregnant women with HIV positive is potential risk to transmit the virus to their infants. Prevention Mother to Child Transmittion (PMTCT) program is a solution for HIV women if they want to have children. However, most pregnant women detected HIV positive when they have been pregnant for more than 6 months through Provider initiated test and counselling (PITC). On the other hand, the data shows that the increasing number of HIV positive women who have been willing to have children.  This research aims to identify and examine the factors influence the plan of having children among HIV-positive women who access HIV treatment in Kariadi Hospital Semarang. Method: This study employs a quantitative research design with cross sectional approach, followed by qualitative study to explore the feeling and attitudes of women with HIV positive to plan of having children. There were 31 women involved in this study, selected with the criteria of fertile women HIV positive who have been taking antiretroviral therapy in Kariadi Hospital and willing to participate in this study. Qualitative data collected from two women who has been planning to have children. Quantitative data were analyzed by univariate, Chi-Square and multiple logistic regression. Whilst, qualitative data employ content analysis.Results: There were 16% of women with HIV positive who have been intending to have children in this study. The rest have not planned it because they worried if their pregnancy and delivery could transmit HIV to their infants. CD4 cell count, ARV access and women’s attitudes have significant correlation to the intention of having children among women with HIV positive. Comprehensive information about PMTCT and ARV were needed to deliver to fertile women with HIV positive.

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