scholarly journals An approach for evaluating early and long term mother-to-child transmission of HIV (MTCT) in low and middle income countries: a South African experience

2019 ◽  
Vol 19 (S1) ◽  
Author(s):  
Debra J. Jackson ◽  
Thu-Ha Dinh ◽  
Carl J. Lombard ◽  
Gayle G. Sherman ◽  
Ameena E. Goga

Abstract Background Eliminating mother-to-child transmission of HIV is a global public health target. Robust, feasible methodologies to measure population level impact of programmes to prevent mother-to-child transmission of HIV (PMTCT) are needed in high HIV prevalence settings. We present a summary of the protocol of the South African PMTCT Evaluation (SAPMTCTE) with its revision over three repeated rounds of the survey, 2010–2014. Methods Three cross sectional surveys (2010, 2011–2012 and 2012–2013) were conducted in 580 primary health care immunisation service points randomly selected after stratified multistage probability proportional to size sampling. All infants aged 4–8 weeks receiving their six-week immunisation at a sampled facility on the day of the visit were eligible to participate. Trained research nurses conducted interviews and took infant dried blood spot (iDBS) samples for HIV enzyme immunoassay (EIA) and total nucleic acid polymerase chain reaction (PCR) testing. Interviews were conducted using mobile phones and iDBS were sent to the National Health Laboratory for testing. All findings were adjusted for study design, non-response, and weighted for number of South African live-birth in each study round. In 2012 a national closed cohort of these 4 to 8-week old infants testing EIA positive (HIV Exposed Infants) from the 2012–2013 cross-sectional survey was established to estimate longer-term PMTCT impact to 18 months. Follow-up analyses were to estimate weighted cumulative MTCT until 18 months, postnatal MTCT from 6 weeks until 18 months and a combined outcome of MTCT-or-death, using a competing risks model, with death as a competing risk. HIV-free survival was defined as a child surviving and HIV-negative up to 18 months or last visit seen. A weighted cumulative incidence analysis was conducted, adjusting for survey design effects. Discussion In the absence of robust high-quality routine medical recording systems, in the context of a generalised HIV epidemic, national surveys can be used to monitor PMTCT effectiveness; however, monitoring long-term outcomes nationally is difficult due to poor retention in care.

2012 ◽  
Vol 13 (4) ◽  
pp. 178 ◽  
Author(s):  
D Besada ◽  
G Van Cutsem ◽  
E Goemaere ◽  
N Ford ◽  
H Bygrave ◽  
...  

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


The Lancet ◽  
2018 ◽  
Vol 392 ◽  
pp. S55 ◽  
Author(s):  
Ailing Wang ◽  
Yaping Qiao ◽  
Lixia Dou ◽  
Qian Wang ◽  
Xiaoyan Wang ◽  
...  

2018 ◽  
Vol 1 (2) ◽  
pp. 170-174
Author(s):  
S Ochejele ◽  
R M Akuse ◽  
J T Akuse ◽  
J Musa ◽  
P Odusolu ◽  
...  

Nigeria has the highest number of new HIV infections worldwide and Benue State was reported to have the highest HIV Prevalence in the country. These may partly be due to low coverage of Prevention-of-Mother-to-child-transmission services in private hospitals. Prevention-of-Mother-to-Child-Transmission outlets are concentrated in public facilities but many people patronize private hospitals. This study assessed Prevention-of-Mother-to-Child-Transmission Service provision by private hospitals in Makurdi. A Cross sectional survey of 12 (private-for-profit) registered hospitals with facilities for antenatal and delivery care was carried out. Information was obtained using structured questionnaires. All hospitals performed HIV testing. Six (50%) routinely counseled all pregnant women for testing.  Eight (66.7%) offered Prevention-of-Mother-to-Child-Transmission Services. Four (33.3%) had staff trained in Prevention-of-Mother-to-Child-Transmission but one hospital where only midwives were trained did not provide Prevention-of-Mother-to-Child-Transmission Services. Five (41.7%) of the hospitals gave antiretroviral prophylaxis, none had facilities for CD4 count or viral load.  A total of 4(50%) of the facilities provided care for infants but only one collected samples for early infant diagnosis.  Service delivery appeared to be influenced by cost and staff training. Gaps in service delivery included lack of routine HIV testing, inadequate ARV prophylaxis, inadequate care and support to infants and family members, limited laboratory capacity and use of obstetric procedures which could increase transmission. Private health facilities need support from governments and international partners. Care must be taken to involve medical directors of hospitals in training, provide regular updates about protocols and linkages with other organizations offering services they lack.  This would increase service coverage, improve quality of services and source data on Prevention-of-Mother-to-Child-Transmission Services.


2020 ◽  
Vol 8 (08) ◽  
pp. 396-402
Author(s):  
Andrew Tassang ◽  
Nana Njamen T ◽  
Assop ◽  
Tassang Thierry ◽  
Njamen Nana CJ ◽  
...  

Introduction: Cameroon in 2014 had a HIV prevalence rate of 4.6 %. It is estimated that about 90% of new infections occur as a result of heterosexual relations. In 2010 in Cameroon, 7,300 babies were estimated to be born HIV positive due to mother-to-child transmission (MTCT). Faced with these realities, Cameroon has been stepping up its response steadily from Option A then B and now Option B+. To have an early appraisal of the Option B+ approach as far as the prevention of mother to child transmission of HIV (PMTCT) is concerned in the Tiko health district- Cameroon. Methodology: This cross-sectional hospital based study was carried out in Tiko from the 1st of December 2015 to the 31st of August 2016. With the use of a questionnaire, a total of 111 women whose infants underwent the polymerase chain reaction (PCR) test at six weeks were surveyed. Univariate and bivariate data analysis were performed with CDC- Epi-Info 7.2.2.6. Results: Out of 111 women included in this study, only 2 (1.8%) babies had a positive PCR test. Two cases of infected babies were realised in the study, 1 in each of the first two trimesters of pregnancy. It could probably be due to the fact that, these women got infected while they were already pregnant or maybe before their introduction to the Option B+. However, the infectious rate was similar to that of women on tritherapy. Interventions like the use of Antiretroviral (ART) drugs by infected pregnant women, safe delivery practices and safe infant feeding helped reduce the risk of transmission to infants (from 40% to 5%). Conclusion: The infection rate of 1.8 % is similar to those of women who are on tritherapy in many studies. Despite the fact that the implementation of option B+ looks more onerous, the long term benefits as far as cost effectiveness is concerned looks laudable. Thus this strategy should be adopted in resource restricted countries.


AIDS ◽  
2007 ◽  
Vol 21 (4) ◽  
pp. 509-516 ◽  
Author(s):  
Debra J Jackson ◽  
Mickey Chopra ◽  
Tanya M Doherty ◽  
Mark SE Colvin ◽  
Jonathan B Levin ◽  
...  

2020 ◽  
Vol 1 (1) ◽  
pp. 21-28
Author(s):  
Mona Rahayu Putri

Penyebaran HIV dan AIDS di Indonesia dari tahun ke tahun menunjukan peningkatan yang cepat. Jumlah kasus HIV sampai dengan mei 2017 sebanyak 103.759 dan AIDS sebanyak 43.347, dengan kematian sebanyak 8.340. dengan peningkatan kasus yang sangat besar tersebut maka WHO mengingatkan Indonesia sebagai salah satu negara Asia tercepat dalam hal peningkatan populasi HIV dan AIDS. (Kemenkes RI, 2015). Ibu hamil merupakan kelompok beresiko tertular HIV yang berdampak pada bayi yang dikandungnya seiring dengan meningkatnya jumlah laki-laki yang melakukan hubungan seksual tidak aman atau beresiko, yang selanjutnya akan menularkan pada pasangannya (istrinya)Dari data yang didapat dari 5.138 ibu hamil yang konseling dan test HIV, ada 32 yang positif HIV dan 15 AIDS, serta ada 19 bayi yang lahir dari ibu dengan HIV positif. Secara keseluruhan, penderita HIV di Kota Batam tahun 2017 mencapai 1038. Tujuan dari penelitian ini adalah untuk mengetahui minat ibu hamil dalam memanfaatkan program PMTCT. Jenis penelitian adalah penelitian survey yang bersifat analitik dengan pendekatan cross sectional. Besar sampel yaitu 100 ibu hamil di Wilayah Kerja Puskesmas Lubuk Baja. Alat pengumpulan data dengan kuesioner. Dari penelitian didapatkan minat ibu hamil dalam mengikuti program Prevention of Mother to Child Transmission (PMTCT) sebagian besar berada pada kategori berminat sebanyak 70 ibu hamil (70%) sedangkan tidak berminat 30 ibu hamil (30%). Untuk mengatasi masalah ini diharapkan kepada tenaga kesehatan untuk memberikan informasi ataupun penyuluhan tentang pemanfaatan PMTCT kepada Ibu hamil.


2021 ◽  
Vol 19 ◽  
Author(s):  
Doret Botha

Orientation: South Africa has been suffering from persistently high levels of unemployment since 2008. The youth is regarded as the most at-risk group in the South African labour market and unemployment amongst the youth is considered one of the most critical socio-economic problems in South Africa. Increasing one’s employability is essential to securing employment and enhancing one’s well-being.Research purpose: This study aimed to explore the self-perceived employability of undergraduate students at a South African university.Motivation for the study: Currently, there is a scarcity of published research on the self-perceived employability amongst undergraduate students at higher education institutions in South Africa.Research approach/design and method: The study was conducted within a positivistic research paradigm. A quantitative-based cross-sectional survey design was used. Convenience sampling was used to select the students who were included in the survey. Data were collected through a web-based survey, using a standardised coded questionnaire that consisted of a five-point Likert-type scale.Main findings: The results indicated that the respondents were relatively confident about their internal employability, but they were less confident about their opportunities in the external labour market.Practical/managerial implications: Understanding one’s employability and the accompanied issues creates awareness of one’s potential, skills and knowledge to become a successful citizen and employee.Contribution/value-add: The study shed light on the self-perceived employability of undergraduate students at a South African university and consequently contributes to the existing literature on employability in the South African context.


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