Country adaptation of the 2010 World Health Organization recommendations for the prevention of mother-to-child transmission of HIV

Background: This article assessed maternal and neonatal outcomes amongst users of prevention of mother-to-child transmission (PMTCT) of HIV services in Addis Ababa, Ethiopia.Objectives: The study aimed to assess the health outcomes (antiretroviral prophylaxis versus antiretroviral treatment, CD4 counts, World Health Organization (WHO) stages of illness, other illnesses) of women who had used these services, as well as the HIV status of their babies and the infant feeding method adopted.Methods: A quantitative, cross sectional, retrospective cohort design was used. Document reviews were conducted with a sample of 384 mother-infant pairs (out of a population of 796) who had used PMTCT services.Results: All respondents were using prophylactic antiretrovirals or antiretroviral therapy, but some were on the wrong treatment based on their CD4 counts. The CD4 counts increased four times more for women on antiretroviral treatment than for those on prophylactic antiretrovirals. The WHO’s stages of HIV illness did not improve but deteriorated in some cases, and 52 other illnesses were recorded. Out of the 384 infants, 6.0% (n = 23) were HIV-positive. Most respondents opted for exclusive breast feeding but some used mixed feeding during the first six months of their infants’ lives, despite having received health education related to infant feeding options.Conclusion: The respondents’ improved CD4 counts were inadequate to improve their World Health Organization stages of HIV illness. Some babies received mixed feeding during the first six months of their lives and 6% of the babies were HIV-positive despite their mothers’ utilisation of PMTCT services.Keywords: anti-retroviral therapy (ART), CD4 counts, human immune deficiency virus (HIV), infant feeding counseling and practices, prevention of mother-to-child transmission of HIV (PMTCT)

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The case for Option B and Optional B+: Ensuring that South Africa’s commitment to eliminating mother-to-child transmission of HIV becomes a reality

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v13i4.112 ◽

2012 ◽

Vol 13 (4) ◽

pp. 178 ◽

Cited By ~ 3

Author(s):

D Besada ◽

G Van Cutsem ◽

E Goemaere ◽

N Ford ◽

H Bygrave ◽

...

Keyword(s):

South African ◽

Population Level ◽

World Health ◽

Mother To Child Transmission ◽

Child Transmission ◽

Trade Offs ◽

The Individual ◽

Mother To Child ◽

African Journal ◽

In Pregnancy

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+.

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

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v18i1.690 ◽

2017 ◽

Vol 18 (1) ◽

Author(s):

Barbara A. Hanrahan ◽

Adri Williams

Keyword(s):

Patient Education ◽

Registered Nurses ◽

Primary Healthcare ◽

Limpopo Province ◽

World Health ◽

Mother To Child Transmission ◽

Child Transmission ◽

Pmtct Programme ◽

Healthcare Facilities ◽

Mother To Child

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.

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Cost-effectiveness of World Health Organization 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in Zimbabwe

Clinical Infectious Diseases ◽

10.1093/cid/cis858 ◽

2012 ◽

Vol 56 (3) ◽

pp. 430-446 ◽

Cited By ~ 40

Author(s):

Andrea L. Ciaranello ◽

Freddy Perez ◽

Barbara Engelsmann ◽

Rochelle P. Walensky ◽

Angela Mushavi ◽

...

Keyword(s):

Cost Effectiveness ◽

World Health Organization ◽

Hiv Transmission ◽

World Health ◽

Health Organization ◽

Mother To Child

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HIV-free survival among breastfed infants born to HIV-positive women in post-conflict northern Uganda: a perspective from two tertiary health facilities

10.21203/rs.2.13574/v1 ◽

2019 ◽

Author(s):

Richard Nyeko ◽

Irene Aguti ◽

Charles Kimbugwe ◽

Patricia Apai ◽

Siraji Munyaga

Keyword(s):

Survival Rate ◽

Low Income ◽

World Health ◽

Northern Uganda ◽

Mother To Child Transmission ◽

Child Transmission ◽

Free Survival ◽

Breastfed Infants ◽

Post Conflict ◽

Mother To Child

Abstract Background Without interventions, the risk of mother-to-child transmission of HIV is up to 25% during pregnancy, labour and delivery with an additional risk of 5-20% during breastfeeding period, leading to an overall rate of up to 45%. Giving anti-retroviral therapy to the mother and anti-retroviral prophylaxis to the infant has been shown to significantly reduce the risk of HIV transmission through breastfeeding to less than 5%. According to the World Health Organization standard, the effectiveness of interventions towards prevention of mother-to-child transmission of HIV in any setting is measured by its HIV-free survival rate. We therefore carried out a study aimed at determining the HIV-free survival among breastfed infants in a resource poor setting in relation breastfeeding duration. Methods A cross-sectional retrospective study using routine clinical data and involving 365 HIV exposed infants followed up in two tertiary facilities in northern Uganda between 2014 and 2016. Data was analysed using Statistical Package for Social Scientists version 16 software package. Results Of the three hundred and sixty five (365) infants sampled for this study, 86.8% (317/365) were enrolled within the first 2 months of life, 12.1% (44/365) between 3-12 months of age and 1.1% (4/365) enrolled after 12 months of age. Almost all the infants (98.4%) were initiated on Nevirapine prophylaxis, 97.5% (356/365) of whom were initiated within 72 hours. The overall HIV-free survival rate in the current study was 93.7% (342/365), while 6.3% (23/365) were either HIV-infected (2.7%) or died (3.6%). The infants’ age at enrolment was the single most important factor significantly associated with HIV-free survival. The overall duration of breastfeeding did not significantly affect the HIV-free survival: 98.1% (304/310) for children breastfed > 12 months versus 100% (15/15) for those breastfed ≤12 months, though exclusive breastfeeding for at least 6 months was protective. Conclusions Adherence to current approaches to prevention of mother-to-child transmission of HIV with support to breastfeeding in low income countries can greatly enhance HIV-free survival for breastfed infants, and supports the current infant and young child feeding recommendations. Key words: HIV-free survival, Mother-to-child transmission, Breastfeeding, Antiretroviral therapy

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Early retention among pregnant women on ‘Option B + ’ in urban and rural Zimbabwe

AIDS Research and Therapy ◽

10.1186/s12981-021-00333-3 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Anesu N. Chimwaza ◽

Hannock Tweya ◽

Owen Mugurungi ◽

Angela Mushavi ◽

Solomon Mukungunugwa ◽

...

Keyword(s):

Pregnant Women ◽

World Health Organisation ◽

World Health ◽

Mother To Child Transmission ◽

Child Transmission ◽

Mtct Rate ◽

Post Test ◽

Early Retention ◽

Mother To Child

Abstract Background In 2013, the World Health Organisation (WHO) recommended Option B+ as a strategy to prevent mother-to-child transmission (PMTCT) of HIV. In option B+ , lifelong antiretroviral therapy (ART) is offered to all HIV positive pregnant and breastfeeding women to reduce MTCT rate to less than or equal to 5%. Its success depends on retaining women on ART during pregnancy, delivery and breast-feeding period. There is limited data on early retention on ART among pregnant women in Zimbabwe. We therefore assessed early retention among women on Option B + from antenatal care (ANC) until 6 months post ANC booking and at delivery in Bulawayo city and Mazowe rural district of Zimbabwe. Methods We collected data for pregnant women booking for ANC between January and March 2018, comparing early retention among ART naïve women and those already on ART. The two cohorts were followed up for 6 months post ANC booking, and this was done in two districts. Data were collected from routine tools used at facility level which include ANC, delivery and ART registers. The Kaplan-Meier survival analysis was used to estimate retention probabilities at 1, 3 and 6 months post-delivery and for retention at delivery proportions were used. Poisson regression was used to investigate factors associated with non-retention at 6 months post ANC booking. Results A total of 388 women were included in the study with median age of 29 years (IQR: 25–34). Two-thirds booked in their second trimester. Retention at 3 and 6 months post ANC booking was 84% (95% CI 80–88) and 73% (95% CI 69–78) respectively. At delivery 81% (95% CI 76–84) were retained in care, 18% lost-to-follow-up and 1% transferred out. In this study we did not find marital status, gestation age, facility location, ART status at ANC booking, to be associated with loss to follow-up. Conclusion In this study, we found low retention at 3, 6 months and delivery, a threat to elimination of Mother-to-child Transmission of HIV in Zimbabwe. Our findings emphasize the need for enhanced interventions to improve early retention such as post-test counselling, patient tracing and visit reminders.

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Elimination of mother-to-child transmission of HIV in Oman: a success story from the Middle East

Eastern Mediterranean Health Journal ◽

10.26719/2021.27.4.381 ◽

2021 ◽

Vol 27 (4) ◽

pp. 381-389

Author(s):

Ali Elgalib ◽

Fatma Al-Hinai ◽

Jamila Al-Abri ◽

Samir Shah ◽

Zeyana Al-Habsi ◽

...

Keyword(s):

Pregnant Women ◽

Service Providers ◽

Mode Of Delivery ◽

World Health ◽

Obstetric Outcomes ◽

Mother To Child Transmission ◽

Child Transmission ◽

Hiv Viral Load ◽

The Impact ◽

Mother To Child

Background: In January 2016, the National AIDS Programme (NAP) in Oman introduced a package of interventions, including capacity building for service providers, to improve the quality of HIV services. Aims: To report the impact of these interventions on the rate of vertical HIV transmission in the period from January 2016 to December 2019. We also describe the virological and obstetric outcomes for HIV-infected pregnant women. Methods: This was a medical record review of 94 HIV-positive pregnant women (median age 32 years; interquartile range 25-34 years) reported to NAP in 2016–2019. Results: There were 110 pregnancies in 94 women. The majority (75.3%, 61/81) of women were diagnosed with HIV infection from routine antenatal screening, with 60% (66/110) of pregnancies occurring in women who knew their HIV status at conception. Caesarean section was the most common (50%) mode of delivery. The preterm labour and low birth weight rates were 21.2% and 15.9%, respectively. The antiretroviral coverage during pregnancy was 95.5%, with most (87.8%) women reporting excellent or good adherence. The majority (81.6%) of women achieved HIV viral load of < 400 copies/ml at or near delivery. Almost all infants (99%) were given prophylactic antiretrovirals. The rate of mother-to-child transmission of HIV was 1%. Conclusion: The obstetric and virological outcomes for HIV-infected pregnant women delivered in 2016–2019 were favourable, with a low rate of mother-to-child transmission of HIV. Oman is now in the process of finalizing application of World Health Organization validation of elimination of mother-to-child transmission of HIV.

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