The Prevalence and Pattern of Traditional Herbal Medicine Use during Pregnancy, Labour, and Postpartum: Implications for Prevention of Mother to Child Transmission of HIV in South Africa

The use of traditional herbal medicines (THM) is widespread among pregnant women in many African societies. Cultural beliefs and social norms largely influence the use of THM. However, its use during pregnancy is not freely discussed during antenatal care and the extent of its use remains unknown. The aim of the study was to determine the prevalence and pattern of THM use during pregnancy, labour, and post-delivery. The study was a quantitative cross-sectional design using a researcher administered questionnaire. Postnatal women enrolled in the prevention of mother to child transmission of HIV (PMTCT) were recruited from healthcare facilities in a rural South African sub-district. Summary and inferential statistics were computed using STATA 14.0 statistical package. The sample consisted of 399 women with mean age of 28 years. A high proportion (158/42.5) were receiving antiretroviral treatment. The prevalence of THM use was 23% and 76/87.4% took THM in the second trimester of pregnancy, 50/57.5% used THM throughout pregnancy, and 27/60% ingested THM when labour started. The majority (50/58.1%) used one type of THM and 35/41.5% used up to four types. The prevalence of THM use on babies was 44%, 82/54.2% were introduced to THM before three months, and 22/14.2% within their first week of life. A third 52/32.3% of babies received more than one concoction of herbal medicines. The women took THM to protect mother and baby from evil spirits as well as to increase labour pains and shorten the duration of labour. The use of THM on the baby was despite the women being enrolled in the PMTCT program which advocates exclusive breastfeeding (EBF) in the first six months. Mixed feeding practices including the use of THM on the baby before the end of the period of EBF have a negative impact on the elimination of vertical transmission of HIV.

Knowledge about vertical transmission of HIV and associated factors among women living with HIV or AIDS attending antiretroviral therapy clinic, Western Ethiopia

Background: The United Nations Program on HIV or AIDS has committed to eliminating the vertical transmission of human immunodeficiency virus. However, significant number of newborn and children are acquiring HIV every year. Therefore, the aim of this study was to assess knowledge of mother on vertical transmission of HIV and associated factors among non-pregnant women receiving antiretroviral therapy in the West Wollega, Western Ethiopia. Methods: A facility-based cross-sectional study design was used on a sample of 422 non-pregnant women attending antiretroviral therapy clinic in West Wollega from 26 February to 26 March 2019. Systematic sampling was used to select the study participants. Pretested and structured interviewer-administered questionnaires and telephone interview were used to collect the data. Multivariable logistic regression model was used to identify factors associated with the knowledge of mother on vertical transmission of HIV. Odds ratio along with 95% confidence interval were estimated to measure the strength of the association. Level of statistical significance was declared at p-value less than 0.05. Result: Out of total participants, 94.1% (95% confidence interval: (91.7%, 96.2%)) of them were knowledgeable about vertical transmission of HIV. Urban resident (adjusted odds ratio: 2.36, 95% confidence interval: (1.27, 4.39)), primary school (adjusted odds ratio: 2.94, 95% confidence interval: (1.11, 7.83)), secondary school (adjusted odds ratio: 3.39, 95% confidence interval: (1.53, 7.55)), being on antiretroviral therapy for greater than 2 years (adjusted odds ratio: 2.67, 95% confidence interval: 1.02, 6.99)), and having child living with HIV (adjusted odds ratio: 1.54, 95% confidence interval: (1.07, 3 .83)) were significantly associated with the knowledge of mother on vertical transmission of HIV. Conclusion: The study indicated that 5.9% of the women lack knowledge about vertical transmission of HIV. This knowledge associated with sociodemographic factors, such as residence, educational status, experiences of having child living with HIV, and being on antiretroviral therapy for greater than 2 years. Thus, interventions toward the elimination of new newborn HIV infections should consider these factors.

From Undetectable Equals Untransmittable (U=U) to Breastfeeding: Is the Jump Short?

Background: Vertical transmission of HIV infection can occur during pregnancy, during childbirth or through breastfeeding. The recommendations issued by the various international guidelines (WHO 2010, EACS 2017, DHHS 2017) on the safety of breastfeeding of HIV-infected women in effective antiretroviral treatment do not provide univocal indications referring to individual countries the choice to advise or advise against such procedure. Methods: A retrospective study was conducted in a small cohort of HIV-infected pregnant women who, despite the information received, decided to breastfeed their children. The observation was carried out in the period between March 2017 and June 2021. In all newborns, prophylaxis therapy was initiated at birth, according to the treatment guidelines, the scheme adopted involved the administration of zidovudine (AZT) orally for 4 weeks, started immediately after the childbirth. Breastfeeding time was, on average, 5 months. Results: No contagion was diagnosed. All infants were tested for HIV-RNA at birth, 1, 3, and 6 months after birth, and 1, 3 and 3 months after stopping breastfeeding. Conclusions: The data obtained represent, in our opinion, a solicitation to discuss and re-evaluate scientific evidence that starting from "Undetectable Equals Untransmittable" (U = U) can open a scientific and cultural review of breastfeeding.

Understanding Viral and Immune Interplay During Vertical Transmission of HIV: Implications for Cure

Despite the significant progress that has been made to eliminate vertical HIV infection, more than 150,000 children were infected with HIV in 2019, emphasizing the continued need for sustainable HIV treatment strategies and ideally a cure for children. Mother-to-child-transmission (MTCT) remains the most important route of pediatric HIV acquisition and, in absence of prevention measures, transmission rates range from 15% to 45% via three distinct routes: in utero, intrapartum, and in the postnatal period through breastfeeding. The exact mechanisms and biological basis of these different routes of transmission are not yet fully understood. Some infants escape infection despite significant virus exposure, while others do not, suggesting possible maternal or fetal immune protective factors including the presence of HIV-specific antibodies. Here we summarize the unique aspects of HIV MTCT including the immunopathogenesis of the different routes of transmission, and how transmission in the antenatal or postnatal periods may affect early life immune responses and HIV persistence. A more refined understanding of the complex interaction between viral, maternal, and fetal/infant factors may enhance the pursuit of strategies to achieve an HIV cure for pediatric populations.

Knowledge and determinants of women’s knowledge on vertical transmission of HIV and AIDS in South Africa

Background HIV/AIDS is still one of the major public health concerns globally. It is one of the major contributory causes of deaths among women in the reproductive age (15–49 years) and has resulted in about 14 million orphaned children globally. Knowledge of Mother-to Child transmission is one of the strategies to fight against HIV. This study, therefore, sought to assess the knowledge and determinants of women’s knowledge on vertical transmission of HIV and AIDS in their reproductive age in South Africa. Methods Data were obtained from the South Africa Demographic and Health Survey (SADHS) 2016. Both descriptive (frequencies and percentages) and inferential analysis (multilevel mixed-effects complementary log–log regression model) were conducted and the statistical significance was set at p < 0.05. Results The prevalence of knowledge of mother to child transmission of HIV and AIDS during pregnancy, delivery, breastfeeding and at least knowledge of one source are 87.0%, 81.1%, 80.3% and 91.4% respectively. At the individual level, those with secondary [AOR = 1.28, CI = 1.04,1.57] and higher [AOR = 1.55, CI = 1.21,1.99], those who read newspaper less than once a week [AOR = 1.16, CI = [1.05,1.28], at least once a week [AOR = 1.14, CI = 1.04,1.25], and those who listen to the radio less than once a week [AOR = 1.22, CI = 1.03,1.43] had higher odds of knowledge on MTCT of HIV and AIDS. However, those with parity 0 [AOR = 0.73, CI = [0.63,0.85] had lower odds of knowledge of MTCT of HIV and AIDS compared with those with parity 4 or more. At the contextual level, those in the poorest wealth quintile [AOR = 0.82,CI = 0.69,0.97] had lower odds of having knowledge of MTCT of HIV and AIDS. Those in the urban areas [AOR = 1.17, CI = [1.04,1.31], those in Limpopo [AOR = 1.35, CI = [1.12,1.64], Gauteng [AOR = 1.35, CI = [1.12,1.62] and North west[AOR = 1.49, CI = [1.22,1.81] had higher odds of knowledge of mother to child transmission of HIV and AIDS. Conclusion The study has demonstrated that there is relatively high knowledge of mother to child transmission of HIV and AIDS in South Africa. The factors associated with the knowledge are educational level, exposure to mass media, parity, wealth status, place of residence and the region of residence. To further increase the knowledge, it is imperative to adopt various messages and target respondents in different part of SSA through the mass media channels. This should be done taking cognizant of the rural–urban variations and socio-economic status.

Readiness of Health Workers to Provide Pregnancy Planning Program for Women Infected with Human Immunodeficiency Virus: A Case Study in Surabaya, East Java, Indonesia

Background: The prevalence of human immunodeficiency virus (HIV) mother-to-child infection, or vertical transmission of HIV, in Indonesia is about 90%. Ministry of Health of the Republic of Indonesia Regulation No. 21 of 2013 stated that HIV infection in sexual productive age needs integrative professional help to lower the transmissions, including voluntary counseling and testing for pregnant women as well as all people at risk. This study aimed to determine the readiness of health workers to provide pregnancy planning program service for women with HIV.Methods: This study was a descriptive study involving 30 obstetricians and 30 residents of Obstetrics and Gynecology specialist education in Surabaya, Indonesia. The respondents’ knowledge on pregnancy planning for HIV-infected women based on based on guidance released by the Ministry of Health of Indonesia in 2017 and Regulation of Ministry of Health no. 52 the year 2017, as well as their attitude and readiness to provide pregnancy planning services, was explored. Questionnaires were distributed from August to December 2019 and the data collected were analyzed using Statistical Package for the Social Science (SPSS) version 17.0 and results were described in percentage.Results: Most health workers (80%) had good knowledge on providing pregnancy planning program for HIV positive women; however, only 63.3% had good attitude towards it. The majority of respondents (90%) were ready to help HIV patients in planning their pregnancy. Conclusion: Health workers in Surabaya are ready to provide services related to pregnancy planning for women infected with HIV.

HIV in pregnancy

HIV is a disease caused by retrovirus (HIV-1 or HIV-2) the that attacks the immune system of the body, leaving it susceptible to various dangerous infections. HIV can have profound effects on pregnancy and pregnancy may in turn cause an aggravation of signs and symptoms HIV.A pregnant woman living with HIV can pass on the virus to her baby during pregnancy, childbirth and through breastfeeding. This is called Vertical transmission of HIV. Without any intervention, the rate of vertical transmission of HIV is as much as 15-45%. National PPTCT program of India run by NACO (National AIDS Control Organization) aims at preventing HIV transmission from mother to child. Women who are known HIV positives or those who are diagnosed as HIV positive for the first-time during pregnancy, are given Triple Dose Anti Retro-viral therapy comprising of Tenofovir, Lamivudine and Efavirenz. Special precautions are taken during their delivery. Whether LSCS is to be performed depends on the indications and on which guidelines are followed. Infant- feeding is advised to be carried out as per the guidelines stated in the PPTCT act so as to minimize the chances of HIV transmission to the infant.

Knowledge and Determinants of Women’s Knowledge on Vertical Transmission of HIV and AIDS in South Africa

Background HIV/AIDS is still one of the major public health concerns globally. It is one of the major contributory causes of deaths among women in the reproductive age (15-49 years) and has resulted in about 14 million orphaned children globally. Knowledge of Mother-to Child transmission is one of the strategies to fight against HIV. This study, therefore, sought to assess the knowledge and determinants of women’s knowledge on vertical transmission of HIV and AIDS in their reproductive age in South Africa. MethodsData were obtained from the South Africa Demographic and Health Survey (SADHS) 2016. Both descriptive (frequencies and percentages) and inferential analysis (binary logistic regression) were conducted and the statistical significance was set at p<0.05. ResultsThe prevalence of knowledge of mother to child transmission of HIV and AIDS during pregnancy, delivery, breastfeeding and at least knowledge of one source are 87.0%, 81.1%, 80.3% and 91.4% respectively. Women with secondary [AOR=1.271,CI=1.04,1.55] and higher [AOR=1.495, CI=1.18,1.89], those in urban areas [AOR=1.153,CI=[1.07,1.25], Limpopo [AOR=1.341,CI=1.16,1.55], Gauteng [AOR=1.337,CI=[1.15,1.55] and North west [AOR=1.410,CI=[1.22,1.63], those who read newspaper at least once a week [AOR=1.136,CI=1.05,1.23], and those who listen to radio less than once a week [AOR=1.163,CI=[1.02,1.33] had higher odds of knowledge on mother to child transmission of HIV and AIDs. However, those with parity 0 [AOR=0.783, CI= [0.68,0.90], poorest [AOR=0.837, CI=0.73,0.96] had lower odds of knowledge of mother to child transmission of HIV and AIDS.Conclusion The study has demonstrated that there is relatively high knowledge of mother to child transmission of HIV and AIDS in South Africa. The factors associated with the knowledge are educational level, wealth status, place of residence, the region of residence, exposure to mass media and parity. To further increase the knowledge, it is imperative to adopt various messages and target respondents in different part of SSA through the mass media channels. This should be done taking cognizant of the rural-urban variations and socio-economic status.

Determinant factor of married women’s knowledge on vertical transmission of HIV in Mecha district, Ethiopia; a community-based study

Introduction Mother-to-child transmission (MTCT) of HIV infection remains a major public health problem and constitutes the most important cause of HIV infection in children. Knowledge of married women on MTCT of HIV is very important for successful intervention toward prevention of mother-to-child transmission (PMTCT) and achieving the goal of eliminating the new HIV infection. The objective of the study was to assess knowledge of married women on MTCT of HIV and associated factors in Mecha district Northwest Ethiopia. Methods A community based cross sectional study was conducted involving 520 married women from January 1 to February 30 /2017 in Mecha district. Interviewer administered questionnaires were used to collect the data. The collected data was entered, cleaned and checked using Epi Data version 3.1 and then analyzed with SPSS version 20. Bivariate and multivariable logistic regression was computed for all explanatory variables to identify determinant factors at 95% confidence interval. Explanatory variables having P-value <0.05 taken as a predictor for knowledge of married women on mother to child transmission of HIV. Result This study was carried out among a total of 520 married reproductive age group women with a response rate of 98%. From the total of 510 respondents, 160(31.4%) of women were knowledgeable on vertical transmission of HIV (MTCT). Women who were knowledgeable on MTCT of HIV was positively associated with urban residence (AOR = 1.75, 95% CI: 1.05–2.92), women who had history of ANC follow up (AOR = 2.68, 95% CI: 1.17–6.13), women who were pregnant during the study period (AOR = 1.86, 95%CI: 1.10–3.13) and those who had discussions with their husband about HIV/AIDS/ MTCT (AOR = 2.40, 95% CI: 1.52-.3.80). Conclusion and recommendation The finding from this study revealed that knowledge of married women on MTCT of HIV was low. This may contribute to increase the spread of MTCT of HIV. Therefore, giving more attention and emphasis on continuous education regarding MTCT of HIV is highly recommended.