Health workers' views on quality of prevention of mother-to-child transmission and postnatal care for HIV-infected women and their children

<p>Abstract</p> <p>Background</p> <p>Prevention of mother-to-child transmission has been considered as not a simple intervention but a comprehensive set of interventions requiring capable health workers. Viet Nam's extensive health care system reaches the village level, but still HIV-infected mothers and children have received inadequate health care services for prevention of mother-to-child transmission. We report here the health workers' perceptions on factors that lead to their failure to give good quality prevention of mother-to-child transmission services.</p> <p>Methods</p> <p>Semistructured interviews with 53 health workers and unstructured observations in nine health facilities in Hanoi were conducted. Selection of respondents was based on their function, position and experience in the development or implementation of prevention of mother-to-child transmission policies/programmes.</p> <p>Results</p> <p>Factors that lead to health workers' failure to give good quality services for prevention of mother-to-child transmission include their own fear of HIV infection; lack of knowledge on HIV and counselling skills; or high workloads and lack of staff; unavailability of HIV testing at commune level; shortage of antiretroviral drugs; and lack of operational guidelines. A negative attitude during counselling and provision of care, treating in a separate area and avoidance of providing service at all were seen by health workers as the result of fear of being infected, as well as distrust towards almost all HIV-infected patients because of the prevailing association with antisocial behaviours. Additionally, the fragmentation of the health care system into specialized vertical pillars, including a vertical programme for HIV/AIDS, is a major obstacle to providing a continuum of care.</p> <p>Conclusion</p> <p>Many hospital staff were not being able to provide good care or were even unwilling to provide appropriate care for HIV-positive pregnant women The study suggests that the quality of prevention of mother-to-child transmission service could be enhanced by improving communication and other skills of health workers, providing them with greater support and enhancing their motivation. Reduction of workload would also be important. Development of a practical strategy is needed to strengthen and adapt the referral system to meet the needs of patients.</p

On Vietnamese Canadian futurities : generational and temporal invocations of refugeeness

This thesis draws upon autotheory and artistic productions by second-generation Vietnamese Canadians—the photovoice project Beyond the Lens and the poetry chapbook translanguaging—to consider the question of collective futurity for subsequent generations of Vietnamese Canadians amidst the longue durée of imperial warfare and refugee resettlement. This project responds to the entanglements between refugeeness and Canadian state futurity, where despite Canada’s complicity in the imperial war in Vietnam, state memory emphasizes Canada’s role as a humanitarian savior that provides refugees and their children with the opportunities for belonging as “good citizens.” I discuss these mechanisms as part of the state’s liberal, settler colonial, and racial capitalist logics of nation-building that mark subsequent generations as abled bodies available for selective rehabilitation; this population is necessary to uphold Canada’s global position as a minor empire. Within these restrictions on futurity, the discipline of critical refugee studies has demonstrated how a broad reading of refugee subjectivity can help re-think futurity, with refugee existence symbolizing fluidity and relations that exceed state citizenship. This thesis examines how second-generation Vietnamese Canadians inherit and negotiate both these legacies of futurity, as those whose subjectivity exists between these modes of belonging. Chapter One's discussion of Beyond the Lens explores various responses about dream futures in Empowered Phụ Nữ’s photovoice project to demonstrates the range of ways through which futurity is imperfectly imagined alongside and within capitalism, the nation-state, refugee lineages, and liberal multicultural community. Chapter Two considers how Winston Le’s translanguaging demonstrates the ongoing effects of war’s debilitation through language. He demonstrates how mistranslation, wordplay, and language ghosts can serve as a connection to refugee knowledges and a tool to refuse alignment with the expectations of the productive citizen. Overall, this project maps out the connection between subsequent generations of Vietnamese Canadians and refugee histories to unpack the limits and possibilities of imagining collective, decolonial futurities within and beyond the nation.Arts, Faculty ofGender, Race, Sexuality and Social Justice, Institute forGraduat

Cross-reactive anti-viral T cells increase prior to an episode of viral reactivation post human lung transplantation

Human Cytomegalovirus (CMV) reactivation continues to influence lung transplant outcomes. Cross-reactivity of anti-viral memory T cells against donor human leukocyte antigens (HLA) may be a contributing factor. We identified cross-reactive HLA-A*02:01-restricted CMV-specific cytotoxic T lymphocytes (CTL) co-recognizing the NLVPMVATV (NLV) epitope and HLA-B27. NLV-specific CD8+ T cells were expanded for 13 days from 14 HLA-A*02:01/CMV seropositive healthy donors and 11 lung transplant recipients (LTR) then assessed for the production of IFN-γ and CD107a expression in response to 19 cell lines expressing either single HLA-A or -B class I molecules. In one healthy individual, we observed functional and proliferative cross-reactivity in response to B*27:05 alloantigen, representing approximately 5% of the NLV-specific CTL population. Similar patterns were also observed in one LTR receiving a B27 allograft, revealing that the cross-reactive NLV-specific CTL gradually increased (days 13-193 post-transplant) before a CMV reactivation event (day 270) and reduced to basal levels following viral clearance (day 909). Lung function remained stable with no acute rejection episodes being reported up to 3 years post-transplant. Individualized immunological monitoring of cross-reactive anti-viral T cells will provide further insights into their effects on the allograft and an opportunity to predict sub-clinical CMV reactivation events and immunopathological complications