Integrating Prevention of Mother-to-Child HIV Transmission Programs to Improve Uptake: A Systematic Review

BACKGROUND: We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries. METHODS: We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources. RESULTS: Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04-1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001). CONCLUSION: Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs

Uptake and outcomes of a prevention-of mother-to-child transmission (PMTCT) program in Zomba district, Malawi

<p>Abstract</p> <p>Background</p> <p>HIV prevalence among pregnant women in Malawi is 12.6%, and mother-to-child transmission is a major route of transmission. As PMTCT services have expanded in Malawi in recent years, we sought to determine uptake of services, HIV-relevant infant feeding practices and mother-child health outcomes.</p> <p>Methods</p> <p>A matched-cohort study of HIV-infected and HIV-uninfected mothers and their infants at 18-20 months post-partum in Zomba District, Malawi. 360 HIV-infected and 360 HIV-uninfected mothers were identified through registers. 387 mother-child pairs were included in the study.</p> <p>Results</p> <p>10% of HIV-infected mothers were on HAART before delivery, 27% by 18-20 months post-partum. sd-NVP was taken by 75% of HIV-infected mothers not on HAART, and given to 66% of infants. 18% of HIV-infected mothers followed all current recommended PMTCT options. HIV-infected mothers breastfed fewer months than HIV-uninfected mothers (12 vs.18, respectively; <it>p </it>< 0.01). 19% of exposed versus 5% of unexposed children had died by 18-20 months; <it>p </it>< 0.01. 28% of exposed children had been tested for HIV prior to the study, 76% were tested as part of the study and 11% were found HIV-positive. HIV-free survival by 18-20 months was 66% (95%CI 58-74). There were 11(6%) maternal deaths among HIV-infected mothers only.</p> <p>Conclusion</p> <p>This study shows low PMTCT program efficiency and effectiveness under routine program conditions in Malawi. HIV-free infant survival may have been influenced by key factors, including underuse of HAART, underuse of sd-NVP, and suboptimal infant feeding practices. Maternal mortality among HIV-infected women demands attention; improved maternal survival is a means to improve infant survival.</p

Repeat pregnancy in women with HIV infection in Latin America and the Caribbean

Maria Isabel Fragoso da Silveira Gouvêa. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta à informação no documento.Submitted by Janaína Nascimento ([email protected]) on 2019-04-04T12:07:40Z No. of bitstreams: 1 ve_ Kreitchmann_Regis_etal_INI_2016.pdf: 503162 bytes, checksum: 9db62c30f29255b3ce8570c9b1e3d498 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-04-04T14:01:20Z (GMT) No. of bitstreams: 1 ve_ Kreitchmann_Regis_etal_INI_2016.pdf: 503162 bytes, checksum: 9db62c30f29255b3ce8570c9b1e3d498 (MD5)Made available in DSpace on 2019-04-04T14:01:20Z (GMT). No. of bitstreams: 1 ve_ Kreitchmann_Regis_etal_INI_2016.pdf: 503162 bytes, checksum: 9db62c30f29255b3ce8570c9b1e3d498 (MD5) Previous issue date: 2015Irmandade da Santa Casa de Misericórdia de Porto Alegre. Porto Alegre, RS, Brasil.Westat. Rockville, MD, USA.Federal University of Minas Gerais. Belo Horizonte, MG, BrazilIrmandade da Santa Casa de Misericórdia de Porto Alegre. Porto Alegre, RS, Brasil.U.S. Department of State. Office of the Global AIDS Coordinator. Washington D.C., USA.Westat. Rockville, MD, USA.Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.University of São Paulo. Faculty of Medicine of Ribeirão Preto. Ribeirão Preto. Ribeirão Preto, SP, Brazil.Hospital General de Agudos José María Ramos Mejía. HIV Unit. Buenos Aires, Argentina.National Institutes of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Maternal Pediatric Infectious Disease Branch. Bethesda, MD, USA.Intended and unintended pregnancies occur frequently among human immunodeficiency virus (HIV)-infected women. We evaluated the occurrence of repeat pregnancy and characteristics associated with this outcome among HIV-infected women in Latin America and the Caribbean who were participating in the National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI). Of the 1342 HIV-infected pregnant women enrolled in NISDI, 124 (9.2%) had one or more repeat pregnancies on study. Median time between the index delivery and date of conception of the subsequent pregnancy was 1.4 years (range 0.1-5.7). Younger age (odds ratio [OR] = 1.07, 95% confidence interval [CI]: 1.04-1.11 per one year decrease in age), hospitalization during the index pregnancy or up to six months post-partum [OR = 2.0, 95% CI: 1.2-3.4], and poor index pregnancy outcome (stillbirth or spontaneous/therapeutic abortion; OR = 3.4, 95% CI: 1.4-8.4) were associated with increased occurrence of repeat pregnancy in multivariable analysis. Among women with repeat pregnancies, the proportion receiving antiretroviral treatment (vs. prophylaxis) increased from 39.4% at the time of the index pregnancy to 81.8% at the time of the repeat pregnancy (p < 0.001). These results can help identify women most likely to benefit from reproductive counseling in order to assist with healthy pregnancy planning and prevention of unintended pregnancies

Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the US National Institutes of Health or the Department of Health and Human Services.Made available in DSpace on 2015-04-08T14:09:55Z (GMT). No. of bitstreams: 2 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) josehenrique_pilotto_IOC_2014.pdf: 431330 bytes, checksum: a8336627d368ba0512d9a5f379c494dc (MD5) Previous issue date: 2014Universidade Federal do Rio de Janeiro. Instituto de Puericultura e Pediatria Martagão Gesteira. Rio de Janeiro, RJ, Brasil.Westat. Rockville, MD, USA.Westat. Rockville, MD, USA.Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Ribeirão Preto, SP, Brasil.Irmandade da Santa Casa de Misericórdia de Porto Alegre. Porto Alegre, RS, Brasil.Universidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.Dr. Cecilia Grierson Hospital. Infectious Diseases Unit. Buenos Aires, AR.Universidade Federal do Rio de Janeiro. Instituto de Puericultura e Pediatria Martagão Gesteira. Rio de Janeiro, RJ, Brasil.National Institute of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Maternal and Pediatric Infectious Disease Branch. Bethesda, MD, USA.National Institute of Health. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Maternal and Pediatric Infectious Disease Branch. Bethesda, MD, USA.Objectives: To evaluate the incidence of and risk factors for hypertensive disorders in a cohort of HIV-infected pregnant women. Methods: Hypertensive disorders (HD) including preeclampsia/eclampsia (PE/E) and pregnancy induced hypertension, and risk factors were evaluated in a cohort of HIV-infected pregnan