Paediatric HIV and elimination of mother-to-child transmission of HIV in the ASEAN region: a call to action

Recent achievements in scaling up paediatric antiretroviral therapy (ART) have changed the life of children living with HIV, who now stay healthy and live longer lives. However, as it becomes more of a chronic infection, a range of new problems have begun to arise. These include the disclosure of HIV serostatus to children, adherence to ART, long-term toxicities of antiretroviral drugs and their sexual and reproductive health, which are posing significant challenges to the existing health systems caring for children with HIV with limited resources, experiences and capacities. While intensified efforts and actions to improve care and treatment for these children are needed, it is crucial to accelerate the prevention of mother-to-child transmission (PMTCT) of HIV, which is the main cause of paediatric HIV in the ASEAN region so as to eliminate the fundamental cause of the problem. This report argues that given over 70% of women have access to at least one antenatal care visit in the region and acceptance of HIV testing after receiving counselling on PMTCT could be as high as 90%, there is an opportunity to strengthen PMTCT services and eventually eliminate new paediatric HIV infections in the ASEAN countries

Health outcomes and cost impact of the new WHO 2013 guidelines on prevention of mother-to-child transmission of HIV in Zambia.

BackgroundCountries are currently progressing towards the elimination of new paediatric HIV infections by 2015. WHO published new consolidated guidelines in June 2013, which now recommend either 'Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)' or 'Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)', while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia.MethodsA decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of ≤350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined.ResultsOur analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with 'ARVs during pregnancy and breastfeeding' and further reduced by 15% with 'Lifelong ART'. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners.ConclusionThe shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment

Additional file 1: of Progress and challenges in implementing HIV care and treatment policies in Latin America following the treatment 2.0 initiative

Questionnaire Spanish version. (XLSX 61 kb

Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America

Submitted by Fábio Marques ([email protected]) on 2018-09-20T18:59:40Z No. of bitstreams: 1 Towards a fair consideration of PrEP as part of combination HIV prevention_Beatriz_Grinsztejn_etal_INI_Lapclin-AIDS_2016.pdf: 231546 bytes, checksum: a85fa3b286d4b42f0f852a5759955d26 (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2018-09-27T18:38:51Z (GMT) No. of bitstreams: 1 Towards a fair consideration of PrEP as part of combination HIV prevention_Beatriz_Grinsztejn_etal_INI_Lapclin-AIDS_2016.pdf: 231546 bytes, checksum: a85fa3b286d4b42f0f852a5759955d26 (MD5)Made available in DSpace on 2018-09-27T18:38:51Z (GMT). No. of bitstreams: 1 Towards a fair consideration of PrEP as part of combination HIV prevention_Beatriz_Grinsztejn_etal_INI_Lapclin-AIDS_2016.pdf: 231546 bytes, checksum: a85fa3b286d4b42f0f852a5759955d26 (MD5) Previous issue date: 2016Pan American Health Organization (PAHO), Washington, DC, USA.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Instituto Nacional de Salud Pública. Cuernavaca, México.Investigaciones Medicas en Salud. Lima, Peru.Ministerio de Salud y Protección Social. Bogotá, Colombia.Centro de Investigación Interdisciplinaria en Sexualidad, SIDA y Sociedad, Universidad Peruana Cayetano Heredia. Lima, Peru.Pan American Health Organization (PAHO). Washington, DC, USA.Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America

HIV/AIDS prevention, care and treatment in the Region of the Americas: achievements, challenges and perspectives

Submitted by Fábio Marques ([email protected]) on 2018-06-21T19:18:25Z No. of bitstreams: 1 HIV-AIDS prevention, care and treatment in the Region of the Americas_Beatriz_Grinsztejn_etal_INI_Lapclin_2016.pdf: 440931 bytes, checksum: fa02b673f104428d6088172696c6a909 (MD5)Approved for entry into archive by Raquel Dinelis ([email protected]) on 2018-07-30T14:28:34Z (GMT) No. of bitstreams: 1 HIV-AIDS prevention, care and treatment in the Region of the Americas_Beatriz_Grinsztejn_etal_INI_Lapclin_2016.pdf: 440931 bytes, checksum: fa02b673f104428d6088172696c6a909 (MD5)Made available in DSpace on 2018-07-30T14:28:34Z (GMT). No. of bitstreams: 1 HIV-AIDS prevention, care and treatment in the Region of the Americas_Beatriz_Grinsztejn_etal_INI_Lapclin_2016.pdf: 440931 bytes, checksum: fa02b673f104428d6088172696c6a909 (MD5) Previous issue date: 2016Pan American Health Organization. Tuberculosis and STI Unit. HIV Hepatitis. Washington, D.C., USA.Pan American Health Organization. Tuberculosis and STI Unit. HIV Hepatitis. Washington, D.C., USA.University of the West Indies. Jamaica.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Centers for Disease Control and Prevention. Division of STD Prevention. National Center for HIV/AIDS. Viral Hepatitis. STD and TB Prevention. Atlanta, GA, USA.Fundación Huésped, Buenos Aires, Argentina.Pan American Health Organization. Tuberculosis and STI Unit. HIV Hepatitis. Washington, D.C., USA.The world has pledged within the Sustainable Development Goals to end the AIDS epidemic by 2030. In Latin America and the Caribbean in 2015 approximately 2.0 million people were living with HIV and an estimated 100 000 new infections occurred. At the same time, significant progress has been made in the Region of the Americas over the past ten years in expanding access and coverage of HIV care and treatment and in achieving elimination of mother-to-child transmission of HIV and syphilis (1, 2). Regarding HIV prevention, stigma and discrimination, new regional elimination targets have also been developed and endorsed (3). However, challenges still persist; among them, a 3% increase in the rate of new HIV infections in the Region between 2010 and 2015 (4). This special issue on HIV/AIDS prevention, care and treatment in the Region of the Americas: achievements, challenges and perspectives provides an opportunity to present the current response to HIV/AIDS in the Region with a focus on three main areas: HIV prevention, HIV care and treatment, and the elimination of mother-to-child transmission of HIV and congenital syphilis. A call for papers was issued in early 2016, and 12 articles were selected for publication—nine original research papers, one brief communication, one review, and one opinion and analysis article. The papers represent seven different countries as well as an overview of the Caribbean sub-region