Socioeconomic and reproductive factors associated with condom use within and outside of marriage among urban pregnant women in Zambia

A cross-sectional questionnaire survey was conducted on 470 pregnant women in Lusaka, Zambia. Multivariate analysis revealed school attendance and child deaths as independently significant variables positively associated with HIV seropositivity. Among women with fidelity, HIV prevalence was not significantly lower, and condom use was much lower than among women who were having extramarital affairs. Factors significantly associated with condom use within and outside of marriage differed-age and number of live births within, and sexual transmission knowledge outside of marriage. School attendance was not effective for gaining knowledge on sexual transmission or condom use. Regular own earning was significantly effective for condom use in both groups, irrespective of school attendance. The following should be implemented intensively: effective education on HIV and sex in and out of school before early sexual debut, further implementation of family planning with emphasis on condom use, and empowering women by assisting with their economic independence. (Afr J Reprod Health 2005 2005; 9[3]:128-136

Infant feeding counseling within Kenyan and Zambian PMTCT services: How well does it promote good feeding practices?

Infant feeding counseling is an important intervention for the prevention of mother-to-child transmission (PMTCT) of HIV. More than one-third of HIV transmission to infants occurs through breastfeeding, and up to 20 percent of infants born to HIV-infected mothers acquire the virus from breast milk in countries where extended breastfeeding of children is the norm. The World Health Organization advises that HIV-positive mothers should be offered nondirective counseling on various infant feeding options that are feasible, affordable, safe, sustainable, and effective in the local context. The Horizons Program collaborated with NARESA in Kenya, the MTCT Working Group in Zambia, and UNICEF to examine the implementation of infant feeding counseling as part of a comprehensive study in each country to document the acceptability, operational barriers, cost, and impact of pilot PMTCT services. This brief presents key findings from the Kenya and Zambia studies on the content of counseling, provider attitudes about infant feeding options, and the extent to which actual infant feeding practice by mothers is consistent with recommended practice

HIV voluntary counseling and testing: An essential component in preventing mother-to-child transmission of HIV

Positive results from clinical trials of the anti-retroviral medications zidovudine and nevirapine created the possibility of offering an affordable and feasible intervention worldwide to reduce HIV transmission from an infected pregnant woman to her infant. Governmental and nongovernmental health services in many highly affected areas of Africa, Asia, Latin America, and Eastern Europe have responded by piloting and rapidly expanding programs for the prevention of mother-to-child HIV transmission (PMTCT). Since their inception in 1999, programs have offered voluntary HIV counseling and testing (VCT) to more than 800,000 pregnant women around the world. An important objective of VCT is to identify which pregnant women are HIV-positive so they can receive antiretroviral drugs to prevent transmitting HIV to their infants. HIV counseling and testing also offer an opportunity to promote HIV prevention, encourage serostatus disclosure, and foster couple communication on HIV and PMTCT. This brief focuses on VCT in the antenatal care setting, examining service utilization by pregnant women, their perceptions of services, client outcomes as a result of undergoing HIV counseling and testing, and strategies for improving quality and coverage of VCT as a key component of PMTCT programs

Family planning and PMTCT services: Examining interrelationships, strengthening linkages

Preventing unintended pregnancy among HIV-positive women through family planning (FP) services is one of the four cornerstones of a comprehensive program for prevention of mother-to-child HIV transmission (PMTCT). Reducing unintended pregnancies among HIV-positive women would yield a reduction in infections among infants and a reduction in the number of children potentially orphaned when parents die of AIDS-related illnesses. It also reduces HIV-positive women\u27s vulnerability to morbidity and mortality related to pregnancy and lactation. In addition, family planning for both HIV-positive and -negative women safeguards their health by enabling them to space births. This brief focuses on findings from Horizons studies on the extent to which voluntary counseling and testing (VCT) and PMTCT programs address family planning. In Kenya and Zambia, the Horizons Program collaborated with NARESA and the MTCT Working Group, respectively, and UNICEF to document the acceptability, operational barriers, costs, and impact of pilot PMTCT services

Optimism alongside new challenges: using a rehabilitation framework to explore experiences of a qualitative longitudinal cohort of people living with HIV on antiretroviral treatment in Lusaka, Zambia.

Previous research has demonstrated increased comorbidities related to the chronic effects of HIV. Rehabilitation science offers a useful approach for studying chronic illness. This longitudinal qualitative study used a rehabilitation science approach to explore the experiences over time of women and men living with HIV and on antiretroviral therapy (ART) in the high HIV-prevalence setting of Lusaka, Zambia. Thirty-five participants participated in a total of 99 in-depth interviews from 2012 to 2015. The central pattern that emerged across the participants' narratives was the paradoxical experience of profound optimism alongside significant new challenges. Participants' stories of hopefulness in the face of ongoing struggles played out in three interconnected themes: (1) impacts on my body and life; (2) interventions I am grateful to have and new interventions I need; and (3) stigma reduced and created by ART. Results reflected the ups and downs of life with HIV as a chronic illness. Participants, whilst committed to and healthier on ART, typically experienced multiple physical, psychological and sensory impairments that varied in type, severity and trajectory. Participants valued improved relationships enabled by ART, but yearned for support for living long-term with HIV. Frequently participants reflected that their needs were overlooked related to managing side-effects, exercise, family planning and healthy sexuality. ART strengthened acceptance by self and others through improved health and productivity and through becoming a source of support for others. However, being on ART also led to stigma, driven by persistent associations with sickness, death, lack of productivity and uncertainty. This study points to shortcomings in the current focus of HIV care in Zambia and the region, which centres on initiating and adhering to ART. Findings call for evolution of the HIV care continuum to embrace a more holistic and long-term approach to living with HIV as a chronic and episodic condition

HIV-1 Drug Resistance Mutations Are Present in Six Percent of Persons Initiating Antiretroviral Therapy in Lusaka, Zambia

Objective: To assess the mutational patterns and factors associated with baseline drug-resistant HIV-1 present at initiation of first-line antiretroviral therapy (ART) at 3 sites in Lusaka, Zambia, in 2007-2008. Methods: Population sequencing of the HIV-1 pol gene was performed in the PharmAccess African Studies to Evaluate Resistance Monitoring cohort. Drug resistance-associated mutations (DRMs) were identified using the WHO 2009 Surveillance DRM list. Multiple logistic regression was used to assess factors associated with baseline resistance. Results: The overall prevalence of baseline resistance was 5.7% [31 of 548 participants; 95% confidence interval (CI): 3.9 to 7.9]; the prevalence of DRMs associated with nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors NNRTIs) and protease inhibitors was 1.1%, 4.0%, and 1.1%, respectively. Resistance prevalence was 5.2% (27 of 523) in antiretroviral-naive and 16.0% (4 of 25) in antiretroviral-experienced (ie, previous use of ART or antiretroviral prophylaxis for prevention of mother-to-child transmission) participants (P = 0.022). Dual-class resistance to NRTIs and NNRTIs was observed in 0.6% of participants. HIV-1 subtype C was identified in 98.0% (537 of 548) of participants. Prior antiretroviral experience (odds ratio: 4.32, CI: 1.34 to 14.0, P = 0.015) and hemoglobin level (highest tertile versus lowest tertile odds ratio: 2.74, CI: 1.09 to 6.89, P = 0.033) were independently associated with baseline resistance. Conclusions: Baseline resistance may compromise the response to standard NNRTI-based first-line ART in 6% of patients in Lusaka, Zambia. Continuous resistance monitoring is warranted to maintain individual and population-level ART effectivenes

HIV-HBV coinfection in Southern Africa and the effect of Lamivudine- Versus tenofovir-containing cART on HBV outcomes

BACKGROUND:: This study assessed HIV-hepatitis B virus (HBV) coinfection in southern Africa in terms of prevalence, viral characteristics, occult HBV, and the effect of lamivudine- versus tenofovir-containing first-line combination antiretroviral treatment (cART) on HBV-related outcomes. METHODS:: A multicenter prospective cohort of HIV-infected adults in Zambia and South Africa who initiated cART. Outcomes by month 12 on cART were immunological recovery, hepatitis B surface antigen (HBsAg) loss, viral suppression, and drug resistance. We used descriptive statistics, logistic regression, and linear mixed models. RESULTS:: Of the 1087 participants, 92 were HBsAg seropositive, yielding a sample-weighted prevalence of 7.4% (95% confidence interval: 5.6 to 9.2), with 76% genotype HBV-A1. The estimated CD4 recovery on cART was similar between HIV monoinfection and HIV-HBV coinfection groups and between lamivudine- and tenofovir-treated participants. HBsAg loss was documented in 20% (4/20) of lamivudine-treated and 18% (3/17) of tenofovir-treated participants (P = 0.305). Viral suppression (HBV-DNA < 20 IU/mL) was achieved in 61.5% (16/26) of lamivudine-treated and 71.4% (15/21) of tenofovir-treated participants (P = 0.477). HBV pol sequencing demonstrated M204I (n = 3) and N236T (n = 1) resistance-associated mutations in 4 of 8 (50%) lamivudine-treated participants and none in tenofovir-treated participants. Occult HBV infection was present in 13.3% before cART, but by month 12, HBV-DNA was below the limit of detection (<15 IU/mL) in 90.5% (19/21) of lamivudine-treated and 100% (18/18) of tenofovir-treated participants (P = 0.179). CONCLUSIONS:: Tenofovir-containing first-line cART is preferred for HIV-HBV coinfection in Africa because of a superior resistance profile relative to lamivudine monotherapy. Extended follow-up will be needed to determine long-term complications of occult HBV coinfection. Improved access to HBsAg screening and tenofovir is needed