Antiretroviral prophylaxis to prevent post-natal transmission of HIV through breastfeeding

Although antiretroviral drugs have a crucial role to play in prevention of mother-to-child HIV transmission through breastfeeding, we still have much to learn about how best to use these drugs taking into account the social and biological context of maternal and child health in the many disadvantaged sub-Saharan African settings where the HIV epidemic predominate

Antiretroviral prophylaxis to prevent post-natal transmission of HIV through Breastfeeding

No Abstract

Breastfeeding and the 2015 South African guidelines for prevention of mother-to-child transmission of HIV

No abstract availabl

Why growth monitoring fails : an exploratory study of child malnutrition intervention in a rural African area

Bibliography: leaves 199-209.This study is an exploratory one of growth monitoring in a rural African village, Thornhill. Growth monitoring is a primary health care approach to prevent child malnutrition in under-developed areas promoted by a variety of development agencies, particularly UNICEF, as a part of the "child survival revolution." It involves weighing children regularly and plotting their weights on a growth chart retained by the child's mother. Growth charts provide a visual display of a child's growth to allow health workers and mothers to identify early signs of growth faltering in order to facilitate ameliorative action (usually food supplementation or nutrition education) to prevent malnutrition. It also aims to facilitate the active participation of mothers in ensuring their child's continual good growth. The history of growth monitoring and its use in the South African context is discussed. The underlying rationale and component processes needed to implement it effectively are identified in a review of process evaluation studies of growth monitoring. Thornhill is an impoverished African rural area in the Ciskei in which malnutrition is a serious health problem and growth monitoring has been systematically implemented. However, although the health service had a demonstrated capacity for successful health interventions it had been unable to improve nutritional status. Background information and previous research in the area is presented. The study aimed to explore why growth monitoring had failed to improve nutritional status in Thornhill by investigating the way in which the component objectives of growth monitoring in terms of making growth visible, facilitating nutrition intervention and facilitating mothers' participation in their children's care were perceived by mothers and health workers

Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review.

BACKGROUND: With an ageing population, there is an increasing societal impact of ill health in later life. People who adopt healthy behaviours are more likely to age successfully. To engage people in health promotion initiatives in mid-life, a good understanding is needed of why people do not undertake healthy behaviours or engage in unhealthy ones. METHODS: Searches were conducted to identify systematic reviews and qualitative or longitudinal cohort studies that reported mid-life barriers and facilitators to healthy behaviours. Mid-life ranged from 40 to 64 years, but younger adults in disadvantaged or minority groups were also eligible to reflect potential earlier disease onset. Two reviewers independently conducted reference screening and study inclusion. Included studies were assessed for quality. Barriers and facilitators were identified and synthesised into broader themes to allow comparisons across behavioural risks. FINDINGS: From 16,426 titles reviewed, 28 qualitative studies, 11 longitudinal cohort studies and 46 systematic reviews were included. Evidence was found relating to uptake and maintenance of physical activity, diet and eating behaviours, smoking, alcohol, eye care, and other health promoting behaviours and grouped into six themes: health and quality of life, sociocultural factors, the physical environment, access, psychological factors, evidence relating to health inequalities. Most of the available evidence was from developed countries. Barriers that recur across different health behaviours include lack of time (due to family, household and occupational responsibilities), access issues (to transport, facilities and resources), financial costs, entrenched attitudes and behaviours, restrictions in the physical environment, low socioeconomic status, lack of knowledge. Facilitators include a focus on enjoyment, health benefits including healthy ageing, social support, clear messages, and integration of behaviours into lifestyle. Specific issues relating to population and culture were identified relating to health inequalities. CONCLUSIONS: The barriers and facilitators identified can inform the design of tailored interventions for people in mid-life.This work was funded by the National Institute for Health and Care Excellence (NICE), invitation to tender reference DDER 42013, and supported by the National Institute for Health Research School for Public Health Research. The scope of the work was defined by NICE and the protocol was agreed with NICE prior to the start of work.This is the final version of the article. It first appeared from PLOS via http://dx.doi.org/10.1371/journal.pone.014507

Moving towards elimination : findings from the South Africa prevention of mother to child transmission evaluation (SAPMTCTE)

It is remarkable that we find ourselves at a point in history where we can seriously consider the possibility of virtual elimination of mother-to-child HIV transmission (MTCT). Effective antiretroviral strategies, carefully honed through randomized clinical trials, provide the means to almost entirely prevent the transmission of HIV from an HIV-infected woman to her infant during pregnancy, delivery and breastfeeding - if started timeously and sustained through the full period of risk. Massive mobilization of governments, policy-makers, health service managers, clinicians, researchers and communities have led to implementation of Prevention of Mother To Child Transmission (PMTCT) interventions on an impressive scale. South Africa, which faces the world’s highest adult HIV prevalence, has risen to the challenge, also implementing the one of the world’s largest antiretroviral drug treatment program. In so doing, South Africa has made impressive gains in mitigating the tragedy of its generalized and substantial HIV epidemic.The South African Medical Research Councilhttps://bmcinfectdis.biomedcentral.comam2020Paediatrics and Child Healt

Distribution of Human Papillomavirus Genotypes among HIV-Positive and HIV-Negative Women in Cape Town, South Africa

Objective: HIV-positive women are known to be at high-risk of human papillomavirus (HPV) infection and its associated cervical pathology. Here, we describe the prevalence and distribution of HPV genotypes among HIV-positive and -negative women in South Africa, with and without cervical intraepithelial neoplasia (CIN). Methods: We report data on 1,371 HIV-positive women and 8,050 HIV-negative women, aged 17–65 years, recruited into three sequential studies in Cape Town, South Africa, conducted among women who had no history of cervical cancer screening recruited from the general population. All women were tested for HIV. Cervical samples were tested for high-risk HPV DNA (Hybrid Capture 2) with positive samples tested to determine the specific genotype (Line Blot). CIN status was determined based on colposcopy and biopsy. Results: The HPV prevalence was higher among HIV-positive women (52.4%) than among HIV-negative women (20.8%) overall and in all age groups. Younger women, aged 17–19 years, had the highest HPV prevalence regardless of HIV status. HIV-positive women were more likely to have CIN 2 or 3 than HIV-negative women. HPV 16, 35, and 58 were the most common high-risk HPV types with no major differences in the type distribution by HIV status. HPV 18 was more common in older HIV-positive women (40–65 years) with no or low grade disease, but less common in younger women (17–29 years) with CIN 2 or 3 compared to HIV-negative counterparts (p < 0.03). Infections with multiple high-risk HPV types were more common in HIV-positive than HIV-negative women, controlling for age and cervical disease status. Conclusion: HIV-positive women were more likely to have high-risk HPV than HIV-negative women; but, among those with HPV, the distribution of HPV types was similar by HIV status. Screening strategies incorporating HPV genotyping and vaccination should be effective in preventing cervical cancer in both HIV-positive and -negative women living in sub-Saharan Africa

Utilisation and outcomes of cervical cancer prevention services among HIV-infected women in Cape Town

Objective. An audit of outcomes of cervical cancer screening and prevention services for HIV-positive women in Cape Town, South Africa. Design. Retrospective review of clinic registers, patient records and pathology databases at three HIV primary health clinics and a tertiary colposcopy referral centre. Subjects. Women recently diagnosed with HIV at three primary health clinics between 2006 and 2008 (N=2 240); new patients seen for colposcopy at a tertiary referral centre between 2006 and 2009 (N=2 031). Outcome measures. The proportion of women undergoing cervical cancer screening after HIV diagnosis at primary health clinics, demographic characteristics of women referred for colposcopy at a tertiary centre, and outcomes of therapy for precancerous lesions of the cervix. Results. The proportion of women undergoing at least one Pap smear at HIV primary health clinics after HIV diagnosis was low (13.1%). Women referred for colposcopy tended to be HIV-positive and over the age of 30 years, and in most (70.2%) cytological examination revealed high-grade cervical dysplasia. HIV-positive women treated with excision for precancerous lesions of the cervix were significantly more likely than their HIV-negative counterparts to undergo incomplete excision, experience persistent cervical disease after treatment, and be lost to follow-up. Conclusion. Cervical cancer screening efforts must be scaled up for women with HIV. Treatment and surveillance guidelines for cervical intraepithelial neoplasia in HIV-positive women may need to be revised and new interventions developed to reduce incomplete treatment and patient default

Impact of antenatal antiretroviral drug exposure on the growth of children who are HIV-exposed uninfected: The national South African prevention of mother to child evaluation cohort study

Background: The relationship between in-utero antiretroviral (ARV) drug exposure and child growth needs further study as current data provide mixed messages. We compared postnatal growth in the first 18-months of life between children who are HIV-exposed uninfected (CHEU) with fetal exposure to ARV drugs (prophylaxis or triple-drug therapy (ART)) and CHEU not exposed to ARVs. We also examined other independent predictors of postnatal growth

Reduced acquisition and reactivation of human papillomavirus infections among older women treated with cryotherapy: results from a randomized trial in South Africa

<p>Abstract</p> <p>Background</p> <p>Treatment of women for high-grade cervical cancer precursors frequently results in clearance of the associated high-risk human papillomavirus (hrHPV) infection but the role of treatment among women without hrHPV is unknown. We investigated whether cervical cryotherapy reduces newly detected hrHPV infections among HIV-positive and HIV-negative women who were hrHPV negative when treated.</p> <p>Methods</p> <p>The impact of cryotherapy on newly detected hrHPV infections was examined among 612 women of known HIV serostatus, aged 35 to 65 years, who were negative for hrHPV DNA, and randomized to either undergo cryotherapy (n = 309) or not (n = 303). All women underwent repeat hrHPV DNA testing 6, 12, 24, and 36 months later.</p> <p>Results</p> <p>Among 540 HIV-negative women, cryotherapy was associated with a significant reduction in newly detected hrHPV infections. Women in the cryotherapy group were 55% less likely to have newly detected hrHPV than women in the control group (95% CI 0.28 to 0.71). This association was independent of the influence of changes in sexual behaviors following therapy (adjusted hazards ratio (HR) = 0.49, 95% CI 0.29 to 0.81). Among 72 HIV-positive women, similar reductions were not observed (HR = 1.10, 95% CI 0.53 to 2.29).</p> <p>Conclusions</p> <p>Cervical cryotherapy significantly reduced newly detected hrHPV infections among HIV-negative, but not HIV-positive women. These results raise intriguing questions about immunological responses and biological mechanisms underlying the apparent prophylactic benefits of cryotherapy.</p