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Background:Prevention of mother-to-child transmission of HIV implementation faces significant challenges globally, particularly in the context of universal lifelong antiretroviral therapy (ART) for all HIV-infected pregnant women.Methods:We describe the rationale and methods of the Maternal and Child Health-Antiretroviral Therapy (MCH-ART) study, an implementation science project examining strategies for providing HIV care and treatment to HIV-infected women who initiate ART during pregnancy and their HIV-exposed infants.Results:MCH-ART is composed of 3 interrelated study designs across the antenatal and postnatal periods. Phase 1 is a cross-sectional evaluation of consecutive HIV-infected pregnant women seeking antenatal care; phase 2 is an observational cohort of all women from phase 1 who are eligible for initiation of ART following local guidelines; and phase 3 is a randomized trial of strategies for delivering ART to breastfeeding women from phase 2 during the postpartum period. During each phase, a set of study measurement visits is carried out separately from antenatal care and ART services; a maximum of 9 visits takes place from the beginning of antenatal care through 12 months postpartum. In parallel, in-depth interviews are used to examine issues of ART adherence and retention qualitatively, and costs and cost-effectiveness of models of care are examined. Separate substudies examine health outcomes in HIV-uninfected women and their HIV-unexposed infants, and the role of the adherence club model for long-term adherence and retention.Discussion:Combining observational and experimental components, the MCH-ART study presents a novel approach to understand and optimize ART delivery for MCH.

Purpose Despite clear need and disproportionate risk, adolescents, and young people living with HIV (AYPLHIV) are underserved within the HIV response. “Peer support” increasingly forms part of adolescent and youth-responsive service packages as a class of implementation strategies that can support adolescents to access, engage, and sustain treatment. This paper examines examples of peer support for AYPLHIV within sub-saharan Africa to explore the determinants of successful implementation, outcomes and scale-up, as well as policy and programmatic implications. Recent Findings Although adolescent peer support has been observed to be widely implemented, there are few examples of detailed program descriptions describing operational logistics or outcomes around peer support interventions. Nevertheless the few examples available provide preliminary support for the potential utility of peer support to improve AYPLHIV outcomes. Summary Implementation science research is an urgent imperative to examine applicability of peer support for this priority population. In the meantime, programs should move forward with implementation based on promising outcomes, programmatic experience, contextual understanding of challenges and gaps, and best practice examples.

Objective Tenofovir (TDF) affects bone health and is widely used in pregnancy but data are limited on the effects of TDF exposure in utero. We examined the association between duration of in utero TDF exposure and linear growth in HIV-exposed, uninfected (HEU) infants. Design A prospective cohort of pregnant women initiating TDF-containing regimens at primary care services in Cape Town, South Africa were enrolled and followed with their breastfeeding infants through 12 months postpartum. Methods Length-for-age z-scores (LAZ) were calculated from infant lengths reported at birth and measured at 6, 12, 24, 36 and 48 weeks, using Fenton and World Health Organization standards. Linear mixed effects models were used to examine the association between duration of TDF exposure and LAZ over time. Results In 464 singleton mother-infant pairs (median CD4 at ART initiation, 346 cells/μL; viral load (VL), 4.0 log10 copies/ml), the median duration of in utero TDF exposure was 16.7 weeks (interquartile range, IQR 11.0-22.0) with 31%, 44% and 25% of infants exposed to <12, 12-22 and >22 weeks of TDF respectively. Overall, 12% of children were stunted (LAZ<-2) at 48 weeks. Duration of exposure was not associated with LAZ: adjusted mean difference for >22 vs <12 wks, -0.12 (95% CI: -0.47; 0.23); 12-22 vs <12 wks, -0.06 (95% CI: -0.35; 0.24). Mean LAZ was 0.15 lower per log increase in maternal VL at ART initiation (95% CI: -0.29; -0.0001). Conclusions These data suggest no association between duration of TDF exposure in utero and early linear growth.