Background In women, single-dose nevirapine for prophylaxis against mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) selects for nevirapine-resistant HIV-1, which subsequently decays rapidly. We hypothesized that the selection, acquisition, and decay of nevirapine-resistant HIV-1 differs in infants, varying by the timing of HIV-1 infection. Methods We conducted a prospective, observational study of 740 Mozambican infants receiving single-dose nevirapine prophylaxis and determined the timing of infection and concentrations of nevirapine-resistant HIV-1 over time. Results Infants with established in utero infection had a high rate (87.0%) of selection of nevirapine-resistant HIV-1 mutants, which rapidly decayed to undetectable levels. The few without nevirapine resistance received zidovudine with single-dose nevirapine and/or their mothers took alternative antiretroviral drugs. Infants with acute in utero infection had a lower rate of nevirapine-resistant HIV-1 (33.3%; P =.006, compared with established in utero infection), but mutants persisted over time. Infants with peripartum infection also had a lower rate of nevirapine-resistant HIV-1 (38.1%; P =.001, compared with established in utero infection) but often acquired 100% mutant virus that persisted over time (P =.017, compared with established in utero infection). Conclusions The detection and persistence of nevirapine-resistant HIV-1 in infants after single-dose nevirapine therapy vary by the timing of infection and the antiretroviral regimen. In infants with persistent high-level nevirapine-resistant HIV-1, nevirapine-based antiretroviral therapy is unlikely to ever be efficacious because of concentrations in long-lived viral reservoirs. However, the absence or decay of nevirapine-resistant HIV-1 in many infants suggests that nevirapine antiretroviral therapy may be effective if testing can identify these individuals.

Loss to follow-up contributes to the low coverage of HIV care interventions among HIV-exposed infants in Beira, Mozambique. This qualitative study explores the perceptions of HIV-infected women and their health care providers regarding the main obstacles preventing women from attending follow-up visits for HIV care, and factors influencing women's decisions about newborn care. Fifty-two in-depth interviews and two focus group discussions were conducted; transcripts were coded and analyzed using ATLAS.ti. Interviewees perceived three major barriers to follow-up: food insecurity, difficulties navigating the health system, and women's familial roles and responsibilities. Our findings unveil the complex context in which HIV-infected women and their children live, and suggest that the structure and function of the HIV care system should be reviewed. Economic empowerment of women is crucial to achieving better compliance with medical care. Integration of mother and child services and more efficient and culturally sensitive medical services may improve follow-up. KeywordsHIV/AIDS, loss to follow-up, adherence, HIV care, access barriers 2 SAGE Open Maman, 2007;Manzi et al., 2005;Painter et al., 2005). Finally, structural factors, including the physical, social, cultural, organizational, community, economic, or policy aspects of the environment, can act as barriers or facilitators to individually oriented HIV prevention and care services (Blankenship, Bray, & Merson, 2000;Farmer, 2004;Farmer, Leandre, et al., 2001;Gupta, Parkhurst, Ogden, Aggleton, & Mahal, 2008;Jones et al., 2005;Parker, Easton, & Klein, 2000;Sumartojo, Doll, Holtgrave, Gayle, & Merson, 2000).However, few data have been systematically collected in Mozambique on the conditions that affect the lives of HIVpositive women and their children on a daily basis, and how these conditions affect their acceptance and utilization of HIV care services. We therefore conducted a qualitative study to determine the factors affecting women's decision to seek HIV care and adhere to follow-up visits for themselves and their newborn babies. MethodWe conducted a cross-sectional qualitative study of a subset of women participating in an observational cohort study of nevirapine (NVP) resistance following prophylaxis with singledose nevirapine, which started in June 2005 and ended in December 2008 (Micek et al., 2010). Briefly, the study enrolled mothers and newborn infants participating in PMTCT programs at three clinics in Beira, Mozambique. Infants were supposed to make five study visits through 8 weeks of age, at which time questionnaires were administered and blood samples taken for analysis of HIV infection and NVP resistance (Blankenship et al., 2000). Similar to the PMTCT program from which participants were recruited, study-related followup of infants was poor, with 57% (499/875) of enrolled infants missing >2 successive scheduled study visits. We investigated the reasons for LTFU in this already assembled cohort of mothers and infants, to provide insights into...

Objective Programmes to control syphilis in developing countries are hampered by a lack of laboratory services, delayed diagnosis, and doubts about current screening methods. We aimed to compare the diagnostic accuracy of an immunochromatographic strip (ICS) test and the rapid plasma reagin (RPR) test with the combined gold standard (RPR, Treponema pallidum haemagglutination assay and direct immunofluorescence stain done at a reference laboratory) for the detection of syphilis in pregnancy. Methods We included test results from 4789 women attending their first antenatal visit at one of six health facilities in Sofala Province, central Mozambique. We compared diagnostic accuracy (sensitivity, specificity, and positive and negative predictive values) of ICS and RPR done at the health facilities and ICS performed at the reference laboratory. We also made subgroup comparisons by human immunodeficiency virus (HIV) and malaria status. Findings For active syphilis, the sensitivity of the ICS was 95.3% at the reference laboratory, and 84.1% at the health facility. The sensitivity of the RPR at the health facility was 70.7%. Specificity and positive and negative predictive values showed a similar pattern. The ICS outperformed RPR in all comparisons (P<0.001). Conclusion The diagnostic accuracy of the ICS compared favourably with that of the gold standard. The use of the ICS in Mozambique and similar settings may improve the diagnosis of syphilis in health facilities, both with and without laboratories.Keywords Syphilis serodiagnosis; Prenatal diagnosis; Mozambique (source: MeSH, NLM). Mots clés Séro-diagnostic syphilis; Diagnostic prénatal; Mozambique (source: MeSH, INSERM). Palabras clave Serodiagnóstico de la sífilis; Diagnóstico prenatal; Mozambique (fuente: DeCS, BIREME). Voir page 103 le résumé en français. En la página 103 figura un resumen en español.

Single-dose nevirapine (sdNVP) given to prevent mother-to-child-transmission of HIV-1 selects NVP-resistance. Short-course zidovudine (ZDV) was hypothesized to lower rates of NVP-resistance. HIV-1 infected pregnant women administered sdNVP with or without short-course ZDV were assessed for HIV-1 mutations (K103N, Y181C, G190A, and V106M) prior to delivery and postpartum. Postpartum NVP-resistance was lower among 31 taking ZDV+sdNVP compared to 33 taking only sdNVP (35.5% vs. 72.7%; χ2 P = .003). NVP mutants decayed to <2% in 24/35 (68.6%) at a median 6 months postpartum, with no differences based on ZDV use (logrank P = .99). Short-course ZDV was associated with reduced NVP-resistance mutations among women taking sdNVP.