Perinatal intervention trial in Africa: effect of a birth canal cleansing intervention to prevent HIV transmission

Biggar, Robert J.; Miotti, Paolo; Taha, Taha E.; Mtimavalye, Laban A.R.; Broadhead, Robin L.; Justesen, Aafke; Yellin, Frances; Liomba, George N.; Miley, Wendel; Waters, David J.; Chiphangwi, John D.; Goedert, James J.

doi:10.1016/s0140-6736(96)91486-5

Cited by 204 publications

(86 citation statements)

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“…A study of the impact of chlorhexidine cleansing was undertaken in Malawi at an urban hospital, at a cost of $0.10 for each maternal-infant pair treated (Table 25). 427,428 Cleansing of the maternal vaginal canal and the newborn skin with a 0.25% chlorhexidine solution resulted in significant reductions in serious postpartum maternal infections (P ϭ .02), neonatal admissions (OR: 0.8; CI: 0.79 -0.97), neonatal sepsis (OR: 0.5; CI: 0.32-0.76), overall neonatal mortality (28.6 vs 36.9 per 1000; P Ͻ .05), and neonatal mortality due to infections (OR: 0.5; CI: 0.29 -0.88; 2.4 vs 7.3 per 1000; P Ͻ .005). 428 Among women with rupture of membranes for Ͼ4 hours, the HIV transmission rate was decreased by 40% (OR: 0.6; CI: 0.4 -0.9).…”

Section: )mentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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Section: )mentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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“…However, despitereducing the prevalence of bacterial vaginosis, whi ch is ass oci ate d wit h pre -te rm lab our and chorioamnionitis, randomisationto metronidazole and erythromycin at 20 -24 weeks was not associated with a reduction in MTCT nor in chorioamnionitis in a controlled study in which all mothers also received single dose nevirapine 14 . In the study of chlorhexidine vaginal lavage, transmiss ion was reduced by the intervention if membranes had been ruptured more than 4 hours 15 . Chronic chorioamnionitis, which is characterised by a mononuclear cell infiltration, is as so ci ated with pr e-p ar tu m tr an smi ssio n an d unaffected by such late intervention.…”

Section: Subsequently In Vitromentioning

confidence: 99%

Advances and controversies in the prevention of HIV-1 mother-to-child transmission

Taylor

2013

Sri Lanka J Vener

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HIV-1 infection can be transmitted from mother-tochild in utero and intra-partum. In the absence of antiret roviral therapy, chorioa mnioniti s has been associated with transmission risk, as has duration of rupture of membranes. Chlorhexidine vaginal lavage reduced transmissiononce membraneswere ruptured more than 4 hours however antibiotics given in the 2 nd trimester did not reduce transmission. Mode of delivery significantly impacts on transmission in the absenceof antiretroviral therapyand whenzidovudine is given as a monotherapy. Most risk factors are eliminated by highly active antiretroviral therapy (HAART) and transmission rates well below 1% are achievable. The role of pre-labour caesarean section (PLCS) in women with undetectable HIV viral load on HAART is now uncertain.The current major controversy is whether HAART, and especially protease-inhibitor containing regimens, are associated with a significa nt increase risk of severe pre-term delivery. Although some argue the case for full suppression of viral load in all pregnant women, most guidelines maintain an optio n for zidovudine monotherapy if baseline viral load is low and PLCS is the preferred mode of delivery.

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“…Apesar de opiniões divergentes quanto ao efeito da lavagem do canal de parto na redução efetiva da TV do HIV-1 53 , sabe-se que ela reduz essa complicação em casos de corioamniorrexe com mais de quatro horas de evolução 54 . Para outros autores, a lavagem do canal vaginal com clorexidina 0,4% associa-se com redução da transmissão perinatal desse vírus 55 .…”

Section: Controle Dos Fatores Obstétricosunclassified

Estratégias que reduzem a transmissão vertical do vírus da imunodeficiência humana tipo 1

Duarte

Quintana

Beitune

2005

Rev. Bras. Ginecol. Obstet.

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768Rev Bras Ginecol Obstet. 2005; 27(12): 768-78 RESUMOO conhecimento dos fatores ou situações que influenciam a transmissão vertical (TV) do vírus da imunodeficiência humana tipo 1 (HIV-1) levou à adoção de estratégias com redução de taxas ao longo dos anos: de 40% para menos de 3% na atualidade. Um dos maiores avanços foi o uso profilático da zidovudina (AZT), administrada durante o pré-natal (via oral), no período anteparto (via endovenosa) e ao recém-nascido (via oral). Esta intervenção reduz a TV do HIV-1 em 68%, fazendo com que seja considerada a estratégia isolada de maior efetividade. Na seqüência cronológica dos avanços, observou-se que a carga viral elevada é o principal indicador do risco para esta forma de transmissão. Como o AZT não reduz a carga viral e não consegue controlar a taxa residual observada na TV do HIV-1, a utilização dos esquemas profiláticos utilizando três anti-retrovirais foi objetivamente impulsionada. Completando o ciclo das estratégias obstétricas de maior impacto na redução da TV do HIV-1 está a cesárea eletiva, cuja efetividade está ligada à observação dos critérios de sua indicação: carga viral aferida após a 34ª semana de gravidez apresentando contagem maior que 1000 cópias/mL, gestação com mais de 38 semanas confirmada por ultra-sonografia, membranas corioamnióticas íntegras e fora de trabalho de parto. Nos casos em que a via de parto tem indicação obstétrica, deve ser lembrado que a corioamniorrexe prolongada, manobras invasivas sobre o feto, parto instrumentalizado e a episiotomia são situações que devem ser evitadas. Das intervenções pós-natais consideradas importantes para a redução da TV do HIV-1 são apontadas a recepção pediátrica (deve ser efetivada por profissional treinado evitando microtraumatismos de mucosa nas manobras aspirativas), utilização do AZT neonatal (por período de seis semanas) e a amamentação artificial. Especial atenção deve ser dispensada às orientações para as nutrizes para evitar a infecção aguda pelo HIV-1 neste período, o que aumenta sobremaneira as taxas de TV desse vírus. PALAVRAS-CHAVE: Transmissão vertical de doença; HIV-1; Intervenções; Agentes anti-HIV; Cuidado pré-natal; Cesárea ABSTRACTKnowledge about the factors or situations that influence the vertical transmission (VT) of human immunodeficiency type 1 (HIV-1) has led to the implementation of strategies which have promoted a rate decline along the years, from 40% to less than 3% nowadays. One of the major advances in the area has been the prophylactic administration of zidovudine (AZT), in the prenatal phase (oral route), in the predelivery phase (intravenous route) and to the newborn (oral route). This intervention may reduce HIV-1 VT 68%, thus being the most effective isolated strategy used so far. In the chronological sequence of advances, it has been observed that a high viral load is the main risk indicator for this type of transmission. As AZT does not reduce the viral load and does not control the residual rate observed in HIV-1 VT, the use of prophylactic schemes using three an...

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Perinatal intervention trial in Africa: effect of a birth canal cleansing intervention to prevent HIV transmission

Cited by 204 publications

References 22 publications

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

Advances and controversies in the prevention of HIV-1 mother-to-child transmission

Estratégias que reduzem a transmissão vertical do vírus da imunodeficiência humana tipo 1

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