Prevention of mother-to-child HIV transmission

Mofenson, Lynne

doi:10.1097/coh.0b013e328363d280

Cited by 9 publications

(2 citation statements)

References 23 publications

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“…To maximize the benefit to mothers and children, pMTCT is delivered in a timed sequence, or “cascade” that includes: attendance at antenatal care (ANC), HIV counselling and testing, provision of combined antiretroviral therapy (cART) – previously prophylactic antiretrovirals (ARVs) – safe delivery, administration of prophylactic ARVs for the exposed newborn through the breastfeeding period, safe infant feeding, infant follow-up including HIV testing, family planning and linkages to long-term HIV care and treatment [ 5 , 6 ]. Comprised of a sequence of linked events, the pMTCT cascade provides a useful framework for organizing pMTCT services and quantifying attrition along the pathway from identifying HIV-positive women, preventing HIV transmission to children and ensuring long-term access to HIV care and treatment [ 7 ]. Improving pMTCT effectiveness requires increasing the number of women and their children who successfully pass through the multiple, sequential steps in the pMTCT cascade; therefore identifying replicable approaches to optimize the cascade is a critical priority [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

What does high and low have to do with it? Performance classification to identify health system factors associated with effective prevention of mother‐to‐child transmission of HIV delivery in Mozambique

Gimbel

Voss

Rustagi

et al. 2014

Journal of the International AIDS Society

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IntroductionEfforts to implement and take to scale highly efficacious, low-cost interventions to prevent mother-to-child HIV transmission (pMTCT) have been a cornerstone of reproductive health services in sub-Saharan Africa for over a decade. Yet efforts to increase access and utilization of these services remain far from optimal. This study developed and applied an approach to systematically classify pMTCT performance to identify modifiable health system factors associated with pMTCT performance which may be replicated in other pMTCT systems.MethodsFacility-level performance measures were collected at 30 sites over a 12-month period and reviewed for consistency. Five combinations of three indicators (1. HIV testing; 2. CD4 testing; 3. antiretroviral prophylaxis and combined antiretroviral therapy initiation) were compared including a composite of all three, a combination of 1. and 3., and each individually. Approaches were visually assessed to describe facility performance, focusing on rank order consistency across high, medium and low categories. Modifiable and non-modifiable factors were ascertained at each site and ranking process was reviewed to estimate association with facility performance through unadjusted Chi-square tests and logistic regression. After describing factors associated with high versus low performing pMTCT clinics, the effect of inclusion of the 10 middle performers was assessed.ResultsThe indicator most consistently associated with the reference composite indicator (HIV testing, antiretroviral prophylaxis and combined antiretroviral therapy) was the single measure of antiretroviral prophylaxis and combined antiretroviral therapy. Lower performing pMTCT clinics ranked consistently low across measurement strategies; high and middle performing clinics demonstrated more variability. Association between clinic characteristics and high pMTCT performance varied markedly across ranking strategies. Using the reference composite indicator, larger catchment area, higher number of institutional deliveries, onsite CD4 point-of-care capacity, and higher numbers of nurses and doctors were associated with high clinic performance while clinic location, NGO support, women's support group, community linkages patient-tracking systems and stock-outs were not associated with high performance.ConclusionsClassifying high and low performance provided consistent results across ranking measures, though granularity was improved by aggregating middle performers with either high or low performers. Human resources, catchment size and utilization were positively associated with effective pMTCT service delivery.

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Section: Introductionmentioning

confidence: 99%

What does high and low have to do with it? Performance classification to identify health system factors associated with effective prevention of mother‐to‐child transmission of HIV delivery in Mozambique

Gimbel

Voss

Rustagi

et al. 2014

Journal of the International AIDS Society

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“…Although ART reduces the risk of MTCT of HIV in utero and peri-partum, adequate access and adherence to ART throughout the period of breastfeeding [10,11], mixed feeding/breastfeeding practices, and undiagnosed acute HIV infection of breast-feeding mothers, limit its effectiveness [12,13,14]; accordingly, in resource-poor areas, HIV MTCT rates remain high [15]. Another success of ART has been the increased rate of survival of HIV-infected children [16,17,18]. The survival of these HIV-infected infants into adolescence and adulthood poses a unique set challenges [17,19,20], as these HIV-1 positive children present with a high prevalence of cognitive and neurodevelopmental deficits [21,22,23].…”

Section: Introductionmentioning

confidence: 99%

Hippocampal Neuronal Loss in Infant Macaques Orally Infected with Virulent Simian Immunodeficiency Virus (SIV)

et al. 2017

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The neurological impact of Human Immunodeficiency Virus (HIV) on children includes loss of brain growth, motor abnormalities and cognitive dysfunction. Despite early antiretroviral treatment (ART) intervention to suppress viral load, neurological consequences of perinatal HIV-1 infection persist. Utilizing the pediatric simian immunodeficiency virus (SIV) infection model, we tested the hypothesis that early-life SIV infection depletes neuronal population in the hippocampus. A total of 22 ART-naïve infant rhesus macaques (Macaca mulatta) from previous studies were retrospectively analyzed. Infant macaques were either intravenously (IV) inoculated with highly virulent SIVmac251 at ~1 week of age and monitored for 6–10 weeks, or orally challenged with SIVmac251 from week 9 of age onwards with a monitoring period of 10–23 weeks post-infection (19–34 weeks of age), and SIV-uninfected controls were euthanized at 16–17 weeks of age. We have previously reported that the IV SIVmac251-infected neonatal macaques (Group 1) displayed a 42% neuronal reduction throughout the hippocampal cornu ammonis (CA) fields. The orally-infected infant macaques displayed a 75% neuronal reduction in the CA1 region compared to controls and 54% fewer neurons than IV SIV infants. The CA2 region showed a similar pattern, with a 67% reduction between orally-infected SIV subjects and controls and a 40% difference between IV-and orally-infected SIV groups. In the CA3 region, there were no significant differences between these groups, however both SIV-infected groups had significantly fewer pyramidal neurons than control subjects. There was no correlation between plasma viral load and neuronal populations in any of the CA fields. The loss of hippocampal neurons may contribute to the rapid neurocognitive decline associated with pediatric HIV infection. While each subfield showed vulnerability to SIV infection, the CA1 and CA2 subregions demonstrated a potentially enhanced vulnerability to pediatric SIV infection. These data underscore the need for early diagnosis and treatment, including therapeutics targeting the central nervous system (CNS).

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MTCT HIV-1 Transmission Update: Transmission Routes and Mechanisms

Semrau¹,

Aldrovandi²

2014

Encyclopedia of AIDS

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Prevention of mother-to-child HIV transmission

Cited by 9 publications

References 23 publications

What does high and low have to do with it? Performance classification to identify health system factors associated with effective prevention of mother‐to‐child transmission of HIV delivery in Mozambique

What does high and low have to do with it? Performance classification to identify health system factors associated with effective prevention of mother‐to‐child transmission of HIV delivery in Mozambique

Hippocampal Neuronal Loss in Infant Macaques Orally Infected with Virulent Simian Immunodeficiency Virus (SIV)

MTCT HIV-1 Transmission Update: Transmission Routes and Mechanisms

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