Mother-to-child transmission of HIV and its prevention: awareness and knowledge in Uganda and Tanzania

Awareness and knowledge about HIV mother-to-child transmission (MTCT) and preventive measures in different population groups and health personnel were analysed in future intervention areas in western Uganda and south-western Tanzania. In Uganda, a total of 751 persons (440 clients of antenatal and outpatient clinics, 43 health workers, 239 villagers, 29 traditional birth attendants) and in Tanzania, 574 persons (410 clients, 49 health workers, 93 villagers, 18 traditional birth attendants) were interviewed. When given options, knowledge on transmission during pregnancy and delivery in women was 93% and 67% in Uganda and Tanzania respectively, and 86% and 78% for transmission during breastfeeding. In Uganda 59% of male interviewees did not believe that HIV is transmitted during breastfeeding. Expressed acceptance of HIV testing was above 90% in men and women in both countries, but only 10% of the clients in Uganda and 14% in Tanzania had been tested for HIV infection. Health workers' knowledge regarding MTCT was acceptable, while traditional birth attendants' knowledge on both MTCT and preventive measures was extremely poor. Recommendations on infant feeding were not compatible with WHO recommendations for HIV-infected women. If prevention of MTCT (PMTCT) interventions are to be accepted by the population and promoted by health personnel, thorough orientation and training are mandatory.     

Risk factors for perinatal transmission of HIV among women attending prevention of mother-to-child transmission clinics in Northwest Nigeria

Despite the effectiveness of antiretroviral therapy (ART) in the prevention of mother-to-child transmission of HIV (PMTCT), some HIV-infected women in PMTCT care are at risk of transmitting HIV to their babies. Using a 1:1 unmatched case–control study design, we assessed the risk factors for perinatal transmission among women who received ART for PMTCT in Sokoto State, Nigeria. Data were abstracted from medical records of cases (94 HIV-infected babies) and controls (94 HIV-uninfected babies) and their mothers who accessed PMTCT services in three purposefully selected secondary health facilities. We conducted univariate and multivariate logistic regressions to determine if sociodemographic characteristics, time of enrolment, type of maternal ART, receipt of infant antiretroviral (ARV) prophylaxis, place of delivery, or feeding practice were associated with HIV infection among HIV-exposed babies. Sixteen percent of the mothers of babies in the case group had early enrolment while 90% of those in the control group enrolled early. Infant prophylaxis was received in 54% of cases and 95% of controls. In both groups, 99% of the mothers practiced mixed feeding. In the univariate analysis, factors that were significantly associated with HIV infection were religion (islam), rural residence, late? enrolment, and non-receipt of infant ARV prophylaxis. In the multivariate analysis, rural residence (Adjusted odds ratio (aOR)?=?8.01, 95% CI?=?1.79–35.78), late enrolment (aOR?=?41.72, 95% CI?=?15.16–114.79), and non-receipt of infant ARV prophylaxis (aOR?=?4.1, 95% CI?=?1.18–14.33) remained statistically significant. Findings from this study indicate that eliminating MTCT in Nigeria requires interventions that will enhance timely access of ART by mother-baby dyads.     

Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania

Prevention of mother-to-child transmission of HIV (PMTCT) is a foundational component of a comprehensive HIV treatment program. In addition to preventing vertical transmission to children, PMTCT is an important catch-point for universal test-and-treat strategies that can reduce community viral load and slow the epidemic. However, systematic reviews suggest that care engagement in PMTCT programs is sub-optimal. This study enrolled a cohort of 200 women initiating PMTCT in Kilimanjaro, Tanzania, and followed them to assess HIV care engagement and associated factors. Six months after delivery, 42/200 (21%) of participants were identified as having poor care engagement, defined as HIV RNA >200?copies/mL or, if viral load was unavailable, being lost-to-follow-up in the clinical records or self-reporting being out of care. In a multivariable risk factor analysis, younger women were more likely to have poor postpartum care engagement; with each year of age, women were 7% less likely to have poor care engagement (aRR: 0.93; 95% CI: 0.89, 0.98). Additionally, women who had told at least one person about their HIV status were 47% less likely to have poor care engagement (aRR: .53; 95% CI: 0.29, 0.97). Among women who entered antenatal care with an established HIV diagnosis, those who were pregnant for the first time had increased risk of poor care engagement (aRR 4.16; 95% CI 1.53, 11.28). The findings suggest that care engagement remains a concern in PMTCT programs, and must be addressed to realize the goals of PMTCT. Comprehensive counseling on HIV disclosure, along with community-based stigma reduction programs to provide a supportive environment for people living with HIV, are crucial to address barriers to care engagement and support long-term treatment. Women presenting to antenatal care with an established HIV status require support for care engagement during the crucial period surrounding childbirth, particularly those pregnant for the first time.     

Desire for Children and Pregnancy Risk Behavior among HIV-Infected Men and Women in Uganda

To identify ways to improve prevention of mother-to-child transmission (PMTCT) of HIV, we conducted a cross-sectional study of 1,092 HIV-infected men and women attending an AIDS support organization in Jinja, Uganda, between October 2003 and June 2004. Pregnancy risk behavior was defined as having sex without contraceptive or condom. Overall, 42% of participants were sexually active, 33% practiced pregnancy risk behavior, and 18% desired more children. Men were almost four times to want more children than the women (27% vs. 7%). Among those practicing pregnancy risk behavior, 73% did not want more children and were at high risk for unwanted pregnancies. Although 81% knew that mother-to-child transmission of HIV could be prevented, only 22% believed that an HIV-infected woman who received PMTCT therapy could still deliver an HIV-infected child. Lack of MTCT information, having attended the program for ≤2 years and desire for children were independently associated with pregnancy risk behavior. PMTCT and other HIV prevention and care programs should ensure provision of family planning for HIV-infected populations who do not want to become pregnant.     

Health care costs associated with clinic visits for prevention of mother-to-child transmission of HIV in Dar es Salaam,Tanzania

Early and appropriate antenatal care (ANC) is key for the effectiveness of prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). We evaluated the importance of ANC visits and related service costs for women receiving option B⁺ to prevent mother-to-child transmission (MTCT) of HIV in Tanzania.A cost analysis from a health care sector perspective was conducted using routine data of 2224 pregnant women newly diagnosed with HIV who gave birth between August 2014 and May 2016 in Dar es Salaam, Tanzania. We evaluated risk of infant HIV infection at 12 weeks postnatally in relation to ANC visits (<4 vs ≥4 visits). Costs for service utilisation were estimated through empirical observations and the World Health Organisation Global Price Reporting Mechanism.Mean gestational age at first ANC visit was 22 (±7) weeks. The average number of ANC/prevention of MTCT visits among the 2224 pregnant women in our sample was 3.6 (95% confidence interval [CI] 3.6–3.7), and 57.3% made ≥4 visits. At 12 weeks postnatally, 2.7% (95% CI 2.2–3.6) of HIV exposed infants had been infected. The risk of MTCT decreased with the number of ANC visits: 4.8% (95% CI 3.6–6.4) if the mother had <4 visits, and 1.0% (95% CI 0.5–1.7) at ≥4. The adjusted MTCT rates decreased by 51% (odds ratio 0.49, 95% CI 0.31–0.77) for each additional ANC visit made. The potential cost-saving was 2.2 US$ per woman at ≥4 visits (84.8 US$) compared to <4 visits (87.0 US$), mainly due to less defaulter tracing.Most pregnant women living with HIV in Dar es Salaam initiated ANC late and >40% failed to adhere to the recommended minimum of 4 visits. Improved ANC attendance would likely lead to fewer HIV-infected infants and reduce both short and long-term health care costs due to less spending on defaulter tracing and future treatment costs for the children.     

艾滋病高发地区预防HIV母婴传播项目实施效果分析

目的了解艾滋病高流行的4省（自治区）的6个县（市、区）,预防艾滋病病毒（HIV）母婴传播项目的实施效果。方法通过全国预防艾滋病母婴传播信息管理系统,收集2007年1月至2010年9月研究地区艾滋病病毒（HIV）感染孕产妇个案卡及其所生儿童的随访登记卡,分析预防HIV母婴传播干预措施落实情况及效果。结果2007-2010年,研究地区HIV感染孕产妇抗病毒药物应用比例和孕期抗病毒药物应用比例,分别从78.4%和27.8%增加至93.7%和78.8%（趋势χ2=17.636,P〈0.01;趋势χ2=76.835,P〈0.01）;HIV感染孕产妇应用三联抗病毒药物方案的比例自19.8%增加至89.9%（趋势χ2=161.757,P〈0.01）。满18月龄艾滋病感染孕产妇所生儿童接受HIV抗体检测比例为84.8%（318/375）,13例儿童抗体检测阳性,艾滋病母婴传播水平为4.1%（95%可信区间：2.98%-5.20%）。结论研究地区预防HIV母婴传播干预措施落实指标逐年提高,HIV母婴传播水平显著下降,孕产妇及早抗病毒用药以及儿童随访检测仍为工作中的薄弱环节。     

Knowledge and perception of HIV/AIDS among pregnant women attending antenatal clinics in Ogun State,Nigeria

Mother-to-child transmission of HIV (MTCT) is responsible for more than 90% of the cases of HIV infection in infants and children in sub-Saharan Africa. Accurate data on the knowledge and perceptions of HIV/AIDS among women attending antenatal clinics in Nigeria are scarce. A cross-sectional survey of 804 women attending antenatal clinics in Ogun State, South-West Nigeria was done using interviewer-administered questionnaires. Approximately 90% of the women respondents had heard of HIV/AIDS, but only about 27% knew HIV could be transmitted from mother to child; of those, almost 94% believed in the reality of HIV disease; in contrast, the majority (64%) believed they were not at risk of HIV infection, and a slightly greater proportion (70%) did not understand the benefits of voluntary HIV counselling and testing (VCT). Nonetheless, almost 90% of respondents were willing to know their status following health education about VCT. Those that were older, attending public hospitals, and with a higher level of education had more knowledge and better perceptions about HIV. The results suggest an urgent need for public health education on HIV/AIDS and the benefits of VCT to control MTCT, particularly targeting young women and those with little or no education.     

Reduced mother-to-child transmission of HIV associated with infant but not maternal GB virus C infection

BACKGROUND: Prolonged coinfection with GB virus C (GBV-C) has been associated with improved survival in human immunodeficiency virus (HIV)-infected adults. We investigated whether maternal or infant GBV-C infection was associated with mother-to-child transmission (MTCT) of HIV-1 infection. METHODS: The study population included 1364 HIV-infected pregnant women enrolled in 3 studies of MTCT of HIV in Bangkok, Thailand (the studies were conducted from 1992-1994, 1996-1997, and 1999-2004, respectively). We tested plasma collected from pregnant women at delivery for GBV-C RNA, GBV-C antibody, and GBV-C viral genotype. If GBV-C RNA was detected in the maternal samples, the 4- or 6-month infant sample was tested for GBV-C RNA. The rates of MTCT of HIV among GBV-C-infected women and infants were compared with the rates among women and infants without GBV-C infection. RESULTS: The prevalence of GBV-C RNA in maternal samples was 19%. Of 245 women who were GBV-C RNA positive, 101 (41%) transmitted GBV-C to their infants. Of 101 infants who were GBV-C RNA positive, 2 (2%) were infected with HIV, compared with 162 (13%) of 1232 infants who were GBV-C RNA negative (odds ratio [OR] adjusted for study, 0.13 [95% confidence interval {CI}, 0.03-0.54]). This association remained after adjustment for maternal HIV viral load, receipt of antiretroviral prophylaxis, CD4(+) count, and other covariates. MTCT of HIV was not associated with the presence of GBV-C RNA (adjusted OR [aOR], 0.94 [95% CI, 0.62-1.42]) or GBV-C antibody (aOR, 0.90 [95% CI, 0.54-1.50]) in maternal samples. CONCLUSIONS: Reduced MTCT of HIV was significantly associated with infant acquisition of GBV-C but not with maternal GBV-C infection. The mechanism for this association remains unknown.     

Factors Associated with Low Early Uptake of a National Program to Prevent Mother to Child Transmission of HIV (PMTCT): Results of a Survey of Mothers and Providers, Botswana, 2003

In Francistown, Botswana, approximately 40% of pregnant women are HIV positive. PMTCT has been available since 1999, antiretroviral (ARV) therapy since 2001, and 95% of women have antenatal care (ANC) and deliver in hospital. However, in 2002, only 33% of ANC clients were tested for HIV, and not all women with HIV received services. In 2003, we conducted a survey of 504 pregnant and postpartum women to explore reasons for poor program uptake, and interviewed 82 health providers about PMTCT. Most women (95%) believed that all pregnant women should be tested for HIV. In multivariate analysis, factors associated with having an HIV test included being interviewed at an urban site, having a high PMTCT knowledge score, knowing someone receiving PMTCT or ARV therapy, and having a partner who had been tested for HIV. Neither fear of stigma nor resistance from partners were frequent reasons for refusing an HIV test. Providers of HIV services reported discomfort with their knowledge and skills, and 84% believed HIV testing should be routine. Ensuring adequate knowledge about HIV and PMTCT, creating systems whereby HIV-positive women receiving care can educate and support other women, and making HIV testing routine for pregnant women may improve the uptake of HIV testing.     

Factors Associated with Maternal-Child Transmission of HIV-1 in Southeastern Brazil: A Retrospective Study

Mother-to-child transmission (MTCT) is the main mode of HIV-1 acquisition among young children worldwide. The goals of this study were to estimate the proportion of HIV MTCT and to identify factors associated with transmission. We reviewed data for HIV-infected pregnant women that had been reported to the National Information on Reportable Diseases System (SINAN) in Espírito Santo state, Brazil, between January 2007 and December 2012. HIV cases in children were followed until age 18 months. The proportion of women who transmitted HIV to their babies was 14% (95% CI 11–17%). In a multivariate logistic regression model, pregnant women who had lower than primary school education (OR 2.74; 95% CI 1.31–5.71), had 2 or more pregnancies during the study period (OR 2.28; 95% CI 1.07–4.84), had emergency cesarean delivery (OR 4.32; 95% CI 1.57–11.9), and did not receive antiretroviral therapy during prenatal care (OR 2.41; 95% CI 1.09–5.31) had higher odds of HIV MTCT. Effort should be made to encourage health care workers and pregnant women to use services for the prevention of MTCT.     

Reducing the risk of HIV infection during pregnancy among South African women: A randomized controlled trial

Mpumalanga Province, South Africa has one of the highest HIV/AIDS diagnosis rates among pregnant women (~29.4%). This study sought to enhance male involvement in pregnancy to increase HIV disclosure, sexual communication, HIV knowledge and reduce unprotected sex. Participants attending Antenatal Clinics (ANC) completed HIV counseling and testing and were enrolled with male partners (n=239 couples, 478 individuals). Twelve ANCs were randomly assigned to provide a prevention of mother-to-child transmission (PMTCT) intervention or the standard of care, health education sessions plus PMTCT. Participants were assessed at baseline and post-intervention (approximately 6–8 weeks post-baseline) on demographics, sexual behavior, HIV-related knowledge, and conflict resolution strategies. Experimental participants increased HIV knowledge, use of negotiation, and decreased intimate partner violence. Additionally, they were more likely to have increased condom use from baseline to post-intervention (OR=5.1, 95% CI=[2.0, 13.3]). Seroconversions in the control condition exceeded experimental (6 vs. 0). HIV serostatus disclosure to partner did not increase over time for men or women within the experimental or control condition. Male involvement in pregnancy may be an important strategy to reduce sexual risk behavior and HIV transmission. Results support the utility of group interventions to enhance communication and HIV knowledge among pregnant couples.     

Prevention of mother-to-child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000-10

Aims To compare clinical status, mother‐to‐child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV‐infected injecting drug users (IDUs) and non‐IDUs. Design and setting Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000–10. Participants Pregnant HIV‐infected women, identified before/during pregnancy or intrapartum, and their live‐born infants (n = 6200); 1028 women followed post‐partum. Measurements Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW). Findings Of 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P < 0.01). Among women with undiagnosed HIV at conception, 20% of IDUs were diagnosed intrapartum versus 4% of non‐IDUs (P < 0.01). At enrolment, 14% of IDUs had severe/advanced HIV symptoms versus 6% of non‐IDUs (P < 0.001). IDUs had higher rates of PTD and LBW infants than non‐IDUs, respectively, 16% versus 7% and 22% versus 10% (P < 0.001). IDUs were more likely to receive no neonatal or intrapartum PMTCT prophylaxis compared with non‐IDUs (OR 2.81, p < 0.001). MTCT rates were 10.8% in IDUs versus 5.9% in non‐IDUs; IDUs had increased MTCT risk (adjusted odds ratio 1.32, P = 0.049). Fewer IDUs with treatment indications received HAART compared with non‐IDUs (58% versus 68%, P = 0.03). Conclusions Pregnant human immunodeficiency virus‐infected injecting drug users in Ukraine have worse clinical status, poorer access to prevention of mother‐to‐child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother‐to‐child transmission than non‐injecting drug user women.     

Placental malaria and mother-to-child transmission of human immunodeficiency virus-1 in rural Rwanda

We conducted a nested case-control study of placental malaria (PM) and mother-to-child transmission (MTCT) of human immunodeficiency virus-1 (HIV-1) within a prospective cohort of 627 mother-infant pairs followed from October 1989 until April 1994 in rural Rwanda. Sixty stored placentas were examined for PM and other placental pathology, comparing 20 HIV-infected mother-infant (perinatal transmitter) pairs, 20 HIV-uninfected pairs, and 20 HIV-infected mothers who did not transmit to their infant perinatally. Of 60 placentas examined, 45% showed evidence of PM. Placental malaria was associated with increased risk of MTCT of HIV-1 (adjusted odds ratio [aOR] = 6.3; 95% confidence interval [CI] = 1.4-29.1), especially among primigravidae (aOR = 12.0; 95% CI = 1.0-150; P < 0.05). Before antiretroviral therapy or prophylaxis, PM was associated with early infant HIV infection among rural Rwandan women living in a hyper-endemic malaria region. Primigravidae, among whom malaria tends to be most severe, may be at higher risk.     

HIV-related knowledge, attitudes, perceived benefits, and risks of HIV testing among pregnant women in rural Southern India

The rising prevalence of HIV among pregnant women in rural India is of great concern. Prenatal voluntary counseling and HIV testing (VCT) is critical to prevent mother-to-child transmission of HIV (PMTCT). We surveyed 202 pregnant women attending a rural antenatal clinic in Southern India to investigate HIV-related knowledge, attitudes toward infant feeding practices, and perceived benefits and risks of HIV testing. Of the total of 202 women surveyed, 189 women (94%) had heard of HIV/AIDS and 60% of them had relatively good knowledge regarding risk factors for HIV transmission. However, 48% did not know that there are "means to prevent mother-to-child HIV transmission." If women were not to breastfeed her baby, negative attitudes expected from the partner would include 84% thinking that that the mother is harming the baby, 78% thinking she is not a good mother, 74% thinking she has HIV, and 66% thinking she has been unfaithful. Ninety-seven percent of women did not perceive themselves at risk for HIV and only 57% had been tested for HIV. Although, 85% of women expressed their willingness to be tested, most were concerned about confidentiality and disclosing HIV serostatus because of fear of negative reactions from their husbands, parents, and community. Many social and cultural barriers confront pregnant women when they decide to opt for HIV testing. If VCT and PMTCT interventions are to be successful, urgent attention must be focused on education, development of innovative culturally appropriate interventions that empower women to make decisions about HIV testing, involvement of men, and addressing stigma and discriminatory attitudes toward people living with HIV/AIDS.     

HIV/AIDS knowledge and stigma among women of reproductive age in Ethiopia

HIV/AIDS stigma is one of the major public health challenges in Ethiopia. This study examined knowledge about HIV/AIDS and factors behind stigmatisation towards people living with the virus based on demographic and health survey data collected in 2011 from women in the age group 15–49 years. The result shows that 49.3% of rural women had adequate knowledge about HIV/AIDS compared with 74.7% of urban women. About three-fourths (72.1%) of the rural women had stigmatising attitudes towards PLWHA whilst the proportion in urban areas was only about a third (34.2%). The likelihood of having adequate knowledge about HIV/AIDS was significantly higher among educated women but lower among those living in Afar, Somali, and Gambella regions and Dire Dawa City. Women with higher levels of education and frequent access to media had a lower tendency to stigmatise people living with the virus. Adequate knowledge about HIV/AIDS was also significantly associated with lower likelihood of stigmatisation. The results generally indicate that HIV/AIDS stigma in Ethiopia is partly explained by people's knowledge about HIV/AIDS and by socio-cultural factors that shape their perception of the epidemic. Awareness-raising efforts should thus consider the socio-cultural contexts in which stigma occurs to tackle discrimination against people living with HIV/AIDS.     

Socio-economic status and HIV/AIDS stigma in Tanzania

Tanzania has a generalised AIDS epidemic but the estimated adult HIV prevalence of 6% is much lower than in many countries in Southern Africa. HIV infection rates are reportedly higher in urban areas, among women and among those with more education. Stigma has been found to be more common in poorer, less-educated people, and those in rural areas. We examined associations between poverty and other variables and a stigmatising attitude (belief that HIV/AIDS is punishment for sinning). The variables we examined in a multivariate model included: food sufficiency (as an indicator of poverty), age, sex, marital status, education, experience of intimate partner violence, condom-related choice disability, discussion about HIV/AIDS, sources of information about HIV/AIDS and urban or rural residence. Of the 1,130 men and 1,803 women interviewed, more than half (58%) did not disagree that "HIV/AIDS is punishment for sinning". Taking other variables into account, people from the poorest households (without enough food in the last week) were more likely to believe HIV/AIDS is punishment for sinning (Odds Ratio [OR] 1.29, 95% confidence intervals [CI] 1.06-1.59). Others factors independently associated with this stigmatising attitude were: having less than primary education (OR 1.29, 95% CI 1.03-1.62); having experienced intimate partner violence in the last year (OR 1.40, 95% CI 1.12-1.75); being choice disabled for condom use (OR 1.36, 95% CI 1.08-1.71); and living in rural areas (OR 1.76, 95% CI 1.06-2.90). The level of HIV and AIDS stigma in Tanzania is high with independent associations with several disadvantages: poverty, less education and living in rural areas. Other vulnerable groups, such as survivors of intimate partner violence, are also more likely to have a stigmatising attitude. HIV prevention programmes should take account of stigma, especially among the disadvantaged, and take care not to increase it.     

Disease progression in children with vertically-acquired HIV infection in sub-Saharan Africa: reviewing the need for HIV treatment

Approximately 700,000 children become newly infected with HIV annually, mainly through mother-to-child transmission (MTCT), making paediatric HIV a leading cause of morbidity and mortality worldwide. The substantial interest in preventing MTCT (PMTCT) has generated information on rates of transmission and associated factors, but there is a lack of information on disease progression and mortality in vertically-infected children, especially from resource-poor settings. Peer-review journals with titles or abstracts containing reference to the review's themes were selected using widely available search engines. We review relevant literature on mortality in children born to HIV infected mothers; morbidity and mortality associated with paediatric HIV infections; eligibility to and efficacy of antiretroviral therapy (ART). Child mortality is independently associated with maternal HIV status and maternal death, with paediatric infection resulting in approximately 4 fold increase in mortality by age 2 years. Morbidities seen in infected children were similar to those seen in uninfected children, although the rates and recurrences of illness were greater. There is some evidence that progression to AIDS may be more rapid in resource poor settings, although data on this are very limited. PMTCT and paediatric ART have been shown to be highly successful in resource-limited settings, but are not universally applied. Further efforts to increase coverage of both PMTCT and paediatric ART could substantially reduce the numbers of children becoming infected and improve survival of those infected. Additionally, improvements in health infrastructures could improve care provision, not only through improved detection and monitoring but also through treatment of co-morbidities and nutritional support.     

Survival in women exposed to single-dose nevirapine for prevention of mother-to-child transmission of HIV: a stochastic model

BACKGROUND: Single-dose nevirapine (sdNVP)-based regimens reduce mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) but result in resistance to NVP and may reduce the ability of highly active antiretroviral therapy (HAART) used for prevention of MTCT (PMTCT). The impact that sdNVP has on survival in the era of increasing access to HAART is unknown. METHODS: We developed a stochastic simulation model to predict survival and sdNVP-attributable mortality in sub-Saharan African women exposed to different PMTCT regimens. RESULTS: Our model predicts that mortality attributable to exposure to sdNVP is low--1.1% (interquartile range [IQR], 0.6%-1.5%) and 3.5% (IQR, 3.1%-3.9%) at 5 and 10 years after PMTCT therapy--when all eligible women receive HAART after PMTCT therapy. Predictions were robust to univariate sensitivity analysis. In the worst-case multivariate sensitivity analysis, the increased mortality attributable to sdNVP was 10.4% (IQR, 10.0%-10.8%) at 10 years after PMTCT therapy. CONCLUSIONS: Concern has been expressed that widespread use of sdNVP for PMTCT in resource-poor settings will compromise the effectiveness of HAART in HIV-infected women. Although our model does not address other important outcomes of PMTCT regimens, such as transmission of resistant virus, it provides strong arguments that sdNVP for PMTCT should not be delayed because of fear of compromising the survival of women after PMTCT therapy.     

Family planning among HIV positive and negative prevention of mother to child transmission (PMTCT) clients in a resource poor setting in South Africa

The purpose of this study was to investigate family planning needs, knowledge of HIV transmission and HIV disclosure in a cohort sample that had undergone PMTCT in a resource poor setting. Five public clinics implementing PMTCT from Qaukeni Local Service Area, O.R. Tambo District in the Eastern Cape. The sample at postnatal care consisted of 758 women with known HIV status. From 116 HIV positive women 76.3% and from 642 HIV negative women 85.2% got counseling on safe sex during pregnancy but only 65.8% and 62.3% of the women respectively practiced safe sex during pregnancy, which did not differ by HIV status. Postnatally, almost all women received counseling on family planning, yet use of contraceptives and condoms were low. Among HIV positive women PMTCT knowledge and younger age of the mother were associated with pregnancy desire, and among HIV negative women HIV disclosure to the partner, younger age of the mother and having a lower number of children were associated with pregnancy desire. High pregnancy desires (yet lower than for HIV negative women); low contraceptive and condom use were found among HIV positive women. HIV prevention and family planning must acknowledge the reproductive desires of HIV positive women and men.