Do Targeted HIV Programs Improve Overall Care for Pregnant Women?

Potter, Dara; Goldenberg, Robert L.; Chao, Ann; Sinkala, Moses; Degroot, Alain; Stringer, Jeffrey S. A.; Bulterys, Marc; Vermund, Sten H.

doi:10.1097/qai.0b013e31815d2f71

Cited by 46 publications

(26 citation statements)

References 28 publications

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“…Conversely, effective ART provision for a high proportion of HIV-positive individuals in a community should lead to substantial decreases in HIV-related morbidity, and this should reduce the incidence of opportunistic infections requiring diagnosis and treatment. A study in Zambia showed ancillary benefit to routine clinical services when disease-specific research was combined with service delivery [105]. Observational studies, for example during feasibility studies or RCTs, should be carried out to collect detailed data on clinic burden and on the delivery of other routine health services.…”

Section: Universal Hiv Treatmentmentioning

confidence: 99%

Universal Testing and Treatment as an HIV Prevention Strategy: Research Questions and Methods

Hayes¹,

Sabapathy²,

Fidler³

2011

CHR

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Achieving high coverage of antiretroviral treatment (ART) in resource-poor settings will become increasingly difficult unless HIV incidence can be reduced substantially. Universal voluntary counselling and testing followed by immediate initiation of ART for all those diagnosed HIV-positive (universal testing and treatment, UTT) has the potential to reduce HIV incidence dramatically but would be very challenging and costly to deliver in the short term. Early modelling work in this field has been criticised for making unduly optimistic assumptions about the uptake and coverage of interventions. In future work, it is important that model parameters are realistic and based where possible on empirical data. Rigorous research evidence is needed before the UTT approach could be considered for wide-scale implementation. This paper reviews the main areas that need to be explored. We consider in turn research questions related to the provision of services for universal testing, services for immediate treatment of HIV-positives and the population-level impact of UTT, and the research methods that could be used to address these questions. Ideally, initial feasibility studies should be carried out to investigate the acceptability, feasibility and uptake of UTT services. If these studies produce promising results, there would be a strong case for a cluster-randomised trial to measure the impact of a UTT intervention on HIV incidence, and we consider the main design features of such a trial.

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Section: Universal Hiv Treatmentmentioning

confidence: 99%

Universal Testing and Treatment as an HIV Prevention Strategy: Research Questions and Methods

Hayes¹,

Sabapathy²,

Fidler³

2011

CHR

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“…Limited evidence also suggests that PMTCT integration may improve the overall quality of antenatal (ANC) and delivery care services and female attendance at ANC services [4–9], although causal relationships are hard to ascribe [10]. Conversely, however, some commentators have noted that the integration of PMTCT might decrease quality of care and have potential negative effects on the workload of ANC service providers, risks which should be taken into account before integrating additional activities [7, 9]. Further, while in theory the linking of sexual and reproductive health and HIV can act as a modality of stigma reduction, this potential has not yet been clearly demonstrated and more work in this area by programme managers has been advocated [2].…”

Section: Introductionmentioning

confidence: 99%

The Linked Response: Lessons Emerging from Integration of HIV and Reproductive Health Services in Cambodia

White

Delvaux

Chhea

et al. 2013

AIDS Research and Treatment

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A qualitative assessment was made of service provider and user perceptions of the quality of integrated reproductive health services established through a pilot intervention in Cambodia. The intervention aimed to promote pregnant women's HIV testing and general utilization of reproductive health facilities as well as improve the follow-up of HIV-positive women and exposed infants through strengthened referral and operational linkages amongst health facilities/services and community-based support interventions for PLHIV. The study was conducted in one operational district where the intervention was piloted and for comparative purposes in a district where integrated services had yet to be implemented. Service providers in the pilot district reported improved collaboration and coordination of services, more effective referral, and the positive impact of improved proximity of HIV testing through integrated local level facilities. Community-based support teams for PLHIV embraced their expanded role, were valued by families receiving their assistance, and were understood to have had an important role in referral, PMTCT follow-up and countering PLHIV stigmatization; findings which underscore the potential role of community support in integrated service provision. Challenges identified included stigmatization of PLHIV by health staff at district hospital level and a lack of confidence amongst non-specialized health staff when managing deliveries by HIV-positive women, partly due to fear of HIV transmission.

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“…In our literature search we found many studies that could have added more information to the present evidence base if the incidence and type of adverse reaction had been systematically recorded [58]–[61], [67]–[75], [80]–[82].…”

Section: Discussionmentioning

confidence: 99%

Safety of Benzathine Penicillin for Preventing Congenital Syphilis: A Systematic Review

Galvão

Serruya²,

Newman

et al. 2013

PLoS ONE

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ObjectiveTo estimate the risk of serious adverse reactions to benzathine penicillin in pregnant women for preventing congenital syphilis.MethodsWe searched for clinical trials or cohorts that assessed the incidence of serious adverse reactions to benzathine penicillin in pregnant women and the general population (indirect evidence). MEDLINE, EMBASE, Scopus and other databases were searched up to December 2012. The GRADE approach was used to assess quality of evidence. Absolute risks of each study were calculated along with their 95% confidence intervals (95% CI). We employed the DerSimonian and Laird random effects model in the meta-analyses.ResultsFrom 2,765 retrieved studies we included 13, representing 3,466,780 patients. The studies that included pregnant women were conducted to demonstrate the effectiveness of benzathine penicillin: no serious adverse reactions were reported among the 1,244 pregnant women included. In the general population, among 2,028,982 patients treated, 4 died from an adverse reaction. The pooled risk of death was virtually zero. Fifty-four cases of anaphylaxis were reported (pooled absolute risk = 0.002%; 95% CI: 0%–0.003% I2 = 12%). From that estimate, penicillin treatment would be expected to result in an incidence of 0 to 3 cases of anaphylaxis per 100,000 treated. Any adverse reactions were reported in 6,377 patients among 3,465,322 treated with penicillin (pooled absolute risk = 0.169%; 95% CI: 0.073%–0.265% I2 = 97%). The quality of evidence was very low.ConclusionStudies that assessed the risk of serious adverse events due to benzathine penicillin treatment in pregnant women were scarce, but no reports of adverse reactions were found. The incidence of severe adverse outcomes was very low in the general population. The risk of treating pregnant women with benzathine penicillin to prevent congenital syphilis appears very low and does not outweigh its benefits. Further research is needed to improve the quality of evidence.

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Do Targeted HIV Programs Improve Overall Care for Pregnant Women?

Abstract: Background-The implementation of disease-specific research or service programs may have an ancillary beneficial or harmful impact on routine clinical services.

Cited by 46 publications

References 28 publications

Universal Testing and Treatment as an HIV Prevention Strategy: Research Questions and Methods

Universal Testing and Treatment as an HIV Prevention Strategy: Research Questions and Methods

The Linked Response: Lessons Emerging from Integration of HIV and Reproductive Health Services in Cambodia

Safety of Benzathine Penicillin for Preventing Congenital Syphilis: A Systematic Review

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