Eliminating mother to child transmission of HIV-1 and keeping mothers alive: Recent progress

Govender, Thiloshini; Coovadia, Hoosen M.

doi:10.1016/j.jinf.2013.09.015

Cited by 41 publications

(49 citation statements)

References 8 publications

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“…This suggests that PMTCT counseling may do what it is supposed to, that is, instill greater understanding about HIV and the need for ART (Govender & Coovadia, 2014). It is also possible that becoming pregnant and having children may lead to increased motivation to understand the virus and prevent transmission, as well as promote maternal health.…”

Section: Discussionmentioning

confidence: 99%

Psychosocial Aspects of ART Counseling: A Comparison of HIV Beliefs and Knowledge in PMTCT and ART-Naïve Women

Gouse¹,

Henry²,

Robbins³

et al. 2017

Journal of the Association of Nurses in AIDS Care

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Antiretroviral therapy (ART)-readiness counseling has been deemed critical to adherence, instilling knowledge, and promoting positive beliefs and attitudes. In the landscape of changing policy in South Africa, some ART initiators have had prior ART-readiness counseling (e.g., for prevention-of-mother-to-child-transmission [PMTCT] programs). The extent to which previous counseling resulted in retained knowledge and belief is unknown, which may be important to the promotion of women’s ART adherence. We compared 320 women living with HIV and initiating ART, with and without prior PMTCT on HIV knowledge, treatment, beliefs, and attitudes. The PMTCT group held more accurate beliefs and more positive attitudes about ART. Both groups lacked understanding of basic HIV biology. Non-disclosure of HIV status was high. Thus, in individuals re-initiating therapy, some knowledge about HIV and its treatment was not well retained. Tailored education and counseling may be critical to adherence, with a focus on biological concepts that impact ART resistance.

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Section: Discussionmentioning

confidence: 99%

Psychosocial Aspects of ART Counseling: A Comparison of HIV Beliefs and Knowledge in PMTCT and ART-Naïve Women

Gouse¹,

Henry²,

Robbins³

et al. 2017

Journal of the Association of Nurses in AIDS Care

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“…Over the past two decades, considerable progress has been made in the prevention of perinatal HIV transmission[1,2]. Strategies for the prevention of perinatal transmission among asymptomatic women with early stage HIV infection need to balance the impact of preventing transmission and optimizing infant outcomes with preserving maternal health.…”

Section: Introductionmentioning

confidence: 99%

Randomized trial of stopping or continuing ART among postpartum women with pre-ART CD4 ≥ 400 cells/mm3

et al. 2017

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BackgroundHealth benefits of postpartum antiretroviral therapy (ART) for human immunodeficiency virus (HIV) positive women with high CD4+ T-counts have not been assessed in randomized trials.MethodsAsymptomatic, HIV-positive, non-breastfeeding women with pre-ART CD4+ T-cell counts ≥ 400 cells/mm3 started on ART during pregnancy were randomized up to 42 days after delivery to continue or discontinue ART. Lopinavir/ritonavir plus tenofovir/emtricitabine was the preferred ART regimen. The sample size was selected to provide 88% power to detect a 50% reduction from an annualized primary event rate of 2.07%. A post-hoc analysis evaluated HIV/AIDS-related and World Health Organization (WHO) Stage 2 and 3 events. All analyses were intent to treat.Results1652 women from 52 sites in Argentina, Botswana, Brazil, China, Haiti, Peru, Thailand and the US were enrolled (1/2010-11/2014). Median age was 28 years and major racial categories were Black African (28%), Asian (25%) White (15%). Median entry CD4 count was 696 cells/mm3 (IQR 575–869), median ART exposure prior to delivery was 19 weeks (IQR 13–24) and 94% had entry HIV-1 RNA < 1000 copies/ml. After a median follow-up of 2.3 years, the primary composite endpoint rate was significantly lower than expected, and not significantly different between arms (continue arm 0.21 /100 person years(py); discontinue 0.31/100 py, Hazard ratio (HR) 0.68, 95% CI: 0.19, 2.40). WHO Stage 2 and 3 events were significantly reduced with continued ART (2.08/100 py vs. 4.36/100 py in the discontinue arm; HR 0.48, 95%CI: 0.33, 0.70). Toxicity rates did not differ significantly between arms. Among women randomized to continue ART, 189/827 (23%) had virologic failure; of the 155 with resistance testing, 103 (66%) failed without resistance to their current regimen, suggesting non-adherence.ConclusionsOverall, serious clinical events were rare among young HIV-positive post-partum women with high CD4 cell counts. Continued ART was safe and was associated with a halving of the rate of WHO 2/3 conditions. Virologic failure rates were high, underscoring the urgent need to improve adherence in this population.Trial registrationClinicalTrials.gov NCT00955968

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“…Despite the increasing feminization of the AIDS epidemic, work to address the reproductive health issues of women living with HIV, particularly regarding unwanted pregnancy and safe abortion care; is lagging behind (de Bruyn, 2012). Also within prevention of mother to child transmission of HIV (PMTCT) programs worldwide the focus remains on providing antiretroviral medicines (ARVs) to the mother-baby pair (Hairston, Bobrow, & Pitter, 2012), although prevention of unwanted pregnancies among HIV infected women has been suggested as an essential strategy (Mahy et al, 2010) (Govender & Coovadia, 2014;Mazzeo, Flanagan, Bobrow, Pitter, & Marlink, 2012;Wilcher, Petruney, & Cates, 2013).…”

Section: Introductionmentioning

confidence: 99%

High prevalence of unwanted pregnancies and induced abortions among HIV-infected women from Western India: need to emphasize dual method use?

Darak

Hutter

Kulkarni³

et al. 2015

AIDS Care

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This study examines the prevalence, reasons and predictors of unwanted pregnancies and induced abortions among ever married HIV infected women attending a care facility in Maharashtra, Western India and discusses its programmatic and policy implications.Retrospectively collected data of pregnancies conceived after the diagnosis of HIV were analyzed using descriptive and logistic regression techniques. Among the 622 women interviewed, 113 women had 158 pregnancies with known outcomes after HIV diagnosis.Among these 80 (51%) were unwanted and 79 (50%) were voluntarily terminated. Fear of transmitting HIV to the child was a frequently mentioned reason for unwanted pregnancy

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Eliminating mother to child transmission of HIV-1 and keeping mothers alive: Recent progress

Cited by 41 publications

References 8 publications

Psychosocial Aspects of ART Counseling: A Comparison of HIV Beliefs and Knowledge in PMTCT and ART-Naïve Women

Psychosocial Aspects of ART Counseling: A Comparison of HIV Beliefs and Knowledge in PMTCT and ART-Naïve Women

Randomized trial of stopping or continuing ART among postpartum women with pre-ART CD4 ≥ 400 cells/mm3

High prevalence of unwanted pregnancies and induced abortions among HIV-infected women from Western India: need to emphasize dual method use?

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