Rapid intrapartum or postpartum HIV testing at a midwife obstetric unit and a district hospital in South Africa

Theron, Gerhard; Shapiro, David E.; Dyke, Russell Van; Cababasay, Mae; Louw, J.G.; Watts, D. Heather; Smith, Elizabeth; Bulterys, Marc; Maupin, Robert

doi:10.1016/j.ijgo.2010.10.011

Cited by 8 publications

(11 citation statements)

References 9 publications

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“…Like the findings in studies investigating rapid intrapartum and postpartum HIV-1 testing, 36,37 our findings show that large-scale rapid HIV-1 testing during labor or the immediate postpartum period, followed by prompt initiation of ART in infants, is feasible, acceptable, and effective. The high level of acceptability of postexposure ART prophylaxis in infants is reflected by 96% adherence.…”

Section: Discussionsupporting

confidence: 81%

Three Postpartum Antiretroviral Regimens to Prevent Intrapartum HIV Infection

Nielsen‐Saines

Watts

Veloso³

et al. 2012

N Engl J Med

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196

103

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Background The safety and efficacy of adding antiretroviral drugs to standard zidovudine prophylaxis in infants of mothers with human immunodeficiency virus (HIV) infection who did not receive antenatal antiretroviral therapy (ART) because of late identification are unclear. We evaluated three ART regimens in such infants. Methods Within 48 hours after their birth, we randomly assigned formula-fed infants born to women with a peripartum diagnosis of HIV type 1 (HIV-1) infection to one of three regimens: zidovudine for 6 weeks (zidovudine-alone group), zidovudine for 6 weeks plus three doses of nevirapine during the first 8 days of life (two-drug group), or zidovudine for 6 weeks plus nelfinavir and lamivudine for 2 weeks (three-drug group). The primary outcome was HIV-1 infection at 3 months in infants uninfected at birth. Results A total of 1684 infants were enrolled in the Americas and South Africa (566 in the zidovudine-alone group, 562 in the two-drug group, and 556 in the three-drug group). The overall rate of in utero transmission of HIV-1 on the basis of Kaplan–Meier estimates was 5.7% (93 infants), with no significant differences among the groups. Intra-partum transmission occurred in 24 infants in the zidovudine-alone group (4.8%; 95% confidence interval [CI], 3.2 to 7.1), as compared with 11 infants in the two-drug group (2.2%; 95% CI, 1.2 to 3.9; P = 0.046) and 12 in the three-drug group (2.4%; 95% CI, 1.4 to 4.3; P = 0.046). The overall transmission rate was 8.5% (140 infants), with an increased rate in the zidovudine-alone group (P = 0.03 for the comparisons with the two- and three-drug groups). On multivariate analysis, zidovudine monotherapy, a higher maternal viral load, and maternal use of illegal substances were significantly associated with transmission. The rate of neutropenia was significantly increased in the three-drug group (P<0.001 for both comparisons with the other groups). Conclusions In neonates whose mothers did not receive ART during pregnancy, prophylaxis with a two- or three-drug ART regimen is superior to zidovudine alone for the prevention of intrapartum HIV transmission; the two-drug regimen has less toxicity than the three-drug regimen. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [NICHD] and others; ClinicalTrials.gov number, NCT00099359.)

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Section: Discussionsupporting

confidence: 81%

Three Postpartum Antiretroviral Regimens to Prevent Intrapartum HIV Infection

Nielsen‐Saines

Watts

Veloso³

et al. 2012

N Engl J Med

Self Cite

196

103

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“…In the present study, the HIV status of all women eligible for enrollment in IMPAACT P1031A [3] was determined in a blinded fashion. The original study was a prospective, cluster‐randomized trial carried out between October 1, 2004, and September 30, 2006, to determine the feasibility and acceptance of intrapartum versus postpartum VCT, and the acceptance of antiretroviral prophylaxis by HIV‐infected women for themselves and their infants [3]. Both studies were conducted at the Macassar Midwife Obstetric Unit and Helderberg Hospital, Somerset West, Western Cape, South Africa.…”

Section: Methodsmentioning

confidence: 99%

“…Selected characteristics of all eligible women were abstracted from the delivery log. Eligible women were cluster randomized—according to calendar week of presentation—to undergo either intrapartum or postpartum VCT; the testing algorithm has been reported in full elsewhere [3].…”

Section: Methodsmentioning

confidence: 99%

“…Many women in South Africa enter labor with an undetermined HIV status. Protocol P1031A of the International Maternal Pediatric and Adolescent AIDS Clinical Trials Group (IMPAACT) was a cluster‐randomized study of the feasibility and acceptance of intrapartum versus postpartum voluntary counseling and testing (VCT) for women who presented for delivery with undetermined HIV status [3].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of HIV among women entering labor who accepted or declined voluntary counseling and testing

Theron

Cababasay

Dyke

et al. 2012

Intl J Gynecology & Obste

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Objective To assess whether there was a difference in HIV seroprevalence between eligible women who declined and those who agreed to participate in a study of voluntary counseling and testing among women entering labor with unknown HIV status in South Africa. Methods Anonymous cord blood specimens were collected—as dried blood spots—from all women approached for participation in a cluster-randomized trial. No patient identifiers were included on the cord blood specimens. The dried blood spots were analyzed for HIV antibody via enzyme immunoassay and western blotting. Results Of 7238 women screened for study participation, 1041 (14.4%) had undocumented HIV status; of these women, 542 were eligible for inclusion and 343 enrolled. Based on 513 evaluable samples, the overall seroprevalence was 13.3% (95% confidence interval [CI], 10.4–16.5), which was similar to the 13.1% (95% CI, 9.7–17.2) seroprevalence among the 343 enrolled women. Conclusion Seroprevalence among eligible women was similar to that among enrolled women, which indicates that study participation did not select for a group with an HIV seroprevalence substantially different from that among women who declined to enroll.

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“…Increasing attention has been focused on pregnancy as a high-risk time for HIV acquisition [46–48] and subsequent transmission to infants; HIV acquisition during the two years of lactation also places an infant at high risk [49]. Current PMTCT programs offer little to HIV negative women after initial screening during antenatal care and may not be adequately reaching women at risk for HIV infection during pregnancy and lactation.…”

Section: Hiv Prevention For Women and Children During Pregnancy Lactmentioning

confidence: 99%

A Lifecycle Approach to HIV Prevention in African Women and Children

et al. 2014

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Effective biomedical and structural HIV prevention approaches are being implemented throughout sub-Saharan Africa. A “lifecycle approach” to HIV prevention recognizes the interconnectedness of the health of women, children and adolescents, and prioritizes interventions that have benefits across these populations. We review new biomedical prevention strategies for women, adolescents and children, structural prevention approaches, and new modalities for eliminating infant HIV infection, and discuss the implications of a lifecycle approach for the success of these methods. Some examples of the lifecycle approach include evaluating education and HIV prevention strategies among adolescent girls not only for their role in reducing risk of HIV infection and early pregnancy, but also to promote healthy adolescents who will have healthier future children. Similarly, early childhood interventions such as exclusive breastfeeding not only prevent HIV, but also contribute to better child and adolescent health outcomes.. The most ambitious biomedical infant HIV prevention effort, Option B+, also represents a lifecycle approach by leveraging the prevention benefits of optimal HIV treatment for mothers; maternal survival benefits from Option B+ may have ultimately more health impact on children than the prevention of infant HIV in isolation. The potential for synergistic and additive benefits of lifecycle interventions should be considered when scaling up HIV prevention efforts in sub-Saharan Africa.

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Rapid intrapartum or postpartum HIV testing at a midwife obstetric unit and a district hospital in South Africa

Cited by 8 publications

References 9 publications

Three Postpartum Antiretroviral Regimens to Prevent Intrapartum HIV Infection

Three Postpartum Antiretroviral Regimens to Prevent Intrapartum HIV Infection

Prevalence of HIV among women entering labor who accepted or declined voluntary counseling and testing

A Lifecycle Approach to HIV Prevention in African Women and Children

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