The need for further integration of services to prevent mother‐to‐child transmission of HIV and syphilis in Mwanza City, Tanzania

Balira, Rebecca; Mabey, David; Weiss, Helen A.; Ross, David A.; Changalucha, John; Watson-Jones, Deborah

doi:10.1016/j.ijgo.2015.04.016

Cited by 19 publications

(25 citation statements)

References 15 publications

(18 reference statements)

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“…Balira et al evaluated the integration of PMTCT and syphilis testing in Tanzania in 2015 and found that only one quarter of health workers had been trained in both PMTCT and syphilis screening and that HIV and syphilis tests were sometimes performed in different rooms by different people, with separate registers. About 80 % of women had been tested for both HIV (79.4 %) and syphilis (88.1 %) during pregnancy, and 70.1 % were tested for HIV at delivery but none for syphilis [16]. Considering recent studies on effective dual syphilis and HIV rapid testing, this integration should be simplified in the near future [34].…”

Section: Integration Of Hiv and Reproductive And Maternal Health Servmentioning

confidence: 99%

“…Duber et al found that vertical programs, even on the scale of PEPFAR, may not impact health outcomes that were not specifically targeted on a national level [12]. Attempts have been made to integrate donor-funded HIV prevention, care, and treatment programs into national health systems to ensure efficiency and sustainability, including: TB [13••, 14], maternal-child health (MCH) [15–20], cervical cancer screening [21], sexually transmitted infection (STI) [16, 22], and family planning [23, 24] programs. In addition, ART has increased the life expectancy of people living with HIV, and HIV is now considered a chronic disease.…”

Section: Introductionmentioning

confidence: 99%

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Integrating Human Immunodeficiency Virus and Reproductive, Maternal and Child, and Tuberculosis Health Services Within National Health Systems

et al. 2016

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Joint United Nations Programme on HIV/AIDS (UNAIDS) established 90–90–90 HIV treatment targets for 2020 including the following: 90 % of HIV-infected people know their HIV status, 90 % of HIV-infected people who know their status are on treatment, and 90 % of people on HIV treatment have a suppressed viral load. Integration of HIV and other programs into the national health system provides an important pathway to reach those targets. We examine the case for integrating HIV and other health services to ensure sustainability and improve health outcomes within national health systems. In this non-systematic review, we examined recent studies on integrating HIV, tuberculosis (TB), maternal-child health (MCH), and sexually transmitted infection (STI) programs. Existing evidence is limited about the effectiveness of integration of HIV and other services. Most studies found that service integration increased uptake of services, but evidence is mixed about the effect on health outcomes or quality of health services. More rigorous studies of different strategies to promote integration over a wider range of services and settings are needed. Research on how best to maximize benefits, including sustainability, of integrated services is necessary to help inform international and national policy. We recommend additional interventions to test how best to integrate HIV and MCH services, HIV and TB services, HIV testing and treatment, and STI testing and treatment.

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Section: Integration Of Hiv and Reproductive And Maternal Health Servmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Integrating Human Immunodeficiency Virus and Reproductive, Maternal and Child, and Tuberculosis Health Services Within National Health Systems

et al. 2016

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“…Quality improvement of these programs could make a difference in reducing maternal and infant morbidity and mortality caused by both syphilis and HIV. Studies have shown the importance of ensuring that syphilis and HIV screening are performed simultaneously on all pregnant women through an integrated program 9,10 , besides the integration between the prevention program of mother-to-child transmission services, postnatal care -and other HIV care and treatment services for HIV-infected mothers and childrenand HIV-exposed infants during post delivery 49 . In Brazil, the policy suggests integration between maternal health care and child care through the Stork Network Program to prevent vertical transmission of both HIV and syphilis 33,44 .…”

Section: Discussionmentioning

confidence: 99%

“…Studies show problems in carrying out simple actions to prevent vertical transmission of AIDS and syphilis, even in women who accomplish the prenatal appointments 8 . Furthermore, the need to include mother-to-child transmission prevention of hiv and syphilis testing and treatment in prenatal care services has been suggested 9,10 . Other studies have shown the influence of individual factors, such as employment status, education status, age and race to access the prevention of vertical transmission of HIV services 11,12 , but these are inadequate to explain the distribution among populations.…”

Section: Introductionmentioning

confidence: 99%

Inequalities in access to HIV and syphilis tests in prenatal care in Brazil

et al. 2019

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This study aims to evaluate the social determinants of access to HIV and VDRL tests during pregnancy in Brazil. The dependent variables were based on prenatal care access: prenatal care appointments, no HIV and syphilis tests. The independent variables at the first level were formal education level, age, race, work and participation in the Family Income program conditional cash transfer program. The city-level variables were the human development index (HDI), Gini index, and indicators related to health services. An exploratory analysis was performed assessing the effect of each level through prevalence ratios (PR) calculation. A multilevel mixed-effect Poisson regression model was constructed for all outcomes to verify the effect of individual level and with both the individual and contextual levels. Regarding prenatal appointments, the main implicated factors were related to individual socioeconomic position (education level and participation in the Family Income Program conditional cash transfer program), however only HDI maintained significance for the city-level context. The city-level variance dropped from 0.049 to 0.042, indicating an important between-city effect. Regarding the outcomes performing tests in prenatal care, the worst conditions such as contextual (HDI > 0.694, p < 0.001; Gini index ≥ 0.521, p < 0.001) and individual (> 8 years of schooling, p < 0.001) showed a risk effect in the final model. Variables related to health services did not show significant effects. They were associated with individual socioeconomic position and a city-level contextual effect. These findings indicate the importance of strengthening HIV and syphilis infection control programs during pregnancy.

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“…The meeting aimed to forge a global alliance to stimulate the development and translation of more efficient tests for the diagnosis of STIs in developing countries. Such tests should be easily performed during medical appointments and should meet the ASSURED criteria: A=affordable, S=sensitive, S=specific, U=user-friendly (simple to perform, uses non-invasive specimens), R=rapid and robust, E=equipment-free, and D=delivered (accessible to end-users) [ 21 , 34 - 36 ].…”

Section: Reviewmentioning

confidence: 99%

Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis

Lago¹

2016

Cureus

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This article aims to provide an update on the prevention of mother-to-child transmission of syphilis by drawing upon some important basic concepts and reviewing the most recent literature on the diagnosis and treatment of syphilis in pregnancy. New technologies, such as automated and point-of-care immunologic tests, are shifting some paradigms, which will certainly be further investigated in the forthcoming years. This is the time to carefully evaluate traditional as well as new strategies to prevent congenital syphilis. Adverse outcomes of mother-to-child transmission of syphilis can be prevented with antenatal screening and penicillin therapy, which proved to have an excellent cost-benefit ratio even in populations with a low prevalence of syphilis. However, syphilis epidemiology is influenced by socioeconomic and cultural factors, and major challenges are faced by poor and developing countries in which the severity of the problem is extremely alarming. On the other hand, the emergence of new technologies has raised doubts about the best algorithm to be used when proper laboratory resources are available. Conditions are quite heterogeneous across populations, and some procedures should not be generalized while there is no evidence that supports some changes and while in-depth studies about local conditions are not conducted. Official organizations need to be alert in order to avoid isolated decisions and ensure that evidence-based guidelines be used in the management of syphilis in pregnancy.

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The need for further integration of services to prevent mother‐to‐child transmission of HIV and syphilis in Mwanza City, Tanzania

Cited by 19 publications

References 15 publications

Integrating Human Immunodeficiency Virus and Reproductive, Maternal and Child, and Tuberculosis Health Services Within National Health Systems

Integrating Human Immunodeficiency Virus and Reproductive, Maternal and Child, and Tuberculosis Health Services Within National Health Systems

Inequalities in access to HIV and syphilis tests in prenatal care in Brazil

Current Perspectives on Prevention of Mother-to-Child Transmission of Syphilis

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