Prevention of Mother-to-Child-transmission: Antiretroviral Coverage and Access to Virological...
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P45.02 Prevention of Mother-to-Child-transmission: Antiretroviral Coverage and Access to Virological Testing during Breastfeeding Olatunji O. Adetokunboh, Tolulope Balogun Stellenbosch University, Division of Community Health, Cape Town, South Africa Background: Sub-Saharan Africa accounts for about 90% of new HIV-infections in children with most of them contracting the in- fection via mother-to-child-transmission (MTCT). Transmission during breastfeeding accounts for about 40% of new infections. Access to antiretroviral (ARV) regimens by the HIV positive mothers and their children during breastfeeding will improve the chances of these children to be free of HIV infection. Ensuring early infant virological diagnosis of HIV infection will help in identifying those who are HIV-exposed but uninfected and mak- ing sure they are free of the disease during breastfeeding period. We will like to evaluate the coverage level of women or infants receiving ARVs during breastfeeding to prevent MTCT and ac- cess to virological testing in sub-Saharan countries. Methods: Data were obtained from United Nations Children’s Fund (UNICEF) 2013 Children and AIDS Sixth Stocktaking Report. We analysed data from 21 SSA priority countries. Our focus was on the percentages of mother or child on ARVs to prevent MTCT during breastfeeding (2009–2012) and early vi- rological diagnosis of HIV in HIV exposed infants (2012). Results: In 2012, 446471 infants had early virological testing for HIV infection with South Africa recording 51.6% of the total number. The average percentage of infants tested was 32.2% with 15 of the countries recording < 50% coverage. Percentage of women or infants receiving ARVs during breastfeeding increased from 10.2% to 42.5%. The mean difference was 32.2%, 95%CI: 19.9-44.6, p = 0.0000. Ghana made a remarkable progress with a difference of 95% while 2 countries were at < 10% level in 2012. Conclusions: The African priority countries made significant progress in the provision of ARVs for mothers and infants during breastfeeding period although some countries are still lagging behind. The level of virological testing is still very low, addi- tional effort is needed to improve the early infant diagnosis in countries with poor coverage. P45.03 Ethics of HIV Prevention Research with Pregnant Women Liza Dawson NIH/NIAID, Division of AIDS, Bethesda, MD, United States Background: Pregnant women need safe and effective HIV prevention methods. In many countries, pregnant women are at high risk of HIV acquisition; countries with high rates of HIV incidence and generalized epidemics are also largely countries with high fertility rates. Also, social and structural barriers to women’s autonomous decision-making may hinder pregnant women from protecting themselves. While the HIV prevention field is moving rapidly, testing pre- vention interventions in trials with pregnant women remains daunting. Ethical and regulatory barriers are significant, and community, provider, and individual women’s perspectives are complex. The consequences of failing to conduct research with pregnant women are serious. Absent robust data, pregnant women must either eventually use these products without knowing if they are safe and effective, or avoid the products and continue to be exposed to high risks of HIV acquisition. Methods: Significant barriers and opportunities must be iden- tified. Human research regulations place stringent restrictions on research with pregnant women. Although the heaviest burden of HIV lies in sub-Saharan African countries, each with its own research regulations, US regulations have a significant impact. The US is a major funder of biomedical HIV prevention re- search, and any study funded by the US government must adhere to US regulations. Researchers may have difficulty meeting criteria for approval under this rule. Results: To overcome these challenges, a more robust ethical approach to research with pregnant women is needed. This paper explores the key ethical parameters that must be considered in finding an appropriate balance for inclusion of pregnant women in research, and discusses how this might fit under current reg- ulatory standards. Conclusions: Research with pregnant must advance to extend the benefits of HIV prevention to this key population. A new and more appropriate ethical framework will help accomplish this goal. P45.04 Barriers to Uptake of Polymerase Chain Reaction Testing for HIV Exposed Infants at Six Weeks among PMTCT Mothers at the State Hospital Osogbo, Nigeria Elizabeth Edoni, PMTCT Mothers Niger Delta University, Bayelsa, Nigeria Background: Expand access to early infant diagnosis and earlier and improved pediatric treatment are essential in order to improve survival rates and health outcomes for children. Non-adherence in the first few weeks may lead to the devel- opment of the premature development of drug-resistant virus. This study therefore designed to document barriers to Uptake of Polymerase Chain Reaction Testing (PCR) and initiation of Cotrimoxazole (CTX) for HIV-exposed Infants at Six Weeks among PMTCT Mothers at the State Hospital, Osogbo, Nigeria Methods: A Case file of 30 PMTCT mothers who delivered two months prior to this study were randomly selected and reviewed. The HIV prevalence of pregnant women in this facility was 16.0%. Client information was reviewed and telephone inter- views were conducted with each client. Counseling was pro- vided to mothers to encourage a clinic visit for infant HIV PCR testing and CTX prophylaxis. Results: Few (17.8%) of the mothers were not aware that they need to bring their infant for HIV PCR testing and these women had brought their babies for immunizations but the infants were not identified as HIV-exposed. Some (36.9%) of the infants had received HIV PCR testing, but CTX was not dispensed. Re- ported barriers among respondents were distance to the clinic (78.9%), spouse disapproval (43.7%), and stigma and discrimi- nation (39.0%). Conclusions: In order to improve early diagnosis and treatment of children, linking of children from PMTCT to care has to be strengthened. This calls for more recruitment and training of Staff. Delivery facilities should also have clear traceable records of the number of HIV-positive women who deliver. A266
Transcript of Prevention of Mother-to-Child-transmission: Antiretroviral Coverage and Access to Virological...
P45.02Prevention of Mother-to-Child-transmission:Antiretroviral Coverage and Access to VirologicalTesting during Breastfeeding
Olatunji O. Adetokunboh, Tolulope Balogun
Stellenbosch University, Division of Community Health, CapeTown, South Africa
Background: Sub-Saharan Africa accounts for about 90% of newHIV-infections in children with most of them contracting the in-fection via mother-to-child-transmission (MTCT). Transmissionduring breastfeeding accounts for about 40% of new infections.Access to antiretroviral (ARV) regimens by the HIV positivemothers and their children during breastfeeding will improve thechances of these children to be free of HIV infection. Ensuringearly infant virological diagnosis of HIV infection will help inidentifying those who are HIV-exposed but uninfected and mak-ing sure they are free of the disease during breastfeeding period.We will like to evaluate the coverage level of women or infantsreceiving ARVs during breastfeeding to prevent MTCT and ac-cess to virological testing in sub-Saharan countries.Methods: Data were obtained from United Nations Children’sFund (UNICEF) 2013 Children and AIDS Sixth StocktakingReport. We analysed data from 21 SSA priority countries. Ourfocus was on the percentages of mother or child on ARVs toprevent MTCT during breastfeeding (2009–2012) and early vi-rological diagnosis of HIV in HIV exposed infants (2012).Results: In 2012, 446471 infants had early virological testing forHIV infection with South Africa recording 51.6% of the totalnumber. The average percentage of infants tested was 32.2% with15 of the countries recording < 50% coverage. Percentage ofwomen or infants receiving ARVs during breastfeeding increasedfrom 10.2% to 42.5%. The mean difference was 32.2%, 95%CI:19.9-44.6, p = 0.0000. Ghana made a remarkable progress with adifference of 95% while 2 countries were at < 10% level in 2012.Conclusions: The African priority countries made significantprogress in the provision of ARVs for mothers and infants duringbreastfeeding period although some countries are still laggingbehind. The level of virological testing is still very low, addi-tional effort is needed to improve the early infant diagnosis incountries with poor coverage.
P45.03Ethics of HIV Prevention Researchwith Pregnant Women
Liza Dawson
NIH/NIAID, Division of AIDS, Bethesda, MD, United States
Background: Pregnant women need safe and effective HIVprevention methods. In many countries, pregnant women are athigh risk of HIV acquisition; countries with high rates of HIVincidence and generalized epidemics are also largely countrieswith high fertility rates. Also, social and structural barriers towomen’s autonomous decision-making may hinder pregnantwomen from protecting themselves.While the HIV prevention field is moving rapidly, testing pre-vention interventions in trials with pregnant women remainsdaunting. Ethical and regulatory barriers are significant, andcommunity, provider, and individual women’s perspectives arecomplex.
The consequences of failing to conduct research with pregnantwomen are serious. Absent robust data, pregnant women musteither eventually use these products without knowing if they aresafe and effective, or avoid the products and continue to beexposed to high risks of HIV acquisition.Methods: Significant barriers and opportunities must be iden-tified. Human research regulations place stringent restrictions onresearch with pregnant women. Although the heaviest burden ofHIV lies in sub-Saharan African countries, each with its ownresearch regulations, US regulations have a significant impact.The US is a major funder of biomedical HIV prevention re-search, and any study funded by the US government must adhereto US regulations. Researchers may have difficulty meetingcriteria for approval under this rule.Results: To overcome these challenges, a more robust ethicalapproach to research with pregnant women is needed. This paperexplores the key ethical parameters that must be considered infinding an appropriate balance for inclusion of pregnant womenin research, and discusses how this might fit under current reg-ulatory standards.Conclusions: Research with pregnant must advance to extendthe benefits of HIV prevention to this key population. A new andmore appropriate ethical framework will help accomplish thisgoal.
P45.04Barriers to Uptake of Polymerase Chain ReactionTesting for HIV Exposed Infants at Six Weeks amongPMTCT Mothers at the State Hospital Osogbo, Nigeria
Elizabeth Edoni, PMTCT Mothers
Niger Delta University, Bayelsa, Nigeria
Background: Expand access to early infant diagnosis andearlier and improved pediatric treatment are essential in orderto improve survival rates and health outcomes for children.Non-adherence in the first few weeks may lead to the devel-opment of the premature development of drug-resistant virus.This study therefore designed to document barriers to Uptakeof Polymerase Chain Reaction Testing (PCR) and initiationof Cotrimoxazole (CTX) for HIV-exposed Infants at SixWeeks among PMTCT Mothers at the State Hospital, Osogbo,NigeriaMethods: A Case file of 30 PMTCT mothers who delivered twomonths prior to this study were randomly selected and reviewed.The HIV prevalence of pregnant women in this facility was16.0%. Client information was reviewed and telephone inter-views were conducted with each client. Counseling was pro-vided to mothers to encourage a clinic visit for infant HIV PCRtesting and CTX prophylaxis.Results: Few (17.8%) of the mothers were not aware that theyneed to bring their infant for HIV PCR testing and these womenhad brought their babies for immunizations but the infants werenot identified as HIV-exposed. Some (36.9%) of the infants hadreceived HIV PCR testing, but CTX was not dispensed. Re-ported barriers among respondents were distance to the clinic(78.9%), spouse disapproval (43.7%), and stigma and discrimi-nation (39.0%).Conclusions: In order to improve early diagnosis and treatmentof children, linking of children from PMTCT to care has to bestrengthened. This calls for more recruitment and training ofStaff. Delivery facilities should also have clear traceable recordsof the number of HIV-positive women who deliver.
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