Malawi has one of the highest rates of HIV prevalence in the world, and accounts for 4% of the total number of people living in sub-Saharan Africa with HIV. Approximately one million people in Malawi were living with ...Malawi has one of the highest rates of HIV prevalence in the world, and accounts for 4% of the total number of people living in sub-Saharan Africa with HIV. Approximately one million people in Malawi were living with HIV in 2016, with 24,000 HIV-related deaths. The Option B+ program, first implemented in Malawi, aimed to initiate ART for all pregnant women, regardless of their CD4 cell count or disease stage. This study serves to analyze and assess the effectiveness of Option B+ retention, in relation to the facilitation of how various social and cultural barriers were handled. A literature review of 29 publications was conducted. Careful evaluation of various studies indicates that although there is a myriad of reasons explaining low levels of retention, the women who were at the highest risk for low retention were young pregnant women who were treated on the same day of HIV-diagnosis. Solutions focused around women and their partners or communities showed promising evidence of success in increasing adherence, as these strategies likely provided women reliable social and emotional support to address major barriers to retention such as a lack of support from male partners, ineffective education from healthcare workers, or stigma towards their HIV disclosure statue.展开更多
Objective: To compare one-year outcomes of women started on antiretroviral therapy (ART) during?pregnancy in the pre-Option B+ era to those in the Option B+ era. Methods: A retrospective chart review was performed at ...Objective: To compare one-year outcomes of women started on antiretroviral therapy (ART) during?pregnancy in the pre-Option B+ era to those in the Option B+ era. Methods: A retrospective chart review was performed at three sites in Malawi. Women were included in the “pre-Option B+” cohort if they started ART during pregnancy for a CD4 count 3?or WHO 3/4 condition and in the “Option B+” cohort if they started ART during pregnancy regardless of CD4 count or clinical stage. One-year outcomes were compared using Fisher’s exact and ANOVA F-tests. Results: A higher proportion of women in the pre-Option B+ cohort started ART at WHO stage 3/4 (11.9% versus 1.1%, P < 0.001), switched ART regimens (5.9% versus 0%, P = 0.002), or died in the first year after starting treatment (3.9% versus 0.5%, P = 0.05). While more women in the Option B+ cohort had poor adherence or defaulted, these differences were not significant. Conclusions: At our study sites, the transition to Option B+ has been associated with ART initiation in women with less advanced HIV infection, improved medication tolerability, and lower mortality. Further research is needed to better understand outcomes of Option B+.展开更多
Background: In Cameroon, the prevalence of HIV in pregnant women was 7.8% in 2012, and they were 8500 HIV positive newborns in 2013. Option B+ is the first highly active antiretroviral therapy (HAART) preventive proto...Background: In Cameroon, the prevalence of HIV in pregnant women was 7.8% in 2012, and they were 8500 HIV positive newborns in 2013. Option B+ is the first highly active antiretroviral therapy (HAART) preventive protocol. The objective was to evaluate the rate of HIV transmission on children born from mothers who were on Option B+ during pregnancy, in three university teaching hospitals of the University of Yaoundé I. Methods: It was a retrospective, cross-sectional study over a period of four years (2013-2017). We included HIV positive mothers not on previous antiretroviral treatment and who received a single tablet daily of combined tenofovir (300 mg) + Lamivudine (300 mg) + Efavirenz (600 mg) started at any time during pregnancy. Newborn received nevirapine syrup according to WHO option B+ protocol. Results: 179 women were included. The average age was 33.5 ± 2.92 years, all ages were represented. Blood donation was the most frequent HIV positive screening opportunity, voluntary testing rate was 29% (29/179), and adherence rate was 98.9%. Few male partners were involved (58/179). Premature deliveries and low birth weight were rare (5/179;10/179)), the indication of mode of delivery was strictly obstetrical, newborn feeding choice didn’t affect the transmission outcome, and the mother to child transmission rate was 2.2% (4/179). Conclusion: Option B+ could achieve the lowest mother to child transmission ever in Cameroon and should be generalized in high endemicity low resources settings.展开更多
Background: Mother to child transmission (MTCT) of HIV constitutes a major source of new pediatric infections in Cameroon. Objective: The aim of this implementation research was to assess outcomes and effectiveness of...Background: Mother to child transmission (MTCT) of HIV constitutes a major source of new pediatric infections in Cameroon. Objective: The aim of this implementation research was to assess outcomes and effectiveness of providing life-long antiretroviral therapy (ART) for HIV-positive pregnant and breastfeeding women (Option B+). Methods: From October 2013 to July 2014, HIV-positive pregnant and breastfeeding women, not on antiretroviral (ARV) prophylaxis and ART, were recruited from 22 purposefully selected health facilities in the Northwest and Southwest regions for a prospective, observational cohort evaluation. Option B+ was offered to participants and outcome indicators were measured. Results: Out of 680 women eligible for this assessment, 669 (98%) were initiated on Option B+. Retention-in-care was 90% (95% CI, 87.85 - 92.61) and 79% (95% CI, 75.20 - 81.88), and loss to follow up (LTFU) was 7% (95% CI: 4.95 - 8.90) and 15% (95% CI: 12.06 - 17.56) at 6 and 12 months respectively. Maternal mortality at 12 months after ART initiation was 2% (13). As of March 2015, 538 HIV exposed infants (HEIs) were enrolled and received postpartum nevirapine prophylaxis within 72 hours of birth and 84% (454) were on cotrimoxazole at 6 to 8 weeks. By 8 weeks of age, 498 (93%) infants had HIV DNA PCR test with 486 (97.6%) negative and 12 (2.4%) positive. Conclusion: In Cameroon, successful implementation of Option B+ increased retention-in-care to 79% at one year for pregnant and breastfeeding women and reduced MTCT rate below 5% for HEIs at 8 weeks of age. Long term retention, maternal and infant mortality and final MTCT rate after cessation of breastfeeding require further evaluation.展开更多
文摘Malawi has one of the highest rates of HIV prevalence in the world, and accounts for 4% of the total number of people living in sub-Saharan Africa with HIV. Approximately one million people in Malawi were living with HIV in 2016, with 24,000 HIV-related deaths. The Option B+ program, first implemented in Malawi, aimed to initiate ART for all pregnant women, regardless of their CD4 cell count or disease stage. This study serves to analyze and assess the effectiveness of Option B+ retention, in relation to the facilitation of how various social and cultural barriers were handled. A literature review of 29 publications was conducted. Careful evaluation of various studies indicates that although there is a myriad of reasons explaining low levels of retention, the women who were at the highest risk for low retention were young pregnant women who were treated on the same day of HIV-diagnosis. Solutions focused around women and their partners or communities showed promising evidence of success in increasing adherence, as these strategies likely provided women reliable social and emotional support to address major barriers to retention such as a lack of support from male partners, ineffective education from healthcare workers, or stigma towards their HIV disclosure statue.
文摘Objective: To compare one-year outcomes of women started on antiretroviral therapy (ART) during?pregnancy in the pre-Option B+ era to those in the Option B+ era. Methods: A retrospective chart review was performed at three sites in Malawi. Women were included in the “pre-Option B+” cohort if they started ART during pregnancy for a CD4 count 3?or WHO 3/4 condition and in the “Option B+” cohort if they started ART during pregnancy regardless of CD4 count or clinical stage. One-year outcomes were compared using Fisher’s exact and ANOVA F-tests. Results: A higher proportion of women in the pre-Option B+ cohort started ART at WHO stage 3/4 (11.9% versus 1.1%, P < 0.001), switched ART regimens (5.9% versus 0%, P = 0.002), or died in the first year after starting treatment (3.9% versus 0.5%, P = 0.05). While more women in the Option B+ cohort had poor adherence or defaulted, these differences were not significant. Conclusions: At our study sites, the transition to Option B+ has been associated with ART initiation in women with less advanced HIV infection, improved medication tolerability, and lower mortality. Further research is needed to better understand outcomes of Option B+.
文摘Background: In Cameroon, the prevalence of HIV in pregnant women was 7.8% in 2012, and they were 8500 HIV positive newborns in 2013. Option B+ is the first highly active antiretroviral therapy (HAART) preventive protocol. The objective was to evaluate the rate of HIV transmission on children born from mothers who were on Option B+ during pregnancy, in three university teaching hospitals of the University of Yaoundé I. Methods: It was a retrospective, cross-sectional study over a period of four years (2013-2017). We included HIV positive mothers not on previous antiretroviral treatment and who received a single tablet daily of combined tenofovir (300 mg) + Lamivudine (300 mg) + Efavirenz (600 mg) started at any time during pregnancy. Newborn received nevirapine syrup according to WHO option B+ protocol. Results: 179 women were included. The average age was 33.5 ± 2.92 years, all ages were represented. Blood donation was the most frequent HIV positive screening opportunity, voluntary testing rate was 29% (29/179), and adherence rate was 98.9%. Few male partners were involved (58/179). Premature deliveries and low birth weight were rare (5/179;10/179)), the indication of mode of delivery was strictly obstetrical, newborn feeding choice didn’t affect the transmission outcome, and the mother to child transmission rate was 2.2% (4/179). Conclusion: Option B+ could achieve the lowest mother to child transmission ever in Cameroon and should be generalized in high endemicity low resources settings.
文摘Background: Mother to child transmission (MTCT) of HIV constitutes a major source of new pediatric infections in Cameroon. Objective: The aim of this implementation research was to assess outcomes and effectiveness of providing life-long antiretroviral therapy (ART) for HIV-positive pregnant and breastfeeding women (Option B+). Methods: From October 2013 to July 2014, HIV-positive pregnant and breastfeeding women, not on antiretroviral (ARV) prophylaxis and ART, were recruited from 22 purposefully selected health facilities in the Northwest and Southwest regions for a prospective, observational cohort evaluation. Option B+ was offered to participants and outcome indicators were measured. Results: Out of 680 women eligible for this assessment, 669 (98%) were initiated on Option B+. Retention-in-care was 90% (95% CI, 87.85 - 92.61) and 79% (95% CI, 75.20 - 81.88), and loss to follow up (LTFU) was 7% (95% CI: 4.95 - 8.90) and 15% (95% CI: 12.06 - 17.56) at 6 and 12 months respectively. Maternal mortality at 12 months after ART initiation was 2% (13). As of March 2015, 538 HIV exposed infants (HEIs) were enrolled and received postpartum nevirapine prophylaxis within 72 hours of birth and 84% (454) were on cotrimoxazole at 6 to 8 weeks. By 8 weeks of age, 498 (93%) infants had HIV DNA PCR test with 486 (97.6%) negative and 12 (2.4%) positive. Conclusion: In Cameroon, successful implementation of Option B+ increased retention-in-care to 79% at one year for pregnant and breastfeeding women and reduced MTCT rate below 5% for HEIs at 8 weeks of age. Long term retention, maternal and infant mortality and final MTCT rate after cessation of breastfeeding require further evaluation.
