Improving utilization of and retention in PMTCT services: Can behavioral economics help?

PubMed Central

2013-01-01

Background The most recent strategic call to action of the World Health Organization sets the elimination of pediatric HIV as a goal. While recent efforts have focused on building infrastructure and ensuring access to high-quality treatment, we must now turn our focus to the behavior change needed to eliminate vertical transmission. We make the case for the application of concepts from the field of behavioral economics to prevention of mother-to-child transmission (PMTCT) programs to more effectively address demand-side issues of uptake and retention. Discussion We introduce five concepts from the field of behavioral economics and discuss their application to PMTCT programs: 1) Mentor mothers who come from similar circumstances as PMTCT patients can serve as social references who provide temporally salient modeling of utilization of services and adherence to treatment. 2) Economic incentives, like cell phone minutes or food vouchers, that reward adherence to PMTCT protocols leverage present bias, the observation that people are generally biased toward immediate versus future awards. 3) Default bias, our preference for the default option, is already being used in many countries in the form of opt-out testing, and could be expanded to all PMTCT programs. 4) We are hardwired to avoid loss more than to pursue an equivalent gain. PMTCT programs can take advantage of loss aversion through the use of commitment contracts that incentivize mothers to return to the clinic in order to avoid both reputational and financial loss. Summary Eliminating vertical transmission of HIV is an ambitious goal. To close the remaining gap, innovations are needed to address demand for PMTCT services. Behavioral economics offers a set of tools that can be engineered into PMTCT programs to increase uptake and improve retention with minimal investment. PMID:24112440

[Cost-effectiveness and cost-benefit analysis on strategy for preventing mother-to-child transmission of hepatitis B virus].

PubMed

Cai, Y L; Zhang, S X; Yang, P C; Lin, Y

2016-06-01

Through cost-benefit analysis (CBA), cost-effectiveness analysis (CEA) and quantitative optimization analysis to understand the economic benefit and outcomes of strategy regarding preventing mother-to-child transmission (PMTCT) on hepatitis B virus. Based on the principle of Hepatitis B immunization decision analytic-Markov model, strategies on PMTCT and universal vaccination were compared. Related parameters of Shenzhen were introduced to the model, a birth cohort was set up as the study population in 2013. The net present value (NPV), benefit-cost ratio (BCR), incremental cost-effectiveness ratio (ICER) were calculated and the differences between CBA and CEA were compared. A decision tree was built as the decision analysis model for hepatitis B immunization. Three kinds of Markov models were used to simulate the outcomes after the implementation of vaccination program. The PMTCT strategy of Shenzhen showed a net-gain as 38 097.51 Yuan/per person in 2013, with BCR as 14.37. The universal vaccination strategy showed a net-gain as 37 083.03 Yuan/per person, with BCR as 12.07. Data showed that the PMTCT strategy was better than the universal vaccination one and would end with gaining more economic benefit. When comparing with the universal vaccination program, the PMTCT strategy would save 85 100.00 Yuan more on QALY gains for every person. The PMTCT strategy seemed more cost-effective compared with the one under universal vaccination program. In the CBA and CEA hepatitis B immunization programs, the immunization coverage rate and costs of hepatitis B related diseases were the most important influencing factors. Outcomes of joint-changes of all the parameters in CEA showed that PMTCT strategy was a more cost-effective. The PMTCT strategy gained more economic benefit and effects on health. However, the cost of PMTCT strategy was more than the universal vaccination program, thus it is important to pay attention to the process of PMTCT strategy and the universal vaccination program. CBA seemed suitable for strategy optimization while CEA was better for strategy evaluation. Hopefully, programs as combination of the above said two methods would facilitate the process of economic evaluation.

Understanding women's uptake and adherence in Option B+ for prevention of mother-to-child HIV transmission in Papua, Indonesia: A qualitative study.

PubMed

Lumbantoruan, Christina; Kermode, Michelle; Giyai, Aloisius; Ang, Agnes; Kelaher, Margaret

2018-01-01

Despite a more proactive approach to reducing new HIV infections in infants through lifelong treatment (Option B+ policy) for infected pregnant women, prevention of mother-to-child transmission of HIV (PMTCT) has not been fully effective in Papua, Indonesia. Mother-to-child transmission (MTCT) is the second greatest risk factor for HIV infection in the community, and an elimination target of <1% MTCT has not yet been achieved. The purpose of this study was to improve understanding of the implementation of Option B+ for PMTCT in Papua through investigation of facilitators and barriers to women's uptake and adherence to antiretroviral therapy (ART) in the program. This information is vital for improving program outcomes and success of program scale up in similar settings in Papua. In-depth interviews were conducted with 20 women and 20 PMTCT health workers at two main referral hospitals for PMTCT in Papua. Development of interview guides was informed by the socio-ecological framework. Qualitative data were managed with NVivo11 software and themes were analysed using template analysis. Factors influencing women's uptake and adherence in Option B+ for PMTCT were identified through final analysis of key themes. Factors that motivated PMTCT uptake and adherence were good quality post-test HIV counselling, belief in the efficacy of antiretroviral (ARV) attained through personal or peer experiences, and a partner who did not prevent women from seeking PMTCT care. Key barriers for PMTCT participation included doubts about ARV efficacy, particularly for asymptomatic women, unsupportive partners who actively prevented women from seeking treatment, and women's concerns about community stigma and discrimination. Results suggest that PMTCT program success is determined by facilitators and barriers from across the spectrum of the socio-ecological model. While roll out of Option B+ as current national policy for pregnant women in Papua has improved detection and enrolment of HIV-positive women, health facilities need to address various existing and potential issues to ensure long-term adherence of women beyond the current PMTCT program, including during pregnancy, childbirth and breastfeeding.

Early assessment of the implementation of a national programme for the prevention of mother-to-child transmission of HIV in Cameroon and the effects of staff training: a survey in 70 rural health care facilities.

PubMed

Labhardt, Niklaus Daniel; Manga, Engelbert; Ndam, Mama; Balo, Jean-Richard; Bischoff, Alexandre; Stoll, Beat

2009-03-01

To assess the availability of equipment and the staff's knowledge to prevent Mother-To-Child Transmission (PMTCT) in rural healthcare facilities recently covered by the national PMTCT programme in Cameroon. In eight districts inventories of antiviral drugs and HIV test kits were made on site, using a standardised check-list. Knowledge of HIV and PMTCT was evaluated with a multiple-choice (MC) questionnaire based on typical clinical PMTCT cases. Staff participated subsequently in a 2-day training on HIV/AIDS and the Cameroon PMTCT guidelines. Immediately after training and after 7 months, retention of knowledge was tested with the same questions but in different order and layout. Sixty two peripheral nurse-led clinics and the eight district hospitals were assessed. Whereas all district hospitals presented complete equipment, only six of the peripheral clinics (10%) were equipped with both complete testing materials and a full set of drugs to provide PMTCT. Thirty six peripheral facilities (58%) possessed full equipment for HIV-testing and 8 (13%) stocked all PMTCT drugs. Of 137 nurses, 102 (74%) agreed to the two knowledge tests. Fewer than 66% knew that HIV-diagnosis requires positive results in two different types of rapid tests and only 19% chose the right recommendation on infant-feeding for HIV-positive mothers. Correct answers on drug regimens in different PMTCT settings varied from 25% to 56%. All percentages of correct answers improved greatly with training (P < 0.001) and retention remained high 7 months after training (P < 0.001). Prevent Mother-To-Child Transmission programmes in settings such as rural Cameroon need to be adapted to the special needs of peripheral nurse-led clinics. Appropriate short training may considerably improve nurses' competence in PMTCT. Other important components are regular supervision and measures to guarantee supply of equipment in rural areas.

The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

PubMed Central

Tudor Car, Lorainne; Brusamento, Serena; Elmoniry, Hoda; van Velthoven, Michelle H. M. M. T.; Pape, Utz J.; Welch, Vivian; Tugwell, Peter; Majeed, Azeem; Rudan, Igor; Car, Josip; Atun, Rifat

2013-01-01

Background The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. Methods and Findings We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30–100%) and 81% (range 26–100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22–99%) and 60% (range 19–100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44–100%) of infants were tested for HIV and 11% (range 3–18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. Conclusion The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed. PMID:23483887

The uptake of integrated perinatal prevention of mother-to-child HIV transmission programs in low- and middle-income countries: a systematic review.

PubMed

Tudor Car, Lorainne; Brusamento, Serena; Elmoniry, Hoda; van Velthoven, Michelle H M M T; Pape, Utz J; Welch, Vivian; Tugwell, Peter; Majeed, Azeem; Rudan, Igor; Car, Josip; Atun, Rifat

2013-01-01

The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed.

Fifteen years of PMTCT HIV and Syphilis outcomes in Haiti from monotherapy to Option B.

PubMed

Deschamps, Marie Marcelle; Jannat-Khah, Deanna; Rouzier, Vanessa; Bonhomme, Jerry; Pierrot, Julma; Lee, Myung Hee; Abrams, Elaine; Pape, Jean; McNairy, Margaret L

2018-05-19

To evaluate mother and infant outcomes in the largest prevention of mother-to-child-transmission (PMTCT) program in Haiti in order to identify gaps towards elimination of HIV and syphilis. Based on retrospective data from HIV+ pregnant women and their infants enrolled in PMTCT care from 1999-2014, we assessed maternal enrolment in PMTCT, receipt of antiretrovirals before delivery, maternal retention through delivery, as well as infant enrolment in PMTCT, HIV testing, and HIV infection. 4 PMTCT program periods were compared: period 1 (1999-2004, mono ARV), period 2 (2005-2009, dual ARV), period 3 (2010-2012, Option B), and period 4 (Oct 2012-2014, Option B+). Kaplan Meier methods were used to assess retention in PMTCT care. Among 4,665 pregnancies, median age was 27 years and median CD4+ was 494 cells/uL (IQR 328-691). 75% of women received antiretrovirals before delivery and 73% were retained in care through delivery. 22% were lost before delivery, <1% died, and 6% had stillbirths or abortions. 94% of infants born alive enrolled in PMTCT, of whom 92% had complete HIV testing. 161 infants were HIV+, giving a 5.4% HIV transmission rate (9.8%, 4.6%, 5.8%, and 3.6% in periods 1-4). Retention among women through 12 months after PMTCT enrolment did not significantly differ across periods. However, among women who received antiretrovirals at the time of enrolment, retention 12 months later was lower in the Option B+ period (83%) than in periods 2 and 3 (94% and 93%) (p<0.001). Syphilis infection decreased from 16% in period 1 to 8% in period 4, whereas syphilis testing of infants increased from 17% to 91%. Despite dramatic reductions in MTCT in Haiti, interventions are needed to improve retention to achieve MTCT elimination of HIV and syphilis. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Evaluating the effectiveness of selected community-level interventions on key maternal, child health, and prevention of mother-to-child transmission of HIV outcomes in three countries (the ACCLAIM Project): a study protocol for a randomized controlled trial.

PubMed

Woelk, Godfrey B; Kieffer, Mary Pat; Walker, Damilola; Mpofu, Daphne; Machekano, Rhoderick

2016-02-16

Efforts to scale up and improve programs for prevention of mother-to-child transmission of HIV (PMTCT) have focused primarily at the health facility level, and limited attention has been paid to defining an effective set of community interventions to improve demand and uptake of services and retention. Many barriers to PMTCT are also barriers to pregnancy, childbirth, and postnatal care faced by mothers regardless of HIV status. Demand for maternal and child health (MCH) and PMTCT services can be limited by critical social, cultural, and structural barriers. Yet, rigorous evaluation has shown limited evidence of effectiveness of multilevel community-wide interventions aimed at improving MCH and HIV outcomes for pregnant women living with HIV. We propose to assess the effect of a package of multilevel community interventions: a social learning and action component, community dialogues, and peer-led discussion groups, on the demand for, uptake of, and retention of HIV positive pregnant/postpartum women in MCH/PMTCT services. This study will undertake a three-arm randomized trial in Swaziland, Uganda, and Zimbabwe. Districts/regions (n = 9) with 45 PMTCT-implementing health facilities and their catchment areas (populations 7,300-27,500) will be randomly allocated to three intervention arms: 1) community leader engagement, 2) community leader engagement with community days, or 3) community leader engagement with community days and male and female community peer groups. The primary study outcome is HIV exposed infants (HEIs) returning to the health facility within 2 months for early infant diagnosis (EID) of HIV. Secondary study outcomes include gestational age of women attending for first antenatal care, male partners tested for HIV, and HEIs receiving nevirapine prophylaxis at birth. Changes in community knowledge, attitudes, practices, and beliefs on MCH/PMTCT will be assessed through household surveys. Implementation of the protocol necessitated changes in the original study design. We purposively selected facilities in the districts/regions though originally the study clusters were to be randomly selected. Lifelong antiretroviral therapy for all HIV positive pregnant and lactating women, Option B+, was implemented in the three countries during the study period, with the potential for a differential impact by study arm. Implementation however, was rapidly done across the districts/regions, so that there is unlikely be this potential confounding. We developed a system of monitoring and documentation of potential confounding activities or actions, and these data will be incorporated into analyses at the conclusion of the project. Strengthens of the study are that it tests multilevel interventions, utilizes program as well as study specific and individual data, and it is conducted under "real conditions" leading to more robust findings. Limitations of the protocol include the lack of a true control arm and inadequate control for the potential effect of Option B+, such as the intensification of messages as the importance of early ANC and male partner testing. ClinicalTrials.gov (study ID: NCT01971710) Protocol version 5, 30 July 2013, registered 13 August 2013.

[Cost-effectiveness and affordability of strategy for preventing mother-to-child transmission of hepatitis B in China].

PubMed

Lin, Y; Zhang, S X; Yang, P C; Cai, Y L; Zou, Y H

2017-07-10

Objective: To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B, and estimate the willing to pay and budget impacts on the PMTCT. Methods: The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention. The parameters in the model were obtained from literatures of national surveys or Meta-analysis. The costs, cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives, respectively. The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization. One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results. In addition, cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy. Results: The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier, which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention. Due to the strategy, a total of 24.516 1 QALYs per person would be gained, which was higher than that in those receiving no intervention. From societal perspective, the ICER was -59 136.6 yuan (RMB) per additional QALYs gained, indicating that the PMTCT is cost effective. The results were reliable indicated by one-way, multi-way and probability sensitivity analyses. By the CEAC, the willing to pay was much lower than the cost-effectiveness threshold. From the affordability curve of the PMTCT strategy, the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB), which was lower than the financial ability. Based on the results of cost-effectiveness affordability curves, the higher annual budget was determined, the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state. Only when the annual budget reaches 688.8 million yuan (RMB), the goal of PMTCT would be fully realized. Conclusions: The PMTCT strategy in China was cost effective, and the cost is not beyond the financial budget needed and the willing to pay. The strategy, which is consistent with the global hepatitis B elimination efforts, should be conducted widely in China.

Preventing mother-to-child transmission of HIV in Vietnam and Indonesia: diverging care dynamics.

PubMed

Hardon, Anita Petra; Oosterhoff, Pauline; Imelda, Johanna D; Anh, Nguyen Thu; Hidayana, Irwan

2009-09-01

How do women and frontline health workers engage in preventing mother-to-child HIV transmission (PMTCT) in urban areas of Vietnam and Indonesia, where HIV is highly stigmatized and is associated with injecting drug use and sex work? This qualitative study explores local dynamics of care, using a mix of observations, focus group discussions, and interviews. In Indonesia the study was conducted in a community-based PMTCT program run by an NGO, while in Vietnam the study explored the care dynamics in routine PMTCT services, implemented by district and provincial public health facilities. In both of these PMTCT arrangements (the routine provider initiated approach in Vietnam and a more client-oriented system in Indonesia), pregnant women value the provision of HIV tests in antenatal care (ANC). Concerns are raised, however, by the unhappy few who test positive. These women are unsatisfied with the quality of counselling, and the failure to provide antiretroviral treatments. Acceptability of HIV testing in ANC is high, but the key policy issue from the perspective of pregnant women is whether the PMTCT services can provide good quality counselling and the necessary follow-up care. We find local level providers of PMTCT are pleased with the PMTCT program. In Vietnam, the PMTCT program offers health workers protection against HIV, since they can refer women away from the district health service for delivery. In Indonesia, community cadres are pleased with the financial incentives gained by mobilizing clients for the program. We conclude that achieving the global aims of reducing HIV infections in children by 50% requires a tailoring of globally designed public health programs to context-specific gendered transmission pathways of HIV, as well as local opportunities for follow-up care and social support.

Timing of maternal HIV testing and uptake of Prevention of Mother-to-Child Transmission interventions among women and their infected infants in Johannesburg, South Africa

PubMed Central

Technau, Karl-Günter; Kalk, Emma; Coovadia, Ashraf; Black, Vivian; Pickerill, Sam; Mellins, Claude A.; Abrams, Elaine J.; Strehlau, Renate; Kuhn, Louise

2013-01-01

Background By 2011, South African prevention of mother-to-child transmission of HIV (PMTCT) programmes had reduced perinatal HIV transmission at 6-weeks of age to 2.7%. We investigated the profile of newly-diagnosed vertically-infected children and their mothers to identify short-falls in the PMTCT programme. Methods In this operational follow-up study, fieldworkers enrolled mothers of newly-diagnosed HIV-infected children up to 2 years of age at 5 major healthcare facilities in Johannesburg. Structured questionnaires and clinical record reviews were conducted and analysed to describe the population and assess factors associated with PMTCT uptake. Results 289 mother-child pairs were enrolled. Timing of maternal HIV diagnosis influenced PMTCT access and feeding choices, and was associated with infants’ age at HIV diagnosis (7 weeks vs. 11 weeks vs. 31 weeks where mothers tested before, during or after the pregnancy respectively; p <0.0001). Women diagnosed before pregnancy (12%) were older (median 31 years) than those diagnosed during the index pregnancy (53% - median 27 years). Women diagnosed after delivery (35%) were younger (median 25 years, p<0.0001), of lower parity, and less likely to be South African citizens. In 81 cases (29%) late maternal diagnosis precluded any PMTCT access. Where women were diagnosed during or before pregnancy, the recommended PMTCT guidelines for mother and infant were followed in 86 (61%) pairs. Conclusion Failure to diagnose maternal HIV infection before delivery was the main reason for missing PMTCT prophylaxis and early infant testing. Timely maternal diagnosis enables PMTCT uptake, but implementation and follow-up gaps require attention to improve infant outcomes. PMID:24759066

Operational issues and barriers to implementation of prevention of mother-to-child transmission of HIV (PMTCT) interventions in Sub-Saharan Africa.

PubMed

Aizire, Jim; Fowler, Mary G; Coovadia, Hoosen M

2013-03-01

Over the past 10 years substantial progress has been made in the implementation of prevention of mother-to-child transmission of HIV (PMTCT) interventions in Sub-Saharan Africa (SSA). In spite of this, new pediatric infections remain unacceptably high, contributing the majority (>90%) of the estimated 390,000 infections globally in 2010; and yet prolonged breastfeeding remains the norm and crucial to overall infant survival. However, there is reason for optimism given the 2010 World Health Organization PMTCT recommendations: to start HIV infected pregnant women with CD4 cell counts less than 350 cells/mm(3) on lifelong antiretroviral therapy (ART); and for mothers not eligible for ART to provide efficacious maternal and/or infant PMTCT antiretroviral (ARV) regimens to be taken during pregnancy, labor/delivery and through breastfeeding. Current attention is on whether to extend maternal ARVs for life once triple ARV PMTCT regimens are started. To dramatically reduce new pediatric infections, individual countries need to politically commit to rapid scale-up of a multi-pronged PMTCT effort: including primary prevention to reduce HIV incidence among women of reproductive age; increased access to family planning services; HIV screening of all pregnant and breastfeeding women followed by ART or ARVs for PMTCT; and comprehensive care for HIV affected families. Efforts to achieve population-level success in SSA need to critically address operational issues and challenges to implementation (health system) and utilization (social, economic and cultural barriers), at the country, health centre and client level that have led to the relatively slow progress in the scale-up of PMTCT strategies.

Knowledge and practice of prevention of mother-to-child transmission of HIV among traditional birth attendants in Lagos State, Nigeria.

PubMed

Balogun, Mobolanle; Odeyemi, Kofo

2010-04-29

Traditional birth attendants (TBAs) assist most deliveries in Nigeria. Knowing and understanding all issues surrounding HIV/AIDS and Prevention of Mother-To-Child Transmission of HIV (PMTCT) can help them to protect themselves and others. This study aimed to assess the knowledge and practice of PMTCT amongst TBAs in Lagos, Nigeria. This was a cross-sectional survey. Multistage sampling method was used to select 108 registered TBAs in 2 local governments areas who were interviewed using a pre-tested questionnaire. All the respondents were aware of HIV but their awareness of PMTCT specifically was not as high. Only 8.3% of the respondents had good level of knowledge about HIV and PMTCT and up to 13% of them claimed to be able to cure HIV using native remedies. The practices of HIV counseling of patients and referral of patients for HIV testing were low and higher levels of knowledge positively influenced these practices significantly (p < 0.05). They were also deficient in certain measures to prevent infection of patients and themselves. Most of the TBAs did not have adequate knowledge and practice of PMTCT illustrating the need for periodic PMTCT training for TBAs.

Interactions among poverty, gender, and health systems affect women's participation in services to prevent HIV transmission from mother to child: A causal loop analysis.

PubMed

Yourkavitch, Jennifer; Hassmiller Lich, Kristen; Flax, Valerie L; Okello, Elialilia S; Kadzandira, John; Katahoire, Anne Ruhweza; Munthali, Alister C; Thomas, James C

2018-01-01

Retention in care remains an important issue for prevention of mother-to-child transmission (PMTCT) programs according to WHO guidelines, formerly called the "Option B+" approach. The objective of this study was to examine how poverty, gender, and health system factors interact to influence women's participation in PMTCT services. We used qualitative research, literature, and hypothesized variable connections to diagram causes and effects in causal loop models. We found that many factors, including antiretroviral therapy (ART) use, service design and quality, stigma, disclosure, spouse/partner influence, decision-making autonomy, and knowledge about PMTCT, influence psychosocial health, which in turn affects women's participation in PMTCT services. Thus, interventions to improve psychosocial health need to address many factors to be successful. We also found that the design of PMTCT services, a modifiable factor, is important because it affects several other factors. We identified 66 feedback loops that may contribute to policy resistance-that is, a policy's failure to have its intended effect. Our findings point to the need for a multipronged intervention to encourage women's continued participation in PMTCT services and for longitudinal research to quantify and test our causal loop model.

Exploring the use of mobile phone technology for the enhancement of the prevention of mother-to-child transmission of HIV program in Nyanza, Kenya: a qualitative study.

PubMed

Jennings, Larissa; Ong'ech, John; Simiyu, Rogers; Sirengo, Martin; Kassaye, Seble

2013-12-05

Community-based mobile phone programs can complement gaps in clinical services for prevention of mother-to-child transmission (PMTCT) of HIV in areas with poor infrastructure and personnel shortages. However, community and health worker perceptions on optimal mobile phone communication for PMTCT are underexplored. This study examined what specific content and forms of mobile communication are acceptable to support PMTCT. Qualitative methods using focus groups and in-depth interviews were conducted in two district hospitals in Nyanza Province, Kenya. A total of 45 participants were purposefully selected, including HIV-positive women enrolled in PMTCT, their male partners, community health workers, and nurses. Semi-structured discussion guides were used to elicit participants' current mobile phone uses for PMTCT and their perceived benefits and challenges. We also examined participants' views on platform design and gender-tailored short message service (SMS) messages designed to improve PMTCT communication and male involvement. Most participants had access to a mobile phone and prior experience receiving and sending SMS, although phone sharing was common among couples. Mobile phones were used for several health-related purposes, primarily as voice calls rather than texts. The perceived benefits of mobile phones for PMTCT included linking with health workers, protecting confidentiality, and receiving information and reminders. Men and women considered the gender-tailored SMS as a catalyst for improving PMTCT male involvement and couples' communication. However, informative messaging relayed safely to the intended recipient was critical. In addition, health workers emphasized the continual need for in-person counseling coupled with, rather than replaced by, mobile phone reinforcement. For all participants, integrated and neutral text messaging provided antenatally and postnatally was most preferred, although not all topics or text formats were equally acceptable. Given the ubiquity of mobile phones in Kenya and current health-related uses of mobile phones, a PMTCT mobile communications platform holds considerable potential. This pre-intervention assessment of community and health worker preferences yielded valuable information on the complexities of design and implementation. An effective PMTCT mobile platform engaging men and women will need to address contexts of non-disclosure, phone sharing, and linkages with existing community and facility-based services.

An effectiveness study of an integrated, community-based package for maternal, newborn, child and HIV care in South Africa: study protocol for a randomized controlled trial

PubMed Central

2011-01-01

Background Progress towards MDG4 in South Africa will depend largely on scaling up effective prevention against mother to child transmission (PMTCT) of HIV and also addressing neonatal mortality. This imperative drives increasing focus on the neonatal period and particularly on the development and testing of appropriate models of sustainable, community-based care in South Africa in order to reach the poor. A number of key implementation gaps affecting progress have been identified. Implementation gaps for HIV prevention in neonates; implementation gaps for neonatal care especially home postnatal care; and implementation gaps for maternal mental health support. We have developed and are evaluating and costing an integrated and scaleable home visit package delivered by community health workers targeting pregnant and postnatal women and their newborns to provide essential maternal/newborn care as well as interventions for Prevention of Mother to Child Transmission (PMTCT) of HIV. Methods The trial is a cluster randomized controlled trial that is being implemented in Umlazi which is a peri-urban settlement with a total population of 1 million close to Durban in KwaZulu Natal, South Africa. The trial consists of 30 randomized clusters (15 in each arm). A baseline survey established the homogeneity of clusters and neither stratification nor matching was performed. Sample size was based on increasing HIV-free survival from 74% to 84%, and calculated to be 120 pregnant women per cluster. Primary outcomes are higher levels of HIV free survival and levels of exclusive and appropriate infant feeding at 12 weeks postnatally. The intervention is home based with community health workers delivering two antenatal visits, a postnatal visit within 48 hours of birth, and a further four visits during the first two months of the infants life. We are undertaking programmatic and cost effectiveness analysis to cost the intervention. Discussion The question is not merely to develop an efficacious package but also to identify and test delivery strategies that enable scaling up, which requires effectiveness studies in a health systems context, adapting and testing Asian community-based studies in various African contexts. Trial registration ISRCTN: ISRCTN41046462 PMID:22044553

Use of services for prevention of mother-to-child transmission in Angola: a retrospective analysis.

PubMed

Augusto, Gonçalo Figueiredo

2016-06-01

After a long civil war that destroyed much of the country's health infrastructure, Angola faced the challenge of reconstruction while fighting HIV/AIDS. This paper analyses recent progress in access and use of prevention of mother-to-child transmission (PMTCT) services in Angola. National level PMTCT data between 2005 and 2012 were analysed. Data were collected from national and international databases and reports. This study assesses progress made, developed best-fit regression models and predicted future points for four major PMTCT indicators. Between 2005 and 2012, the number of PMTCT sites increased from 9 to 347, and the number of HIV tests preformed to pregnant women increased from 12 061 to 314 805. However, in 2012, 46% of the pregnant women who tested positive for HIV at PMTCT sites and only 36% HIV exposed infants were receiving antiretroviral (ARV) prophylaxis. Based on current trends, this study predicts that by 2015, 35.5% of pregnant women will be tested for HIV, 1.1% of women will test positive for HIV at PMTCT and 46% of HIV-positive pregnant women will receive antiretroviral therapy. Despite expansion of PMTCT services, urgent action is needed to rapidly scale-up HIV prevention and treatment services for HIV-positive pregnant women and for children. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A multi-disciplinary approach to implementation science: the NIH-PEPFAR PMTCT implementation science alliance.

PubMed

Sturke, Rachel; Harmston, Christine; Simonds, R J; Mofenson, Lynne M; Siberry, George K; Watts, D Heather; McIntyre, James; Anand, Nalini; Guay, Laura; Castor, Delivette; Brouwers, Pim; Nagel, Joan D

2014-11-01

In resource-limited countries, interventions to prevent mother-to-child HIV transmission (PMTCT) have not yet realized their full potential health impact, illustrating the common gap between the scientific proof of an intervention's efficacy and effectiveness and its successful implementation at scale into routine health services. For PMTCT, this gap results, in part, from inadequate adaptation of PMTCT interventions to the realities of the implementation environment, including client and health care worker behaviors and preferences, health care policies and systems, and infrastructure and resource constraints. Elimination of mother-to-child HIV transmission can only be achieved through understanding of key implementation barriers and successful adaptation of scientifically proven interventions to the local environment. Central to such efforts is implementation science (IS), which aims to investigate and address major bottlenecks that impede effective implementation and to test new approaches to identifying, understanding, and overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions. Advancing IS will require deliberate and strategic efforts to facilitate collaboration, communication, and relationship-building among researchers, implementers, and policy-makers. To speed the translation of effective PMTCT interventions into practice and advance IS more broadly, the US National Institutes of Health, in collaboration with the President's Emergency Plan for AIDS Relief launched the National Institutes of Health/President's Emergency Plan for AIDS Relief PMTCT IS Alliance, comprised of IS researchers, PMTCT program implementers, and policy-makers as an innovative platform for interaction and coordination.

Lay health worker experiences administering a multi-level combination intervention to improve PMTCT retention.

PubMed

DiCarlo, Abby; Fayorsey, Ruby; Syengo, Masila; Chege, Duncan; Sirengo, Martin; Reidy, William; Otieno, Juliana; Omoto, Jackton; Hawken, Mark P; Abrams, Elaine J

2018-01-10

The recent scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has rapidly accelerated antiretroviral therapy (ART) uptake among pregnant and postpartum women in sub-Saharan Africa. The Mother and Infant Retention for Health (MIR4Health) study evaluates the impact of a combination intervention administered by trained lay health workers to decrease attrition among HIV-positive women initiating PMTCT services and their infants through 6 months postpartum. This was a qualitative study nested within the MIR4Health trial. MIR4Health was conducted at 10 health facilities in Nyanza, Kenya from September 2013 to September 2015. The trial intervention addressed behavioral, social, and structural barriers to PMTCT retention and included: appointment reminders via text and phone calls, follow-up and tracking for missed clinic visits, PMTCT health education at home visits and during clinic visits, and retention and adherence support and counseling. All interventions were administered by lay health workers. We describe results of a nested small qualitative inquiry which conducted two focus groups to assess the experiences and perceptions of lay health workers administering the interventions. Discussions were recorded and simultaneously transcribed and translated into English. Data were analyzed using framework analysis approach. Study findings show lay health workers played a critical role supporting mothers in PMTCT services across a range of behavioral, social, and structural domains, including improved communication and contact, health education, peer support, and patient advocacy and assistance. Findings also identified barriers to the uptake and implementation of the interventions, such as concerns about privacy and stigma, and the limitations of the healthcare system including healthcare worker attitudes. Overall, study findings indicate that lay health workers found the interventions to be feasible, acceptable, and well received by clients. Lay health workers played a fundamental role in supporting mothers engaged in PMTCT services and provided valuable feedback on the implementation of PMTCT interventions. Future interventions must include strategies to ensure client privacy, decrease stigma within communities, and address the practical limitations of health systems. This study adds important insight to the growing body of research on lay health worker experiences in HIV and PMTCT care. Clinicaltrials.gov NCT01962220 .

Evaluation of a community health worker intervention and the World Health Organization's Option B versus Option A to improve antenatal care and PMTCT outcomes in Dar es Salaam, Tanzania: study protocol for a cluster-randomized controlled health systems implementation trial.

PubMed

Sando, David; Geldsetzer, Pascal; Magesa, Lucy; Lema, Irene Andrew; Machumi, Lameck; Mwanyika-Sando, Mary; Li, Nan; Spiegelman, Donna; Mungure, Ester; Siril, Hellen; Mujinja, Phares; Naburi, Helga; Chalamilla, Guerino; Kilewo, Charles; Ekström, Anna Mia; Fawzi, Wafaie W; Bärnighausen, Till W

2014-09-15

Mother-to-child transmission of HIV remains an important public health problem in sub-Saharan Africa. As HIV testing and linkage to PMTCT occurs in antenatal care (ANC), major challenges for any PMTCT option in developing countries, including Tanzania, are delays in the first ANC visit and a low overall number of visits. Community health workers (CHWs) have been effective in various settings in increasing the uptake of clinical services and improving treatment retention and adherence. At the beginning of this trial in January 2013, the World Health Organization recommended either of two medication regimens, Option A or B, for prevention of mother-to-child transmission of HIV (PMTCT). It is still largely unclear which option is more effective when implemented in a public healthcare system. This study aims to determine the effectiveness, cost-effectiveness, acceptability, and feasibility of: (1) a community health worker (CWH) intervention and (2) PMTCT Option B in improving ANC and PMTCT outcomes. This study is a cluster-randomized controlled health systems implementation trial with a two-by-two factorial design. All 60 administrative wards in the Kinondoni and Ilala districts in Dar es Salaam were first randomly allocated to either receiving the CHW intervention or not, and then to receiving either Option B or A. Under the standard of care, facility-based health workers follow up on patients who have missed scheduled appointments for PMTCT, first through a telephone call and then with a home visit. In the wards receiving the CHW intervention, the CHWs: (1) identify pregnant women through home visits and refer them to antenatal care; (2) provide education to pregnant women on antenatal care, PMTCT, birth, and postnatal care; (3) routinely follow up on all pregnant women to ascertain whether they have attended ANC; and (4) follow up on women who have missed ANC or PMTCT appointments. ClinicalTrials.gov: EJF22802. Registration date: 14 May 2013.

Missed Opportunities along the Prevention of Mother-to-Child Transmission Services Cascade in South Africa: Uptake, Determinants, and Attributable Risk (the SAPMTCTE)

PubMed Central

Woldesenbet, Selamawit; Jackson, Debra; Lombard, Carl; Dinh, Thu-Ha; Puren, Adrian; Sherman, Gayle; Ramokolo, Vundli; Doherty, Tanya; Mogashoa, Mary; Bhardwaj, Sanjana; Chopra, Mickey; Shaffer, Nathan; Pillay, Yogan; Goga, Ameena

2015-01-01

Objectives We examined uptake of prevention of mother-to-child HIV transmission (PMTCT) services, predictors of missed opportunities, and infant HIV transmission attributable to missed opportunities along the PMTCT cascade across South Africa. Methods A cross-sectional survey was conducted among 4–8 week old infants receiving first immunisations in 580 nationally representative public health facilities in 2010. This included maternal interviews and testing infants’ dried blood spots for HIV. A weighted analysis was performed to assess uptake of antenatal and perinatal PMTCT services along the PMTCT cascade (namely: maternal HIV testing, CD4 count test/result, and receiving maternal and infant antiretroviral treatment) and predictors of dropout. The population attributable fraction associated with dropouts at each service point are estimated. Results Of 9,803 mothers included, 31.7% were HIV-positive as identified by reactive infant antibody tests. Of these 80.4% received some form of maternal and infant antiretroviral treatment. More than a third (34.9%) of mothers dropped out from one or more steps in the PMTCT service cascade. In a multivariable analysis, the following characteristics were associated with increased dropout from the PMTCT cascade: adolescent (<20 years) mothers, low socioeconomic score, low education level, primiparous mothers, delayed first antenatal visit, homebirth, and non-disclosure of HIV status. Adolescent mothers were twice (adjusted odds ratio: 2.2, 95% confidence interval: 1.5–3.3) as likely to be unaware of their HIV-positive status and had a significantly higher rate (85.2%) of unplanned pregnancies compared to adults aged ≥20 years (55.5%, p = 0.0001). A third (33.8%) of infant HIV infections were attributable to dropout in one or more steps in the cascade. Conclusion A third of transmissions attributable to missed opportunities of PMTCT services can be prevented by optimizing the uptake of PMTCT services. Identified risk factors for low PMTCT service uptake should be addressed through health facility and community-level interventions, including raising awareness, promoting women education, adolescent focused interventions, and strengthening linkages/referral-system between communities and health facilities. PMID:26147598

Level of adherence and predictors of adherence to the Option B+ PMTCT programme in Tigray, northern Ethiopia.

PubMed

Ebuy, Haftamu; Yebyo, Henock; Alemayehu, Mussie

2015-04-01

The aim of this study was to determine the level of adherence to Option B+ PMTCT drugs and factors associated with adherence among HIV-positive pregnant women in public hospitals of Tigray, northern Ethiopia. A cross-sectional study was conducted among 277 HIV-positive pregnant women in 2014. A two-stage cluster sampling technique was used to select the study participants. Individual consent was obtained from each participant. Multivariate logistic regression was used to estimate the net effect sizes of factors associated with adherence to Option B+ PMTCT drugs. The level of adherence of respondents to Option B+ PMTCT drugs was 87.1% (95% confidence interval (CI) 82.6-90.7%). Controlling for the effect of other factors, the odds of adhering to Option B+ PMTCT were 4.7 times higher among women who received counselling on medication as compared to those who did not (adjusted odds ratio (aOR) 4.7, 95% CI 1.98-11.35). Similarly, disclosing HIV status was positively associated with good adherence (aOR 4.2, 95% CI 1.07-16.33). The adherence level was found to be reasonably good. Counselling on medication and HIV status disclosure were positive predictors of adherence to Option B+ PMTCT drugs. Copyright © 2015. Published by Elsevier Ltd.

The importance of addressing gender inequality in efforts to end vertical transmission of HIV.

PubMed

Ghanotakis, Elena; Peacock, Dean; Wilcher, Rose

2012-07-11

The recently launched "Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive" sets forth ambitious targets that will require more widespread implementation of comprehensive prevention of vertical HIV transmission (PMTCT) programmes. As PMTCT policymakers and implementers work toward these new goals, increased attention must be paid to the role that gender inequality plays in limiting PMTCT programmatic progress. A growing body of evidence suggests that gender inequality, including gender-based violence, is a key obstacle to better outcomes related to all four components of a comprehensive PMTCT programme. Gender inequality affects the ability of women and girls to protect themselves from HIV, prevent unintended pregnancies and access and continue to use HIV prevention, care and treatment services. In light of this evidence, global health donors and international bodies increasingly recognize that it is critical to address the gender disparities that put women and children at increased risk of HIV and impede their access to care. The current policy environment provides unprecedented opportunities for PMTCT implementers to integrate efforts to address gender inequality with efforts to expand access to clinical interventions for preventing vertical HIV transmission. Effective community- and facility-based strategies to transform harmful gender norms and mitigate the impacts of gender inequality on HIV-related outcomes are emerging. PMTCT programmes must embrace these strategies and expand beyond the traditional focus of delivering ARV prophylaxis to pregnant women living with HIV. Without greater implementation of comprehensive, gender transformative PMTCT programmes, elimination of vertical transmission of HIV will remain elusive.

Integrating Prevention of Mother to Child HIV Transmission competencies into the nursing curriculum: Methodological lessons from a university-based undergraduate programme.

PubMed

Mbombo, Nomafrench; Bimerew, Million

2012-11-14

South Africa (SA) has the highest number of women infected with HIV and AIDS during pregnancy, which results in more than 70 000 infected babies being born each year AIDS is the major contributor to maternal and child morbidities and mortalities in the country. To combat this, the SA government has developed a national policy to prevent mother-to-child HIV transmission (PMTCT). However, for effective implementation of this policy, there is a dire need for a competent, skilled health worker to render the service. In response to this, the School of Nursing at the University of the Western Cape has integrated PMTCT competencies into the undergraduate Bachelor of Nursing Science curriculum. In this paper, we described teaching and learning approaches used to integrate PMTCT competencies, including the skills laboratory methodology and case-based learning, as well as a portfolio of evidence assessment tool. A quantitative descriptive design was used to analyse data collected from students in regard to assessment of PMTCT competencies achieved. The study used the conceptual framework of Lenburg's competency outcomes and performance assessment model, which focuses on competency development and assessment in a clinical environment. HIV competencies, including PMTCT, should be integrated both theoretically and at service delivery into other nursing and midwifery competencies, including assessment strategies. Provincial policies in provision of antiretrovirals by nurses and midwives become barriers to successful implementation of PMTCT, resulting in limited learning opportunities for students to practice PMTCT competencies. Further research is required to assess an attribute, affect, which is another prong for competencies.

The importance of addressing gender inequality in efforts to end vertical transmission of HIV

PubMed Central

Ghanotakis, Elena; Peacock, Dean; Wilcher, Rose

2012-01-01

Issues The recently launched “Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive” sets forth ambitious targets that will require more widespread implementation of comprehensive prevention of vertical HIV transmission (PMTCT) programmes. As PMTCT policymakers and implementers work toward these new goals, increased attention must be paid to the role that gender inequality plays in limiting PMTCT programmatic progress. Description A growing body of evidence suggests that gender inequality, including gender-based violence, is a key obstacle to better outcomes related to all four components of a comprehensive PMTCT programme. Gender inequality affects the ability of women and girls to protect themselves from HIV, prevent unintended pregnancies and access and continue to use HIV prevention, care and treatment services. Lessons Learned In light of this evidence, global health donors and international bodies increasingly recognize that it is critical to address the gender disparities that put women and children at increased risk of HIV and impede their access to care. The current policy environment provides unprecedented opportunities for PMTCT implementers to integrate efforts to address gender inequality with efforts to expand access to clinical interventions for preventing vertical HIV transmission. Effective community- and facility-based strategies to transform harmful gender norms and mitigate the impacts of gender inequality on HIV-related outcomes are emerging. PMTCT programmes must embrace these strategies and expand beyond the traditional focus of delivering ARV prophylaxis to pregnant women living with HIV. Without greater implementation of comprehensive, gender transformative PMTCT programmes, elimination of vertical transmission of HIV will remain elusive. PMID:22789642

Effects on preventing mother-to-child transmission of syphilis and associated adverse pregnant outcomes: a longitudinal study from 2001 to 2015 in Shanghai, China.

PubMed

Li, Yang; Zhu, Liping; Du, Li; Qu, Lingxiao; Jiang, Weili; Xu, Biao

2017-09-18

Maternal syphilis is a health threat to both the pregnant women and the children. This study aimed to delineate the longitudinal trend of maternal syphilis and burden of associated adverse pregnant outcomes (APOs) in Shanghai from 2001 to 2015; and to evaluate the effects of preventing mother-to-child transmission (PMTCT) of syphilis in Shanghai with regard to service coverage and APOs averted. PMTCT program of syphilis has been implemented since 2001. Municipal and national PMTCT surveillance data were used in analysis. By using WHO estimation model, the burden of associated APOs and APOs averted were estimated. The differences in access to antenatal care and PMTCT services between resident and non-resident pregnant women were analyzed. The prevalence of seropositivity for maternal syphilis in Shanghai ranged from 0.20% to 0.38% during 2001-2015. The treatment rate varied from 69.8% to 96.8% and remained 83.6% in 2015. Under the PMTCT program, 2163 APOs had been averted during the 15-year period, including 852(39.4%) early fetal loss/stillbirth, 356(16.4%) neonatal death, 190(8.8%) prematurity or low birth weight, and 765(35.4%) clinical evidence of congenital syphilis. Compared with the residents, the non-resident pregnant women had a higher prevalence of syphilis (1.2‰ vs. 2.5‰) and contributed to 81.7% of the syphilis associated APOs in 2015. Screening of maternal syphilis has reached a full coverage both in residents and non-residents. Large numbers of APOs has been averted attributing to the PMTCT program. More attentions should be paid to those vulnerable non-resident pregnant women and tailored interventions including health education, PMTCT promotion and point of care should be given to maximize the effects of PMTCT in Shanghai.

Feasibility Study of HIV Sentinel Surveillance using PMTCT data in Cameroon: from Scientific Success to Programmatic Failure.

PubMed

Billong, Serge C; Dee, Jacob; Fokam, Joseph; Nguefack-Tsague, Georges; Ekali, Gabriel L; Fodjo, Raoul; Temgoua, Edith S; Billong, Edson-Joan; Sosso, Samuel M; Mosoko, Jembia J; Monebenimp, Francisca; Ndjolo, Alexis; Bissek, Anne-Cecile Z-K; Bolu, Omotayo; Elat, Jean-Bosco N

2017-01-03

In low-income countries (LICs), HIV sentinel surveillance surveys (HIV-SSS) are recommended in between two demographic and health surveys, due to low-cost than the latter. Using the classical unlinked anonymous testing (UAT), HIV-SSS among pregnant women raised certain ethical and financial challenges. We therefore aimed at evaluating how to use prevention of mother-to-child transmission of HIV (PMTCT) routine data as an alternative approach for HIV-SSS in LICs. A survey conducted through 2012 among first antenatal-care attendees (ANC1) in the ten regions of Cameroon. HIV testing was performed at PMTCT clinics as-per the national serial algorithm (rapid test), and PMTCT site laboratory (PMTCT-SL) performances were evaluated by comparison with results of the national reference laboratory (NRL), determined as the reference standard. Acceptance rate for HIV testing was 99%, for a total of 6521 ANC1 (49 · 3% aged 15-24) enrolled nationwide. Among 6103 eligible ANC1, sensitivity (using NRL testing as the reference standard) was 81 · 2%, ranging from 58 · 8% (South region) to 100% (West region); thus implying that 18 · 8% HIV-infected ANC1 declared HIV-negative at the PMTCT-SL were positive from NRL-results. Specificity was 99 · 3%, without significant disparity across sites. At population-level, this implies that every year in Cameroon, ~2,500 HIV-infected women are wrongly declared seronegative, while ~1,000 are wrongly declared seropositive. Only 44 · 4% (16/36) of evaluated laboratories reached the quality target of 80%. The study identified weaknesses in routine PMTCT HIV testing. As Cameroon transitions to using routine PMTCT data for HIV-SSS among pregnant women, there is need in optimizing quality system to ensure robust routine HIV testing for programmatic and surveillance purposes.

Outcomes of prevention of mother to child transmission of the human immunodeficiency virus-1 in rural Kenya--a cohort study.

PubMed

Nduati, Eunice Wambui; Hassan, Amin Shaban; Knight, Miguel Garcia; Muema, Daniel Muli; Jahangir, Margaret Nassim; Mwaringa, Shalton Lwambi; Etyang, Timothy Juma; Rowland-Jones, Sarah; Urban, Britta Christina; Berkley, James Alexander

2015-10-03

Success in prevention of mother-to-child transmission (PMTCT) raises the prospect of eliminating pediatric HIV infection. To achieve global elimination, however, strategies are needed to strengthen PMTCT interventions. This study aimed to determine PMTCT outcomes and identify challenges facing its successful implementation in a rural setting in Kenya. A retrospective cohort design was used. Routine demographic and clinical data for infants and mothers enrolling for PMTCT care at a rural hospital in Kenya were analysed. Cox and logistic regression were used to determine factors associated with retention and vertical transmission respectively. Between 2006 and 2012, 1338 infants were enrolled and followed up for PMTCT care with earlier age of enrollment and improved retention observed over time. Mother to child transmission of HIV declined from 19.4 % in 2006 to 8.9 % in 2012 (non-parametric test for trend p = 0.024). From 2009 to 2012, enrolling for care after 6 months of age, adjusted Odds Ratio [aOR]: 23.3 [95 % confidence interval (CI): 8.3-65.4], presence of malnutrition ([aOR]: 2.3 [95 % CI: 1.1-5.2]) and lack of maternal use of highly active antiretroviral therapy (HAART) (aOR: 6.5 [95 % CI: 1.4-29.4]) was associated with increased risk of HIV infection. Infant's older age at enrollment, malnutrition and maternal HAART status, were also associated with drop out from care. Infants who were not actively followed up were more likely to drop out from care (adjusted Hazard Ratio: 6.6 [95 % CI: 2.9-14.6]). We report a temporal increase in the proportion of infants enrolling for PMTCT care before 3 months of age, improved retention in PMTCT and a significant reduction in the proportion of infants enrolled who became HIV-infected, emphasizing the benefits of PMTCT. A simple set of risk factors at enrollment can identify mother-infant pairs most at risk of infection or drop out for targeted intervention.

Prevention of mother-to-child transmission (PMTCT) of HIV services in Adama town, Ethiopia: clients' satisfaction and challenges experienced by service providers.

PubMed

Asefa, Anteneh; Mitike, Getnet

2014-02-01

The coverage and uptake of prevention of mother-to-child transmission (PMTCT) of HIV services has remained very low in Ethiopia. One of the pillars of improving quality of health services is measuring and addressing client satisfaction. In Ethiopia, information about the quality of PMTCT services regarding client satisfaction is meager. A facility-based cross-sectional study using quantitative methods was conducted in Adama town. We interviewed 423 pregnant women and 31 health providers from eight health facilities. Satisfaction of clients was measured using a standard questionnaire adapted from the UNAIDS best practices collection on HIV/AIDS. Bivariate and multivariate logistic regression analyses were used to identify factors associated with clients' satisfaction. About three-fourth (74.7%) of clients reported that they were satisfied with the PMTCT services provided by the health facilities. However, a much lower proportion (39%) of the total respondents (pregnant women who underwent an ANC follow-up session), said they received and understood the messages related to mother-to-child transmission (MTCT) of HIV and PMTCT. The main challenges reported by service providers were lack of training, lack of feedback on job performance and inadequate pay. Clients' satisfaction with PMTCT service was found to be associated with liking the discussion they had with their counselor, non-preference to a different counselor with regards to sex and/or age and not seeing the same ANC counselor before and after HIV test. Although 74.7% of clients were satisfied, the majority did not have a good understanding of the counseling on MTCT and PMTCT. We recommend more efforts to be exerted on improving provider-client communication, devising ways of increasing clients' satisfaction and designing an effective motivation strategy for service providers to enhance the status of PMTCT services.

“You Know You Are Sick, Why Do You Carry A Pregnancy Again?” Applying the Socio-Ecological Model to Understand Barriers to PMTCT Service Utilization in Western Kenya

PubMed Central

Onono, Maricianah; Kwena, Zachary; Turan, Janet; Bukusi, Elizabeth A; Cohen, Craig R; Gray, Glenda E

2015-01-01

Objective Throughout most of sub-Saharan Africa (SSA), prevention of mother-to-child transmission (PMTCT) services are readily available. However, PMTCT programs in SSA have had suboptimal performance compared to other regions of the world. The main objective of this study is to explore the socio-ecological and individual factors influencing the utilization of PMTCT services among HIV-positive pregnant women in western Kenya using a social ecological model as our analytical lens. Methods Data were collected using in-depth interviews with 33 HIV-infected women attending government health facilities in rural western Kenya. Women with HIV-infected infants aged between 6 weeks to 6 months with a definitive diagnosis of HIV in the infant, as well as those with an HIV-negative test result in the infant were interviewed between November 2012 and June 2013. Coding and analysis of the transcripts followed grounded theory tenets. Coding reports were discussed in a series of meetings held among the authors. We then employed constant comparative analysis to discover dominant individual, family, society and structural determinants of PMTCT use. Results Barriers to women’s utilization of PMTCT services fell within the broad constructs of the socio-ecological model of individual, family, society and structural determinants. Several themes cut across the different steps of PMTCT cascade and relate to different constructs of the socio-ecological model. These themes include: self-motivation, confidence and resilience, family support, absence or reduced stigma, right provider attitude and quality of health services provided. We also found out that these factors ensured enhanced maternal health and HIV negative children. Conclusion The findings of this study suggest that a woman’s social environment is an important determinant of MTCT. PMTCT Interventions must comprehensively address multiple factors across the different ecological levels. More research is however required for the development of multi-component interventions that combine strategies at different ecological levels. PMID:26457229

Correlates of women's knowledge of mother-to-child transmission of HIV and its prevention in Tanzania: a population-based study.

PubMed

Haile, Zelalem T; Teweldeberhan, Asli K; Chertok, Ilana R A

2016-01-01

Studies that explored women's knowledge on mother-to-child transmission (MTCT) of HIV and its prevention (PMTCT) in the general population are currently lacking. This paper examined factors associated with having adequate knowledge of MTCT of HIV and PMTCT among a nationally representative sample of women in Tanzania. We conducted a cross-sectional analysis including 10,299 women from the 2011-2012 Tanzania HIV/AIDS and Malaria Indicator Survey. The outcome of interest was the presence of adequate knowledge on MTCT and PMTCT of HIV. We used multivariable logistic regression to identify factors associated with having adequate knowledge on MTCT and PMTCT of HIV. Results revealed that the overall prevalence of having adequate knowledge on MTCT and PMTCT of HIV was low (46%). We found a statistically significant difference in the proportions of having adequate knowledge between HIV-negative and HIV-positive women (45% vs. 56%; p < .0001), although knowledge of the transplacental route of transmission did not differ by HIV serostatus. Overall, having adequate knowledge on MTCT and PMTCT of HIV was positively associated with experiencing at least one pregnancy, having some education, having higher household wealth, residing in urban area, being exposed to HIV education, having tested for HIV, knowing a place to get HIV test, and having comprehensive knowledge on HIV and AIDS. Among HIV-seropositive women, experiencing at least one pregnancy and having comprehensive knowledge on HIV and AIDS were strongly associated with having adequate knowledge on MTCT and PMTCT of HIV (Adjusted odds ratio: aOR 2.78, 95% CI 1.21, 6.37 and aOR 1.71, 95% CI 1.15, 2.73, respectively). Further efforts are needed to enhance HIV/AIDS education among women of childbearing age and strengthen PMTCT services in Tanzania.

Playing the Catch-Up Game: Accelerating the Scale-Up of Prevention of Mother-To-Child Transmission of HIV (PMTCT) Services to Eliminate New Pediatric HIV Infection in Nigeria.

PubMed

Oladele, Edward Adekola; Khamofu, Hadiza; Asala, Seun; Saleh, Mariya; Ralph-Opara, Uche; Nwosisi, Charles; Anyaike, Chukwuma; Gana, Catherine; Adedokun, Oluwasanmi; Dirks, Rebecca; Adebayo, Olufunsho; Oduwole, Modupe; Mandala, Justin; Torpey, Kwasi

2017-01-01

As the world is making progress towards elimination of mother-to-child transmission of HIV, poor coverage of PMTCT services in Nigeria remains a major challenge. In order to address this, scale-up was planned with activities organized into 3 phases. This paper describes the process undertaken in eight high burden Nigerian states to rapidly close PMTCT coverage gaps at facility and population levels between February 2013 and March 2014. Activities were grouped into three phases-pre-assessment phase (engagement of a wide range of stakeholders), assessment (rapid health facility assessment, a cross sectional survey using mixed methods conducted in the various states between Feb and May 2013 and impact modelling), and post-assessment (drawing up costed state operational plans to achieve eMTCT by 2015, data-driven smart scale-up). Over a period of 10 months starting June 2013, 2044 facilities were supported to begin provision of PMTCT services. This increased facility coverage from 8% to 50%. A 246% increase was also recorded in the number of pregnant women and their families who have access to HIV testing and counselling in the context of PMTCT. Similarly, access to antiretrovirals for PMTCT has witnessed a 152% increase in these eight states between October 2013 and October 2014. A data-driven and participatory approach can be used to rapidly scale-up PMTCT services at community and facility levels in this region. These results present us with hope for real progress in Nigeria. We are confident that the efforts described here will contribute significantly to eliminating new pediatric HIV infection in Nigeria.

The impact of mentor mother programs on PMTCT service uptake and retention-in-care at primary health care facilities in Nigeria: a prospective cohort study (MoMent Nigeria).

PubMed

Sam-Agudu, Nadia A; Cornelius, Llewellyn J; Okundaye, Joshua N; Adeyemi, Olusegun A; Isah, Haroun O; Wiwa, Owens M; Adejuyigbe, Ebun; Galadanci, Hadiza; Afe, Abayomi J; Jolaoso, Ibidun; Bassey, Emem; Charurat, Manhattan E

2014-11-01

Nigeria is a key target country in the global effort toward elimination of mother-to-child transmission of HIV. Low coverage of prevention of mother-to-child transmission (PMTCT) interventions, adherence, and retention-in-care rates in HIV-positive pregnant women are contributing factors to high mother-to-child transmission of HIV (MTCT) rates. In Nigeria, rural areas, served largely by primary health care facilities, have particularly poor indicators of PMTCT coverage. Mentor Mothers are HIV-positive women who serve as peer counselors for PMTCT clients, provide guidance, and support in keeping appointments and promoting antiretroviral adherence and retention-in-care. The Mother Mentor (MoMent) study aims to investigate the impact of structured Mentor Mother programs on PMTCT outcomes in rural Nigeria. A prospective cohort study will compare rates of retention-in-care among PMTCT clients who are supported by formally-trained supervised Mentor Mothers versus clients who receive standard-of-care, informal peer support. Study sites are 20 primary health care centers (10 intervention, 10 control) in rural North-Central Nigeria. The study population is HIV-positive mothers and exposed infant pairs (MIPs) (N = 480; 240 MIPs per study arm). Primary outcome measures are the proportion of exposed infants receiving early HIV testing by age 2 months, and the proportion of MIPs retained in care at 6 months postpartum. Secondary outcome measures examine antiretroviral adherence, 12-month postpartum MIP retention, and MTCT rates. This article presents details of the study design, the structured Mentor Mother programs, and how their impact on PMTCT outcomes will be assessed.

HIV-Positive Status Disclosure and Use of Essential PMTCT and Maternal Health Services in Rural Kenya

PubMed Central

Spangler, Sydney A.; Onono, Maricianah; Bukusi, Elizabeth A.; Cohen, Craig R.

2014-01-01

Background: In sub-Saharan Africa, women's disclosure of HIV-positive status to others may affect their use of services for prevention of mother-to-child transmission of HIV (PMTCT) of HIV and maternal and child health—including antenatal care, antiretroviral drugs (ARVs) for PMTCT, and skilled birth attendance. Methods: Using data from the Migori and AIDS Stigma Study conducted in rural Nyanza Province, Kenya, we compared the use of PMTCT and maternal health services for all women by HIV status and disclosure category (n = 390). Among HIV-infected women (n = 145), associations between disclosure of HIV-positive status and the use of services were further examined with bivariate and multivariate logistic regression analyses. Results: Women living with HIV who had not disclosed to anyone had the lowest levels of maternity and PMTCT service utilization. For example, only 21% of these women gave birth in a health facility, compared with 35% of HIV-negative women and 49% of HIV-positive women who had disclosed (P < 0.001). Among HIV-positive women, the effect of disclosure to anyone on ARV drug use [odds ratio (OR) = 5.8; 95% confidence interval (CI): 1.9 to 17.8] and facility birth (OR = 2.9; 95% CI: 1.4 to 5.7) remained large and significant after adjusting for confounders. Disclosure to a male partner had a particularly strong effect on the use of ARVs for PMTCT (OR = 7.9; 95% CI: 3.7 to 17.1). Conclusions: HIV-positive status disclosure seems to be a complex yet critical factor for the use of PMTCT and maternal health services in this setting. The design of interventions to promote such disclosure must recognize the impact of HIV-related stigma on disclosure decisions and protect women's rights, autonomy, and safety. PMID:25436823

HIV-positive status disclosure and use of essential PMTCT and maternal health services in rural Kenya.

PubMed

Spangler, Sydney A; Onono, Maricianah; Bukusi, Elizabeth A; Cohen, Craig R; Turan, Janet M

2014-12-01

In sub-Saharan Africa, women's disclosure of HIV-positive status to others may affect their use of services for prevention of mother-to-child transmission of HIV (PMTCT) of HIV and maternal and child health-including antenatal care, antiretroviral drugs (ARVs) for PMTCT, and skilled birth attendance. Using data from the Migori and AIDS Stigma Study conducted in rural Nyanza Province, Kenya, we compared the use of PMTCT and maternal health services for all women by HIV status and disclosure category (n = 390). Among HIV-infected women (n = 145), associations between disclosure of HIV-positive status and the use of services were further examined with bivariate and multivariate logistic regression analyses. Women living with HIV who had not disclosed to anyone had the lowest levels of maternity and PMTCT service utilization. For example, only 21% of these women gave birth in a health facility, compared with 35% of HIV-negative women and 49% of HIV-positive women who had disclosed (P < 0.001). Among HIV-positive women, the effect of disclosure to anyone on ARV drug use [odds ratio (OR) = 5.8; 95% confidence interval (CI): 1.9 to 17.8] and facility birth (OR = 2.9; 95% CI: 1.4 to 5.7) remained large and significant after adjusting for confounders. Disclosure to a male partner had a particularly strong effect on the use of ARVs for PMTCT (OR = 7.9; 95% CI: 3.7 to 17.1). HIV-positive status disclosure seems to be a complex yet critical factor for the use of PMTCT and maternal health services in this setting. The design of interventions to promote such disclosure must recognize the impact of HIV-related stigma on disclosure decisions and protect women's rights, autonomy, and safety.

Effects of antenatal care and HIV treatment integration on elements of the PMTCT cascade: Results from the SHAIP cluster-randomized controlled trial in Kenya

PubMed Central

Turan, Janet M.; Onono, Maricianah; Steinfeld, Rachel L.; Shade, Starley B.; Owuor, Kevin; Washington, Sierra; Bukusi, Elizabeth A.; Ackers, Marta L.; Kioko, Jackson; Interis, Evelyn C.; Cohen, Craig R.

2015-01-01

Background Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. The current study aimed to determine if integration of HIV services into ANC settings improves PMTCT service utilization outcomes. Methods ANC clinics in rural Kenya were randomized to integrated (6 clinics, 569 women) or non-integrated (6 clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART), while control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression. Results HIV care enrollment was higher in intervention compared to control clinics (69% versus 36%, Odds Ratio (OR)=3.94, 95% Confidence Interval (CI): 1.14–13.63). Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, Hazard Ratio (HR)=2.20, 95% CI: 1.62–3.01). Eligible women in the intervention arm were more likely to initiate HAART (40% versus 17%, OR=3.22, 95% CI: 1.81–5.72). Infant testing was more common in the intervention arm (25% versus 18%), however not statistically different. No significant differences were detected in postnatal service uptake or maternal retention. Conclusions Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. Further improvements in the PMTCT cascade will require additional research and interventions. PMID:25967269

Distance from household to clinic and its association with the uptake of prevention of mother-to-child HIV transmission regimens in rural Zambia

PubMed Central

Escamilla, Veronica; Chibwesha, Carla J.; Gartland, Matthew; Chintu, Namwinga; Mubiana-Mbewe, Mwangelwa; Musokotwane, Kebby; Musonda, Patrick; Miller, William C.; Stringer, Jeffrey S. A.; Chi, Benjamin H.

2016-01-01

Background In rural settings, HIV-infected pregnant women often live significant distances from facilities that provide prevention of mother-to-child transmission (PMTCT) services. Methods We implemented a pilot project to offer universal maternal combination antiretroviral regimens in 4 clinics in rural Zambia. To evaluate the impact of services, we conducted a household survey in communities surrounding each facility. We collected information about HIV status and antenatal service utilization from women who delivered in the past two years. Using household global positing systems coordinates collected in the survey, we measured Euclidean (i.e., straight line) distance between individual households and clinics. Multivariable logistic regression and predicted probabilities were used to determine associations between distance and uptake of any PMTCT regimen and combination antiretroviral regimens specifically. Results From March to December 2011, 390 HIV-infected mothers were surveyed across four communities. Of these, 254 (65%) had household geographical coordinates documented. 168 women reported use of a PMTCT regimen during pregnancy, including 102 who initiated a combination antiretroviral regimen. The probability of PMTCT regimen initiation was highest within 1.9 km of the facility and gradually declined. Overall, 103 of 145 (71%) who lived within 1.9 km of the facility initiated PMTCT, versus 65 of 109 (60%) who lived farther away. For every kilometer increase, the association with PMTCT regimen uptake (adjusted odds ratio [AOR]: 0.90, 95%CI: 0.82—0.99) and combination antiretroviral regimen uptake (AOR: 0.88, 95%CI: 0.80—0.97) decreased. Conclusions In this rural African setting, uptake of PMTCT regimens was influenced by distance to health facility. Program models that further decentralize care into remote communities are urgently needed. PMID:26470035

Public sector services for the prevention of mother-to-child transmission of HIV infection: a micro-costing survey in Namibia and Rwanda.

PubMed

Touré, Hapsatou; Audibert, Martine; Doughty, Patricia; Tsague, Landry; Mugwaneza, Placidie; Nyankesha, Elevanie; Okokwu, Steve; Limbo, Cedric; Coulibaly, Makan; Ettiègne-Traoré, Virginie; Luo, Chewe; Dabis, Francois

2013-06-01

To assess the costs associated with the provision of services for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus in two African countries. In 2009, the costs to health-care providers of providing comprehensive PMTCT services were assessed in 20 public health facilities in Namibia and Rwanda. Information on prices and on the total amount of each service provided was collected at the national level. The costs of maternal testing and counselling, male partner testing, CD4+ T-lymphocyte (CD4+ cell) counts, antiretroviral prophylaxis and treatment, community-based activities, contraception for 2 years postpartum and early infant diagnosis were estimated in United States dollars (US$). The estimated costs to the providers of PMTCT, for each mother-infant pair, were US$202.75-1029.55 in Namibia and US$94.14-342.35 in Rwanda. These costs varied with the drug regimen employed. At 2009 coverage levels, the maximal estimates of the national costs of PMTCT were US$3.15 million in Namibia and US$7.04 million in Rwanda (or < US$0.75 per capita in both countries). Adult testing and counselling accounted for the highest proportions of the national costs (37% and 74% in Namibia and Rwanda, respectively), followed by management and supervision. Treatment and prophylaxis accounted for less than 20% of the costs of PMTCT in both study countries. The costs involved in the PMTCT of HIV varied widely between study countries and in accordance with the protocols used. However, since per-capita costs were relatively low, the scaling up of PMTCT services in Namibia and Rwanda should be possible.

Male partners' involvement in prevention of mother-to-child HIV transmission in sub-Saharan Africa: A systematic review.

PubMed

Manjate Cuco, Rosa Marlene; Munguambe, Khátia; Bique Osman, Nafissa; Degomme, Olivier; Temmerman, Marleen; Sidat, Mohsin M

2015-01-01

In sub-Saharan Africa (SSA), male partners are rarely present during prevention of mother-to-child transmission (PMTCT) services. This systematic review aims to synthesize, from a male perspective, male partners' perceived roles, barriers and enablers of their involvement in PMTCT, and highlights persisting gaps. We carried out a systematic search of papers published between 2002 and 2013 in English on Google Scholar and PubMed using the following terms: men, male partners, husbands, couples, involvement, participation, Antenatal Care (ANC), PMTCT, SSA countries, HIV Voluntary Counseling and Testing and disclosure. A total of 28 qualitative and quantitative original studies from 10 SSA countries were included. Men's perceived role was addressed in 28% (8/28) of the studies. Their role to provide money for ANC/PMTCT fees was stated in 62.5% (5/8) of the studies. For other men, the financial responsibilities seemed to be used as an excuse for not participating. Barriers were cited in 85.7% (24/28) of the studies and included socioeconomic factors, gender role, cultural beliefs, male unfriendly ANC/PMTCT services and providers' abusive attitudes toward men. About 64% (18/28) of the studies reported enablers such as: older age, higher education, being employed, trustful monogamous marriages and providers' politeness. In conclusion, comprehensive PMTCT policies that are socially and culturally sensitive to both women and men need to be developed.

To what extent could performance-based schemes help increase the effectiveness of prevention of mother-to-child transmission of HIV (PMTCT) programs in resource-limited settings? a summary of the published evidence

PubMed Central

2010-01-01

Background In resource-limited settings, HIV/AIDS remains a serious threat to the social and physical well-being of women of childbearing age, pregnant women, mothers and infants. Discussion In sub-Saharan African countries with high prevalence rates, pediatric HIV/AIDS acquired through mother-to-child transmission (MTCT) can in largely be prevented by using well-established biomedical interventions. Logistical and socio-cultural barriers continue, however, to undermine the successful prevention of MTCT (PMTCT). In this paper, we review reports on maternal, neonatal and child health, as well as HIV care and treatment services that look at program incentives. Summary These studies suggest that comprehensive PMTCT strategies aiming to maximize health-worker motivation in developing countries must involve a mix of both financial and non-financial incentives. The establishment of robust ethical and regulatory standards in public-sector HIV care centers could reduce barriers to PMTCT service provision in sub-Saharan Africa and help them in achieving universal PMTCT targets. PMID:21080926

The effect of an interactive weekly mobile phone messaging on retention in prevention of mother to child transmission (PMTCT) of HIV program: study protocol for a randomized controlled trial (WELTEL PMTCT).

PubMed

Awiti, Patricia Opondo; Grotta, Alessandra; van der Kop, Mia; Dusabe, John; Thorson, Anna; Mwangi, Jonathan; Belloco, Rino; Lester, Richard; Ternent, Laura; Were, Edwin; Ekström, Anna Mia

2016-07-11

Improving retention in prevention of mother to child transmission (PMTCT) of HIV programs is critical to optimize maternal and infant health outcomes, especially now that lifelong treatment is immediate regardless of CD4 cell count). The WelTel strategy of using weekly short message service (SMS) to engage patients in care in Kenya, where mobile coverage even in poor areas is widespread has been shown to improve adherence to antiretroviral therapy (ART) and viral load suppression among those on ART. The aim of this study is to determine the effect of the WelTel SMS intervention compared to standard care on retention in PMTCT program in Kenya. WelTel PMTCT is a four to seven-centers, two-arm open randomized controlled trial (RCT) that will be conducted in urban and rural Kenya. Over 36 months, we plan to recruit 600 pregnant women at their first antenatal care visit and follow the mother-infant pair until they are discharged from the PMTCT program (when infant is aged 24 months). Participants will be randomly allocated to the intervention or control arm (standard care) at a 1:1 ratio. Intervention arm participants will receive an interactive weekly SMS 'How are you?' to which they are supposed to respond within 24 h. Depending on the response (ok, problem or no answer), a PMTCT nurse will follow-up and triage any problems that are identified. The primary outcome will be retention in care defined as the proportion of mother-infant pairs coming for infant HIV testing at 24 months from delivery. Secondary outcomes include a) adherence to WelTel; (b) adherence to antiretroviral medicine; (c) acceptance of WelTel and (d) cost-effectiveness of the WelTel intervention. This trial will provide evidence on the effectiveness of mHealth for PMTCT retention. Trial results and the cost-effectiveness evaluation will be used to inform policy and potential scale-up of mHealth among mothers living with HIV. ISRCTN98818734 ; registered on 9th December 2014.

Barriers to uptake of prevention of mother-to-child transmission of HIV services among mothers of vertically infected HIV-seropositive infants in Makurdi, Nigeria

PubMed Central

Anígilájé, Emmanuel Ademola; Ageda, Bem Ruben; Nweke, Nnamdi Okechukwu

2016-01-01

Background Perinatal transmission of human immunodeficiency virus (HIV) continues in Nigeria because of the poor use of prevention of mother-to-child transmission of HIV (PMTCT) services. This study reports on the barriers preventing mothers of vertically infected HIV-seropositive infants to use the PMTCT services at the Federal Medical Centre, Makurdi, Nigeria. Methods This is a descriptive study conducted between January and April, 2014. A quantitative survey was applied to detect barriers along the PMTCT services cascade among 52 mothers of vertically infected HIV-seropositive infants. This includes 22 women who attended antenatal care at the Federal Medical Centre (designated as Group A mothers) and 30 women who did not receive any form of PMTCT service (Group B mothers). The study was supplemented with a focused group discussion involving 12 discussants from the two groups. Results In the quantitative assessment: among the Group A mothers, falling asleep was the most common reason (n=22, 100%) for missing therapeutic/prophylactic antiretroviral medicine; financial constraint (n=22, 100%) was the most common reason for antenatal care visit defaults; and a lot of the mothers (n=11, 50.0%) did not give nevirapine to their newborns because they delivered at home. Among Group B mothers, unawareness of HIV-seropositive status was the most common reason (n=28, 93.3%) given for not accessing PMTCT services. In the qualitative study: noninvolvement of male partners, stigma and discrimination experienced by HIV-seropositive mothers, financial constraints in couples, involvement of traditional birth attendants in antenatal care and delivery of HIV-infected women, unawareness of HIV-seropositive status by pregnant women, poor health system, and the lack of funding for PMTCT services at private and rural health facilities were the major barriers preventing the use of PMTCT services. Conclusion In order to reduce the missed opportunities for PMTCT interventions in Makurdi and by extension the Benue State it represents in Nigeria, strong political and financial commitments are needed to overcome the identified barriers. PMID:26869770

"If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing": The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda.

PubMed

Flax, Valerie L; Yourkavitch, Jennifer; Okello, Elialilia S; Kadzandira, John; Katahoire, Anne Ruhweza; Munthali, Alister C

2017-01-01

The role of gender in prevention of mother-to-child transmission (PMTCT) participation under Option B+ has not been adequately studied, but it is critical for reducing losses to follow-up. This study used qualitative methods to examine the interplay of gender and individual, interpersonal, health system, and community factors that contribute to PMTCT participation in Malawi and Uganda. We conducted in-depth interviews with women in PMTCT, women lost to follow-up, government health workers, and stakeholders at organizations supporting PMTCT as well as focus group discussions with men. We analyzed the data using thematic content analysis. We found many similarities in key themes across respondent groups and between the two countries. The main facilitators of PMTCT participation were knowledge of the health benefits of ART, social support, and self-efficacy. The main barriers were fear of HIV disclosure and stigma and lack of social support, male involvement, self-efficacy, and agency. Under Option B+, women learn about their HIV status and start lifelong ART on the same day, before they have a chance to talk to their husbands or families. Respondents explained that very few husbands accompanied their wives to the clinic, because they felt it was a female space and were worried that others would think their wives were controlling them. Many respondents said women fear disclosing, because they fear HIV stigma as well as the risk of divorce and loss of economic support. If women do not disclose, it is difficult for them to participate in PMTCT in secret. If they do disclose, they must abide by their husbands' decisions about their PMTCT participation, and some husbands are unsupportive or actively discouraging. To improve PMTCT participation, Ministries of Health should use evidence-based strategies to address HIV stigma, challenges related to disclosure, insufficient social support and male involvement, and underlying gender inequality.

The prevention of mother-to-child transmission of HIV cascade analysis tool: supporting health managers to improve facility-level service delivery.

PubMed

Gimbel, Sarah; Voss, Joachim; Mercer, Mary Anne; Zierler, Brenda; Gloyd, Stephen; Coutinho, Maria de Joana; Floriano, Florencia; Cuembelo, Maria de Fatima; Einberg, Jennifer; Sherr, Kenneth

2014-10-21

The objective of the prevention of Mother-to-Child Transmission (pMTCT) cascade analysis tool is to provide frontline health managers at the facility level with the means to rapidly, independently and quantitatively track patient flows through the pMTCT cascade, and readily identify priority areas for clinic-level improvement interventions. Over a period of six months, five experienced maternal-child health managers and researchers iteratively adapted and tested this systems analysis tool for pMTCT services. They prioritized components of the pMTCT cascade for inclusion, disseminated multiple versions to 27 health managers and piloted it in five facilities. Process mapping techniques were used to chart PMTCT cascade steps in these five facilities, to document antenatal care attendance, HIV testing and counseling, provision of prophylactic anti-retrovirals, safe delivery, safe infant feeding, infant follow-up including HIV testing, and family planning, in order to obtain site-specific knowledge of service delivery. Seven pMTCT cascade steps were included in the Excel-based final tool. Prevalence calculations were incorporated as sub-headings under relevant steps. Cells not requiring data inputs were locked, wording was simplified and stepwise drop-offs and maximization functions were included at key steps along the cascade. While the drop off function allows health workers to rapidly assess how many patients were lost at each step, the maximization function details the additional people served if only one step improves to 100% capacity while others stay constant. Our experience suggests that adaptation of a cascade analysis tool for facility-level pMTCT services is feasible and appropriate as a starting point for discussions of where to implement improvement strategies. The resulting tool facilitates the engagement of frontline health workers and managers who fill out, interpret, apply the tool, and then follow up with quality improvement activities. Research on adoption, interpretation, and sustainability of this pMTCT cascade analysis tool by frontline health managers is needed. ClinicalTrials.gov NCT02023658, December 9, 2013.

“If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing”: The influence of gender on Option B+ prevention of mother-to-child transmission participation in Malawi and Uganda

PubMed Central

Flax, Valerie L.; Yourkavitch, Jennifer; Okello, Elialilia S.; Kadzandira, John; Katahoire, Anne Ruhweza; Munthali, Alister C.

2017-01-01

The role of gender in prevention of mother-to-child transmission (PMTCT) participation under Option B+ has not been adequately studied, but it is critical for reducing losses to follow-up. This study used qualitative methods to examine the interplay of gender and individual, interpersonal, health system, and community factors that contribute to PMTCT participation in Malawi and Uganda. We conducted in-depth interviews with women in PMTCT, women lost to follow-up, government health workers, and stakeholders at organizations supporting PMTCT as well as focus group discussions with men. We analyzed the data using thematic content analysis. We found many similarities in key themes across respondent groups and between the two countries. The main facilitators of PMTCT participation were knowledge of the health benefits of ART, social support, and self-efficacy. The main barriers were fear of HIV disclosure and stigma and lack of social support, male involvement, self-efficacy, and agency. Under Option B+, women learn about their HIV status and start lifelong ART on the same day, before they have a chance to talk to their husbands or families. Respondents explained that very few husbands accompanied their wives to the clinic, because they felt it was a female space and were worried that others would think their wives were controlling them. Many respondents said women fear disclosing, because they fear HIV stigma as well as the risk of divorce and loss of economic support. If women do not disclose, it is difficult for them to participate in PMTCT in secret. If they do disclose, they must abide by their husbands’ decisions about their PMTCT participation, and some husbands are unsupportive or actively discouraging. To improve PMTCT participation, Ministries of Health should use evidence-based strategies to address HIV stigma, challenges related to disclosure, insufficient social support and male involvement, and underlying gender inequality. PMID:28594842

The Tingathe programme: a pilot intervention using community health workers to create a continuum of care in the prevention of mother to child transmission of HIV (PMTCT) cascade of services in Malawi

PubMed Central

Kim, Maria H; Ahmed, Saeed; Buck, W Chris; Preidis, Geoffrey A; Hosseinipour, Mina C; Bhalakia, Avni; Nanthuru, Debora; Kazembe, Peter N; Chimbwandira, Frank; Giordano, Thomas P; Chiao, Elizabeth Y; Schutze, Gordon E; Kline, Mark W

2012-01-01

Introduction Loss to follow-up is a major challenge in the prevention of mother to child transmission of HIV (PMTCT) programme in Malawi with reported loss to follow-up of greater than 70%. Tingathe-PMTCT is a pilot intervention that utilizes dedicated community health workers (CHWs) to create a complete continuum of care within the PMTCT cascade, improving service utilization and retention of mothers and infants. We describe the impact of the intervention on longitudinal care starting with diagnosis of the mother at antenatal care (ANC) through final diagnosis of the infant. Methods PMTCT service utilization, programme retention and outcomes were evaluated for pregnant women living with HIV and their exposed infants enrolled in the Tingathe-PMTCT programme between March 2009 and March 2011. Multivariate logistic regression was done to evaluate maternal factors associated with failure to complete the cascade. Results Over 24 months, 1688 pregnant women living with HIV were enrolled. Median maternal age was 27 years (IQR, 23.8 to 30.8); 333 (19.7%) were already on ART. Among the remaining women, 1328/1355 (98%) received a CD4 test, with 1243/1328 (93.6%) receiving results. Of the 499 eligible for ART, 363 (72.8%) were successfully initiated. Prior to, delivery there were 93 (5.7%) maternal/foetal deaths, 137 (8.1%) women transferred/moved, 51 (3.0%) were lost and 58 (3.4%) refused ongoing PMTCT services. Of the 1318 live births to date, 1264 (95.9%) of the mothers and 1285 (97.5%) of the infants received ARV prophylaxis; 1064 (80.7%) infants were tested for HIV by PCR and started on cotrimoxazole. Median age at PCR was 1.7 months (IQR, 1.5 to 2.5). Overall transmission at first PCR was 43/1047 (4.1%). Of the 43 infants with positive PCR results, 36 (83.7%) were enrolled in ART clinic and 33 (76.7%) were initiated on ART. Conclusions Case management and support by dedicated CHWs can create a continuum of longitudinal care in the PMTCT cascade and result in improved outcomes. PMID:22789644

Expanding contraceptive options for PMTCT clients: a mixed methods implementation study in Cape Town, South Africa

PubMed Central

2014-01-01

Background Clients of prevention of mother-to-child transmission (PMTCT) services in South Africa who use contraception following childbirth rely primarily on short-acting methods like condoms, pills, and injectables, even when they desire no future pregnancies. Evidence is needed on strategies for expanding contraceptive options for postpartum PMTCT clients to include long-acting and permanent methods. Methods We examined the process of expanding contraceptive options in five health centers in Cape Town providing services to HIV-positive women. Maternal/child health service providers received training and coaching to strengthen contraceptive counseling for postpartum women, including PMTCT clients. Training and supplies were introduced to strengthen intrauterine device (IUD) services, and referral mechanisms for female sterilization were reinforced. We conducted interviews with separate samples of postpartum PMTCT clients (265 pre-intervention and 266 post-intervention) to assess knowledge and behaviors regarding postpartum contraception. The process of implementing the intervention was evaluated through systematic documentation and interpretation using an intervention tracking tool. In-depth interviews with providers who participated in study-sponsored training were conducted to assess their attitudes toward and experiences with promoting voluntary contraceptive services to HIV-positive clients. Results Following the intervention, 6% of interviewed PMTCT clients had the desired knowledge about the IUD and 23% had the desired knowledge about female sterilization. At both pre- and post-intervention, 7% of clients were sterilized and IUD use was negligible; by comparison, 75% of clients used injectables. Intervention tracking and in-depth interviews with providers revealed intervention shortcomings and health system constraints explaining the failure to produce intended effects. Conclusions The intervention failed to improve PMTCT clients’ knowledge about the IUD and sterilization or to increase use of those methods. To address the family planning needs of postpartum PMTCT clients in a way that is consistent with their fertility desires, services must expand the range of contraceptive options to include long-acting and permanent methods. In turn, to ensure consistent access to high quality family planning services that are effectively linked to HIV services, attention must also be focused on resolving underlying health system constraints weakening health service delivery more generally. PMID:24410922

Intimate partner violence and HIV-positive women's non-adherence to antiretroviral medication for the purpose of prevention of mother-to-child transmission in Lusaka, Zambia.

PubMed

Hampanda, Karen M

2016-03-01

Prevention of mother-to-child transmission (PMTCT) depends critically on HIV-positive women's adherence to antiretroviral drugs during and after pregnancy. Adherence among pregnant and breastfeeding women remains a challenge across sub-Saharan Africa. Power dynamics within couples, such as intimate partner violence, has largely been neglected in research regarding PMTCT adherence. This study aims to determine if there is a relationship between intimate partner violence and non-adherence to PMTCT. In 2014, using a verbally administered cross-sectional survey at a large public health clinic in Lusaka, Zambia, 320 HIV-positive postpartum women, who were currently married or living with a man, provided information on their drug adherence during and after pregnancy, as well as relationship dynamics. Adherence was defined as the woman reporting she took or gave to the infant at least 80% of prescribed medication doses. Experiencing intimate partner violence was associated with decreased odds of adherence to PMTCT during and after pregnancy. Different forms of violence affected PMTCT adherence differentially. Physical violence had a less pronounced effect on non-adherence than emotional and sexual violence. A dose-response relationship between intimate partner violence and non-adherence was also observed. Intimate partner violence is associated with non-adherence to PMTCT during and after pregnancy, which deserves increased attention in the effort to eliminate mother-to-child transmission of HIV. Copyright © 2016 Elsevier Ltd. All rights reserved.

Shame, Guilt, and Stress: Community Perceptions of Barriers to Engaging in Prevention of Mother to Child Transmission (PMTCT) Programs in Western Kenya

PubMed Central

Ondenge, Kenneth; Mills, Lisa A.; Okanda, John; Kinuthia, John; Olilo, George; Odhiambo, Frank; Laserson, Kayla F.; Zierler, Brenda; Voss, Joachim; John-Stewart, Grace

2014-01-01

Abstract While global scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has been expansive, only half of HIV-infected pregnant women receive antiretroviral regimens for PMTCT in sub-Saharan Africa. To evaluate social factors influencing uptake of PMTCT in rural Kenya, we conducted a community-based, cross-sectional survey of mothers residing in the KEMRI/CDC Health and Demographic Surveillance System (HDSS) area. Factors included referrals and acceptability, HIV-related stigma, observed discrimination, and knowledge of violence. Chi-squared tests and multivariate regression analyses were used to detect stigma domains associated with uptake of PMTCT services. Most HIV-positive women (89%) reported blame or judgment of people with HIV, and 46% reported they would feel shame if they were associated with someone with HIV. In multivariate analyses, shame was significantly associated with decreased likelihood of maternal HIV testing (Prevalence Ratio 0.91, 95% Confidence Interval 0.84–0.99), a complete course of maternal antiretrovirals (ARVs) (PR 0.73, 95% CI 0.55–0.97), and infant HIV testing (PR 0.86, 95% CI 0.75–0.99). Community perceptions of why women may be unwilling to take ARVs included stigma, guilt, lack of knowledge, denial, stress, and despair or futility. Interventions that seek to decrease maternal depression and internalization of stigma may facilitate uptake of PMTCT. PMID:25361205

A cluster randomized controlled trial of lay health worker support for prevention of mother to child transmission of HIV (PMTCT) in South Africa.

PubMed

Peltzer, Karl; Weiss, Stephen M; Soni, Manasi; Lee, Tae Kyoung; Rodriguez, Violeta J; Cook, Ryan; Alcaide, Maria Luisa; Setswe, Geoffrey; Jones, Deborah L

2017-12-16

We evaluate the impact of clinic-based PMTCT community support by trained lay health workers in addition to standard clinical care on PMTCT infant outcomes. In a cluster randomized controlled trial, twelve community health centers (CHCs) in Mpumalanga Province, South Africa, were randomized to have pregnant women living with HIV receive either: a standard care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; n  = 357), or an enhanced intervention (EI) condition of SC PMTCT plus the "Protect Your Family" intervention (EI; 6 CHCs; n  = 342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions and those in the EI, four antenatal and two postnatal PMTCT plus "Protect Your Family" sessions led by trained lay health workers. Maternal PMTCT and HIV knowledge were assessed. Infant HIV status at 6 weeks postnatal was drawn from clinic PCR records; at 12 months, HIV status was assessed by study administered DNA PCR. Maternal adherence was assessed by dried blood spot at 32 weeks, and infant adherence was assessed by maternal report at 6 weeks. The impact of the EI was ascertained on primary outcomes (infant HIV status at 6 weeks and 12 months and ART adherence for mothers and infants), and secondary outcomes (HIV and PMTCT knowledge and HIV transmission related behaviours). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention on study outcomes. In all, 699 women living with HIV were recruited during pregnancy (8-24 weeks), and assessments were completed at baseline, at 32 weeks pregnant (61.7%), and at 6 weeks (47.6%), 6 months (50.6%) and 12 months (59.5%) postnatally. Infants were tested for HIV at 6 weeks and 12 months, 73.5% living infants were tested at 6 weeks and 56.7% at 12 months. There were no significant differences between SC and EI on infant HIV status at 6 weeks and at 12 months, and no differences in maternal adherence at 32 weeks, reported infant adherence at 6 weeks, or PMTCT and HIV knowledge by study condition over time. The enhanced intervention administered by trained lay health workers did not have any salutary impact on HIV infant status, ART adherence, HIV and PMTCT knowledge. Trial registration clinicaltrials.gov: number NCT02085356.

Can Disease-Specific Funding Harm Health? in the Shadow of HIV/AIDS Service Expansion.

PubMed

Wilson, Nicholas

2015-10-01

This article examines the effect of introducing a new HIV/AIDS service-prevention of mother-to-child transmission of HIV (PMTCT)-on overall quality of prenatal and postnatal care. My results suggest that local PMTCT introduction in Zambia may have actually increased all-cause child mortality in the short term. There is some evidence that vaccinations may have declined in the short term in association with local PMTCT introduction, suggesting that the new service may have partly crowded out existing pediatric health services.

Barriers to men's participation in antenatal and prevention of mother-to-child HIV transmission care in Cameroon, Africa.

PubMed

Nkuoh, Godlove N; Meyer, Dorothy J; Tih, Pius M; Nkfusai, Joseph

2010-01-01

Men's role in HIV prevention is pivotal to changing the course of the epidemic. When men participate in Prevention of Mother-to-Child Transmission (PMTCT) programs, their knowledge of HIV increases, their behavior becomes supportive, and their receptiveness to HIV testing increases. In Cameroon, Africa, multiple efforts have been implemented that encourage men to "follow" their wives to obstetric/PMTCT care and to undergo HIV testing. However, only 18% of men have participated in this care. As a quality improvement initiative, a survey was administered to identify men's knowledge and attitudes regarding antenatal care (ANC), PMTCT, and HIV. The survey consisted of a questionnaire with an emphasis on identifying barriers to men's participation in PMTCT programs and obtaining HIV testing. A convenience sampling method was used, and no participant identifying information was collected. Men's participation in ANC/PMTCT is affected by sociocultural barriers centered in tribal beliefs and traditional gender roles. The barriers identified included the belief that pregnancy is a "woman's affair"; the belief that a man's role is primarily to provide financial support for the woman's care; the man's perception that he will be viewed as jealous by the community if he comes to clinic with his pregnant wife; and cultural gender-based patterns of communication. Most men consider accompanying their wife to ANC/PMTCT a good practice. Yet fewer men actually do this, because they feel that the provision of finance for ANC registration and delivery fees is their most important role in supporting their wife's pregnancy. Health care workers should encourage individuals and community leaders to build upon the traditional value of financial responsibility, expanding a man's involvement to include supportive social roles in obstetric care, PMTCT, and HIV testing. Copyright 2010 American College of Nurse-Midwives. Published by Elsevier Inc. All rights reserved.

The Achilles' heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability.

PubMed

Rodriguez, Violeta J; LaCabe, Richard P; Privette, C Kyle; Douglass, K Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo Willy; Horigian, Viviana; Weiss, Stephen M; Jones, Deborah L

2017-12-01

The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff-patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention.

A bird's eye view of PMTCT coverage at two regional hospitals and their referral clinics in a resource-limited setting.

PubMed

Moodley, Dhayendre; Srikewal, Jyothi; Msweli, Lindiwe; Maharaj, Niren R

2011-02-01

While countries strengthen their health information systems, local health managers require alternative strategies to monitor their prevention of mother-to-child transmission (PMTCT) programmes to improve coverage and service delivery. To demonstrate the use of a postpartum audit to establish PMTCT coverage and programme deficiencies at hospitals and multiple primary health care facilities. A cross-sectional hospital-based medical chart audit of pregnant women admitted in labour to their regional hospital. Their antenatal hand-held medical records were added to a hospital-issued maternity chart that was used to record further obstetric and perinatal management during their hospital stay. Women recuperating in the postnatal wards up to 48 hours after delivery at two hospitals in KwaZulu-Natal participated. Data included their antenatal attendance, access to HIV counselling and testing (HCT), and access to nevirapine (NVP) for PMTCT. Fifty-three clinics were indirectly evaluated as a result of the postpartum audit. All clinics provided HCT and the average HIV testing rate was 91% (range 40 - 100); 15% (N = 8) of these clinics with HIV testing rates of < 80% were identified. The median frequency of NVP dispensing at 53 clinics was 87% (interquartile range 67 - 100); among these 30% (N = 16) with NVP dispensing frequencies of < 80% were identified. An exit survey by trained nurses at a maternity hospital can provide health services management with a quick estimate of antenatal and PMTCT coverage of multiple primary health facilities in a specified catchment area. Challenges in the PMTCT programme at primary health clinic and hospital levels were highlighted.

HIV disclosure to partners and family among women enrolled in prevention of mother to child transmission of HIV program: implications for infant feeding in poor resourced communities in South Africa.

PubMed

Madiba, Sphiwe; Letsoalo, Rosemary

2013-03-07

The introduction of routine HIV counselling and testing (HCT) has increased the number of pregnant women being tested and receiving prevention of mother to child transmission of HIV (PMTCT) interventions in South Africa. While many women may enroll in PMTCT, there are barriers that hinder the success of PMTCT programmes. The success of the PMTCT is dependent on the optimal utilization of PMTCT interventions which require the support of the woman's partner, and other members of her family. We conducted focus groups interviews with 25 HIV-positive post-natal women enrolled in PMTCT, in the City of Tshwane, South Africa. The study explored HIV-positive status disclosure to partners and significant family members and assessed the effect of nondisclosure on exclusive infant feeding. Most women disclosed to partners while few disclosed to significant family members. Most women initiated mixed feeding practices as early as one month and reported that they were pressurized by the family to mix feed. Mixed feeding was common among women who had not disclosed their HIV-positive status to families, and women who had limited understanding of mother to child transmission of HIV. Women who disclosed to partners and family were supported to adhere to the feeding option of choice. Health providers have a critical role to play in developing interventions to support HIV pregnant women to disclose in order to avoid mixed feeding. Improving the quality of information provided to HIV-positive pregnant women during counselling will also reduce mixed feeding.

Assessing missed opportunities for the prevention of mother-to-child HIV transmission in an Eastern Cape local service area.

PubMed

Rispel, L C; Peltzer, K; Phaswana-Mafuya, N; Metcalf, C A; Treger, L

2009-03-01

Prevention of new HIV infections is a critical imperative for South Africa; the prevention of mother-to-child transmission (PMTCT) is one of the most efficacious HIV prevention interventions. Assessment of a PMTCT programme to determine missed opportunities. The Kouga local service area (LSA), bordering Nelson Mandela Bay Municipality (Port Elizabeth) in the Eastern Cape. An assessment was conducted in 2007 before implementing technical support for strengthening the PMTCT programme, including: interviews with 20 PMTCT managers, 4 maternity staff and 27 other health workers on service provision, management, infrastructure, human resources and the health information system; 296 antenatal clinic users on their service perceptions; 70 HIV-positive women on HIV knowledge, infant feeding, coping, support and service perceptions; 8 representatives from community organisations and 101 traditional health practitioners (THPs). Observations were conducted during site visits to health facilities, and the District Health Information System (DHIS) data were reviewed. Staff had high levels of awareness of HIV policies and most had received some relevant training. Nevirapine uptake varied by clinic, with an average of 56%. There were many missed opportunities for PMTCT, with 67% of pregnant women tested for HIV and only 43% of antenatal care attendees tested during a previous pregnancy. Only 6% of HIV-positive women reported support group participation. Reducing missed opportunities for PMTCT requires strengthening of the formal health sector, intersectoral liaison, and greater community support. Priority areas that require strengthening in the formal health sector include HIV counselling and testing; family planning and nutrition counselling; infant follow-up; human resources; and monitoring and evaluation.

HIV Disclosure to Partners and Family among Women Enrolled in Prevention of Mother to Child Transmission of HIV Program: Implications for Infant Feeding in Poor Resourced Communities in South Africa

PubMed Central

Madiba, Sphiwe; Letsoalo, Rosemary

2013-01-01

The introduction of routine HIV counselling and testing (HCT) has increased the number of pregnant women being tested and receiving prevention of mother to child transmission of HIV (PMTCT) interventions in South Africa. While many women may enroll in PMTCT, there are barriers that hinder the success of PMTCT programmes. The success of the PMTCT is dependent on the optimal utilization of PMTCT interventions which require the support of the woman's partner, and other members of her family. We conducted focus groups interviews with 25 HIV-positive post-natal women enrolled in PMTCT, in the City of Tshwane, South Africa. The study explored HIV-positive status disclosure to partners and significant family members and assessed the effect of nondisclosure on exclusive infant feeding. Most women disclosed to partners while few disclosed to significant family members. Most women initiated mixed feeding practices as early as one month and reported that they were pressurized by the family to mix feed. Mixed feeding was common among women who had not disclosed their HIV-positive status to families, and women who had limited understanding of mother to child transmission of HIV. Women who disclosed to partners and family were supported to adhere to the feeding option of choice. Health providers have a critical role to play in developing interventions to support HIV pregnant women to disclose in order to avoid mixed feeding. Improving the quality of information provided to HIV-positive pregnant women during counselling will also reduce mixed feeding. PMID:23777716

Male involvement and prevention of mother-to-child transmission of HIV in Sub-Saharan Africa: an integrative review.

PubMed

Auvinen, Jaana; Kylmä, Jari; Suominen, Tarja

2013-03-01

The purpose of the study was to describe male involvement in programmes for preventing mother-tochild transmission (PMTCT) in Sub-Saharan Africa. The study questions guiding this review were: how are male partners involved in PMTCT programmes in Sub-Saharan Africa and what are the strategies for improvement of male involvement? An integrative review was conducted based on the data retrieved from the PubMed MEDLINE database. In all, 18 articles were included in this review. Qualitative content analysis was used as a method of data synthesis. Based on the findings of this review, some studies suggested that men had positive attitudes towards PMTCT programmes. However, also barriers to male involvement were identified. These barriers included negative attitude, lack of resources, fear of human immunodeficiency virus (HIV) test result, marital difficulties, problems with health care services and cultural barriers. Accepting HIV testing was associated with factors related to both wife and husband. Strategies for improving male involvement included ones that focus on men's and their wives' resources (sensitizing men about antenatal care (ANC) and PMTCT, focusing on the conjugal context and couples counselling), the development of health care services (tailoring the services to male needs, taking care of health care staff's resources, developing health care strategies) and the community (educating the community, testing, safer infant feeding). We should highlight the male participation in PMTCT programmes. However, more research is needed in order to evaluate their impact on PMTCT, as well as on broader family health outcomes.

The Achilles’ heel of prevention to mother-to-child transmission of HIV: Protocol implementation, uptake, and sustainability

PubMed Central

Rodriguez, Violeta J.; LaCabe, Richard P.; Privette, C. Kyle; Douglass, K. Marie; Peltzer, Karl; Matseke, Gladys; Mathebula, Audrey; Ramlagan, Shandir; Sifunda, Sibusiso; Prado, Guillermo “Willy”; Horigian, Viviana; Weiss, Stephen M.; Jones, Deborah L.

2017-01-01

Abstract The Joint United Nations Programme on HIV and AIDS proposed to reduce the vertical transmission of HIV from ∼72,200 to ∼8300 newly infected children by 2015 in South Africa (SA). However, cultural, infrastructural, and socio-economic barriers hinder the implementation of the prevention of mother-to-child transmission (PMTCT) protocol, and research on potential solutions to address these barriers in rural areas is particularly limited. This study sought to identify challenges and solutions to the implementation, uptake, and sustainability of the PMTCT protocol in rural SA. Forty-eight qualitative interviews, 12 focus groups discussions (n = 75), and one two-day workshop (n = 32 participants) were conducted with district directors, clinic leaders, staff, and patients from 12 rural clinics. The delivery and uptake of the PMTCT protocol was evaluated using the Consolidated Framework for Implementation Research (CFIR); 15 themes associated with challenges and solutions emerged. Intervention characteristics themes included PMTCT training and HIV serostatus disclosure. Outer-setting themes included facility space, health record management, and staff shortage; inner-setting themes included supply use and availability, staff–patient relationship, and transportation and scheduling. Themes related to characteristics of individuals included staff relationships, initial antenatal care visit, adherence, and culture and stigma. Implementation process themes included patient education, test results delivery, and male involvement. Significant gaps in care were identified in rural areas. Information obtained from participants using the CFIR framework provided valuable insights into solutions to barriers to PMTCT implementation. Continuously assessing and correcting PMTCT protocol implementation, uptake and sustainability appear merited to maximize HIV prevention. PMID:28922974

Effectiveness of a prevention of mother-to-child HIV transmission program in Guangdong province from 2007 to 2010

PubMed Central

2013-01-01

Background To achieve the goal of United Nations of elimination of new HIV infections, a program of prevention of mother-to-child transmission (PMTCT) was launched in Guangdong province. The objective of this study is to evaluate the effectiveness of the PMTCT program. Methods The retrospective cross-section analysis was conducted using the data of case reported cards of HIV positive mothers and their infants from 2007 to 2010 in Guangdong province, and 108 pairs of eligible subjects were obtained. We described the data and compared the rates of MTCT by various PMTCT interventions respectively. Results The overall rate of HIV MTCT was 13.89% (15) among 108 pairs of HIV positive mothers and their infants; 60.19% (65) of the mothers ever received ARVs, 80.56% (87) of infants born to HIV positive mothers ever received ARVs, but 16.67% (18) of the mothers and infants neither received ARVs. Among all the mothers and infants, who both received ARVs, received triple ARVs, mother received ARVs during pregnancy, and both received ARVs and formula feeding showed the lower rates of HIV MTCT, and the rates were 8.06%, 2.50%, 5.77%, and 6.67% respectively. In infants born to HIV positive mother, who received mixed feeding had a higher HIV MTCT up to 60.00%. Delivery mode might not relative to HIV MTCT. Conclusions The interventions of PMTCT program in Guangdong could effectively reduce the rate of HIV MTCT, but the effectiveness of the PMTCT program were heavily cut down by the lower availability of the PMTCT interventions. PMID:23773623

Is endemic political corruption hampering provision of ART and PMTCT in developing countries?

PubMed

Young Nicola Man, Wing; Worth, Heather; Kelly, Angela; Wilson, David P; Siba, Peter

2014-01-01

Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic. The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries. This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses. Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage. Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies.

Is endemic political corruption hampering provision of ART and PMTCT in developing countries?

PubMed Central

Man, Wing Young Nicola; Worth, Heather; Kelly, Angela; Wilson, David P; Siba, Peter

2014-01-01

Introduction Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic. Aim The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries. Methods This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses. Results Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage. Conclusions Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies. PMID:24802716

Identifying factors associated with the uptake of prevention of mother to child HIV transmission programme in Tigray region, Ethiopia: a multilevel modeling approach.

PubMed

Lerebo, Wondwossen; Callens, Steven; Jackson, Debra; Zarowsky, Christina; Temmerman, Marleen

2014-04-23

Prevention of mother to child HIV transmission (PMTCT) remains a challenge in low and middle-income countries. Determinants of utilization occur--and often interact--at both individual and community levels, but most studies do not address how determinants interact across levels. Multilevel models allow for the importance of both groups and individuals in understanding health outcomes and provide one way to link the traditionally distinct ecological- and individual-level studies. This study examined individual and community level determinants of mother and child receiving PMTCT services in Tigray region, Ethiopia. A multistage probability sampling method was used for this 2011 cross-sectional study of 220 HIV positive post-partum women attending child immunization services at 50 health facilities in 46 districts. In view of the nested nature of the data, we used multilevel modeling methods and assessed macro level random effects. Seventy nine percent of mothers and 55.7% of their children had received PMTCT services. Multivariate multilevel modeling found that mothers who delivered at a health facility were 18 times (AOR = 18.21; 95% CI 4.37,75.91) and children born at a health facility were 5 times (AOR = 4.77; 95% CI 1.21,18.83) more likely to receive PMTCT services, compared to mothers delivering at home. For every addition of one nurse per 1500 people, the likelihood of getting PMTCT services for a mother increases by 7.22 fold (AOR = 7.22; 95% CI 1.02,51.26), when other individual and community level factors were controlled simultaneously. In addition, district-level variation was low for mothers receiving PMTCT services (0.6% between districts) but higher for children (27.2% variation between districts). This study, using a multilevel modeling approach, was able to identify factors operating at both individual and community levels that affect mothers and children getting PMTCT services. This may allow differentiating and accentuating approaches for different settings in Ethiopia. Increasing health facility delivery and HCT coverage could increase mother-child pairs who are getting PMTCT. Reducing the distance to health facility and increasing the number of nurses and laboratory technicians are also important variables to be considered by the government.

Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial

PubMed Central

2014-01-01

Background Despite significant increases in global health investment and the availability of low-cost, efficacious interventions to prevent mother-to-child HIV transmission (pMTCT) in low- and middle-income countries with high HIV burden, the translation of scientific advances into effective delivery strategies has been slow, uneven and incomplete. As a result, pediatric HIV infection remains largely uncontrolled. A five-step, facility-level systems analysis and improvement intervention (SAIA) was designed to maximize effectiveness of pMTCT service provision by improving understanding of inefficiencies (step one: cascade analysis), guiding identification and prioritization of low-cost workflow modifications (step two: value stream mapping), and iteratively testing and redesigning these modifications (steps three through five). This protocol describes the SAIA intervention and methods to evaluate the intervention’s impact on reducing drop-offs along the pMTCT cascade. Methods This study employs a two-arm, longitudinal cluster randomized trial design. The unit of randomization is the health facility. A total of 90 facilities were identified in Côte d’Ivoire, Kenya and Mozambique (30 per country). A subset was randomly selected and assigned to intervention and comparison arms, stratified by country and service volume, resulting in 18 intervention and 18 comparison facilities across all three countries, with six intervention and six comparison facilities per country. The SAIA intervention will be implemented for six months in the 18 intervention facilities. Primary trial outcomes are designed to assess improvements in the pMTCT service cascade, and include the percentage of pregnant women being tested for HIV at the first antenatal care visit, the percentage of HIV-infected pregnant women receiving adequate prophylaxis or combination antiretroviral therapy in pregnancy, and the percentage of newborns exposed to HIV in pregnancy receiving an HIV diagnosis eight weeks postpartum. The Consolidated Framework for Implementation Research (CFIR) will guide collection and analysis of qualitative data on implementation process. Discussion This study is a pragmatic trial that has the potential benefit of improving maternal and infant outcomes by reducing drop-offs along the pMTCT cascade. The SAIA intervention is designed to provide simple tools to guide decision-making for pMTCT program staff at the facility level, and to identify low cost, contextually appropriate pMTCT improvement strategies. Trial registration ClinicalTrials.gov NCT02023658 PMID:24885976

Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial.

PubMed

Sherr, Kenneth; Gimbel, Sarah; Rustagi, Alison; Nduati, Ruth; Cuembelo, Fatima; Farquhar, Carey; Wasserheit, Judith; Gloyd, Stephen

2014-05-08

Despite significant increases in global health investment and the availability of low-cost, efficacious interventions to prevent mother-to-child HIV transmission (pMTCT) in low- and middle-income countries with high HIV burden, the translation of scientific advances into effective delivery strategies has been slow, uneven and incomplete. As a result, pediatric HIV infection remains largely uncontrolled. A five-step, facility-level systems analysis and improvement intervention (SAIA) was designed to maximize effectiveness of pMTCT service provision by improving understanding of inefficiencies (step one: cascade analysis), guiding identification and prioritization of low-cost workflow modifications (step two: value stream mapping), and iteratively testing and redesigning these modifications (steps three through five). This protocol describes the SAIA intervention and methods to evaluate the intervention's impact on reducing drop-offs along the pMTCT cascade. This study employs a two-arm, longitudinal cluster randomized trial design. The unit of randomization is the health facility. A total of 90 facilities were identified in Côte d'Ivoire, Kenya and Mozambique (30 per country). A subset was randomly selected and assigned to intervention and comparison arms, stratified by country and service volume, resulting in 18 intervention and 18 comparison facilities across all three countries, with six intervention and six comparison facilities per country. The SAIA intervention will be implemented for six months in the 18 intervention facilities. Primary trial outcomes are designed to assess improvements in the pMTCT service cascade, and include the percentage of pregnant women being tested for HIV at the first antenatal care visit, the percentage of HIV-infected pregnant women receiving adequate prophylaxis or combination antiretroviral therapy in pregnancy, and the percentage of newborns exposed to HIV in pregnancy receiving an HIV diagnosis eight weeks postpartum. The Consolidated Framework for Implementation Research (CFIR) will guide collection and analysis of qualitative data on implementation process. This study is a pragmatic trial that has the potential benefit of improving maternal and infant outcomes by reducing drop-offs along the pMTCT cascade. The SAIA intervention is designed to provide simple tools to guide decision-making for pMTCT program staff at the facility level, and to identify low cost, contextually appropriate pMTCT improvement strategies. ClinicalTrials.gov NCT02023658.

HIV prevention costs and their predictors: evidence from the ORPHEA Project in Kenya

PubMed Central

Galárraga, Omar; Wamai, Richard G; Sosa-Rubí, Sandra G; Mugo, Mercy G; Contreras-Loya, David; Bautista-Arredondo, Sergio; Nyakundi, Helen; Wang’ombe, Joseph K

2017-01-01

Abstract We estimate costs and their predictors for three HIV prevention interventions in Kenya: HIV testing and counselling (HTC), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC). As part of the ‘Optimizing the Response of Prevention: HIV Efficiency in Africa’ (ORPHEA) project, we collected retrospective data from government and non-governmental health facilities for 2011–12. We used multi-stage sampling to determine a sample of health facilities by type, ownership, size and interventions offered totalling 144 sites in 78 health facilities in 33 districts across Kenya. Data sources included key informants, registers and time-motion observation methods. Total costs of production were computed using both quantity and unit price of each input. Average cost was estimated by dividing total cost per intervention by number of clients accessing the intervention. Multivariate regression methods were used to analyse predictors of log-transformed average costs. Average costs were $7 and $79 per HTC and PMTCT client tested, respectively; and $66 per VMMC procedure. Results show evidence of economies of scale for PMTCT and VMMC: increasing the number of clients per year by 100% was associated with cost reductions of 50% for PMTCT, and 45% for VMMC. Task shifting was associated with reduced costs for both PMTCT (59%) and VMMC (54%). Costs in hospitals were higher for PMTCT (56%) in comparison to non-hospitals. Facilities that performed testing based on risk factors as opposed to universal screening had higher HTC average costs (79%). Lower VMMC costs were associated with availability of male reproductive health services (59%) and presence of community advisory board (52%). Aside from increasing production scale, HIV prevention costs may be contained by using task shifting, non-hospital sites, service integration and community supervision. PMID:29029086

Luba-Kasai Men and the Prevention of Mother to Child Transmission (PMTCT) of HIV program in Lusaka.

PubMed

Auvinen, Jaana; Kylmä, Jari; Välimäki, Maritta; Bweupe, Max; Suominen, Tarja

2015-09-01

Male participation in the prevention of mother-to-child transmission (PMTCT) of HIV has been determined as one of the key factors in sub-Saharan African countries, but its realization is challenging because of male-related and institutional factors. The purpose of this study is two-fold: first, we explored the views of Luba-Kasai men, living in Zambia in the Lusaka Province, on the factors that encourage, inconvenience or inhibit them in accompanying their wives to the antenatal clinic and their ideas to improve their experience. Secondly, the study considered their knowledge of the PMTCT program and how such knowledge conformed to the Zambian National Protocol Guidelines Integrated PMTCT of HIV /: AIDS. Twenty-one interviews were analyzed using qualitative inductive content analysis. The National Protocol Guidelines Integrated PMTCT of HIV/AIDS were analyzed using the deductive content analysis. The encouraging factors that emerged were involvement in the program, the time of delivery, love and care, and also the suspicion of corruption. The inconveniencing factors were the arrangements and working culture of the clinic, together with stigma and guilt. A lack of motivation, fear of death, socioeconomic circumstances and again the arrangements and working culture at the clinic were held as inhibiting factors. The ideas to remove inconvenient factors were maintaining a spiritual outlook on life, education, interaction, a good mood and a sense of meaningfulness. Considering such male views and paying attention to minorities in the development of national PMTCT of HIV Programs may enhance male participation in the process. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

PubMed Central

Geldsetzer, Pascal; Yapa, H Manisha N; Vaikath, Maria; Ogbuoji, Osondu; Fox, Matthew P; Essajee, Shaffiq M; Negussie, Eyerusalem K; Bärnighausen, Till

2016-01-01

Introduction The World Health Organization recommends lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV. Effective transitioning from maternal and child health to ART services, and long-term retention in ART care postpartum is crucial to the successful implementation of lifelong ART for pregnant women. This systematic review aims to determine which interventions improve (1) retention within prevention of mother-to-child HIV transmission (PMTCT) programmes after birth, (2) transitioning from PMTCT to general ART programmes in the postpartum period, and (3) retention of postpartum women in general ART programmes. Methods We searched Medline, Embase, ISI Web of Knowledge, the regional World Health Organization databases and conference abstracts for data published between 2002 and 2015. The quality of all included studies was assessed using the GRADE criteria. Results and Discussion After screening 8324 records, we identified ten studies for inclusion in this review, all of which were from sub-Saharan Africa except for one from the United Kingdom. Two randomized trials found that phone calls and/or text messages improved early (six to ten weeks) postpartum retention in PMTCT. One cluster-randomized trial and three cohort studies found an inconsistent impact of different levels of integration between antenatal care/PMTCT and ART care on postpartum retention. The inconsistent results of the four identified studies on care integration are likely due to low study quality, and heterogeneity in intervention design and outcome measures. Several randomized trials on postpartum retention in HIV care are currently under way. Conclusions Overall, the evidence base for interventions to improve postpartum retention in HIV care is weak. Nevertheless, there is some evidence that phone-based interventions can improve retention in PMTCT in the first one to three months postpartum. PMID:27118443

High Prevalence of HIV Drug Resistance Among Newly Diagnosed Infants Aged <18 Months: Results From a Nationwide Surveillance in Nigeria.

PubMed

Inzaule, Seth C; Osi, Samuels J; Akinbiyi, Gbenga; Emeka, Asadu; Khamofu, Hadiza; Mpazanje, Rex; Ilesanmi, Oluwafunke; Ndembi, Nicaise; Odafe, Solomon; Sigaloff, Kim C E; Rinke de Wit, Tobias F; Akanmu, Sulaimon

2018-01-01

WHO recommends protease-inhibitor-based first-line regimen in infants because of risk of drug resistance from failed prophylaxis used in prevention of mother-to-child transmission (PMTCT). However, cost and logistics impede implementation in sub-Saharan Africa, and >75% of children still receive nonnucleoside reverse transcriptase inhibitor-based regimen (NNRTI) used in PMTCT. We assessed the national pretreatment drug resistance prevalence of HIV-infected children aged <18 months in Nigeria, using WHO-recommended HIV drug resistance surveillance protocol. We used remnant dried blood spots collected between June 2014 and July 2015 from 15 early infant diagnosis facilities spread across all the 6 geopolitical regions of Nigeria. Sampling was through a probability proportional-to-size approach. HIV drug resistance was determined by population-based sequencing. Overall, in 48% of infants (205 of 430) drug resistance mutations (DRM) were detected, conferring resistance to predominantly NNRTIs (45%). NRTI and multiclass NRTI/NNRTI resistance were present at 22% and 20%, respectively, while resistance to protease inhibitors was at 2%. Among 204 infants with exposure to drugs for PMTCT, 57% had DRMs, conferring NNRTI resistance in 54% and multiclass NRTI/NNRTI resistance in 29%. DRMs were also detected in 34% of 132 PMTCT unexposed infants. A high frequency of PDR, mainly NNRTI-associated, was observed in a nationwide surveillance among newly diagnosed HIV-infected children in Nigeria. PDR prevalence was equally high in PMTCT-unexposed infants. Our results support the use of protease inhibitor-based first-line regimens in HIV-infected young children regardless of PMTCT history and underscore the need to accelerate implementation of the newly disseminated guideline in Nigeria.

Prevention of mother-to-child transmission of Human Immunodeficiency Virus Type 1 (HIV): the role of neonatal and infant prophylaxis

PubMed Central

Hurst, Stacey A.; Appelgren, Kristie E.; Kourtis, Athena P.

2015-01-01

Summary The prevention of mother-to-child transmission (PMTCT) of HIV is one of the great public health successes of the past 20 years. Much concerted research efforts and dedicated work have led to the achievement of very low rates of PMTCT of HIV in settings that can implement optimal prophylaxis. Though several implementation challenges remain, global elimination of pediatric HIV infection seems now more than ever to be an attainable goal. Often overlooked, the role of prophylaxis of the newborn is nevertheless a very important component of PMTCT. In this paper, we focus on the role of neonatal and infant prophylaxis, discuss mechanisms of protection, and present the clinical trial-generated evidence that led to the current recommendations for preventing infections in breastfed and nonbreastfed infants. PMTCT of HIV should not end at birth; a continuum of care extending postpartum and postnatally is required to minimize the risk of new pediatric HIV infections. PMID:25578882

Performance of HIV Prevention of Mother-To-Child Transmission Programs in Sub-Saharan Africa: Longitudinal Assessment of 64 Nevirapine-Based Programs Implemented in 25 Countries, 2000-2011

PubMed Central

Ladner, Joël; Besson, Marie-Hélène; Rodrigues, Mariana; Saba, Joseph; Audureau, Etienne

2015-01-01

Background To evaluate the performance and to identify predictive factors of performance in prevention of mother-to-child HIV transmission programs (PMTCT) in sub-Saharan African countries. Methods From 2000 to 2011, PMTCT programs included in the Viramune Donation Programme (VDP) were prospectively followed. Each institution included in the VDP provided data on program implementation, type of management institution, number of PMTCT sites, key programs outputs (HIV counseling and testing, NVP regimens received by mothers and newborns). Nevirapine Coverage Ratio (NCR), defined as the number of women who should have received nevirapine (observed HIV prevalence x number of women in antenatal care), was used to measure performance. Included programs were followed every six months through progress reports. Results A total of 64 programs in 25 sub-Saharan African countries were included. The mean program follow-up was 48.0 months (SD = 24.5); 20,084,490 women attended in antenatal clinics were included. The overall mean NCR was 0.52 (SD = 0.25), with an increase from 0.37 to 0.57 between the first and last progress reports (p<.0001); NCR increased by 3.26% per year-program. Between the first and the last report, the number of women counseled and tested increased from 64.3% to 86.0% (p<.0001), the number of women post-counseled from 87.5% to 91.3% (p = 0.08). After mixed linear regression analysis, type of responsible institution, number of women attended in ANC, and program initiation in 2005-2006 were significant predictive factors associated with the NCR. The effect of the time period increased from earlier to later periods. Conclusion A longitudinal assessment of large PMTCT programs shows that scaling-up of programs was increased in sub-Saharan African countries. The PMTCT coverage increased throughout the study period, especially after 2006. Performance may be better for programs with a small or medium number of women attended in ANC. Identification of factors that predict PMTCT program performance may help in the development and expansion of additional large PMTCT services in sub-Saharan Africa. PMID:26098311

Reliability and accuracy of three imaging software packages used for 3D analysis of the upper airway on cone beam computed tomography images.

PubMed

Chen, Hui; van Eijnatten, Maureen; Wolff, Jan; de Lange, Jan; van der Stelt, Paul F; Lobbezoo, Frank; Aarab, Ghizlane

2017-08-01

The aim of this study was to assess the reliability and accuracy of three different imaging software packages for three-dimensional analysis of the upper airway using CBCT images. To assess the reliability of the software packages, 15 NewTom 5G ® (QR Systems, Verona, Italy) CBCT data sets were randomly and retrospectively selected. Two observers measured the volume, minimum cross-sectional area and the length of the upper airway using Amira ® (Visage Imaging Inc., Carlsbad, CA), 3Diagnosys ® (3diemme, Cantu, Italy) and OnDemand3D ® (CyberMed, Seoul, Republic of Korea) software packages. The intra- and inter-observer reliability of the upper airway measurements were determined using intraclass correlation coefficients and Bland & Altman agreement tests. To assess the accuracy of the software packages, one NewTom 5G ® CBCT data set was used to print a three-dimensional anthropomorphic phantom with known dimensions to be used as the "gold standard". This phantom was subsequently scanned using a NewTom 5G ® scanner. Based on the CBCT data set of the phantom, one observer measured the volume, minimum cross-sectional area, and length of the upper airway using Amira ® , 3Diagnosys ® , and OnDemand3D ® , and compared these measurements with the gold standard. The intra- and inter-observer reliability of the measurements of the upper airway using the different software packages were excellent (intraclass correlation coefficient ≥0.75). There was excellent agreement between all three software packages in volume, minimum cross-sectional area and length measurements. All software packages underestimated the upper airway volume by -8.8% to -12.3%, the minimum cross-sectional area by -6.2% to -14.6%, and the length by -1.6% to -2.9%. All three software packages offered reliable volume, minimum cross-sectional area and length measurements of the upper airway. The length measurements of the upper airway were the most accurate results in all software packages. All software packages underestimated the upper airway dimensions of the anthropomorphic phantom.

Accelerated HIV testing for PMTCT in maternity and labour wards is vital to capture mothers at a critical point in the programme at district level in Malawi.

PubMed

Beltman, J J; Fitzgerald, M; Buhendwa, L; Moens, M; Massaquoi, M; Kazima, J; Alide, N; van Roosmalen, J

2010-11-01

Round the clock (24 hours×7 days) HIV testing is vital to maintain a high prevention of mother to child transmission (PMTCT) coverage for women delivering in district health facilities. PMTCT coverage increases when most of the pregnant women will have their HIV status tested. Therefore routine offering of HIV testing should be integrated and seen as a part of comprehensive antenatal care. For women who miss antenatal care and deliver in a health facility without having had their HIV status tested, the labour and maternity ward could still serve as other entry points.

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

PubMed

Gouse, Hetta; Henry, Michelle; Robbins, Reuben N; Lopez-Rios, Javier; Mellins, Claude A; Remien, Robert H; Joska, John A

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. Nondisclosure 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. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child HIV transmission programme in Côte d'Ivoire.

PubMed

Delvaux, Thérèse; Konan, Jean-Paul Diby; Aké-Tano, Odile; Gohou-Kouassi, Valérie; Bosso, Patrice Emery; Buvé, Anne; Ronsmans, Carine

2008-08-01

To assess whether implementation of a prevention of mother-to-child HIV transmission (PMTCT) programme in Côte d'Ivoire improved the quality of antenatal and delivery care services. Quality of antenatal and delivery care services was assessed in five urban health facilities before (2002-2003) and after (2005) the implementation of a PMTCT programme through review of facility data; observation of antenatal consultations (n = 606 before; n = 591 after) and deliveries (n = 229 before; n = 231 after) and exit interviews of women; and interviews of health facility staff. HIV testing was never proposed at baseline and was proposed to 63% of women at the first ANC visit after PMTCT implementation. The overall testing rate was 42% and 83% of tested HIV-infected pregnant women received nevirapine. In addition, inter-personal communication and confidentiality significantly improved in all health facilities. In the maternity ward, quality of obstetrical care at admission, delivery and post-partum care globally improved in all facilities after the implementation of the programme although some indicators remained poor, such as filling in the partograph directly during labour. Episiotomy rates among primiparous women dropped from 64% to 25% (P < 0.001) after PMTCT implementation. Global scores for quality of antenatal and delivery care significantly improved in all facilities after the implementation of the programme. Introducing comprehensive PMTCT services can improve the quality of antenatal and delivery care in general.

Community-Based Evaluation of PMTCT Uptake in Nyanza Province, Kenya

PubMed Central

Kohler, Pamela K.; Okanda, John; Kinuthia, John; Mills, Lisa A.; Olilo, George; Odhiambo, Frank; Laserson, Kayla F.; Zierler, Brenda; Voss, Joachim; John-Stewart, Grace

2014-01-01

Introduction Facility-based assessments of prevention of mother-to-child HIV transmission (PMTCT) programs may overestimate population coverage. There are few community-based studies that evaluate PMTCT coverage and uptake. Methods During 2011, a cross-sectional community survey among women who gave birth in the prior year was performed using the KEMRI-CDC Health and Demographic Surveillance System in Western Kenya. A random sample (n = 405) and a sample of women known to be HIV-positive through previous home-based testing (n = 247) were enrolled. Rates and correlates of uptake of antenatal care (ANC), HIV-testing, and antiretrovirals (ARVs) were determined. Results Among 405 women in the random sample, 379 (94%) reported accessing ANC, most of whom (87%) were HIV tested. Uptake of HIV testing was associated with employment, higher socioeconomic status, and partner HIV testing. Among 247 known HIV-positive women, 173 (70%) self-disclosed their HIV status. Among 216 self-reported HIV-positive women (including 43 from the random sample), 82% took PMTCT ARVs, with 54% completing the full antenatal, peripartum, and postpartum course. Maternal ARV use was associated with more ANC visits and having an HIV tested partner. ARV use during delivery was lowest (62%) and associated with facility delivery. Eighty percent of HIV infected women reported having their infant HIV tested, 11% of whom reported their child was HIV infected, 76% uninfected, 6% declined to say, 7% did not recall; 79% of infected children were reportedly receiving HIV care and treatment. Conclusions Community-based assessments provide data that complements clinic-based PMTCT evaluations. In this survey, antenatal HIV test uptake was high; most HIV infected women received ARVs, though many women did not self-disclose HIV status to field team. Community-driven strategies that encourage early ANC, partner involvement, and skilled delivery, and provide PMTCT education, may facilitate further reductions in vertical transmission. PMID:25360758

Impact of a systems engineering intervention on PMTCT service delivery in Côte d’Ivoire, Kenya, Mozambique: a cluster randomized trial

PubMed Central

Rustagi, Alison Silvis; Gimbel, Sarah; Nduati, Ruth; de Fatima Cuembelo, Maria; Wasserheit, Judith N.; Farquhar, Carey; Gloyd, Stephen; Sherr, Kenneth

2016-01-01

BACKGROUND Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Prior studies of systems engineering applications to PMTCT lacked comparison groups or randomization. METHODS Thirty-six health facilities in Côte d’Ivoire, Kenya, and Mozambique were randomized to usual care or a systems engineering intervention, stratified by country and volume. The intervention guided facility staff to iteratively identify and then rectify barriers to PMTCT implementation. Registry data quantified coverage of HIV testing during first antenatal care visit, antiretrovirals (ARVs) for HIV-positive pregnant women, and screening HIV-exposed infants (HEI) for HIV by 6–8 weeks. We compared the change between baseline (January 2013–January 2014) and post-intervention (January–March 2015) periods using t-tests. All analyses were intent-to-treat. RESULTS ARV coverage increased 3-fold (+13.3 percentage points [95% CI: 0.5, 26.0] in intervention vs. +4.1 [−12.6, 20.7] in control facilities) and HEI screening increased 17-fold (+11.6 [−2.6, 25.7] in intervention vs. +0.7 [−12.9, 14.4] in control facilities). In pre-specified sub-group analyses, ARV coverage increased significantly in Kenya (+20.9 [−3.1, 44.9] in intervention vs. −21.2 [−52.7, 10.4] in controls; p=0.02). HEI screening increased significantly in Mozambique (+23.1 [10.3, 35.8] in intervention vs. +3.7 [−13.1, 20.6] in controls; p=0.04). HIV testing did not differ significantly between arms. CONCLUSIONS In this first randomized trial of systems engineering to improve PMTCT, we saw substantially larger improvements in ARV coverage and HEI screening in intervention facilities compared to controls, which were significant in pre-specified sub-groups. Systems engineering could strengthen PMTCT service delivery and protect infants from HIV. PMID:27082507

Implementation and Operational Research: Impact of a Systems Engineering Intervention on PMTCT Service Delivery in Côte d'Ivoire, Kenya, Mozambique: A Cluster Randomized Trial.

PubMed

Rustagi, Alison Silvis; Gimbel, Sarah; Nduati, Ruth; Cuembelo, Maria de Fatima; Wasserheit, Judith N; Farquhar, Carey; Gloyd, Stephen; Sherr, Kenneth

2016-07-01

Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Previous studies of systems engineering applications to PMTCT lacked comparison groups or randomization. Thirty-six health facilities in Côte d'Ivoire, Kenya, and Mozambique were randomized to usual care or a systems engineering intervention, stratified by country and volume. The intervention guided facility staff to iteratively identify and then rectify barriers to PMTCT implementation. Registry data quantified coverage of HIV testing during first antenatal care visit, antiretrovirals (ARVs) for HIV-positive pregnant women, and screening HIV-exposed infants (HEI) for HIV by 6-8 weeks. We compared the change between baseline (January 2013-January 2014) and postintervention (January 2015-March 2015) periods using t-tests. All analyses were intent-to-treat. ARV coverage increased 3-fold [+13.3% points (95% CI: 0.5 to 26.0) in intervention vs. +4.1 (-12.6 to 20.7) in control facilities] and HEI screening increased 17-fold [+11.6 (-2.6 to 25.7) in intervention vs. +0.7 (-12.9 to 14.4) in control facilities]. In prespecified subgroup analyses, ARV coverage increased significantly in Kenya [+20.9 (-3.1 to 44.9) in intervention vs. -21.2 (-52.7 to 10.4) in controls; P = 0.02]. HEI screening increased significantly in Mozambique [+23.1 (10.3 to 35.8) in intervention vs. +3.7 (-13.1 to 20.6) in controls; P = 0.04]. HIV testing did not differ significantly between arms. In this first randomized trial of systems engineering to improve PMTCT, we saw substantially larger improvements in ARV coverage and HEI screening in intervention facilities compared with controls, which were significant in prespecified subgroups. Systems engineering could strengthen PMTCT service delivery and protect infants from HIV.

Knowledge, perception about antiretroviral therapy (ART) and prevention of mother-to-child-transmission (PMTCT) and adherence to ART among HIV positive women in the Ashanti Region, Ghana: a cross-sectional study.

PubMed

Boateng, Daniel; Kwapong, Golda Dokuaa; Agyei-Baffour, Peter

2013-01-22

Mother-to-Child Transmission (MTCT) has been identified as the greatest means of HIV infection among children. Adherence to antiretroviral drugs is necessary to prevent drug resistance and MTCT of HIV among HIV positive women. However, there is a gap in clients' knowledge, attitudes and perceptions of antiretroviral therapy (ART) and Prevention of Mother-To-Child Transmission (PMTCT) which influence their decision to adhere to ART. The study was a descriptive cross-sectional employing both qualitative and quantitative methods. The study involved 229 HIV positive women in reproductive age (18 - 49 years) and had been on ART for at least six months. Fourteen health workers were also included in the qualitative study. Respondents were selected from three ART centers in the Kumasi Metropolis through systematic random sampling from August to November 2011. HIV positive women who had consistently missed two or more ART appointments within the previous two months were classified as defaulters. Data was analyzed with SPSS 19 and STATA 11. Logistic regression was run to assess the odds ratios at 95% confidence level. The ART defaulter rate was 27% and clients had good knowledge about ART and PMTCT. More than 90% of the HIV positive women had inadequate knowledge about ART and PMTCT and these women were more likely to default ART (OR = 3.5; 95% CI = 1.89, 6.21). The educational background of HIV positive women did not have significant influence on their knowledge of ART and PMTCT. Mothers, knowledge and understanding of ART and PMTCT could influence their adherence to ART. Educational interventions which target the understanding of both the literate and illiterate women in society are necessary to develop positive behaviors and enhance adherence to ART.

Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa

PubMed Central

Gumede-Moyo, Sehlulekile; Filteau, Suzanne; Munthali, Tendai; Todd, Jim; Musonda, Patrick

2017-01-01

Abstract Background: To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets. Methods: Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU). Results: Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants. Conclusion: Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa. PMID:28984760

Stakeholders’ participation in planning and priority setting in the context of a decentralised health care system: the case of prevention of mother to child transmission of HIV programme in Tanzania

PubMed Central

2013-01-01

Background In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania. Methods This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied in-depth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers. Results Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector. Conclusion The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery. PMID:23849730

Estimating mother-to-child HIV transmission rates in Cameroon in 2011: a computer simulation approach.

PubMed

Nguefack, Hermine L Nguena; Gwet, Henri; Desmonde, Sophie; Oukem-Boyer, Odile Ouwe Missi; Nkenfou, Céline; Téjiokem, Mathurin; Tchendjou, Patrice; Domkam, Irénée; Leroy, Valériane; Alioum, Ahmadou

2016-01-12

Despite the progress in the Prevention of the Mother-to-Child Transmission of HIV (PMTCT), the paediatric HIV epidemic remains worrying in Cameroon. HIV prevalence rate for the population of pregnant women was 7.6% in 2010 in Cameroon. The extent of the paediatric HIV epidemic is needed to inform policymakers. We developed a stochastic simulation model to estimate the number of new paediatric HIV infections through MTCT based on the observed uptake of services during the different steps of the PMTCT cascade in Cameroon in 2011. Different levels of PMTCT uptake was also assessed. A discrete events computer simulation-based approach with stochastic structure was proposed to generate a cohort of pregnant women followed-up until 6 weeks post-partum, and optionally until complete breastfeeding cessation in both prevalent and incident lactating HIV-infected women. The different parameters of the simulation model were fixed using data sources available from the 2011 national registry surveys, and from external cohorts in Cameroon. Different PMTCT coverages were simulated to assess their impact on MTCT. Available data show a low coverage of PMTCT services in Cameroon in 2011. Based on a simulation approach on a population of 995, 533 pregnant women, the overall residual MTCT rate in 2011 was estimated to be 22.1% (95 % CI: 18.6%-25.2%), the 6-week perinatal MTCT rate among prevalent HIV-infected mothers at delivery is estimated at 12.1% (95% CI: 8.1%-15.1%), with an additional postnatal MTCT rate estimated at 13.3% (95% CI: 9.3%-17.8%). The MTCT rate among children whose mothers seroconverted during breastfeeding was estimated at 20.8% (95% CI: 14.1%-26.9%). Overall, we estimated the number of new HIV infections in children in Cameroon to be 10, 403 (95% CI: 9, 054-13, 345) in 2011. When PMTCT uptake have been fixed at 100%, 90% and 80%, global MTCT rate failed to 0.9% (9% CI: 0.5%-1.7%), 2.0% (95% CI: 0.9%-3.2%) and 4.3% (95% CI: 2.4%-6.7%) respectively. This model is helpful to provide MTCT estimates to guide the national HIV policy in Cameroon. Increasing supply and uptake of PMTCT services among prevalent HIV infected pregnant women, as well as HIV-prevention interventions including the offer and acceptance of HIV testing and counselling in lactating women could reduce significantly the residual HIV MTCT in Cameroon. A public health effort should be made to encourage health care workers and pregnant women to use PMTCT services until complete breastfeeding cessation.

Integration of prevention of mother-to-child HIV transmission into maternal health services in Senegal.

PubMed

Cisse, C

2017-06-01

The objective of this study was to assess the level of integration of prevention of mother-to-child HIV transmission (PMTCT) in facilities providing services for maternal, newborn, and child health (MNCH) and reproductive health (RH) in Senegal. The survey, conducted from August through November, 2014, comprised five parts : a literature review to assess the place of this integration in the health policies, standards, and protocols in effect in Senegal; an analysis by direct observation of attitudes and practices of 25 healthcare providers at 5 randomly-selected obstetrics and gynecology departments representative of different levels of the health pyramid; a questionnaire evaluating knowledge and attitudes of 10 providers about the integration of PMTCT services into MNCH/RH facilities; interviews to collect the opinions of 70 clients, including 16 HIV-positive, about the quality of PMTCT services they received; and a questionnaire evaluating knowledge and opinions of 14 policy-makers/managers of health programs focusing on mothers and children about this integration. The literature review revealed several constraints impeding this integration : the policy documents, standards, and protocols of each of the programs involved do not clearly indicate the modalities of this integration; the programs are housed in two different divisions while the national Program against the Human Immunodeficiency Virus reports directly to the Prime Minister; program operations remains generally vertical; the resources for the different programs are not sufficiently shared; there is no integrated training module covering integrated management of pregnancy and delivery; and supervision for each of the different programs is organized separately.The observation of the providers supporting women during pregnancy, during childbirth, and in the postpartum period, showed an effort to integrate PMTCT into the MNCH/RH services delivered daily to clients. But this desire is hampered by many problems, including the inconsistent availability of HIV testing and antiretroviral drugs at program sites and the deficit in training and supervision for PMTCT. Clients interviewed after their contact with providers often complained about the lack of information received about PMTCT. They considered that effective integration of these services would provide them with better quality care while reducing their waiting time, costs, and trips to health facilities. The responses of policymakers and program managers interviewed mostly revealed gaps in their understanding and implementation of the integration. There is an effort to integrate MNCH/RH and PMTCT services at the healthcare facilities we visited. But our investigation revealed many shortcomings in both the screening and support of new or expectant HIV+ mothers. To improve this situation it is necessary to improve the skills and motivation of PMTCT providers, enhance the level of equipment, and empower local maternity wards.

Baseline characteristics of study sites and women enrolled in a three-arm cluster randomized controlled trial: PMTCT uptake and retention (pure) Malawi.

PubMed

van Lettow, Monique; Tweya, Hannock; Rosenberg, Nora E; Trapence, Clement; Kayoyo, Virginia; Kasende, Florence; Kaunda, Blessings; Hosseinipour, Mina C; Eliya, Michael; Cataldo, Fabian; Gugsa, Salem; Phiri, Sam

2017-07-11

Malawi introduced an ambitious public health program known as "Option B+" which provides all HIV-infected pregnant and breastfeeding women with lifelong combination antiretroviral therapy, regardless of WHO clinical stage or CD4 cell count. The PMTCT Uptake and REtention (PURE) study aimed at evaluating the effect of peer-support on care-seeking and retention in care. PURE Malawi was a three-arm cluster randomized controlled trial that compared facility-based and community-based models of peer support to standard of care under Option B+ strategy. Each arm was expected to enroll a minimum of 360 women with a total minimum sample size of 1080 participants. 21 sites (clusters) were selected for inclusion in the study. This paper describes the site selection, recruitment, enrollment process and baseline characteristics of study sites and women enrolled in the trial. Study implementation was managed by 3 partner organizations; each responsible for 7 study sites. The trial was conducted in the South East, South West, and Central West zones of Malawi, the zones where the implementing partners operate. Study sites included 2 district hospitals, 2 mission hospitals, 2 rural hospitals, 13 health centers and 1 private clinic. Enrollment occurred from November 2013 to November 2014, over a median period of 31 weeks (range 17-51) by site. A total of 1269 HIV-infected pregnant (1094) and breastfeeding (175) women, who were eligible to initiate ART under Option B+, were enrolled. Each site reached or surpassed the minimum sample size. Comparing the number of women enrolled versus antenatal cohort reports, sites recruited a median of 90% (IQR 75-100) of eligible reported women. In the majority of sites the ratio of pregnant and lactating women enrolled in the study was similar to the ratio of reported pregnant and lactating women starting ART in the same sites. The median age of all women was 27 (IQR 22-31) years. All women have ≥20 months of possible follow-up time; 96% ≥ 2 years (24-32 months). The PURE Malawi study showed that 3 implementing partner organizations could successfully recruit a complex cohort of pregnant and lactating women across 3 geographical zones in Malawi within a reasonable timeline. This study is registered at clinicaltrials.gov - ID Number NCT02005835 . Registered 4 December, 2013.

HIV testing among male partners of pregnant women in Nigeria: a missing link in the elimination of mother-to-child transmission of HIV.

PubMed

Olakunde, Babayemi O; Adeyinka, Daniel A; Oladele, Tolulope; Ozigbu, Chamberline E

2018-03-01

In this study, we assessed male partner testing and the serodiscordance rate among pregnant women and their partners in the prevention of mother-to-child transmission (PMTCT) programme in Nigeria. We conducted a retrospective analysis of the consolidated national health sector PMTCT data over a five-year period (2012-2016). Over the period, a total of 11,833,062 pregnant women were tested for HIV with a positivity rate of 2.2%. About 266,188 (2.2%) of sexual partners of pregnant women who presented at PMTCT clinics had an HIV test within the period. The uptake of male partner testing varied across the years, ranging from 22,269 (1.7%) in 2012 to 90,603 (2.9%) in 2014 (χ 2 for trend = 1320; p < 0.001). Overall, the proportion of partners of HIV-negative pregnant women who tested was higher than the proportion of partners of HIV-positive pregnant women (81% versus 19%, respectively). The serodiscordance rate among partners who tested over the five-year period was 18%. The serodiscordance rate declined from 24% in 2012 to 13% in 2016 (χ 2 for trend = 1202; p < 0.001). Partner testing in the PMTCT programme in Nigeria has remained low in the last five years while the clinic-based serodiscordance rate among partners appears to be declining. There is a need for multilevel interventions to address the possible barriers to partner testing in the PMTCT programme and intensification of the HIV combination prevention approach in the HIV response.

Investigation of the effects of a prevention of mother-to-child HIV transmission program among Iranian neonates.

PubMed

Bokharaei-Salim, Farah; Kalantari, Saeed; Gholamypour, Zahra; Najafi, AliReza; Keyvani, Hossein; Esghaei, Maryam; Monavari, Seyed Hamidreza; Khanaliha, Khadijeh; Bastani, Mohammad-Navid; Fakhim, Atousa; Garshasbi, Saba

2018-05-01

Human immunodeficiency virus (HIV) infection is mostly spreading in developing countries. One of the most important pathways of HIV infection in these nations is the vertical route, from mother to infant. Therefore, this study evaluated the effectiveness of the prevention of mother-to-child transmission (PMTCT) program for HIV among Iranian neonates born to HIV-positive mothers. A total of 54 neonates born to HIV-1 positive mothers, all of whom were in a PMTCT program for HIV, as per the Iranian guidelines, were enrolled in this descriptive cross sectional study from March 2014 to July 2017. After RNA extraction of a plasma specimen, HIV-1 viral load was tested by an Artus HIV-1 RG RT-PCR Kit. Out of 54 evaluated neonates, 32 (59.3%) were male. The mean age of the HIV-infected mothers was 30.1 ± 5.4 (range: 19-47) years, and 36 (66.7%) of the mothers were in the age group 26-34 years. In the present study, it was found that none of the neonates whose mothers had previously entered PMTCT programs had HIV. 15 children were found who were born to HIV-positive mothers who had not entered the PMTCT program. Three of these children were infected with HIV (CRF35_AD), and none of them carried HIV-1 variants with SDRMs. The results of this study indicate that if HIV-positive pregnant women enter the PMTCT program for HIV, they can realistically hope to give birth to a non-infected child.

Preventing Mother-to-Child Transmission of HIV in Resource-Limited Settings: The Elizabeth Glaser Pediatric AIDS Foundation Experience

PubMed Central

Sripipatana, Tabitha; Turner, Abigail Norris; Hoblitzelle, Chuck; Robinson, Joanna; Wilfert, Catherine

2009-01-01

Objectives. In September 1999, the Elizabeth Glaser Pediatric AIDS Foundation initiated a multicountry, service-based programmatic effort in the developing world to reduce perinatally acquired HIV infection. We review 6½ years of one of the world's largest programs for the prevention of mother-to-child transmission (PMTCT) of HIV. Methods. Each PMTCT facility records patient data in antenatal clinics and labor and delivery settings about counseling, testing, HIV status, and antiretroviral prophylaxis and submits the data to foundation staff. Results. More than 2.6 million women have accessed foundation-affiliated services through June 2006. Overall, 92.9% of women who received antenatal care or were eligible for PMTCT services in labor and delivery have been counseled, and 82.8% of those counseled accepted testing. Among women identified as HIV positive, 75.0% received antiretroviral prophylaxis (most a single dose of nevirapine), as did 45.6% of their infants. Conclusions. The foundation's experience has demonstrated that opt-out testing, supplying mothers with medication at time of diagnosis, and providing the infant dose early have measurably improved program efficiency. PMTCT should be viewed as an achievable paradigm and an essential part of the continuum of care. PMID:18703458

Exploring the feasibility of engaging Traditional Birth Attendants in a prevention of mother to child HIV transmission program in Lilongwe, Malawi.

PubMed

Lippmann, Quinn Kerr; Mofolo, Innocent; Bobrow, Emily; Maida, Alice; Kamanga, Esmie; Pagadala, Nina; Martinson, Francis; van der Horst, Charles; Hosseinipour, Mina; Hoffman, Irving

2012-12-01

To investigate the willingness of Traditional Birth Attendants (TBAs) to provide single dose antiretroviral prophylaxis to infants born to mothers with HIV and the feasibility of providing the TBAs with antiretroviral medication. 2 focus groups with a total of 17 registered TBAs. Lilongwe, Malawi. TBAs were recruited by local health workers and participated in focus groups assessing their attitudes towards participation in a PMTCT program. TBAs were willing to participate in this prevention of mother-to-child HIV transmission (PMTCT) program and helped identify barriers to their participation. Given appropriate support and training, TBAs' participation in PMTCT programs could be an additional way to deliver medication to mothers and neonates who might otherwise miss crucial doses of medication.

49 CFR 178.503 - Marking of packagings.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the Associate Administrator; (9) For metal or plastic drums or jerricans intended for reuse or...., “1.0-1.2-1.0” or “0.9-1.0-1.0”). (ii) Plastic drums or jerricans must be marked with the minimum thickness of the packaging material. Minimum thicknesses of plastic must be as determined in accordance with...

Early infant diagnosis of HIV infection using DNA-PCR at a referral center: an 8 years retrospective analysis.

PubMed

Olana, Tolessa; Bacha, Tigist; Worku, Walelign; Tadesse, Birkneh Tilahun

2016-01-01

Over the last decade, Ethiopia adopted different strategies of prevention of mother to child transmission of HIV (PMTCT). Prior to implementation of Option A in 2011, there was no provision of prophylaxis for PMTCT. With 'Option A', PMTCT interventions relied on maternal CD4 count. In early 2013, ''Option B+'' has been started; with this option, antiretroviral therapy is started and continued for life to any HIV positive pregnant mother irrespective of CD4 count with an enhanced treatment for the baby. Though there are a number of studies which evaluated the effectiveness of PMTCT interventions, the current study assessed the real-world effectiveness of PMTCT options in a setting where there is limitation of resources. This study tried to address three questions: what proportion of babies tested by DNA-PCR are HIV infected in the first 2 months of life? How does the type of PMTCT intervention affect presence of HIV infection at this age? What are the factors affecting HIV transmission, after controlling for type of PMCT-HIV intervention? We assessed records of 624 registered HIV exposed infants and 412 mothers who were delivered at Bishoftu Hospital from May 2006 to August 2014. Presence of HIV infection at 6-8 weeks of age was assessed from the records. Maternal and infant risk factors for infection at this age were analyzed. Data were collected using standard data abstraction format and were analyzed using SPSS version 20. Among all the infants who were delivered at the hospital during the study period, 624/936 (66.7 %) had undergone early infant diagnosis at 6-8 weeks. Twenty-seven (4.3 %) were positive for HIV DNA PCR at the age of 6-8 weeks. None of the infants who received ''Option B+'' had a positive HIV DNA PCR result. HIV infection rate was highest among those who took either no prophylaxis or single dose Nevirapine (11.5 and 11.1 % respectively). Those who took single dose Nevirapine and Zidovudine had HIV positivity rate of 3.9 %. Many of the covariates which were shown to be predictors on bivariate analysis were found not to be independent predictors on multivariate analysis. PMTCT ''Option B+'' resulted in zero HIV infection rates among the included infants. There was a high loss to follow up rate at 6-8 weeks of age. The authors recommend that a better strategy of linkage to care and treatment should be devised for HIV exposed infants.

Challenges and opportunities of optimal breastfeeding in the context of HIV option B+ guidelines.

PubMed

Marinda, Pamela; Chibwe, Nkandu; Tambo, Ernest; Lulanga, Sidney; Khayeka-Wandabwa, Christopher

2017-06-02

In 2013, the World Health Organization released a new set of guidelines widely known as Option B+. Prior to that there were guidelines released in 2010. Option B+ recommends lifelong antiretroviral treatment for all pregnant and breastfeeding women living with Human Immunodeficiency Virus. The study aimed at investigating challenges and opportunities in implementing Infant and Young Child Feeding in the context of Prevention of Mother To Child Transmission (PMTCT) guidelines among HIV positive mothers of children aged 0-24 months. The study also examined implications presented by implementing the 2013 PMTCT consolidated guidelines in the transition phase from the 2010 approach in Zambia. A mixed methods approach was employed in the descriptive cross sectional study utilizing semi structured questionnaires and Focused Group Discussions. Further, data was captured from the Health Information Management System. During the PMTCT transition, associated needs and challenges in institutionalizing the enhanced guidelines from option A and B to option B+ were observed. Nonetheless, there was a decline in Mother to Child Transmission (MTCT) of HIV rates with an average of 4%. Mothers faced challenges in complying with optimal breastfeeding practices owing to lack of community support systems and breast infections due to poor breast feeding occasioned by infants' oral health challenges. Moreover, some mothers were hesitant of lifelong ARVs. Health workers faced programmatic and operational challenges such as compromised counseling services. Despite the ambitious timelines for PMTCT transition, the need to inculcate new knowledge and vary known practice among mothers and the shift in counseling content for health workers, the consolidated guidelines for PMTCT proved effective. Some mothers were hesitant of lifelong ARVs, rationalizing the debated paradigm that prolonged chemotherapy/polypharmacy may be a future challenge in the success of ART in PMTCT. Conflicting breast feeding practices was a common observation across mothers thus underpinning the need to strongly invigorate Infant and Young Child Feeding information sharing across the continuum of heath care from facility level to community and up to the family; for cultural norms, practices and attitudes enshrined within communities play a vital role in child care.

Bidirectional links between HIV and intimate partner violence in pregnancy: implications for prevention of mother-to-child transmission

PubMed Central

Hatcher, Abigail M; Woollett, Nataly; Pallitto, Christina C; Mokoatle, Keneuoe; Stöckl, Heidi; MacPhail, Catherine; Delany-Moretlwe, Sinead; García-Moreno, Claudia

2014-01-01

Introduction Prevention of mother-to-child transmission (PMTCT) has the potential to eliminate new HIV infections among infants. Yet in many parts of sub-Saharan Africa, PMTCT coverage remains low, leading to unacceptably high rates of morbidity among mothers and new infections among infants. Intimate partner violence (IPV) may be a structural driver of poor PMTCT uptake, but has received little attention in the literature to date. Methods We conducted qualitative research in three Johannesburg antenatal clinics to understand the links between IPV and HIV-related health of pregnant women. We held focus group discussions with pregnant women (n=13) alongside qualitative interviews with health care providers (n=10), district health managers (n=10) and pregnant abused women (n=5). Data were analysed in Nvivo10 using a team-based approach to thematic coding. Findings We found qualitative evidence of strong bidirectional links between IPV and HIV among pregnant women. HIV diagnosis during pregnancy, and subsequent partner disclosure, were noted as a common trigger of IPV. Disclosure leads to violence because it causes relationship conflict, usually related to perceived infidelity and the notion that women are “bringing” the disease into the relationship. IPV worsened HIV-related health through poor PMTCT adherence, since taking medication or accessing health services might unintentionally alert male partners of the women's HIV status. IPV also impacted on HIV-related health via mental health, as women described feeling depressed and anxious due to the violence. IPV led to secondary HIV risk as women experienced forced sex, often with little power to negotiate condom use. Pregnant women described staying silent about condom negotiation in order to stay physically safe during pregnancy. Conclusions IPV is a crucial issue in the lives of pregnant women and has bidirectional links with HIV-related health. IPV may worsen access to PMTCT and secondary prevention behaviours, thereby posing a risk of secondary transmission. IPV should be urgently addressed in antenatal care settings to improve uptake of PMTCT and ensure that goals of maternal and child health are met in sub-Saharan African settings. PMID:25371218

Lessons Learned From Option B+ in the Evolution Toward "Test and Start" From Malawi, Cameroon, and the United Republic of Tanzania.

PubMed

Kalua, Thokozani; Tippett Barr, Beth A; van Oosterhout, Joep J; Mbori-Ngacha, Dorothy; Schouten, Erik J; Gupta, Sundeep; Sande, Amakobe; Zomba, Gerald; Tweya, Hannock; Lungu, Edgar; Kajoka, Deborah; Tih, Pius; Jahn, Andreas

2017-05-01

The acceleration of prevention of mother-to-child transmission (PMTCT) activities, coupled with the rollout of 2010 World Health Organization (WHO) guidelines, led to important discussions and innovations at global and country levels. One paradigm-shifting innovation was Option B+ in Malawi. It was later included in WHO guidelines and eventually adopted by all 22 Global Plan priority countries. This article presents Malawi's experience with designing and implementing Option B+ and provides complementary narratives from Cameroon and Tanzania. Malawi's HIV program started in 2002, but by 2009, the PMTCT program was lagging far behind the antiretroviral therapy (ART) program because of numerous health system challenges. When WHO recommended Option A and Option B for PMTCT in 2010, it was clear that Malawi's HIV program would not be able to successfully implement either option without increasing existing barriers to PMTCT services and potentially decreasing women's access to care. Subsequent stakeholder discussions led to the development of Option B+. Operationalizing Option B+ required several critical considerations, including the complete integration of ART and PMTCT programs, systematic reduction of barriers to facilitate doubling the number of ART sites in less than a year, building consensus with stakeholders, and securing additional resources for the new program. During the planning and implementation process, several lessons were learned which are considerations for countries transitioning to "treat-all": Comprehensive change requires effective government leadership and coordination; national clinical guidelines must accommodate health system limitations; ART services and commodities should be decentralized within facilities; the general public should be well informed about major changes in the national HIV program; and patients should be educated on clinic processes to improve program monitoring.

Evaluating the benefits of incorporating traditional birth attendants in HIV prevention of mother to child transmission service delivery in Lilongwe, Malawi.

PubMed

Hamela, Gloria; Kabondo, Charity; Tembo, Tapiwa; Zimba, Chifundo; Kamanga, Esmie; Mofolo, Innocent; Bulla, Bertha; Sellers, Christopher; Nakanga, R C; Lee, Clara; Martinson, Francis; Hoffman, Irving; van der Horst, Charles; Hosseinipour, Mina C

2014-03-01

The objective of our intervention was to examine the benefits of incorporating traditional birth attendants (TBA) in HIV Prevention of Mother to Child Transmission (PMTCT) service delivery. We developed a training curriculum for TBAs related to PMTCT and current TBA roles in Malawi. Fourteen TBAs and seven TBA assistants serving 4 urban health centre catchment areas were assessed, trained and supervised. Focus group discussions with the TBAs were conducted after implementation of the program. From March 2008 to August 2009, a total of 4017 pregnant women visited TBAs, out of which 2133 (53.1%) were directly referred to health facilities and 1,884 (46.9%) women delivered at TBAs and subsequently referred. 168 HIV positive women were identified by TBAs. Of these, 86/168 (51.2%) women received nevirapine and 46/168 (27.4%) HIV exposed infants received nevirapine. The challenges in providing PMTCT services included lack of transportation for referrals and absence of a reporting system to confirm the woman's arrival at the health center. Non-disclosure of HIV status by patients to the TBAs resulted in inability to assist nevirapine uptake. TBAs, when trained and well-supervised, can supplement efforts to provide PMTCT services in communities.

Effectiveness of counseling at primary health facilities: level of knowledge of antenatal attendee and their attitude on Prevention of Mother to Child Transmission of HIV in primary health facilities in Dar es Salaam, Tanzania.

PubMed

Wangwe, P J T; Nyasinde, M; Charles, D S K

2014-03-01

Children living with HIV worldwide majority are infected through mother to child transmission of HIV (MTCT) acquired during pregnancy. Knowledge, attitude and behavioral changes are pivot tools towards success of any interventions. To determine the effectiveness of counseling on HIV done in primary health facilities (PHF), level of knowledge gained and attitude changes towards PMTCT. A cross sectional study assessing pregnant women's knowledge and their attitude towards PMTCT was conducted in Temeke district from October 2010 to Jan 2011 using a structured questionnaire. A total of 383 antenatal attendees were referred to Temeke district for management after counselled and tested for HIV in PHFs. Majority (86.9%) had primary education and good knowledge on MTCT. Correct timing of ARVs prophylaxis (15.7%) as preventive measures for MTCT was poor. Education and employment were associated with good knowledge on MTCT of HIV. Women had positive attitudes towards HIV counseling and testing, but stigma was a barrier to disclosure of one's serostatus. There is knowledge gap in routine PMTCT counseling among antenatal attendees in our PHFs. Effective counseling on PMTCT in the PHFs will bridge the identified knowledge gap and help in reduction of pediatric HIV.

Evaluating the benefits of incorporating traditional birth attendants in HIV Prevention of Mother to Child Transmission service delivery in Lilongwe, Malawi

PubMed Central

Hamela, Gloria; Kabondo, Charity; Tembo, Tapiwa; Zimba, Chifundo; Kamanga, Esmie; Mofolo, Innocent; Bulla, Bertha; Sellers, Christopher; Nakanga, R.C.; Lee, Clara; Martinson, Francis; Hoffman, Irving; van der Horst, Charles; Hosseinipour, Mina C.

2016-01-01

The objective of our intervention was to examine the benefits of incorporating traditional birth attendants (TBA) in HIV Prevention of Mother to Child Transmission (PMTCT) service delivery. We developed a training curriculum for TBAs related to PMTCT and current TBA roles in Malawi. Fourteen TBAs and seven TBA assistants serving 4 urban health centre catchment areas were assessed, trained and supervised. Focus group discussions with the TBAs were conducted after implementation of the program. From March 2008 to August 2009, a total of 4017 pregnant women visited TBAs, out of which 2133 (53.1%) were directly referred to health facilities and 1,884 (46.9%) women delivered at TBAs and subsequently referred. 168 HIV positive women were identified by TBAs. Of these, 86/168 (51.2%) women received nevirapine and 46/168 (27.4%) HIV exposed infants received nevirapine. The challenges in providing PMTCT services included lack of transportation for referrals and absence of a reporting system to confirm the woman’s arrival at the health center. Non-disclosure of HIV status by patients to the TBAs resulted in inability to assist nevirapine uptake. TBAs, when trained and well-supervised, can supplement efforts to provide PMTCT services in communities. PMID:24796166

Counselling at primary health facilities and level of knowledge of antenatal attendees and their attitude on prevention of Mother to Child Transmission of HIV in Dar-es salaam, Tanzania.

PubMed

Wangwe, P J T; Nyasinde, M; Charles, D S K

2013-12-01

Children living with HIV worldwide majority are infected through mother to child transmission of HIV (MTCT) acquired during pregnancy. Knowledge, attitude and behavioral changes are pivot tools towards success of any interventions. To determine the effectiveness of counseling on HIV done in primary health facilities (PHF), level of knowledge gained and attitude changes towards PMTCT. A cross sectional study assessing pregnant women's knowledge and their attitude towards PMTCT was conducted in Temeke district from October 2010 to Jan 2011 using a structured questionnaire. A total of 383 antenatal attendees were referred to Temeke district for management after counselled and tested for HIV in PHFs. Majority (86.9%) had primary education and good knowledge on MTCT. Correct timing of ARVs prophylaxis (15.7%) as preventive measures for MTCT was poor. Education and employment were associated with good knowledge on MTCT of HIV. Women had positive attitudes towards HIV counseling and testing, but stigma was a barrier to disclosure of one's serostatus. There is knowledge gap in routine PMTCT counseling among antenatal attendees in our PHFs. Effective counseling on PMTCT in the PHFs will bridge the identified knowledge gap and help in reduction of pediatric HIV.

HIV status disclosure, facility-based delivery and postpartum retention of mothers in a prevention clinical trial in rural Nigeria.

PubMed

Sarko, Kidane A; Blevins, Meridith; Ahonkhai, Aimalohi A; Audet, Carolyn M; Moon, Troy D; Gebi, Usman I; Gana, Ahmed M; Wester, C William; Vermund, Sten H; Aliyu, Muktar H

2017-07-01

Within the context of a cluster randomized prevention of mother-to-child HIV transmission (PMTCT) trial, we evaluated the impact of disclosure on selected PMTCT continuum of care measures. In 12 rural matched-pair clinics randomly assigned to an intervention package versus standard-of-care, we enrolled 372 HIV-infected pregnant women from April 2013 to March 2014. This secondary analysis included 327 (87.9%) women with unknown HIV status or who were treatment naïve at presentation to antenatal care. We employed mixed effects logistic regression to estimate impact of disclosure on facility delivery and postpartum retention in HIV care at 6 and 12 weeks. Fully 86.5% (283/327) of women disclosed their HIV status to their partner, more in the trial intervention arm (OR 3.17, 95% CI 1.39-7.23). Adjusting for intervention arm, maternal age, education and employment, women who disclosed were more likely to deliver at a health facility (OR 2.73, 95%CI 1.11-6.72). Participants who disclosed also had a trend towards being retained in care at 6 and 12 weeks' postpartum (OR 2.72, 95% CI 0.79-9.41 and 2.46, 95% CI 0.70-8.63, respectively). HIV status disclosure at 6 weeks' postpartum was positively associated with facility-based delivery, but not with early postpartum retention. Facilitating HIV status disclosure to partners can increase utilization of facility obstetric services. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Contribution of Maternal Antiretroviral Therapy and Breastfeeding to 24-Month Survival in Human Immunodeficiency Virus-Exposed Uninfected Children: An Individual Pooled Analysis of African and Asian Studies.

PubMed

Arikawa, Shino; Rollins, Nigel; Jourdain, Gonzague; Humphrey, Jean; Kourtis, Athena P; Hoffman, Irving; Essex, Max; Farley, Tim; Coovadia, Hoosen M; Gray, Glenda; Kuhn, Louise; Shapiro, Roger; Leroy, Valériane; Bollinger, Robert C; Onyango-Makumbi, Carolyne; Lockman, Shahin; Marquez, Carina; Doherty, Tanya; Dabis, François; Mandelbrot, Laurent; Le Coeur, Sophie; Rolland, Matthieu; Joly, Pierre; Newell, Marie-Louise; Becquet, Renaud

2018-05-17

Human immunodeficiency virus (HIV)-infected pregnant women increasingly receive antiretroviral therapy (ART) to prevent mother-to-child transmission (PMTCT). Studies suggest HIV-exposed uninfected (HEU) children face higher mortality than HIV-unexposed children, but most evidence relates to the pre-ART era, breastfeeding of limited duration, and considerable maternal mortality. Maternal ART and prolonged breastfeeding while on ART may improve survival, although this has not been reliably quantified. Individual data on 19 219 HEU children from 21 PMTCT trials/cohorts undertaken from 1995 to 2015 in Africa and Asia were pooled to estimate the association between 24-month mortality and maternal/infant factors, using random-effects Cox proportional hazards models. Adjusted attributable fractions of risks computed using the predict function in the R package "frailtypack" were used to estimate the relative contribution of risk factors to overall mortality. Cumulative incidence of death was 5.5% (95% confidence interval, 5.1-5.9) by age 24 months. Low birth weight (LBW <2500 g, adjusted hazard ratio (aHR, 2.9), no breastfeeding (aHR, 2.5), and maternal death (aHR, 11.1) were significantly associated with increased mortality. Maternal ART (aHR, 0.5) was significantly associated with lower mortality. At the population level, LBW accounted for 16.2% of 24-month mortality, never breastfeeding for 10.8%, mother not receiving ART for 45.6%, and maternal death for 4.3%; combined, these factors explained 63.6% of deaths by age 24 months. Survival of HEU children could be substantially improved if public health practices provided all HIV-infected mothers with ART and supported optimal infant feeding and care for LBW neonates.

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

The purpose of this document is to provide the technical requirements for operation, inspection and maintenance of a TRUPACT-II Shipping Package and directly related components. This document shall supply the minimum requirements as specified in the TRUPACT-II Safety Analysis Report for Packaging (SARP) and Certificate of Compliance (C of C) 9218. In the event there is a conflict between this document and the TRUPACT-II SARP (NRC Certificate of Compliance No. 9218), the TRUPACT-II SARP shall govern. This document details the operations, maintenance, repair, replacement of components, as well as the documentation required and the procedures to be followed to maintainmore » the integrity of the TRUPACT-II container. These procedures may be modified for site use, but as a minimum all parameters and format listed herein must be included in any site modified version. For convenience and where applicable steps may be performed out of sequence. Packaging and payload handling equipment and transport trailers have been specifically designed for use with the TRUPACT-II Packaging. This document discusses the minimum required procedures for use of the adjustable center of gravity lift fixture and the TRUPACT-II transport trailer in conjunction with the TRUPACT-II Packaging.« less

Factors Associated with PMTCT Cascade Completion in Four African Countries.

PubMed

Dionne-Odom, Jodie; Welty, Thomas K; Westfall, Andrew O; Chi, Benjamin H; Ekouevi, Didier Koumavi; Kasaro, Margaret; Tih, Pius M; Tita, Alan T N

2016-01-01

Background. Many countries are working to reduce or eliminate mother-to-child transmission (MTCT) of HIV. Prevention efforts have been conceptualized as steps in a cascade but cascade completion rates during and after pregnancy are low. Methods. A cross-sectional survey was performed across 26 communities in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Women who reported a pregnancy within two years were enrolled. Participant responses were used to construct the PMTCT cascade with all of the following steps required for completion: at least one antenatal visit, HIV testing performed, HIV testing result received, initiation of maternal prophylaxis, and initiation of infant prophylaxis. Factors associated with cascade completion were identified using multivariable logistic regression modeling. Results. Of 976 HIV-infected women, only 355 (36.4%) completed the PMTCT cascade. Although most women (69.2%) did not know their partner's HIV status; awareness of partner HIV status was associated with cascade completion (aOR 1.4, 95% CI 1.01-2.0). Completion was also associated with receiving an HIV diagnosis prior to pregnancy compared with HIV diagnosis during or after pregnancy (aOR 14.1, 95% CI 5.2-38.6). Conclusions. Pregnant women with HIV infection in Africa who were aware of their partner's HIV status and who were diagnosed with HIV before pregnancy were more likely to complete the PMTCT cascade.

Factors Associated with PMTCT Cascade Completion in Four African Countries

PubMed Central

Welty, Thomas K.; Westfall, Andrew O.; Chi, Benjamin H.; Ekouevi, Didier Koumavi; Tih, Pius M.; Tita, Alan T. N.

2016-01-01

Background. Many countries are working to reduce or eliminate mother-to-child transmission (MTCT) of HIV. Prevention efforts have been conceptualized as steps in a cascade but cascade completion rates during and after pregnancy are low. Methods. A cross-sectional survey was performed across 26 communities in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Women who reported a pregnancy within two years were enrolled. Participant responses were used to construct the PMTCT cascade with all of the following steps required for completion: at least one antenatal visit, HIV testing performed, HIV testing result received, initiation of maternal prophylaxis, and initiation of infant prophylaxis. Factors associated with cascade completion were identified using multivariable logistic regression modeling. Results. Of 976 HIV-infected women, only 355 (36.4%) completed the PMTCT cascade. Although most women (69.2%) did not know their partner's HIV status; awareness of partner HIV status was associated with cascade completion (aOR 1.4, 95% CI 1.01–2.0). Completion was also associated with receiving an HIV diagnosis prior to pregnancy compared with HIV diagnosis during or after pregnancy (aOR 14.1, 95% CI 5.2–38.6). Conclusions. Pregnant women with HIV infection in Africa who were aware of their partner's HIV status and who were diagnosed with HIV before pregnancy were more likely to complete the PMTCT cascade. PMID:27872760

HIV knowledge, disclosure and sexual risk among pregnant women and their partners in rural South Africa

PubMed Central

Shikwane, Molatelo Elisa; Villar-Loubet, Olga M.; Weiss, Stephen M.; Peltzer, Karl; Jones, Deborah L.

2014-01-01

Partner involvement has been deemed fundamental for the prevention of mother-to-child transmission (PMTCT) of HIV, although it remains difficult to achieve. This study aimed to explore the attitudes and behaviours of pregnant women and their partners who participated in a behavioural risk reduction intervention in six community health centres in the Mpumalanga province of South Africa. Qualitative methods only were used in this study. Women and their partners took part in four gender-concordant groups that addressed HIV, PMTCT, disclosure of HIV status and safer sex practices. The results indicate that men value and understand the importance of being involved in women's reproductive health, although some components of the PMTCT programme such as condom use were still met with some resistance. Participants demonstrated high levels of HIV- and sexually transmitted infection-related knowledge. Men lacked knowledge about PMTCT but were interested in acquiring information so that they could support their partners. All groups highlighted the emotional and physical benefits of disclosing one's HIV status. The involvement of men in antenatal care has the potential to prevent women from becoming infected with HIV both during pregnancy and post-partum when they are more vulnerable to infection and have a high risk of transmission to the infant. There is a need for interventions that focus on both increasing male involvement and promoting condom use during pregnancy. PMID:24405286

Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities

PubMed Central

Oyediran, Kola’ A; Mullen, Stephanie; Kolapo, Usman M

2016-01-01

Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect—that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and strengthen services and systems in resource-limited countries. PMID:26363172

Maternal Health Service Disparities Across Incomes and Implications on Prevention of Mother-to-Child Transmission Service Coverage: Current Context in Sub-Saharan Africa.

PubMed

Workneh, Nibretie Gobezie; Kevany, Sebastian

2016-12-31

About 69% of people living with HIV globally and over 90% of the children who acquired HIV infection are in Sub-Saharan Africa. Despite this, promising results have been observed, especially over the last decade - for example, a 25% decline in new HIV infections as compared to 2001 and a 38% decline in the number of children newly infected by HIV in 2012 as compared to 2009. However, the Global Plan and the Global Fast-Track Commitments of eliminating new HIV infections among children require addressing impediments to service expansion. In this regard, this paper attempts to draw attention to the extent to which disparities across income in using antenatal care (ANC) services may constrain the prevention of mother-to-child transmission (PMTCT) service expansion in Sub-Saharan Africa. The analysis is based on ANC service coverage data from Demographic and Health Surveys conducted between 2008 and 2015 in 31 Sub-Saharan African countries; and PMTCT coverage data from UNAIDS datasets released in 2016. Our analysis found that women in the highest wealth quintile are about three times more likely to frequently use ANC services (at least four visits) as compared to those in the lowest wealth quintile (95%CI: 1.7-5.7, P<0.0001). A regression analysis shows that one-quarter of the PMTCT service coverage can be explained by the disparity in ANC use associated with income; and the higher the disparity in ANC use, the lower the PMTCT service (P<0.05). The findings suggest that achieving the ambitious plan of zero new HIV infections among children while keeping their mothers alive will require on-going PMTCT/ANC service integration and ensuring that programs reach women who are most in need; specifically those in the poorest income categories.

Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries

PubMed Central

2012-01-01

Background Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. Methods Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study's main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher's exact tests. Results The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband. Conclusion To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously. PMID:22236097

Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries.

PubMed

Hardon, Anita; Vernooij, Eva; Bongololo-Mbera, Grace; Cherutich, Peter; Desclaux, Alice; Kyaddondo, David; Ky-Zerbo, Odette; Neuman, Melissa; Wanyenze, Rhoda; Obermeyer, Carla

2012-01-11

Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study's main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher's exact tests. The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband. To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.

Women's decision-making and uptake of services to prevent mother-to-child HIV transmission in Zambia.

PubMed

Ford, Catherine; Chibwesha, Carla J; Winston, Jennifer; Jacobs, Choolwe; Lubeya, Mwansa Ketty; Musonda, Patrick; Stringer, Jeffrey S A; Chi, Benjamin H

2018-04-01

Women's empowerment is associated with engagement in some areas of healthcare, but its role in prevention of mother-to-child HIV transmission (PMTCT) services has not been previously considered. In this secondary analysis, we investigated the association of women's decision-making and uptake of health services for PMTCT. Using data from population-based household surveys, we included women who reported delivery in the 2-year period prior to the survey and were HIV-infected. We measured a woman's self-reported role in decision-making in her own healthcare, making of large purchases, schooling of children, and healthcare for children. For each domain, respondents were categorized as having an "active" or "no active" role. We investigated associations between decision-making and specific steps along the PMTCT cascade: uptake of maternal antiretroviral drugs, uptake of infant HIV prophylaxis, and infant HIV testing. We calculated unadjusted and adjusted odds ratios via logistic regression. From March to December 2011, 344 HIV-infected mothers were surveyed and 276 completed the relevant survey questions. Of these, 190 (69%) took antiretroviral drugs during pregnancy; 175 (64%) of their HIV-exposed infants received antiretroviral prophylaxis; and 160 (58%) had their infant tested for HIV. There was no association between decision-making and maternal or infant antiretroviral drug use. We observed a significant association between decision-making and infant HIV testing in univariate analyses (OR 1.56-1.85; p < 0.05); however, odds ratios for the decision-making indicators were no longer statistically significant predictors of infant HIV testing in multivariate analyses. In conclusion, women who reported an active role in decision-making trended toward a higher likelihood of uptake of infant testing in the PMTCT cascade. Larger studies are needed to evaluate the impact of empowerment initiatives on the PMTCT service utilization overall and infant testing in particular.

Influence of the home environment on the prevention of mother to child transmission of human immunodeficiency virus/acquired immune-deficiency syndrome in South Africa.

PubMed

Sewnunan, A; Modiba, L M

2015-01-01

The human immunodeficiency virus and acquired immune-deficiency syndrome (HIV/AIDS) is still a 'family crises' which marks the beginning of the deterioration of the family unit and the trauma in the emotional, psychological and material lives of both the mother and child. In South African context where the majority of HIV-positive mothers are young single women who live in extended families, disclosure to the sexual partner alone is not an adequate condition for the success of prevention of mother to child transmission (PMTCT). In South Africa, close to one in three women who attend antenatal clinics are HIV positive. KwaZulu-Natal is one of the worst affected provinces, where as many as 40-60% of pregnant women attending antenatal services are living with HIV infection. The study sought to investigate the link between the home environment and its contribution to the success of the programme on PMTCT of HIV/AIDS. A qualitative, explorative, descriptive and contextual study was used in this study to explore whether the home environment for the support system is available for the HIV-positive women on the PMTCT programme. The population of this study included all women who have undergone counselling and tested HIV positive and who have joined the programme on PMTCT of HIV/AIDS in a specific hospital in KwaZulu-Natal Province. Although 14 women agreed to participate in the study, only 10 women were interviewed as saturation was attained. Data were collected using semi-structured interview schedule. Interviews were audio-taped and field notes were taken. Content analysis was used and it was done manually. This study revealed that one of the major issues still surrounding HIV/AIDS and PMTCT is that of non-disclosure, selective disclosure and the stigma and discrimination that surrounds this disease.

Interventions to significantly improve service uptake and retention of HIV-positive pregnant women and HIV-exposed infants along the prevention of mother-to-child transmission continuum of care: systematic review.

PubMed

Vrazo, Alexandra C; Firth, Jacqueline; Amzel, Anouk; Sedillo, Rebecca; Ryan, Julia; Phelps, B Ryan

2018-02-01

Despite the success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programmes, low uptake of services and poor retention pose a formidable challenge to achieving the elimination of vertical HIV transmission in low- and middle-income countries. This systematic review summarises interventions that demonstrate statistically significant improvements in service uptake and retention of HIV-positive pregnant and breastfeeding women and their infants along the PMTCT cascade. Databases were systematically searched for peer-reviewed studies. Outcomes of interest included uptake of services, such as antiretroviral therapy (ART) such as initiation, early infant diagnostic testing, and retention of HIV-positive pregnant and breastfeeding women and their infants. Interventions that led to statistically significant outcomes were included and mapped to the PMTCT cascade. An eight-item assessment tool assessed study rigour. CRD42017063816. Of 686 citations reviewed, 11 articles met inclusion criteria. Ten studies detailed maternal outcomes and seven studies detailed infant outcomes in PMTCT programmes. Interventions to increase access to antenatal care (ANC) and ART services (n = 4) and those using lay cadres (n = 3) were most common. Other interventions included quality improvement (n = 2), mHealth (n = 1), and counselling (n = 1). One study described interventions in an Option B+ programme. Limitations included lack of HIV testing and counselling and viral load monitoring outcomes, small sample size, geographical location, and non-randomized assignment and selection of participants. Interventions including ANC/ART integration, family-centred approaches, and the use of lay healthcare providers are demonstrably effective in increasing service uptake and retention of HIV-positive mothers and their infants in PMTCT programmes. Future studies should include control groups and assess whether interventions developed in the context of earlier 'Options' are effective in improving outcomes in Option B+ programmes. © 2017 John Wiley & Sons Ltd.

Mother-to-child transmission of HIV in Kenya: A cross-sectional analysis of the national database over nine years.

PubMed

Mwau, Matilu; Bwana, Priska; Kithinji, Lucy; Ogollah, Francis; Ochieng, Samuel; Akinyi, Catherine; Adhiambo, Maureen; Ogumbo, Fred; Sirengo, Martin; Boeke, Caroline

2017-01-01

To describe factors associated with mother-to-child HIV transmission (MTCT) in Kenya and identify opportunities to increase testing/care coverage. Cross-sectional analysis of national early infant diagnosis (EID) database. 365,841 Kenyan infants were tested for HIV from January 2007-July 2015 and results, demographics, and treatment information were entered into a national database. HIV risk factors were assessed using multivariable logistic regression. 11.1% of infants tested HIV positive in 2007-2010 and 6.9% in 2014-2015. Greater odds of infection were observed in females (OR: 1.08; 95% CI:1.05-1.11), older children (18-24 months vs. 6 weeks-2 months: 4.26; 95% CI:3.87-4.69), infants whose mothers received no PMTCT intervention (vs. HAART OR: 1.92; 95% CI:1.79-2.06), infants receiving no prophylaxis (vs. nevirapine for 6 weeks OR: 2.76; 95% CI:2.51-3.05), and infants mixed breastfed (vs. exclusive breastfeeding OR: 1.39; 95% CI:1.30-1.49). In 2014-2015, 9.1% of infants had mothers who were not on treatment during pregnancy, 9.8% were not on prophylaxis, and 7.0% were mixed breastfed. Infants exposed to all three risky practices had a seven-fold higher odds of HIV infection compared to those exposed to recommended practices. The highest yield of HIV-positive infants were found through targeted testing of symptomatic infants in pediatric/outpatient departments (>15%); still, most infected infants were identified through PMTCT programs. Despite impressive gains in Kenya's PMTCT program, some HIV-infected infants present late and are not benefitting from PMTCT best practices. Efforts to identify these early and enforce evidence-based practice for PMTCT should be scaled up. Infant testing should be expanded in pediatric/outpatient departments, given high yields in these portals.

Costs of HIV/AIDS outpatient services delivered through Zambian public health facilities.

PubMed

Bratt, John H; Torpey, Kwasi; Kabaso, Mushota; Gondwe, Yebo

2011-01-01

To present evidence on unit and total costs of outpatient HIV/AIDS services in ZPCT-supported facilities in Zambia; specifically, to measure unit costs of selected outpatient HIV/AIDS services, and to estimate total annual costs of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in Zambia. Cost data from 2008 were collected in 12 ZPCT-supported facilities (hospitals and health centres) in four provinces. Costs of all resources used to produce ART, PMTCT and CT visits were included, using the perspective of the provider. All shared costs were distributed to clinic visits using appropriate allocation variables. Estimates of annual costs of HIV/AIDS services were made using ZPCT and Ministry of Health data on numbers of persons receiving services in 2009. Unit costs of visits were driven by costs of drugs, laboratory tests and clinical labour, while variability in visit costs across facilities was explained mainly by differences in utilization. First-year costs of ART per client ranged from US$278 to US$523 depending on drug regimen and facility type; costs of a complete course of antenatal care (ANC) including PMTCT were approximately US$114. Annual costs of ART provided in ZPCT-supported facilities were estimated at US$14.7-$40.1 million depending on regimen, and annual costs of antenatal care including PMTCT were estimated at US$16 million. In Zambia as a whole, the respective estimates were US$41.0-114.2 million for ART and US$57.7 million for ANC including PMTCT. Consistent with the literature, total costs of services were dominated by drugs, laboratory tests and clinical labour. For each visit type, variability across facilities in total costs and cost components suggests that some potential exists to reduce costs through greater harmonization of care protocols and more intensive use of fixed resources. Improving facility-level information on the costs of resources used to produce services should be emphasized as an element of health systems strengthening. © 2010 Blackwell Publishing Ltd.

Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities.

PubMed

Fronczak, Nancy; Oyediran, Kola' A; Mullen, Stephanie; Kolapo, Usman M

2016-04-01

Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect-that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and strengthen services and systems in resource-limited countries. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

7 CFR 51.1527 - Standard pack.

Code of Federal Regulations, 2010 CFR

2010-01-01

... plums or prunes in the top layer of any package shall be reasonably representative in quality and size... minimum diameter, or number of fruit per package, or in accordance with the arrangement of the top layer... peach boxes, lug boxes and small consumer packages. In layer-packed California peach boxes or lug boxes...

HIV Surveillance Among Pregnant Women Attending Antenatal Clinics: Evolution and Current Direction

PubMed Central

Garcia Calleja, Jesus M; Marsh, Kimberly; Zaidi, Irum; Murrill, Christopher; Swaminathan, Mahesh

2017-01-01

Since the late 1980s, human immunodeficiency virus (HIV) sentinel serosurveillance among pregnant women attending select antenatal clinics (ANCs) based on unlinked anonymous testing (UAT) has provided invaluable information for tracking HIV prevalence and trends and informing global and national HIV models in most countries with generalized HIV epidemics. However, increased coverage of HIV testing, prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy has heightened ethical concerns about UAT. PMTCT programs now routinely collect demographic and HIV testing information from the same pregnant women as serosurveillance and therefore present an alternative to UAT-based ANC serosurveillance. This paper reports on the evolution and current direction of the global approach to HIV surveillance among pregnant women attending ANCs, including the transition away from traditional UAT-based serosurveillance and toward new guidance from the World Health Organization and the Joint United Nations Programme on HIV/AIDS on the implementation of surveillance among pregnant women attending ANCs based on routine PMTCT program data. PMID:29208587

7 CFR 51.2927 - Marking and packing requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... and packing requirements. The minimum size or numerical count of the apricots in any package shall be plainly labeled, stenciled, or otherwise marked on the package. (a) Numerical count. When the numerical...

7 CFR 51.2927 - Marking and packing requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and packing requirements. The minimum size or numerical count of the apricots in any package shall be plainly labeled, stenciled, or otherwise marked on the package. (a) Numerical count. When the numerical...

7 CFR 51.2927 - Marking and packing requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and packing requirements. The minimum size or numerical count of the apricots in any package shall be plainly labeled, stenciled, or otherwise marked on the package. (a) Numerical count. When the numerical...

7 CFR 58.732 - Cooling the packaged cheese.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Cooling the packaged cheese. 58.732 Section 58.732... Procedures § 58.732 Cooling the packaged cheese. After the containers are filled they shall be stacked, or... immediate progressive cooling of the individual containers of cheese. As a minimum the cheese should be...

7 CFR 58.732 - Cooling the packaged cheese.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 3 2011-01-01 2011-01-01 false Cooling the packaged cheese. 58.732 Section 58.732... Procedures § 58.732 Cooling the packaged cheese. After the containers are filled they shall be stacked, or... immediate progressive cooling of the individual containers of cheese. As a minimum the cheese should be...

Implementation and outcomes of an active defaulter tracing system for HIV, prevention of mother to child transmission of HIV (PMTCT), and TB patients in Kibera, Nairobi, Kenya.

PubMed

Thomson, Kerry A; Cheti, Erastus O; Reid, Tony

2011-06-01

Retention of patients in long term care and adherence to treatment regimens are a constant challenge for HIV, prevention of mother to child transmission of HIV (PMTCT), and TB programmes in sub-Saharan Africa. This study describes the implementation and outcomes of an active defaulter tracing system used to reduce loss to follow-up (LTFU) among HIV, PMTCT, TB, and HIV/TB co-infected patients receiving treatment at three Médecins Sans Frontières clinics in the informal settlement of Kibera, Nairobi, Kenya. Patients are routinely contacted by a social worker via telephone, in-person visit, or both very soon after they miss an appointment. Patient outcomes identified through 1066 tracing activities conducted between 1 April 2008 and 31 March 2009 included: 59.4% returned to the clinic, 9.0% unable to return to clinic, 6.3% died, 4.7% refused to return to clinic, 4.5% went to a different clinic, and 0.8% were hospitalized. Fifteen percent of patients identified for tracing could not be contacted. LTFU among all HIV patients decreased from 21.2% in 2006 to 11.5% in 2009. An active defaulter tracing system is feasible in a resource poor setting, solicits feedback from patients, retains a mobile population of patients in care, and reduces LTFU among HIV, PMTCT, and TB patients. Copyright © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Early diagnosis of HIV in children below 18 months using DNA PCR test--assessment of the effectiveness of PMTCT interventions and challenges in early initiation of ART in a resource-limited setting.

PubMed

Gupta, Anil; Singh, Girraj; Kaushik, Pratap; Joshi, Bipin; Kalra, Kamlesh; Chakraborty, Sabyasachi

2013-04-01

This study was conducted to assess efficacy of the current Indian Prevention of Mother-to-Child Transmission (PMTCT) protocol in 217 HIV-exposed infants, and to assess challenges in the early initiation of antiretroviral treatment (ART) in 18 (8.3%) infants with HIV, as determined by the HIV-1 DNA polymerase chain reaction (PCR) test at ≥ 6 weeks to <18 months of age. The mother-to-child transmission (MTCT) rate in 154 mother-baby pairs fully compliant with the PMTCT protocol was 5.2%. However, if 25 pairs who were positive using dried blood spot (DBS) DNA PCR and who did not undergo whole blood testing are included in the analysis, then the overall MTCT rate would be 19.8%. The current protocol is 50% effective considering an MTCT rate of 35-40% without any intervention. ART was initiated in 10 (55.6%) HIV-infected children at a mean ± standard deviation (SD) age of 10.45 ± 4.9 (range: 4-17.5) months; delay resulted in opportunistic infections in one-third of the children. A single-dose nevirapine PMTCT regimen should be replaced by a triple antiretroviral regimen; DBS DNA PCR-positive infants may be given ART, and simultaneously a whole blood specimen should be taken to determine whether ART should be continued.

Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa.

PubMed

Mphatswe, W; Mate, K S; Bennett, B; Ngidi, H; Reddy, J; Barker, P M; Rollins, N

2012-03-01

To evaluate the effect of an intervention to improve the quality of data used to monitor the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus in South Africa. The study involved 58 antenatal clinics and 20 delivery wards (37 urban, 21 rural and 20 semi-urban) in KwaZulu-Natal province that provided PMTCT services and reported data to the District Health Information System. The data improvement intervention, which was implemented between May 2008 and March 2009, involved training on data collection and feedback for health information personnel and programme managers, monthly data reviews and data audits at health-care facilities. Data on six data elements used to monitor PMTCT services and recorded in the information system were compared with source data from health facility registers before, during and after the intervention. Data completeness (i.e. their presence in the system) and accuracy (i.e. being within 10% of their true value) were evaluated. The level of data completeness increased from 26% before to 64% after the intervention. Similarly, the proportion of data in the information system considered accurate increased from 37% to 65% (P < 0.0001). Moreover, the correlation between data in the information system and those from facility registers rose from 0.54 to 0.92. A simple, practical data improvement intervention significantly increased the completeness and accuracy of the data used to monitor PMTCT services in South Africa.

HIV drug resistance in infants increases with changing prevention of mother-to-child transmission regimens.

PubMed

Poppe, Lisa K; Chunda-Liyoka, Catherine; Kwon, Eun H; Gondwe, Clement; West, John T; Kankasa, Chipepo; Ndongmo, Clement B; Wood, Charles

2017-08-24

The objectives of this study were to determine HIV drug resistance (HIVDR) prevalence in Zambian infants upon diagnosis, and to determine how changing prevention of mother-to-child transmission (PMTCT) drug regimens affect drug resistance. Dried blood spot (DBS) samples from infants in the Lusaka District of Zambia, obtained during routine diagnostic screening, were collected during four different years representing three different PMTCT drug treatment regimens. DNA extracted from dried blood spot samples was used to sequence a 1493 bp region of the reverse transcriptase gene. Sequences were analyzed via the Stanford HIVDRdatabase (http://hivdb.standford.edu) to screen for resistance mutations. HIVDR in infants increased from 21.5 in 2007/2009 to 40.2% in 2014. Nonnucleoside reverse transcriptase inhibitor resistance increased steadily over the sampling period, whereas nucleoside reverse transcriptase inhibitor resistance and dual class resistance both increased more than threefold in 2014. Analysis of drug resistance scores in each group revealed increasing strength of resistance over time. In 2014, children with reported PMTCT exposure, defined as infant prophylaxis and/or maternal treatment, showed a higher prevalence and strength of resistance compared to those with no reported exposure. HIVDR is on the rise in Zambia and presents a serious problem for the successful lifelong treatment of HIV-infected children. PMTCT affects both the prevalence and strength of resistance and further research is needed to determine how to mitigate its role leading to resistance.

Stakeholders’ perceptions on factors influencing male involvement in prevention of mother to child transmission of HIV services in Blantyre, Malawi

PubMed Central

2014-01-01

Background Male Involvement (MI) in the Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) services is essential in a patriarchal society where men are decision makers of the household. Male partners have a role in the woman’s risk of acquiring HIV, uptake of HIV testing and participation in Mother to Child Transmission (MTCT) prevention programmes. Although MI is important for uptake of PMTCT interventions, it remains low in Africa. The purpose of this study was to identify factors that promote and hinder MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. Understanding of the factors that influence MI will assist in developing strategies that will involve men more in the programme thereby improving the uptake of PMTCT and HIV testing and counselling services by women and men respectively. Methods An exploratory qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC) in Blantyre, Malawi. It consisted of six face to face Key Informant Interviews (KIIs) with health care workers and four Focus Group discussions (FGDs) with 18 men and 17 pregnant women attending antenatal care at the clinic. The FGDs were divided according to sex and age. All FGDs and KIIs were digitally recorded and simultaneously transcribed and translated verbatim into English. Data were analysed using thematic content analysis. Results Participants in both FGDs and KIIs identified the following barriers: lack of knowledge of MI in PMTCT, socioeconomic factors, relationship issues, timidity to be seen in a woman’s domain, unplanned and or extramarital pregnancies, fear of knowing one's HIV status, unwillingness to be associated with the service, health facility based factors, peer influence and cultural factors. The factors that would potentially promote male involvement were categorized into community, health facility and personal or family level factors. Conclusions The factors that may hinder or promote MI arise from different sources. The success of MI lies on recognizing sources of barriers and averting them. Factors that promote MI need to be implemented at different levels of health care. PMID:24998152

Option B+ for the prevention of mother-to-child transmission of HIV infection in developing countries: a review of published cost-effectiveness analyses.

PubMed

Karnon, Jonathan; Orji, Nneka

2016-10-01

To review the published literature on the cost effectiveness of Option B+ (lifelong antiretroviral therapy) for preventing mother-to-child transmission (PMTCT) of HIV during pregnancy and breastfeeding to inform decision making in low- and middle-income countries. PubMed, Scopus, Google scholar and Medline were searched to identify studies of the cost effectiveness of the World Health Organization (WHO) treatment guidelines for PMTCT. Study quality was appraised using the consolidated health economic evaluation reporting standards checklist. Eligible studies were reviewed in detail to assess the relevance and impact of alternative evaluation frameworks, assumptions and input parameter values. Five published cost effectiveness analyses of Option B+ for the PMTCT of HIV were identified. The reported cost-effectiveness of Option B+ varies substantially, with the results of different studies implying that Option B+ is dominant (lower costs, greater benefits), cost-effective (additional benefits at acceptable additional costs) or not cost-effective (additional benefits at unacceptable additional costs). This variation is due to significant differences in model structures and input parameter values. Structural differences were observed around the estimation of programme effects on infants, HIV-infected mothers and their HIV negative partners, over multiple pregnancies, as well assumptions regarding routine access to antiretroviral therapies. Significant differences in key input parameters were observed in transmission rates, intervention costs and effects and downstream cost savings. Across five model-based cost-effectiveness analyses of strategies for the PMTCT of HIV, the most comprehensive analysis reported that option B+ is highly likely to be cost-effective. This evaluation may have been overly favourable towards option B+ with respect to some input parameter values, but potentially important additional benefits were omitted. Decision makers might be best advised to review this analysis, with a view to requesting additional analyses of the model to inform local funding decisions around alternative strategies for the PMTCT of HIV. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Predictive Factors of Plasma HIV Suppression during Pregnancy: A Prospective Cohort Study in Benin

PubMed Central

Ogouyemi-Hounto, Aurore; Azon-Kouanou, Angèle; d'Almeida, Marcelline; Azondékon, Alain; Alao, Marouf J.; Dossou-Gbété, Véronique; Afangnihoun, Aldric; Girard, Pierre-Marie; Cot, Michel; Zannou, Djimon-Marcel

2013-01-01

Objective To investigate the factors associated with HIV1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin. Design Sub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT. Methods HIV-infected women were enrolled in the second trimester of pregnancy. Socio-economic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy. Results Overall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression. Conclusions This study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control. PMID:23555035

Current knowledge and future research on infant feeding in the context of HIV: basic, clinical, behavioral, and programmatic perspectives.

PubMed

Young, Sera L; Mbuya, Mduduzi N N; Chantry, Caroline J; Geubbels, Eveline P; Israel-Ballard, Kiersten; Cohan, Deborah; Vosti, Stephen A; Latham, Michael C

2011-05-01

In 2008, between 129,000 and 194,000 of the 430,000 pediatric HIV infections worldwide were attributable to breastfeeding. Yet in many settings, the health, economic, and social consequences of not breastfeeding would have dire consequences for many more children. In the first part of this review we provide an overview of current knowledge about infant feeding in the context of HIV. Namely, we describe the benefits and risks of breastmilk, the evolution of recommended infant feeding modalities in high-income and low-income countries in the last two decades, and contextualize the recently revised guidelines for infant feeding in the context of HIV current knowledge. In the second section, we suggest areas for future research on the postnatal prevention of mother-to-child transmission of HIV (PMTCT) in developing and industrialized countries. We suggest two shifts in perspective. The first is to evaluate PMTCT interventions more holistically, to include the psychosocial and economic consequences as well as the biomedical ones. The second shift in perspective should be one that contextualizes postnatal PMTCT efforts in the cascade of maternal health services. We conclude by discussing basic, clinical, behavioral, and programmatic research questions pertaining to a number of PMTCT efforts, including extended postnatal ARV prophylaxis, exclusive breastfeeding promotion, counseling, breast milk pasteurization, breast milk banking, novel techniques for making breast milk safer, and optimal breastfeeding practices. We believe the research efforts outlined here will maximize the number of healthy, thriving, HIV-free children around the world.

Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a review.

PubMed

Ditekemena, John; Koole, Olivier; Engmann, Cyril; Matendo, Richard; Tshefu, Antoinette; Ryder, Robert; Colebunders, Robert

2012-11-21

Male participation is a crucial component in the optimization of Maternal and Child Health (MCH) services. This is especially so where prevention strategies to decrease Mother-to-Child Transmission (MTCT) of Human Immunodeficiency Virus (HIV) are sought. This study aims to identify determinants of male partners' involvement in MCH activities, focusing specifically on HIV prevention of maternal to child transmission (PMTCT) in sub-Saharan Africa. Literature review was conducted using the following data bases: Pubmed/MEDLINE; CINAHL; EMBASE; COCHRANE; Psych INFORMATION and the websites of the International AIDS Society (IAS), the International AIDS Conference and the International Conference on AIDS in Africa (ICASA) 2011. We included 34 studies in this review, which reported on male participation in MCH and PMTCT services. The majority of studies defined male participation as male involvement solely during antenatal HIV testing. Other studies defined male involvement as any male participation in HIV couple counseling. We identified three main determinants for male participation in PMTCT services: 1) Socio-demographic factors such as level of education, income status; 2) health services related factors such as opening hours of services, behavior of health providers and the lack of space to accommodate male partners; and 3) Sociologic factors such as beliefs, attitudes and communication between men and women. There are many challenges to increase male involvement/participation in PMTCT services. So far, few interventions addressing these challenges have been evaluated and reported. It is clear however that improvement of antenatal care services by making them more male friendly, and health education campaigns to change beliefs and attitudes of men are absolutely needed.

Current Knowledge and Future Research on Infant Feeding in the Context of HIV: Basic, Clinical, Behavioral, and Programmatic Perspectives12

PubMed Central

Young, Sera L.; Mbuya, Mduduzi N. N.; Chantry, Caroline J.; Geubbels, Eveline P.; Israel-Ballard, Kiersten; Cohan, Deborah; Vosti, Stephen A.; Latham, Michael C.

2011-01-01

In 2008, between 129,000 and 194,000 of the 430,000 pediatric HIV infections worldwide were attributable to breastfeeding. Yet in many settings, the health, economic, and social consequences of not breastfeeding would have dire consequences for many more children. In the first part of this review we provide an overview of current knowledge about infant feeding in the context of HIV. Namely, we describe the benefits and risks of breastmilk, the evolution of recommended infant feeding modalities in high-income and low-income countries in the last two decades, and contextualize the recently revised guidelines for infant feeding in the context of HIV current knowledge. In the second section, we suggest areas for future research on the postnatal prevention of mother-to-child transmission of HIV (PMTCT) in developing and industrialized countries. We suggest two shifts in perspective. The first is to evaluate PMTCT interventions more holistically, to include the psychosocial and economic consequences as well as the biomedical ones. The second shift in perspective should be one that contextualizes postnatal PMTCT efforts in the cascade of maternal health services. We conclude by discussing basic, clinical, behavioral, and programmatic research questions pertaining to a number of PMTCT efforts, including extended postnatal ARV prophylaxis, exclusive breastfeeding promotion, counseling, breast milk pasteurization, breast milk banking, novel techniques for making breast milk safer, and optimal breastfeeding practices. We believe the research efforts outlined here will maximize the number of healthy, thriving, HIV-free children around the world. PMID:22332055

Predictive factors of plasma HIV suppression during pregnancy: a prospective cohort study in Benin.

PubMed

Denoeud-Ndam, Lise; Fourcade, Camille; Ogouyemi-Hounto, Aurore; Azon-Kouanou, Angèle; d'Almeida, Marcelline; Azondékon, Alain; Alao, Marouf J; Dossou-Gbété, Véronique; Afangnihoun, Aldric; Girard, Pierre-Marie; Cot, Michel; Zannou, Djimon-Marcel

2013-01-01

To investigate the factors associated with HIV1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin. Sub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT. HIV-infected women were enrolled in the second trimester of pregnancy. Socio-economic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy. Overall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression. This study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control.

Understanding factors, outcomes and reasons for loss to follow-up among women in Option B+ PMTCT programme in Lilongwe, Malawi.

PubMed

Tweya, Hannock; Gugsa, Salem; Hosseinipour, Mina; Speight, Colin; Ng'ambi, Wingston; Bokosi, Mphatso; Chikonda, Janet; Chauma, Annie; Khomani, Patricia; Phoso, Malocho; Mtande, Tiwonge; Phiri, Sam

2014-11-01

To assess factors, outcomes and reasons for loss to follow-up (LTFU) among pregnant and breastfeeding women initiated on a lifelong antiretroviral therapy (ART) for PMTCT in a large antenatal clinic in Malawi. We identified all pregnant and breastfeeding women who were initiated on ART between September 2011 and September 2013 and had missed their clinic appointment by at least 3 weeks at Bwaila Hospital, the largest antenatal clinic in Malawi. These women were traced by phone or home visits. Their true status and reasons for ART discontinuation were documented during tracing. A total of 2930 women started ART for PMTCT; 2458 (84%) pregnant and 472 (16%) breastfeeding, of which, 577 (20%) missed a scheduled clinic appointment. LTFU was associated with younger age, being pregnant, and earlier year of ART initiation. We successfully traced 229 (40%), of whom, 10 (4%) had died. Of the 219 women found alive, 118 (54%) had stopped taking ARV drugs, 67 (30%) had self-transferred to another ART clinic, 13 (6%) had collected drugs from other sources, 9 (4%) had treatment interruptions and 12 (5%) had other outcomes. Reasons cited for stopping ART were travel (38%), lack of transport money (16%), not understanding the initial ARV education session (10%), being too weak/sick (10%), ARV side effects (10%) and other reasons. Approximately half of the women who were traced were taking ARVs. The study emphasises the need for enhanced post-test counselling strategies, ongoing psychosocial support, provision of incentives and further decentralisation efforts of PMTCT services. © 2014 John Wiley & Sons Ltd.

The Evolution of Alternative Rural Development Strategies in Ethiopia; Implications for Employment and Income Distribution. African Rural Employment Paper No. 12.

ERIC Educational Resources Information Center

Tecle, Tesfai

As Ethiopia has designed and implemented numerous intensive (geographically concentrated) and minimum-package rural development programs between 1967-75, the purpose of this monograph is to: (1) trace the evolution of these package projects; (2) analyze package performances; and (3) identify the implications for Ethiopian planners and policy…

Factors influencing teen mothers' enrollment and participation in prevention of mother-to-child HIV transmission services in Limpopo Province, South Africa.

PubMed

Varga, Christine; Brookes, Heather

2008-06-01

In this article, we examine barriers to HIV testing uptake and participation in prevention of mother-to-child HIV transmission (PMTCT) services among adolescent mothers aged 15 to 19 years in rural and urban Limpopo Province, South Africa. We used the narrative research method involving key informants constructing typical case studies of adolescent experiences with HIV testing and entry into PMTCT. Case studies formed the basis of a community-based questionnaire and focus group discussions with adolescent mothers. Client-counselor dynamics during pretest counseling were pivotal in determining uptake and participation, and counselor profile strongly influenced the nature of the interaction. Other factors found to influence adherence to PMTCT recommendations included HIV and early premarital pregnancy stigma, fear of a positive test result, and concerns over confidentiality and poor treatment by health care providers. Adolescents described elaborate strategies to avoid HIV disclosure to labor and delivery staff, despite knowing this would mean no antiretroviral therapy for their newborn infants. Theoretical, methodological, and programmatic implications of study findings are also discussed.

Study for application of a sounding rocket experiment to spacelab/shuttle mission

NASA Technical Reports Server (NTRS)

Code, A. D.

1975-01-01

An inexpensive adaptation of rocket-size packages to Spacelab/Shuttle use was studied. A two-flight project extending over two years was baselined, requiring 80 man-months of effort. It was concluded that testing should be held to a minimum since rocket packages seem to be able to tolerate shuttle vibration and noise levels. A standard, flexible control and data collection language such as FORTH should be used rather than a computation language such as FORTRAN in order to hold programming costs to a minimum.

A comparison of six software packages for evaluation of solid lung nodules using semi-automated volumetry: what is the minimum increase in size to detect growth in repeated CT examinations.

PubMed

de Hoop, Bartjan; Gietema, Hester; van Ginneken, Bram; Zanen, Pieter; Groenewegen, Gerard; Prokop, Mathias

2009-04-01

We compared interexamination variability of CT lung nodule volumetry with six currently available semi-automated software packages to determine the minimum change needed to detect the growth of solid lung nodules. We had ethics committee approval. To simulate a follow-up examination with zero growth, we performed two low-dose unenhanced CT scans in 20 patients referred for pulmonary metastases. Between examinations, patients got off and on the table. Volumes of all pulmonary nodules were determined on both examinations using six nodule evaluation software packages. Variability (upper limit of the 95% confidence interval of the Bland-Altman plot) was calculated for nodules for which segmentation was visually rated as adequate. We evaluated 214 nodules (mean diameter 10.9 mm, range 3.3 mm-30.0 mm). Software packages provided adequate segmentation in 71% to 86% of nodules (p < 0.001). In case of adequate segmentation, variability in volumetry between scans ranged from 16.4% to 22.3% for the various software packages. Variability with five to six software packages was significantly less for nodules >or=8 mm in diameter (range 12.9%-17.1%) than for nodules <8 mm (range 18.5%-25.6%). Segmented volumes of each package were compared to each of the other packages. Systematic volume differences were detected in 11/15 comparisons. This hampers comparison of nodule volumes between software packages.

49 CFR Appendix C to Part 178 - Nominal and Minimum Thicknesses of Steel Drums and Jerricans

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 3 2013-10-01 2013-10-01 false Nominal and Minimum Thicknesses of Steel Drums and Jerricans C Appendix C to Part 178 Transportation Other Regulations Relating to Transportation (Continued...) SPECIFICATIONS FOR PACKAGINGS Pt. 178, App. C Appendix C to Part 178—Nominal and Minimum Thicknesses of Steel...

49 CFR Appendix C to Part 178 - Nominal and Minimum Thicknesses of Steel Drums and Jerricans

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 3 2014-10-01 2014-10-01 false Nominal and Minimum Thicknesses of Steel Drums and Jerricans C Appendix C to Part 178 Transportation Other Regulations Relating to Transportation (Continued...) SPECIFICATIONS FOR PACKAGINGS Pt. 178, App. C Appendix C to Part 178—Nominal and Minimum Thicknesses of Steel...

49 CFR Appendix C to Part 178 - Nominal and Minimum Thicknesses of Steel Drums and Jerricans

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 3 2011-10-01 2011-10-01 false Nominal and Minimum Thicknesses of Steel Drums and Jerricans C Appendix C to Part 178 Transportation Other Regulations Relating to Transportation (Continued...) SPECIFICATIONS FOR PACKAGINGS Pt. 178, App. C Appendix C to Part 178—Nominal and Minimum Thicknesses of Steel...

49 CFR Appendix C to Part 178 - Nominal and Minimum Thicknesses of Steel Drums and Jerricans

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 3 2012-10-01 2012-10-01 false Nominal and Minimum Thicknesses of Steel Drums and Jerricans C Appendix C to Part 178 Transportation Other Regulations Relating to Transportation (Continued...) SPECIFICATIONS FOR PACKAGINGS Pt. 178, App. C Appendix C to Part 178—Nominal and Minimum Thicknesses of Steel...

21 CFR 178.3130 - Antistatic and/or anti-fogging agents in food-packaging materials.

Code of Federal Regulations, 2011 CFR

2011-04-01

...-hydroxyethyl)dodecanamide produced when diethanolamine is made to react with methyl laurate such that the... with methyl laurate such that the finished product: Has a minimum melting point of 36 °C; has a minimum...

Integrated prevention of mother-to-child transmission for human immunodeficiency virus, syphilis and hepatitis B virus in China.

PubMed

Wang, Ai-Ling; Qiao, Ya-Ping; Wang, Lin-Hong; Fang, Li-Wen; Wang, Fang; Jin, Xi; Qiu, Jie; Wang, Xiao-Yan; Wang, Qian; Wu, Jiu-Ling; Vermund, Sten H; Song, Li

2015-01-01

China continues to face challenges in eliminating mother-to-child transmission of human immunodeficiency virus (HIV), syphilis and hepatitis B virus (HBV). In 2010, a programme that integrated and standardized prevention of mother-to-child transmission (PMTCT) efforts for HIV, syphilis and HBV was implemented in 1156 counties. At participating antenatal care clinics, pregnant women were offered all three tests concurrently and free of charge. Further interventions such as free treatment, prophylaxis and testing for mothers and their children were provided for HIV and syphilis. China's national PMTCT HIV programme started in 2003, at which time there were no national programmes for perinatal syphilis and HBV. In 2009, the rate of maternal-to-child transmission of HIV was 8.1% (57/702). Reported congenital syphilis was 60.8 per 100,000 live births. HBV infection was 7.2% of the overall population infected. Between 2010 and 2013 the number of pregnant women attending antenatal care clinics with integrated PMTCT services increased from 5.5 million to 13.1 million. In 2013, 12.7 million pregnant women were tested for HIV, 12.6 million for syphilis and 12.7 million for HBV. Mother-to-child transmission of HIV fell to 6.7% in 2013. Data on syphilis transmission are not yet available. Integrated PMTCT services proved to be feasible and effective, and they are now part of the routine maternal and child health services provided to infected women. The services are provided through a collaboration between maternal and child health clinics, the national and local Centers for Disease Control and Prevention, and general hospitals.

Point-of-care CD4 testing to inform selection of antiretroviral medications in south african antenatal clinics: a cost-effectiveness analysis.

PubMed

Ciaranello, Andrea L; Myer, Landon; Kelly, Kathleen; Christensen, Sarah; Daskilewicz, Kristen; Doherty, Katie; Bekker, Linda-Gail; Hou, Taige; Wood, Robin; Francke, Jordan A; Wools-Kaloustian, Kara; Freedberg, Kenneth A; Walensky, Rochelle P

2015-01-01

Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO "Option A"): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory, POC improved clinical outcomes and reduced healthcare costs. In antenatal clinics implementing Option A, the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.

Previous antiretroviral therapy for prevention of mother-to-child transmission of HIV does not hamper the initial response to PI-based multitherapy during subsequent pregnancy.

PubMed

Briand, Nelly; Mandelbrot, Laurent; Blanche, Stéphane; Tubiana, Roland; Faye, Albert; Dollfus, Catherine; Le Chenadec, Jérôme; Benhammou, Valérie; Rouzioux, Christine; Warszawski, Josiane

2011-06-01

Few data are available on the possible long-term negative effects of a short exposure to antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT). To determine whether ART for PMTCT, discontinued after delivery, affects the virological response to highly active antiretroviral therapy (HAART) administered during subsequent pregnancies. All current pregnancies of HIV-1-infected women enrolled in the French Perinatal Cohort (ANRS CO-01 EPF) between 2005 and 2009 and not receiving ART at the time of conception were eligible. We studied the association between history of exposure to ART during a previous pregnancy and detectable viral load (VL) under multitherapy at current delivery (VL ≥ 50 copies/mL). Among 1116 eligible women, 869 were ART naive and 247 had received PMTCT during a previous pregnancy. Previous ART was protease inhibitor (PI)-based HAART in 48%, non-PI-based HAART in 4%, nucleoside reverse transcriptase inhibitor bitherapy in 19% and zidovudine monotherapy in 29% of the women. At current pregnancy, women with or without prior exposure to ART had similar CD4 cell counts and VL before ART initiation. PI-based HAART was initiated in 90% of the women. VL was undetectable (<50 copies/mL) at delivery in 65% of previously ART-naive women, 72% of women previously exposed to HAART, 62% previously exposed to bitherapy, and 67% previously exposed to monotherapy for prophylaxis (P = 0.42). Detectable VL was not associated with previous exposure in multivariate analysis (adjusted OR for previous versus no previous exposure to ART: 0.92; 0.95% confidence interval: 0.59 to 1.44). Efficacy of PI-based combinations is not decreased in women previously exposed to various regimens of antiretroviral PMTCT.

Determinants of vct uptake among pregnant women attending two ANC clinics in Addis Ababa City: unmatched case control study.

PubMed

Maedot, Paulos; Haile, Amaha; Lulseged, Sileshi; Belachew, Ayele

2007-10-01

With HAART PMTCT interventions can reduce the risk of MTCT below 2%. However, low uptake of VCT is challenging effectiveness of PMTCT programs in sub-Saharan Africa. The aim of this study is to identify factors that determine VCT uptake among pregnant women attending ANC services. A case-control study was conducted from August 30, 2005 - November 30, 2005 among pregnant women attending ANC PMTCT services at Teklehaimanot Health Center and Gandhi memorial Hospital in Addis Ababa City. Cases were pregnant mothers who accepted VCT (n=202) and controls were pregnant mothers who refused VCT (n=200). Data was collected by counselor nurses working at the respective services Factors that determine VCT acceptance were women's perceived ability to cope with a positive result (OR = 5.5, 95% CI 3.5-8.5, MHOR = 6.3, 95% CI 3.9-10.2); perceived favorable reaction of husband's after sharing positive test result (OR = 2.7 95% CI 1.4-5.1, MHOR = 2.9, 95% CI 1.4-5.7); perceived positive community response (OR = 2.2 95% CI 1.1-4.2, MHOR = 2.6 95% CI 1.3-5.2); perceived ability to get continuous medical care if found out to be positive (OR = 2.0, 95% CI 1.2-3.5, MHOR = 2.4, 95% CI 1.3-4.5). Women's perceived ability to cope with a positive result, accesses to medical care, fear of husband's negative reaction and the stigma and discrimination following a positive test result were key determinants of uptake of VCT. Therefore, increasing uptake of VCT/PMTCT services needs policy makers and service providers' effort to promote couple counseling, intensifying the fight against stigma and discrimination and ensuring continuous HIV/AIDS related medical care.

Factors associated with HIV infection among children born to mothers on the prevention of mother to child transmission programme at Chitungwiza Hospital, Zimbabwe, 2008.

PubMed

Ngwende, Stella; Gombe, Notion T; Midzi, Stanley; Tshimanga, Mufuta; Shambira, Gerald; Chadambuka, Addmore

2013-12-14

Zimbabwe is one of the five countries worst affected by the HIV/AIDS pandemic with HIV infection contributing increasingly to childhood morbidity and mortality. Among the children born to HIV positive mothers participating in the PMTCT programme, 25% tested positive to HIV. We investigated factors associated with HIV infection among children born to mothers on the PMTCT programme. A 1:1 unmatched case-control study was conducted at Chitungwiza Hospital, Zimbabwe, 2008. A case was defined as a child who tested HIV positive, born to a mother who had been on PMTCT programme. A control was a HIV negative child born to a mother who had been on PMTCT programme. An interviewer-administered questionnaire was used to collect data on demographic characteristics, risk factors associated with HIV infection and immunization status. A total of 120 mothers were interviewed. Independent risk factors associated with HIV infection among children included maternal CD4 count of less than 200 during pregnancy [aOR = 7.1, 95% CI (2.6-17)], mixed feeding [aOR = 29, 95% CI (4.2-208)], being hospitalized since birth [aOR = 2.9, 95% CI (1.2-4.8)] whilst being exclusively breast fed for less than 6 months [aOR = 0.1 (95% CI 0.03-0.4)] was protective. HIV infection among children increased if the mother's CD4 count was ≤200 cells/μL and if the child was exposed to mixed feeding. Breastfeeding exclusively for less than six months was protective. We recommended exclusive breast feeding period for the first six months and stop breast feeding after 6 months if affordable, sustainable and safe.

Free formula milk in the prevention of mother-to-child transmission programme: voices of a peri-urban community in South Africa on policy change.

PubMed

Ijumba, Petrida; Doherty, Tanya; Jackson, Debra; Tomlinson, Mark; Sanders, David; Persson, Lars-Åke

2013-10-01

In 2001, South Africa began implementing the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. This programme included distribution of free formula milk for infants up to 6 months of age at all public health facilities. Effective from 1 January 2011, KwaZulu-Natal became the first province to phase out free formula milk from its PMTCT programme. On 23 August 2011, the South African National Department of Health adopted promotion of exclusive breastfeeding as the national infant feeding strategy and made a decision to withdraw free formula milk from the PMTCT programme. To explore the perceptions and understanding of households at community level on the policy decision to phase out free formula milk from the PMTCT programme in South Africa. An exploratory qualitative study was conducted amongst women enrolled in a community randomized trial known as Good Start III. Focus group discussions were held with grandmothers, fathers and teenage mothers; and in-depth interviews were performed with HIV-positive and HIV-negative mothers. Data were analysed using thematic analysis. Identified themes included: (1) variations in awareness and lack of understanding of the basis for the policy change, (2) abuse of and dysfunctional policy as perceived reasons for policy change and (3) proposed strategies for communicating the policy change. There is an urgent need to develop a multifaceted communication strategy clearly articulating the reasons for the infant feeding policy change and promoting the new breastfeeding strategy. The communication strategy should take into account inputs from the community. With a supportive environment and one national infant feeding strategy, South Africa has an opportunity to reverse years of poor infant feeding practices and to improve the health of all children in the country.

Confronting Challenges in Monitoring and Evaluation: Innovation in the Context of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive.

PubMed

Radin, Anna K; Abutu, Andrew A; Okwero, Margaret A; Adler, Michelle R; Anyaike, Chukwuma; Asiimwe, Hilda T; Behumbiize, Prosper; Efuntoye, Timothy A; King, Rachel L; Kisaakye, Linda Nabitaka; Ogundehin, Dolapo T; Phelps, Benjamin Ryan; Watts, Heather; Weissglas, Fitti

2017-05-01

The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), which was launched in 2011, set a series of ambitious targets, including a reduction of new HIV infections among children by 90% by 2015 (from a baseline year of 2009) and AIDS-related maternal mortality by 50% by 2015. To reach these targets, the Global Plan called for unprecedented investments in the prevention of mother-to-child transmission of HIV (PMTCT), innovative new approaches to service delivery, immense collective effort on the programmatic and policy fronts, and importantly, a renewed focus on data collection and use. We provide an overview of major achievements in monitoring and evaluation across Global Plan countries and highlight key challenges and innovative country-driven solutions using PMTCT program data. Specifically, we describe the following: (1) Uganda's development and use of a weekly reporting system for PMTCT using short message service technology that facilitates real-time monitoring and programmatic adjustments throughout the transition to a "treat all" approach for pregnant and breastfeeding women living with HIV (Option B+); (2) Uganda's work to eliminate parallel reporting systems while strengthening the national electronic district health information system; and (3) how routine PMTCT program data in Nigeria can be used to estimate HIV prevalence at the local level and address a critical gap in local descriptive epidemiologic data to better target limited resources. We also identify several ongoing challenges in data collection, analysis, and use, and we suggest potential solutions.

Confronting Challenges in Monitoring & Evaluation: Innovation in the Context of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive

PubMed Central

Radin, Anna K.; Abutu, Andrew A.; Okwero, Margaret Achom; Adler, Michelle R.; Anyaike, Chukwuma; Asiimwe, Hilda T.; Behumbiize, Prosper; Efuntoye, Timothy A.; King, Rachel L.; Kisaakye, Linda Nabitaka; Ogundehin, Dolapo T.; Phelps, Benjamin Ryan; Watts, D. Heather; Weissglas, Fitti

2017-01-01

The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), which was launched in 2011, set a series of ambitious targets, including a reduction of new HIV infections among children by 90% by 2015 (from a baseline year of 2009) and AIDS-related maternal mortality by 50% by 2015.1 To reach these targets, the Global Plan called for unprecedented investments in the prevention of mother-to-child HIV transmission (PMTCT), innovative new approaches to service delivery, immense collective effort on the programmatic and policy fronts, and, importantly, a renewed focus on data collection and use. We provide an overview of major achievements in monitoring and evaluation across Global Plan countries and highlight key challenges and innovative country-driven solutions using PMTCT program data. Specifically, we describe the following: (1) Uganda’s development and use of a weekly reporting system for PMTCT using short message service (SMS) technology that facilitates real-time monitoring and programmatic adjustments throughout the transition to a “treat all” approach for pregnant and breastfeeding women living with HIV (Option B+); (2) Uganda’s work to eliminate parallel reporting systems while strengthening the national electronic district health information system; and (3) how routine PMTCT program data in Nigeria can be used to estimate HIV prevalence at the local level and address a critical gap in local descriptive epidemiologic data to better target limited resources. We also identify several ongoing challenges in data collection, analysis, and use, and we suggest potential solutions. PMID:28398999

The costs and benefits of Option B+ for the prevention of mother-to-child transmission of HIV.

PubMed

Gopalappa, Chaitra; Stover, John; Shaffer, Nathan; Mahy, Mary

2014-01-01

Most countries follow WHO 2010 guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV using either Option A or B for women not yet eligible for antiretroviral therapy (ART). Both of these approaches involve the use of antiretrovirals during pregnancy and breastfeeding. Some countries have adopted a new strategy, Option B+, in which HIV-positive pregnant women are started immediately on ART and continued for life. Option B+ is more costly than Options A or B, but provides additional health benefits. In this article, we estimate the additional costs and effectiveness of Option B+. We developed a deterministic model to simulate births, breastfeeding, and HIV infection in women in four countries, Kenya, Zambia, South Africa, and Vietnam that differ in fertility rate, birth interval, age at first birth, and breastfeeding patterns, but have similar age at HIV infection. We estimated the total PMTCT costs and new child infections under Options A, B, and B+, and measured cost-effectiveness as the incremental PMTCT-related costs per child infection averted. We included adult sexual transmissions averted from ART, the corresponding costs saved, and estimated the total incremental cost per transmission (child and adult) averted. When considering PMTCT-related costs and child infections, Option B+ was the most cost-effective strategy costing between $6000 and $23 000 per infection averted compared with Option A. Option B+ averted more child infections compared with Option B in all four countries and cost less than Option B in Kenya and Zambia. When including adult sexual transmissions averted, Option B+ cost less and averted more infections than Options A and B.

Costs along the service cascades for HIV testing and counselling and prevention of mother-to-child transmission

PubMed Central

Bautista-Arredondo, Sergio; Sosa-Rubí, Sandra G.; Opuni, Marjorie; Contreras-Loya, David; Kwan, Ada; Chaumont, Claire; Chompolola, Abson; Condo, Jeanine; Galárraga, Omar; Martinson, Neil; Masiye, Felix; Nsanzimana, Sabin; Ochoa-Moreno, Ivan; Wamai, Richard; Wang’ombe, Joseph

2016-01-01

Objective: We estimate facility-level average annual costs per client along the HIV testing and counselling (HTC) and prevention of mother-to-child transmission (PMTCT) service cascades. Design: Data collected covered the period 2011–2012 in 230 HTC and 212 PMTCT facilities in Kenya, Rwanda, South Africa, and Zambia. Methods: Input quantities and unit prices were collected, as were output data. Annual economic costs were estimated from the service providers’ perspective using micro-costing. Average annual costs per client in 2013 United States dollars (US$) were estimated along the service cascades. Results: For HTC, average cost per client tested ranged from US$5 (SD US$7) in Rwanda to US$31 (SD US$24) in South Africa, whereas average cost per client diagnosed as HIV-positive ranged from US$122 (SD US$119) in Zambia to US$1367 (SD US$2093) in Rwanda. For PMTCT, average cost per client tested ranged from US$18 (SD US$20) in Rwanda to US$89 (SD US$56) in South Africa; average cost per client diagnosed as HIV-positive ranged from US$567 (SD US$417) in Zambia to US$2021 (SD US$3210) in Rwanda; average cost per client on antiretroviral prophylaxis ranged from US$704 (SD US$610) in South Africa to US$2314 (SD US$3204) in Rwanda; and average cost per infant on nevirapine ranged from US$888 (SD US$884) in South Africa to US$2359 (SD US$3257) in Rwanda. Conclusion: We found important differences in unit costs along the HTC and PMTCT service cascades within and between countries suggesting that more efficient delivery of these services is possible. PMID:27753679

Morbidity and Mortality of a Cohort of Peruvian HIV-infected Children 2003-2012.

PubMed

Baker, Amira N; Bayer, Angela M; Viani, Rolando M; Kolevic, Lenka; Sim, Myung-Shin; Deville, Jaime G

2018-06-01

Data on pediatric HIV in Peru are limited. The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the most HIV-infected children under the age of 18 years in the country. We describe the outcomes of children seen at INSN's HIV clinic over the 10 years when antiretroviral therapy and prevention of mother-to-child transmission (PMTCT) interventions became available in 2004. We conducted a retrospective review of INSN HIV clinic patients between 2003 and 2012. Deidentified data were collected and analyzed. A total of 280 children were included: 50.0% (140/280) were male; 80.0% (224/280) lived in metropolitan Lima. Perinatal transmission was the mode of HIV infection in 91.4% (256/280) of children. Only 17% (32/191) of mothers were known to be HIV-infected at delivery; of these mothers, 41% (13/32) were receiving antiretroviral therapy at delivery, 72% (23/32) delivered by Cesarean section and 47% (15/32) of their infants received antiretroviral prophylaxis. Median age at HIV diagnosis for all children was 35.7 months (interquartile range 14.5-76.8 months), and 67% (143/213) had advanced disease (clinical stage C). After HIV diagnosis, the most frequent hospitalization discharge diagnoses were bacterial pneumonia, chronic malnutrition, diarrhea, anemia and tuberculosis. Twenty-four patients (8.6%) died at a median age of 77.4 months. Most cases of pediatric HIV were acquired via perinatal transmission; few mothers were diagnosed before delivery; and among mothers with known HIV status, PMTCT was suboptimal even after national PMTCT policy was implemented. Most children were diagnosed with advanced disease. These findings underscore the need for improving early pediatric HIV diagnosis and treatment, as well as PMTCT strategies.

49 CFR Appendix C to Part 178 - Nominal and Minimum Thicknesses of Steel Drums and Jerricans

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Nominal and Minimum Thicknesses of Steel Drums and Jerricans C Appendix C to Part 178 Transportation Other Regulations Relating to Transportation PIPELINE AND... SPECIFICATIONS FOR PACKAGINGS Pt. 178, App. C Appendix C to Part 178—Nominal and Minimum Thicknesses of Steel...

25 CFR 547.15 - What are the minimum technical standards for electronic data communications between system...

Code of Federal Regulations, 2010 CFR

2010-04-01

... WITH THE PLAY OF CLASS II GAMES § 547.15 What are the minimum technical standards for electronic data...) Player tracking information; (8) Download Packages; and (9) Any information that affects game outcome. (b...

25 CFR 547.15 - What are the minimum technical standards for electronic data communications between system...

Code of Federal Regulations, 2012 CFR

2012-04-01

... WITH THE PLAY OF CLASS II GAMES § 547.15 What are the minimum technical standards for electronic data...) Player tracking information; (8) Download Packages; and (9) Any information that affects game outcome. (b...

25 CFR 547.15 - What are the minimum technical standards for electronic data communications between system...

Code of Federal Regulations, 2011 CFR

2011-04-01

... WITH THE PLAY OF CLASS II GAMES § 547.15 What are the minimum technical standards for electronic data...) Player tracking information; (8) Download Packages; and (9) Any information that affects game outcome. (b...

HIV Surveillance Among Pregnant Women Attending Antenatal Clinics: Evolution and Current Direction.

PubMed

Dee, Jacob; Garcia Calleja, Jesus M; Marsh, Kimberly; Zaidi, Irum; Murrill, Christopher; Swaminathan, Mahesh

2017-12-05

Since the late 1980s, human immunodeficiency virus (HIV) sentinel serosurveillance among pregnant women attending select antenatal clinics (ANCs) based on unlinked anonymous testing (UAT) has provided invaluable information for tracking HIV prevalence and trends and informing global and national HIV models in most countries with generalized HIV epidemics. However, increased coverage of HIV testing, prevention of mother-to-child transmission (PMTCT), and antiretroviral therapy has heightened ethical concerns about UAT. PMTCT programs now routinely collect demographic and HIV testing information from the same pregnant women as serosurveillance and therefore present an alternative to UAT-based ANC serosurveillance. This paper reports on the evolution and current direction of the global approach to HIV surveillance among pregnant women attending ANCs, including the transition away from traditional UAT-based serosurveillance and toward new guidance from the World Health Organization and the Joint United Nations Programme on HIV/AIDS on the implementation of surveillance among pregnant women attending ANCs based on routine PMTCT program data. ©Jacob Dee, Jesus M Garcia Calleja, Kimberly Marsh, Irum Zaidi, Christopher Murrill, Mahesh Swaminathan. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 05.12.2017.

Pregnant adolescents living with HIV: what we know, what we need to know, where we need to go.

PubMed

Callahan, Tegan; Modi, Surbhi; Swanson, Jennifer; Ng'eno, Bernadette; Broyles, Laura N

2017-08-04

HIV-infected pregnant and breastfeeding adolescents are a particularly vulnerable group that require special attention and enhanced support to achieve optimal maternal and infant outcomes. The objective of this paper is to review published evidence about antenatal care (ANC) service delivery and outcomes for HIV-infected pregnant adolescents in low-income country settings, identify gaps in knowledge and programme services and highlight the way forward to improve clinical outcomes of this vulnerable group. Emerging data from programmes in sub-Saharan Africa highlight that HIV-infected pregnant adolescents have poorer prevention of mother-to-child HIV transmission (PMTCT) service outcomes, including lower PMTCT service uptake, compared to HIV-infected pregnant adults. In addition, the limited evidence available suggests that there may be higher rates of mother-to-child HIV transmission among infants of HIV-infected pregnant adolescents. While the reasons for the inferior outcomes among adolescents in ANC need to be further explored and addressed, there is sufficient evidence that immediate operational changes are needed to address the unique needs of this population. Such changes could include integration of adolescent-friendly services into PMTCT settings or targeting HIV-infected pregnant adolescents with enhanced retention and follow-up activities.

Estimating the impact of the US President's Emergency Plan for AIDS Relief on HIV treatment and prevention programmes in Africa.

PubMed

Heaton, Laura M; Bouey, Paul D; Fu, Joe; Stover, John; Fowler, Timothy B; Lyerla, Rob; Mahy, Mary

2015-12-01

Since 2004, the US President's Emergency Plan for AIDS Relief (PEPFAR) has supported the tremendous scale-up of HIV prevention, care and treatment services, primarily in sub-Saharan Africa. We evaluate the impact of antiretroviral treatment (ART), prevention of mother-to-child transmission (PMTCT) and voluntary medical male circumcision (VMMC) programmes on survival, mortality, new infections and the number of orphans from 2004 to 2013 in 16 PEPFAR countries in Africa. PEPFAR indicators tracking the number of persons receiving ART for their own health, ART regimens for PMTCT and biomedical prevention of HIV through VMMC were collected across 16 PEPFAR countries. To estimate the impact of PEPFAR programmes for ART, PMTCT and VMMC, we compared the current scenario of PEPFAR-supported interventions to a counterfactual scenario without PEPFAR, and assessed the number of life years gained (LYG), number of orphans averted and HIV infections averted. Mathematical modelling was conducted using the SPECTRUM modelling suite V.5.03. From 2004 to 2013, PEPFAR programmes provided support for a cumulative number of 24 565 127 adults and children on ART, 4 154 878 medical male circumcisions, and ART for PMTCT among 4 154 478 pregnant women in 16 PEPFAR countries. Based on findings from the model, these efforts have helped avert 2.9 million HIV infections in the same period. During 2004-2013, PEPFAR ART programmes alone helped avert almost 9 million orphans in 16 PEPFAR countries and resulted in 11.6 million LYG. Modelling results suggest that the rapid scale-up of PEPFAR-funded ART, PMTCT and VMMC programmes in Africa during 2004-2013 led to substantially fewer new HIV infections and orphaned children during that time and longer lives among people living with HIV. Our estimates do not account for the impact of the PEPFAR-funded non-biomedical interventions such as behavioural and structural interventions included in the comprehensive HIV prevention, care and treatment strategy used by PEPFAR countries. Therefore, the number of HIV infections and orphans averted and LYG may be underestimated by these models. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The effectiveness of interventions to improve uptake and retention of HIV-infected pregnant and breastfeeding women and their infants in prevention of mother-to-child transmission care programs in low- and middle-income countries: protocol for a systematic review and meta-analysis.

PubMed

Puchalski Ritchie, Lisa M; van Lettow, Monique; Hosseinipour, Mina C; Rosenberg, Nora E; Phiri, Sam; Landes, Megan; Cataldo, Fabian; Straus, Sharon E

2015-11-03

Despite recent improvements, uptake and retention of mothers and infants in prevention of mother-to-child transmission (PMTCT) services remain well below target levels in many low- and middle-income countries (LMICs). Identification of effective interventions to support uptake and retention is the first step towards improvement. We aim to complete a systematic review and meta-analysis to evaluate the effectiveness of interventions at the patient, provider or health system level in improving uptake and retention of HIV-infected mothers and their infants in PMTCT services in LMICs. We will include studies comparing usual care or no intervention to any type of intervention to improve uptake and retention of HIV-infected pregnant or breastfeeding women and their children from birth to 2 years of age attending PMTCT services in LMICs. We will include randomized controlled trials (RCTs), cluster RCTs, non-randomized controlled trials, and interrupted time series. The primary outcomes of interest are percentage of HIV-infected women receiving/initiated on anti-retroviral prophylaxis or treatment, percentage of infants receiving/initiated on anti-retroviral prophylaxis, and percentage of women and infants completing the anti-retroviral regimen/retained in PMTCT care. The following databases will be searched from inception: Ovid MEDLINE and EMBASE, The WHO Global Health Library, CAB abstracts, EBM Reviews, CINAHL, HealthSTAR and Web of Science databases, Scopus, PsychINFO, POPLINE, Sociological Abstracts, ERIC, AIDS Education Global Information System, NLM Gateway, LILACS, Google Scholar, British Library Catalogue, DARE, ProQuest Dissertation & Theses, the New York Academy of Grey Literature, Open Grey, The Cochrane Library, WHO International Clinical Trials Registry, Controlled Clinical Trials, and clinicaltrials.gov. Reference lists of included articles will be hand searched and study authors and content experts contacted to inquire about eligible unpublished or in progress studies. Screening, data abstraction, and risk of bias appraisal using the Cochrane Effective Practice and Organization of Care criteria will be conducted independently by two team members. Results will be synthesized narratively and a meta-analysis conducted using the DerSimonian Laird random effects method if appropriate based on assessment of clinical and statistical heterogeneity. Our findings will be useful to PMTCT implementers, policy makers, and implementation researchers working in LMICs. PROSPERO CRD42015020829.

7 CFR 35.13 - Minimum quantity.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Minimum quantity. 35.13 Section 35.13 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing... part, transport or receive for transportation to any foreign destination, a shipment of 25 packages or...

Packaging of microwave integrated circuits operating beyond 100 GHz

NASA Technical Reports Server (NTRS)

Samoska, L.; Daniel, E.; Sokolov, V.; Sommerfeldt, S.; Bublitz, J.; Olson, K.; Gilbert, B.; Chow, D.

2002-01-01

Several methods of packaging high speed (75-330 GHz) InP HEMT MMIC devices are discussed. Coplanar wirebonding is presented with measured insertion loss of less than 0.5dB and return loss better than -17 dB from DC to 110 GHz. A motherboard/daughterboard packaging scheme is presented which supports minimum loss chains of MMICs using this coplanar wirebonding method. Split waveguide block packaging approaches are presented in G-band (140-220 GHz) with two types of MMIC-waveguide transitions: E-plane probe andantipodal finline.

75 FR 60333 - Hazardous Material; Miscellaneous Packaging Amendments

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... minimum thickness requirements for remanufactured steel and plastic drums; (2) reinstate the previous... communication problem for emergency responders in that it may interfere with them discovering a large amount of... prescribed in Sec. 178.2(c). D. Minimum Thickness Requirement for Remanufactured Steel and Plastic Drums...

49 CFR 175.706 - Separation distances for undeveloped film from packages containing Class 7 (radioactive) materials.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 2 2014-10-01 2014-10-01 false Separation distances for undeveloped film from... Classification of Material § 175.706 Separation distances for undeveloped film from packages containing Class 7... film. Transport index Minimum separation distance to nearest undeveloped film for various times in...

49 CFR 175.706 - Separation distances for undeveloped film from packages containing Class 7 (radioactive) materials.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 2 2011-10-01 2011-10-01 false Separation distances for undeveloped film from... Classification of Material § 175.706 Separation distances for undeveloped film from packages containing Class 7... film. Transport index Minimum separation distance to nearest undeveloped film for various times in...

49 CFR 175.706 - Separation distances for undeveloped film from packages containing Class 7 (radioactive) materials.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 2 2013-10-01 2013-10-01 false Separation distances for undeveloped film from... Classification of Material § 175.706 Separation distances for undeveloped film from packages containing Class 7... film. Transport index Minimum separation distance to nearest undeveloped film for various times in...

49 CFR 175.706 - Separation distances for undeveloped film from packages containing Class 7 (radioactive) materials.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 2 2012-10-01 2012-10-01 false Separation distances for undeveloped film from... Classification of Material § 175.706 Separation distances for undeveloped film from packages containing Class 7... film. Transport index Minimum separation distance to nearest undeveloped film for various times in...

7 CFR 51.2927 - Marking and packing requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Requirements § 51.2927 Marking and packing requirements. The minimum size or numerical count of the apricots in any package shall be plainly labeled, stenciled, or otherwise marked on the package. (a) Numerical count. When the numerical count is used the fruit in any sample shall not vary more than one-fourth inch...

7 CFR 51.2927 - Marking and packing requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Requirements § 51.2927 Marking and packing requirements. The minimum size or numerical count of the apricots in any package shall be plainly labeled, stenciled, or otherwise marked on the package. (a) Numerical count. When the numerical count is used the fruit in any sample shall not vary more than one-fourth inch...

49 CFR 175.706 - Separation distances for undeveloped film from packages containing Class 7 (radioactive) materials.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Separation distances for undeveloped film from... Classification of Material § 175.706 Separation distances for undeveloped film from packages containing Class 7... film. Transport index Minimum separation distance to nearest undeveloped film for various times in...

Power Extension Package (PEP) system definition extension, orbital service module systems analysis study. Volume 11: PEP, cost, schedules, and work breakdown structure dictionary

NASA Technical Reports Server (NTRS)

1979-01-01

Cost scheduling and funding data are presented for the reference design of the power extension package. Major schedule milestones are correlated with current Spacelab flight dates. Funding distributions provide for minimum expenditure during the first year of the project.

Estimating HIV Incidence during Pregnancy and Knowledge of Prevention of Mother-to-Child Transmission with an Ad Hoc Analysis of Potential Cofactors.

PubMed

Egbe, Thomas Obinchemti; Tazinya, Rose-Mary Asong; Halle-Ekane, Gregory Edie; Egbe, Eta-Nkongho; Achidi, Eric Akum

2016-01-01

We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT) for HIV. The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so.

Energy Savings Measure Packages. Existing Homes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Casey, Sean; Booten, Chuck

2011-11-01

This document presents the most cost effective Energy Savings Measure Packages (ESMP) for existing mixed-fuel and all electric homes to achieve 15% and 30% savings for each BetterBuildings grantee location across the United States. These packages are optimized for minimum cost to homeowners for source energy savings given the local climate and prevalent building characteristics (i.e. foundation types). Maximum cost savings are typically found between 30% and 50% energy savings over the reference home; this typically amounts to $300 - $700/year.

Depression, retention in care, and uptake of PMTCT service in Kinshasa, the Democratic Republic of Congo: a prospective cohort.

PubMed

Yotebieng, Kelly A; Fokong, Kunuwo; Yotebieng, Marcel

2017-03-01

There is a clear need for effective strategies to address the factors that affect retention, or lost-to-follow-up (LTFU) and adherence to HIV care and treatment. Depression in particular may play an important role in the high rates of LTFU along the prevention of mother-to-child HIV transmission (PMTCT) cascade in sub-Saharan Africa. This study assessed the association between prenatal depression and (1) LTFU or (2) uptake of PMTCT services. As part of a randomized control trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services, newly diagnosed HIV-infected women, ≤32 weeks pregnant, registering for antenatal care (ANC), in 85 clinics in Kinshasa, Democratic Republic of Congo (DRC), were recruited and followed-up until LTFU, death, transfer out, or six weeks postpartum. Participants were interviewed at enrollment using a questionnaire which included the Patient Health Questionnaire (PHQ-9). Depression was defined as a PHQ-9 score of ≥15. Among 433 women enrolled, 51 (11.8%) had a PHQ-9 score ≥15 including 15 (3.5%) with a score ≥20. At six weeks postpartum, 67 (15.5%) were LFTU and 331 (76.4%) were in care and had accepted all available PTMCT services. Of participants with depression at enrollment, 17.7% (9/51) were LTFU at six weeks postpartum compared to 15.2% (58/382) among those without, but the association was not statistically significant. On the other hand, 78.4% (40/51) of participants with prenatal depression were in care at six weeks postpartum and had attended all their scheduled visits and accepted available services compared to 76.2% (291/382) among those without depression. In this cohort of newly diagnosed HIV-infected pregnant women, prenatal depression assessed with a PHQ-9 score ≥15 was not a strong predictor of LTFU among newly diagnosed HIV-infected women in Kinshasa, DRC.

Assessment of strategies for male involvement in the prevention of mother-to-child transmission of HIV services in Blantyre, Malawi.

PubMed

Nyondo, Alinane Linda; Muula, Adamson Sinjani; Chimwaza, Angela Faith

2013-12-16

Despite the documented benefits of prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) services, the uptake remains low in sub-Saharan Africa. The lack of male involvement (MI) may be one of the reasons for this. However, there are limited data on strategies for MI in PMTCT. The objective of this study was to identify strategies that may promote MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. An exploratory qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC) in Blantyre, Malawi. It consisted of six face-to-face key informant interviews (KIIs) with healthcare workers and four focus group discussions (FGDs) with 18 men and 17 pregnant women attending ANC at SLHC. The FGDs were divided according to sex and age. All FGDs and KIIs were digitally recorded and simultaneously transcribed and translated verbatim into English. Data were analyzed using thematic content analysis. Three major themes with several subcategories emerged. Theme 1 was a gatekeeping strategy with two subcategories: (1) healthcare workers refusing service provision to women accessing antenatal clinic without their partners and (2) women refusing ANC attention in the absence of a partner. Theme 2 comprised extending invitations and had six subcategories: (1) word of mouth, (2) card invites, (3) woman's health passport book invites, (4) telephonic invites, (5) use of influential people, and (6) home visits. Theme 3 was information education and communication, such as health education forums and advertisements. Of all the strategies, an invitation card addressed to the male partner was most preferred by study participants. There are several strategies by which men may be involved in PMTCT. Healthcare workers should offer a pregnant woman all strategies available for MI for her to select the appropriate one. Further research and consultations with men should continue to achieve higher levels of MI.

Assessment of strategies for male involvement in the prevention of mother-to-child transmission of HIV services in Blantyre, Malawi

PubMed Central

Nyondo, Alinane Linda; Muula, Adamson Sinjani; Chimwaza, Angela Faith

2013-01-01

Background Despite the documented benefits of prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) services, the uptake remains low in sub-Saharan Africa. The lack of male involvement (MI) may be one of the reasons for this. However, there are limited data on strategies for MI in PMTCT. Objective The objective of this study was to identify strategies that may promote MI in PMTCT services in antenatal care (ANC) services in Blantyre, Malawi. Study design An exploratory qualitative study was conducted from December 2012 to January 2013 at South Lunzu Health Centre (SLHC) in Blantyre, Malawi. It consisted of six face-to-face key informant interviews (KIIs) with healthcare workers and four focus group discussions (FGDs) with 18 men and 17 pregnant women attending ANC at SLHC. The FGDs were divided according to sex and age. All FGDs and KIIs were digitally recorded and simultaneously transcribed and translated verbatim into English. Data were analyzed using thematic content analysis. Results Three major themes with several subcategories emerged. Theme 1 was a gatekeeping strategy with two subcategories: (1) healthcare workers refusing service provision to women accessing antenatal clinic without their partners and (2) women refusing ANC attention in the absence of a partner. Theme 2 comprised extending invitations and had six subcategories: (1) word of mouth, (2) card invites, (3) woman's health passport book invites, (4) telephonic invites, (5) use of influential people, and (6) home visits. Theme 3 was information education and communication, such as health education forums and advertisements. Of all the strategies, an invitation card addressed to the male partner was most preferred by study participants. Conclusions There are several strategies by which men may be involved in PMTCT. Healthcare workers should offer a pregnant woman all strategies available for MI for her to select the appropriate one. Further research and consultations with men should continue to achieve higher levels of MI. PMID:24345635

"If donors woke up tomorrow and said we can't fund you, what would we do?" A health system dynamics analysis of implementation of PMTCT option B+ in Uganda.

PubMed

Doherty, Tanya; Besada, Donnela; Goga, Ameena; Daviaud, Emmanuelle; Rohde, Sarah; Raphaely, Nika

2017-07-26

In October 2012 Uganda extended its prevention of mother to child HIV transmission (PMTCT) policy to Option B+, providing lifelong antiretroviral treatment for HIV positive pregnant and breastfeeding women. The rapid changes and adoptions of new PMTCT policies have not been accompanied by health systems research to explore health system preparedness to implement such programmes. The implementation of Option B+ provides many lessons which can inform the shift to 'Universal Test and Treat', a policy which many sub-Saharan African countries are preparing to adopt, despite fragile health systems. This qualitative study of PMTCT Option B+ implementation in Uganda three years following the policy adoption, uses the health system dynamics framework to explore the impacts of this programme on ten elements of the health system. Qualitative data were gathered through rapid appraisal during in-country field work. Key informant interviews and focus group discussions (FGDs) were undertaken with the Ministry of Health, implementing partners, multilateral agencies, district management teams, facility-based health workers and community cadres. A total of 82 individual interviews and 16 focus group discussions were completed. We conducted a simple manifest analysis, using the ten elements of a health system for grouping data into categories and themes. Of the ten elements in the health system dynamics framework, context and resources (finances, infrastructure & supplies, and human resources) were the most influential in the implementation of Option B+ in Uganda. Support from international actors and implementing partners attempted to strengthen resources at district level, but had unintended consequences of creating dependence and uncertainty regarding sustainability. The health system dynamics framework offers a novel approach to analysis of the effects of implementation of a new policy on critical elements of the health system. Its emphasis on relationships between system elements, population and context is helpful in unpacking impacts of and reactions to pressures on the system, which adds value beyond some previous frameworks.

HIV drug resistance patterns in pregnant women using next generation sequence in Mozambique.

PubMed

Rupérez, María; Noguera-Julian, Marc; González, Raquel; Maculuve, Sonia; Bellido, Rocío; Vala, Anifa; Rodríguez, Cristina; Sevene, Esperança; Paredes, Roger; Menéndez, Clara

2018-01-01

Few data on HIV resistance in pregnancy are available from Mozambique, one of the countries with the highest HIV toll worldwide. Understanding the patterns of HIV drug resistance in pregnant women might help in tailoring optimal regimens for prevention of mother to child transmission of HIV (pMTCT) and antenatal care. To describe the frequency and characteristics of HIV drug resistance mutations (HIVDRM) in pregnant women with virological failure at delivery, despite pMTCT or antiretroviral therapy (ART). Samples from HIV-infected pregnant women from a rural area in southern Mozambique were analysed. Only women with HIV-1 RNA >400c/mL at delivery were included in the analysis. HIVDRM were determined using MiSeq® (detection threshold 1%) at the first antenatal care (ANC) visit and at the time of delivery. Ninety and 60 samples were available at the first ANC visit and delivery, respectively. At first ANC, 97% of the women had HIV-1 RNA>400c/mL, 39% had CD4+ counts <350 c/mm3 and 30% were previously not on ART. Thirteen women (14%) had at least one HIVDRM of whom 70% were not on previous ART. Eight women (13%) had at least one HIVDRM at delivery. Out of 37 women with data available from the two time points, 8 (21%) developed at least one new HIVDRM during pMTCT or ART. Twenty seven per cent (53/191), 32% (44/138) and 100% (5/5) of the mutations that were present at enrolment, delivery and that emerged during pregnancy, respectively, were minority mutations (frequency <20%). Even with ultrasensitive HIV-1 genotyping, less than 20% of women with detectable viremia at delivery had HIVDRM before initiating pMTCT or ART. This suggests that factors other than pre-existing resistance, such as lack of adherence or interruptions of the ANC chain, are also relevant to explain lack of virological suppression at the time of delivery in women receiving antiretrovirals drugs during pregnancy.

Health Utility of Pregnant Women Living with HIV/AIDS: Prevention of Mother-to-Child Transmission of HIV (PMTCT) Programs in Yunnan Province: A Cross-Sectional Study.

PubMed

Wang, Xiaowen; Guo, Guangping; Liang, Xiumin; Zhou, Ling; Zheng, Jiarui; Li, Shaoqin; Luo, Hongzhuan; Yang, Yuyan; Yang, Liyuan; Tan, Ting; Yu, Jun; Lu, Lin

2018-05-01

Health utility (HU) is essential to understanding the effects of HIV infection as a chronic disease. No HU data on pregnant women living with human immunodeficiency virus (HIV) in Yunnan Province are available. This study aims to construct a database on HU and explore factors associated with HU by pregnant women living with HIV/acquired immunodeficiency syndrome (AIDS) who were enrolled in the Prevention of mother-to-child transmission of HIV (PMTCT) programs in Yunnan Province. A cross-sectional study was conducted in Yunnan Province on pregnant women living with HIV who were selected by convenience sampling. Sociodemographic, HIV-related, social support, and HU data were collected through face-to-face interviews. The European quality of life five-dimensional three-level (EQ-5D-3L) questionnaire and the social support rate scale (SSRS) were applied. One hundred and one pregnant women (mean age of 30.4 ± 5.1 years) participated in the survey. The mean EQ-5D index score and the EQ visual analogue scale (EQ-VAS) score of participants were 0.77 (95% confidence interval [CI] 0.74-0.79) and 75.77 (95% CI 75.00-80.00), respectively. The effect of social support on HU was maintained significant difference even after adjusting for such factors as education level, household income per year, and HIV disclosure, demonstrating a significant difference within EQ-5D index scores and EQ-VAS scores. Pregnant women living with HIV/AIDS who were enrolled in PMTCT programs reported the same level of HU as other patients living with HIV/AIDS. Integrating measurements of HU by using the EQ-5D-3L questionnaire could be helpful for economic evaluation of the PMTCT program. This study also suggests a potential benefit of appropriate social support. Copyright © 2018. Published by Elsevier Inc.

Combination Antiretroviral Treatment for Women Previously Treated Only in Pregnancy: Week 24 Results of AIDS Clinical Trials Group Protocol A5227

PubMed Central

Vogler, Mary A; Smeaton, Laura M; Wright, Rodney L; Cardoso, Sandra Wagner; Sanchez, Jorge; Infante, Rosa; Moran, Laura E; Godfrey, Catherine; Demeter, Lisa M; Johnson, Victoria A

2014-01-01

Background Women with HIV and prior exposure to combination antiretroviral therapy (cART) solely for prevention of Mother to Child Transmission (pMTCT) need to know whether they can later be treated successfully with a commonly used regimen of efavirenz (EFV) and co-formulated emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) Methods Non-pregnant women with plasma HIV-1 RNA of ≥ 500 copies/mL, previously cART- exposed for pMTCT only, were eligible if they were off ART for ≥ 24 weeks prior to entry, were without evidence of drug resistance on standard genotyping, and were ready to start EFV plus FTC/TDF. The primary endpoint was virologic response (defined as plasma HIV RNA <400 copies/mL) at 24 weeks. Results 54 women were enrolled between 10/07 and 12/09; 52/54 completed 24 weeks of follow- up. Median baseline CD4+ T-cell count was 265/mm3 and baseline plasma HIV-1 RNA was 4.6 log10 copies/mL. Median prior cART duration was 14 weeks, and median time elapsed from the last pMTCT dose to entry was 22 months. Virologic response at 24 weeks was observed in 42/52 women or 81% (exact 95% CI: 68%–90%). There were no differences in response by country, by number or class of prior pMTCT exposures. While confirmed virologic failure occurred in 8 women, no virologic failures were observed in women reporting perfect early adherence. Conclusions In this first prospective clinical trial studying combination antiretroviral re- treatment in women with a history of pregnancy-limited cART, the observed virologic response to TDF/FTC and EFV at 24 weeks was 81%. Virologic failures occurred and correlated with self-reported non-adherence. PMID:24759064

Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry.

PubMed

Sprague, Courtenay; Chersich, Matthew F; Black, Vivian

2011-03-03

HIV remains responsible for an estimated 40% of mortality in South African pregnant women and their children. To address these avoidable deaths, eligibility criteria for antiretroviral therapy (ART) in pregnant women were revised in 2010 to enhance ART coverage. With greater availability of HIV services in public health settings and increasing government attention to poor maternal-child health outcomes, this study used the patient's journey through the continuum of maternal and child care as a framework to track and document women's experiences of accessing ART and prevention of mother-to-child HIV transmission (PMTCT) programmes in the Eastern Cape (three peri-urban facilities) and Gauteng provinces (one academic hospital). In-depth interviews identified considerable weaknesses within operational HIV service delivery. These manifested as missed opportunities for HIV testing in antenatal care due to shortages of test kits; insufficient staff assigned to HIV services; late payment of lay counsellors, with consequent absenteeism; and delayed transcription of CD4 cell count results into patient files (required for ART initiation). By contrast, individual factors undermining access encompassed psychosocial concerns, such as fear of a positive test result or a partner's reaction; and stigma. Data and information systems for monitoring in the three peri-urban facilities were markedly inadequate. A single system- or individual-level delay reduced the likelihood of women accessing ART or PMTCT interventions. These delays, when concurrent, often signalled wholesale denial of prevention and treatment. There is great scope for health systems' reforms to address constraints and weaknesses within PMTCT and ART services in South Africa. Recommendations from this study include: ensuring autonomy over resources at lower levels; linking performance management to facility-wide human resources interventions; developing accountability systems; improving HIV services in labour wards; ensuring quality HIV and infant feeding counselling; and improved monitoring for performance management using robust systems for data collection and utilisation.

49 CFR 173.302a - Additional requirements for shipment of nonliquefied (permanent) compressed gases in...

Code of Federal Regulations, 2012 CFR

2012-10-01

... hydrogen. When used in methane service, the methane must be a nonliquefied gas with a minimum purity of 98... nonliquefied (permanent) compressed gases in specification cylinders. 173.302a Section 173.302a Transportation... PACKAGINGS Gases; Preparation and Packaging § 173.302a Additional requirements for shipment of nonliquefied...

Scaling up prevention of mother-to-child HIV transmission programs in sub-Saharan African countries: a multilevel assessment of site-, program- and country-level determinants of performance.

PubMed

Audureau, Etienne; Kahn, James G; Besson, Marie-Hélène; Saba, Joseph; Ladner, Joël

2013-04-01

Uptake of prevention of mother-to-child HIV transmission (PMTCT) programs remains challenging in sub-Saharan Africa because of multiple barriers operating at the individual or health facility levels. Less is known regarding the influence of program-level and contextual determinants. In this study, we explored the multilevel factors associated with coverage in single-dose nevirapine PMTCT programs. We analyzed aggregate routine data collected within the framework of the Viramune(®) Donation Programme (VDP) from 269 sites in 20 PMTCT programs and 15 sub-Saharan countries from 2002 to 2005. Site performance was measured using a nevirapine coverage ratio (NCR), defined as the reported number of women receiving nevirapine divided by the number of women who should have received nevirapine (observed HIV prevalence x number of women in antenatal care [ANC]). Data on program-level determinants were drawn from the initial application forms, and country-level determinants from the Demographic and Health Surveys (DHS) and the World Bank (World Development Indicators). Multilevel linear mixed models were used to identify independent factors associated with NCR at the site-, program- and country-level. Of 283,410 pregnant women attending ANC in the included sites, 174,312 women (61.5%) underwent HIV testing after receiving pre-test counselling, of whom 26,700 tested HIV positive (15.3%), and 22,591 were dispensed NVP (84.6%). Site performance was highly heterogeneous between and within programs. Mean NCR by site was 43.8% (interquartile range: 19.1-63.9). Multilevel analysis identified higher HIV prevalence (Beta coefficient: 25.1, 95% confidence interval [CI] 18.7 to 31.6), higher proportion of persons with knowledge of PMTCT (8.3; CI 0.5 to 16.0), higher health expenditure as a proportion of Gross Domestic Product (3.9 per %; CI 2.0 to 5.8) and lower percentage of rural population (-0.7 per %; CI -1.0 to -0.5) as significant country-level predictors of higher NCR at the p<0.05 level. A medium ANC monthly activity (30-100/month) was the only site-level predictor found (-7.6; CI -15.1 to -0.1). Heterogeneity of nevirapine coverage between sites and programs was high. Multilevel analysis identified several significant contextual determinants, which may warrant additional research to further define important multi-level and potentially modifiable determinants of performance of PMTCT programs.

Short-term effectiveness of a community health worker intervention for HIV-infected pregnant women in Tanzania to improve treatment adherence and retention in care: A cluster-randomized trial.

PubMed

Nance, Nerissa; Pendo, Prosper; Masanja, Joseph; Ngilangwa, David Paul; Webb, Karen; Noronha, Rita; McCoy, Sandra I

2017-01-01

Community health workers (CHWs) are lay workers who have the potential to enhance services to prevent mother-to-child HIV transmission (PMTCT) and improve the health of women living with HIV infection. We conducted a cluster-randomized trial of an intervention to integrate CHWs with 'Option B+' PMTCT services in Shinyanga Region, Tanzania. The intervention was implemented for 11 months and included four integrated components: 1) formal linkage of CHWs to health facilities; 2) CHW-led antiretroviral therapy (ART) adherence counseling; 3) loss to follow-up tracing by CHWs; and 4) distribution of Action Birth Cards (ABCs), a birth planning tool. We cluster-randomized 32 facilities offering PMTCT services, within strata of size, to the intervention (n = 15) or comparison (standard of care, n = 17) groups. Intervention effectiveness was determined with a difference-in-differences strategy based on clinical and pharmacy data from HIV-infected postpartum women at baseline (births in 2014) and endline (births April-Oct 2015). The primary outcome was retention in care between 60 and 120 days postpartum. Secondary outcomes included ART initiation, timing of ART initiation (as measured by week of gestation), and ART adherence 90 days postpartum, measured using the medication possession ratio (MPR≥95%). Intervention and comparison facilities were similar at baseline. Data were collected from 1,152 and 678 mother-infant pairs at baseline and endline, respectively. There were no significant differences in retention in care, ART initiation, or timing of ART initiation between the intervention and control groups. Adherence (MPR≥95%) at 90 days postpartum was 11.3 percentage points higher in the intervention group in ITT analyses (95% CI: -0.7, 23.3, p = 0.06), though this effect was attenuated after adjusting for baseline imbalance (9.5 percentage points, 95% CI: -2.9, 22.0, p = 0.13). Among only sites that had the greatest fidelity to the intervention, however, we found a stronger effect on adherence (13.6 percentage points, 95% CI: 2.5, 24.6). Despite being feasible and acceptable, the CHW-based intervention did not have strong effects on most PMTCT indicators. CHW involvement in PMTCT programs may improve ART adherence among HIV-infected postpartum women, however, and success appears heavily dependent on program implementation. Registry for International Development Impact Evaluations (RIDIE, ID 552553838b402) and ClinicalTrials.gov (NCT03058484).

Minimum package for cross-border TB control and care in the WHO European region: a Wolfheze consensus statement

PubMed Central

Dara, Masoud; de Colombani, Pierpaolo; Petrova-Benedict, Roumyana; Centis, Rosella; Zellweger, Jean-Pierre; Sandgren, Andreas; Heldal, Einar; Sotgiu, Giovanni; Jansen, Niesje; Bahtijarevic, Rankica; Migliori, Giovanni Battista

2012-01-01

The World Health Organization (WHO) European region estimates that more than 400,000 tuberculosis (TB) cases occur in Europe, a large proportion of them among migrants. A coordinated public health mechanism to guarantee TB prevention, diagnosis, treatment and care across borders is not in place. A consensus paper describing the minimum package of cross-border TB control and care was prepared by a task force following a literature review, and with input from the national TB control programme managers of the WHO European region and the Wolfheze 2011 conference. A literature review focused on the subject of TB in migrants was carried out, selecting documents published during the 11-yr period 2001–2011. Several issues were identified in cross-border TB control and care, varying from the limited access to early TB diagnosis, to the lack of continuity of care and information during migration, and the availability of, and access to, health services in the new country. The recommended minimum package addresses the current shortcomings and intends to improve the situation by covering several areas: political commitment (including the implementation of a legal framework for TB cross-border collaboration), financial mechanisms and adequate health service delivery (prevention, infection control, contact management, diagnosis and treatment, and psychosocial support). PMID:22653772

Decentralization Does Not Assure Optimal Delivery of PMTCT and HIV-Exposed Infant Services in a Low Prevalence Setting

PubMed Central

Edmonds, Andrew; Feinstein, Lydia; Okitolonda, Vitus; Thompson, Deidre; Kawende, Bienvenu; Behets, Frieda

2016-01-01

Background The consequences of decentralizing prevention of mother-to-child HIV transmission and HIV-exposed infant services to antenatal care (ANC)/labor and delivery (L&D) sites from dedicated HIV care and treatment (C&T) centers remain unknown, particularly in low prevalence settings. Methods In a cohort of mother–infant pairs, we compared delivery of routine services at ANC/L&D and C&T facilities in Kinshasa, Democratic Republic of Congo from 2010–2013, using methods accounting for competing risks (eg, death). Women could opt to receive interventions at 90 decentralized ANC/L&D sites, or 2 affiliated C&T centers. Additionally, we assessed decentralization’s population-level impacts by comparing proportions of women and infants receiving interventions before (2009–2010) and after (2011–2013) decentralization. Results Among newly HIV-diagnosed women (N = 1482), the 14-week cumulative incidence of receiving the package of CD4 testing and zidovudine or antiretroviral therapy was less at ANC/L&D [66%; 95% confidence interval (CI): 63% to 69%] than at C&T (88%; 95% CI: 83% to 92%) sites (subdistribution hazard ratio, 0.62; 95% CI: 0.55 to 0.69). Delivery of cotrimoxazole and DNA polymerase chain reaction testing to HIV-exposed infants (N = 1182) was inferior at ANC/L&D sites (subdistribution hazard ratio, 0.84; 95% CI: 0.76 to 0.92); the 10-month cumulative incidence of the package at ANC/L&D sites was 89% (95% CI: 82% to 93%) versus 97% (95% CI: 93% to 99%) at C&T centers. Receipt of the pregnancy (20% of 1518, to 64% of 1405) and infant (16%–31%) packages improved post decentralization. Conclusions Services were delivered less efficiently at ANC/L&D sites than C&T centers. Although access improved with decentralization, its potential cannot be realized without sufficient and sustained support. PMID:26262776

Retention in Care among HIV-Infected Pregnant Women in Haiti with PMTCT Option B.

PubMed

Dionne-Odom, Jodie; Massaro, Courtney; Jogerst, Kristen M; Li, Zhongze; Deschamps, Marie-Marcelle; Destine, Cleonas Junior; Senecharles, Redouin; Aristhene, Moleine Moles; Domercant, Joseph Yves; Rouzier, Vanessa; Wright, Peter F

2016-01-01

Background. Preventing mother-to-child transmission of HIV relies on engagement in care during the prenatal, peripartum, and postpartum periods. Under PMTCT Option B, pregnant women with elevated CD4 counts are provided with antiretroviral prophylaxis until cessation of breastfeeding. Methods. Retrospective analysis of retention in care among HIV-infected pregnant women in Haiti was performed. Logistic regression was used to identify risk factors associated with loss to follow-up (LFU) defined as no medical visit for at least 6 months and Kaplan-Meier curves were created to show LFU timing. Results. Women in the cohort had 463 pregnancies between 2009 and 2012 with retention rates of 80% at delivery, 67% at one year, and 59% at 2 years. Among those who were LFU, the highest risk period was during pregnancy (60%) or shortly afterwards (24.4% by 12 months). Never starting on antiretroviral therapy (aRR 2.29, 95% CI 1.4-3.8) was associated with loss to follow-up. Conclusions. Loss to follow-up during and after pregnancy was common in HIV-infected women in Haiti under PMTCT Option B. Since sociodemographic factors and distance from home to facility did not predict LFU, future work should elicit and address barriers to retention at the initial prenatal care visit in all women. Better tracking systems to capture engagement in care in the wider network are needed.

Retention in Care among HIV-Infected Pregnant Women in Haiti with PMTCT Option B

PubMed Central

Massaro, Courtney; Li, Zhongze; Deschamps, Marie-Marcelle; Destine, Cleonas Junior; Senecharles, Redouin; Aristhene, Moleine Moles; Domercant, Joseph Yves; Rouzier, Vanessa; Wright, Peter F.

2016-01-01

Background. Preventing mother-to-child transmission of HIV relies on engagement in care during the prenatal, peripartum, and postpartum periods. Under PMTCT Option B, pregnant women with elevated CD4 counts are provided with antiretroviral prophylaxis until cessation of breastfeeding. Methods. Retrospective analysis of retention in care among HIV-infected pregnant women in Haiti was performed. Logistic regression was used to identify risk factors associated with loss to follow-up (LFU) defined as no medical visit for at least 6 months and Kaplan-Meier curves were created to show LFU timing. Results. Women in the cohort had 463 pregnancies between 2009 and 2012 with retention rates of 80% at delivery, 67% at one year, and 59% at 2 years. Among those who were LFU, the highest risk period was during pregnancy (60%) or shortly afterwards (24.4% by 12 months). Never starting on antiretroviral therapy (aRR 2.29, 95% CI 1.4–3.8) was associated with loss to follow-up. Conclusions. Loss to follow-up during and after pregnancy was common in HIV-infected women in Haiti under PMTCT Option B. Since sociodemographic factors and distance from home to facility did not predict LFU, future work should elicit and address barriers to retention at the initial prenatal care visit in all women. Better tracking systems to capture engagement in care in the wider network are needed. PMID:27651953

Factors associated with short-course antiretroviral prophylaxis (dual therapy) adherence for PMTCT in Nkangala district, South Africa.

PubMed

Peltzer, Karl; Sikwane, Elisa; Majaja, Mmapaseka

2011-09-01

To identify factors that influence adherence to short-course antiretroviral (ARV) prophylaxis by pregnant women and mothers participating in the HIV prevention of mother to child (PMTCT) programme. The sample interviewed included 139 HIV-positive antenatal women (mean gestational age 32 weeks; sexually transmitted diseases [STD] = 2.8, range 4-9 months) and 607 postnatal HIV-positive women, with either having an infant aged 1-10 weeks (30.8%), 11 weeks to 6 months (36.7%) or 7-12 months (32.5%) from Nkangala district, Mpumalanga province, South Africa. A large percentage of antenatal and postnatal women in this study initiated ARV prophylaxis for PMTCT or were on ARV (85.6% and 98%, respectively). Sixty-one per cent of antenatal and 85.9% of postnatal women reported complete adherence to the appropriate medication schedule in the 4 days preceding the interview or prior to delivery. In multivariate analysis, it was found that women with higher HIV status disclosure and less discrimination were better in maternal AZT adherence, women with higher male involvement were better in maternal and infant nevirapine adherence. Adherence to maternal and infant dual therapy prophylaxis was found to be less than optimal. Community factors (discrimination, HIV disclosure, male involvement) contribute to adherence to short-course ARV prophylaxis in this largely rural setting in South Africa. © 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.

Mode of delivery and neonatal respiratory morbidity among HIV-exposed newborns in Latin America and the Caribbean: NISDI Perinatal–LILAC Studies

PubMed Central

Kreitchmann, Regis; Cohen, Rachel A.; Stoszek, Sonia K.; Pinto, Jorge A.; Losso, Marcelo; Pierre, Russell; Alarcon, Jorge; Succi, Regina; Szyld, Edgardo; Abreu, Thalita; Read, Jennifer S.

2012-01-01

Objective To evaluate respiratory morbidity (RM) in HIV-exposed newborns according to mode of delivery. Methods The NISDI Perinatal/LILAC prospective cohort studies enrolled HIV-infected pregnant women and their newborns in Latin America and the Caribbean. Associations between RM and delivery mode or other characteristics were evaluated. Results Between September 2002 and December 2009, 1630 women were enrolled, and 1443 mother–infant pairs met the inclusion criteria. There were 561 vaginal (VD), 269 cesarean before labor and membrane rupture (SCS) for preventing mother-to-child transmission (SCS–PMTCT), 248 other SCS, and 365 cesarean after labor and/or ruptured membranes (NSCS) deliveries. In total, 108 (7.5%) newborns had RM: 49 had respiratory distress syndrome (RDS), 39 had transient tachypnea (TTN), and 28 had other events (7 newborns had >1 RM event). Delivery mode was associated with RDS (P<0.001) and TTN (P<0.001). The proportion with RDS and TTN was lowest for VD (1.6% and 0.5%, respectively), highest for NSCS (4.9% and 4.7%), and intermediate for SCS–PMTCT (3.0% and 2.6%). Newborns with RDS or TTN were hospitalized longer (median +1 day) than those without. A minority required ventilatory support (RDS, 24.5%–28.6%; TTN, 2.6–15.4%). Conclusions SCS–PMTCT is relatively safe for newborns of HIV-infected women. PMID:21620404

Progress towards elimination of HIV mother-to-child transmission in the Dominican Republic from 1999 to 2011.

PubMed

Lorenzo, Osvaldo; Beck-Sagué, Consuelo M; Bautista-Soriano, Claudia; Halpern, Mina; Roman-Poueriet, José; Henderson, Nora; Perez-Then, Eddy; Abreu-Perez, Rosa; Soto, Solange; Martínez, Luis; Rives-Gray, Sarah; Veras, Bienvenido; Connolly, Maureen; Callender, Greer Brittany; Nicholas, Stephen W

2012-01-01

In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999-2008 and 12/302 (4.0%) in 2009-2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003-2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.

Packaged Food

NASA Technical Reports Server (NTRS)

1976-01-01

After studies found that many elderly persons don't eat adequately because they can't afford to, they have limited mobility, or they just don't bother, Innovated Foods, Inc. and JSC developed shelf-stable foods processed and packaged for home preparation with minimum effort. Various food-processing techniques and delivery systems are under study and freeze dried foods originally used for space flight are being marketed. (See 77N76140)

Cold chain monitoring during cold transportation of human corneas for transplantation.

PubMed

Net, M; Trias, E; Navarro, A; Ruiz, A; Diaz, P; Fontenla, J R; Manyalich, M

2003-08-01

As recommended by international standards the cornea should be maintained in a specific temperature range (2 degrees -8 degrees C) to guarantee its viability. However, there is no standard packaging method to maintain these conditions during transport. Our packaging system is similar to those used by the main eye banks in Spain and elsewhere in Europe. The objective is to monitor the cold chain in the current packaging method to validate the maintenance of temperature within the adequate range for a minimum 24-hour period. The effects of the following variables were studied: number and freezing temperature of the cold packs; air volume in the packaging system; position of the cornea in the packaging system; and the wall section of the container. Exterior temperature was maintained constant at 20 degrees to 24 degrees C. The cold chain was monitored using a device that measures temperature continuously and for which a histogram of temperature variation can be downloaded to a computer for further analysis. When the cold packs were frozen to -40 degrees C or the number of cold packs increased to four, the temperature decreased quickly to 0 degrees C and the transport period was not prolonged. The main objective was to improve isolation by reducing inner air volume, and maintaining the position of the cornea in the container. The currently used cold packaging systems (not frozen, 4 degrees C) do not maintain the temperature within the accepted range for the required distribution period. The improved system maintains the cornea at between 2 degrees C and 6 degrees C for a minimum of 24 hours.

HIV-1 transmission and survival according to feeding options in infants born to HIV-infected women in Yaoundé, Cameroon.

PubMed

Njom Nlend, Anne Esther; Motaze, Annie Carole Nga; Sandie, Arsene; Fokam, Joseph

2018-02-19

Evidence of 24-months survival in the frame of prevention of mother-to-child transmission (PMTCT) cascade-care is scare from routine programs in sub-Saharan African (SSA) settings. Specifically, data on infant outcomes according to feeding options remain largely unknown by month-24, thus limiting its breath for public-health recommendations toward eliminating new pediatric HIV-1 infections and improving care. We sought to evaluate HIV-1 vertical transmission and infant survival rates according to feeding options. A retrospective cohort-study conducted in Yaounde from April 2008 through December 2013 among 1086 infants born to HIV-infected women and followed-up throughout the PMTCT cascade-care until 24-months. Infants with documented feeding option during their first 3 months of life (408 on Exclusive Breastfeeding [EBF], 663 Exclusive Replacement feeding [ERF], 15 mixed feeding [MF]) and known HIV-status were enrolled. HIV-1 vertical transmission, survival and feeding options were analyzed using Kaplan Meier Survival Estimate, Cox model and Schoenfeld residuals tests, at 5% statistical significance. Overall HIV-1 vertical transmission was 3.59% (39), and varied by feeding options: EBF (2.70%), ERF (3.77%), MF (20%), p = 0.002; without significance between EBF and ERF (p = 0.34). As expected, HIV-1 transmission also varied with PMTCT-interventions: 1.7% (10/566) from ART-group, 1.9% (8/411) from AZT-group, and 19.2% (21/109) from ARV-naïve group, p < 0.0001. Overall mortality was 2.58% (28), higher in HIV-infected (10.25%) vs. uninfected (2.29%) infants (p = 0.016); with a survival cumulative probability of 89.3% [79.9%-99.8%] vs. 96.4% [94.8%-97.9% respectively], p = 0.024. Mortality also varied by feeding option: ERF (2.41%), EBF (2.45%), MF (13.33%), p = 0.03; with a survival cumulative probability of 96% [94%-98%] in ERF, 96.4% [94.1%-98.8%] in EBF, and 86.67% [71.06%-100%] in MF, p = 0.04. Using Schoenfeld residuals test, only HIV status was a predictor of survival at 24 months (hazard ratio 0.23 [0.072-0.72], p = 0.01). Besides using ART for PMTCT-interventions, practice of MF also drives HIV-1 vertical transmission and mortality among HIV-infected children. Thus, throughout PMTCT option B+ cascade-care, continuous counseling on safer feeding options would to further eliminating new MTCT, optimizing response to care, and improving the life expectancy of these children in high-priority countries.

Tree Classification Software

NASA Technical Reports Server (NTRS)

Buntine, Wray

1993-01-01

This paper introduces the IND Tree Package to prospective users. IND does supervised learning using classification trees. This learning task is a basic tool used in the development of diagnosis, monitoring and expert systems. The IND Tree Package was developed as part of a NASA project to semi-automate the development of data analysis and modelling algorithms using artificial intelligence techniques. The IND Tree Package integrates features from CART and C4 with newer Bayesian and minimum encoding methods for growing classification trees and graphs. The IND Tree Package also provides an experimental control suite on top. The newer features give improved probability estimates often required in diagnostic and screening tasks. The package comes with a manual, Unix 'man' entries, and a guide to tree methods and research. The IND Tree Package is implemented in C under Unix and was beta-tested at university and commercial research laboratories in the United States.

Predictors of loss to follow-up among children registered in an HIV prevention mother-to-child transmission cohort study in Pernambuco, Brazil.

PubMed

Gouveia, Pedro Alves da Cruz; da Silva, Gerlane Alves Pontes; de Albuquerque, Maria de Fatima Pessoa Militão

2014-11-27

Mother-to-child transmission of HIV (MTCT) is the major form of acquiring the disease among children. The loss to follow-up (LTF) of mothers and their children is a problem that affects the effectiveness of programs for the prevention of mother-to-child transmission (PMTCT). The aim of this study is to identify risk factors associated with the LTF of HIV-exposed children in the state of Pernambuco, Brazil. A retrospective cohort study was carried out with 1200 HIV-exposed children born between 2000 and 2009, registered up to the age of 2 months in a public health PMTCT program. Children were considered LTF if they did not return for scheduled visits to monitor infection status. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for LTF. A total of 185 children (15.4%; CI: 95%: 13.4-17.4%) met the case definition of LTF before the determination of serological HIV status. Risk factors independently associated with LTF were mother-child pairs who reside in rural and remote areas (OR 1.86; 95% CI: 1.30-2.66) and mothers who use illicit drugs (OR 1.8; 95% CI: 1.08-3.0). Initiation of the PMTCT during pregnancy was a protective factor for LTF (OR 0.69; 95% CI: 0.49-0.96). The decentralization of support services for HIV-exposed children to other cities in the state seems to be crucial for the accurate monitoring of outcomes. It is also important to introduce additional measures addressing mothers who are drug users so that they remain in the program: an intensive follow-up program that actively searches for absentee mother-child pairs, support from social services and treatment for drug-dependency. The findings of this study highlight the importance of diagnosing mothers as early as possible in order to conduct a more complete follow-up period of the children. Solving the above-mentioned problems is a challenge, which must be overcome so as to improve the quality of PMTCT.

Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria.

PubMed

Sam-Agudu, Nadia A; Aliyu, Muktar H; Adeyemi, Olusegun A; Oronsaye, Frank; Oyeledun, Bolanle; Ogidi, Amaka G; Ezeanolue, Echezona E

2018-04-17

Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation. Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas. The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.

Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis

PubMed Central

Zeng, Huan; Chow, Eric P F; Zhao, Yong; Wang, Yang; Tang, Maozhi; Li, Leyu; Tang, Xue; Liu, Xi; Zhong, Yi; Wang, Ailing; Lo, Ying-Ru; Zhang, Lei

2016-01-01

Introduction The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade. Methods Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003–2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas antiretroviral (ARV) prophylaxis uptake increased from 35.2% (12.2% to 47.3%) and 26.9% (24.3% to 28.9%) to 86.2% (53.2% to 97.2%) and 90.3% (85.5% to 93.7%). HIV vertical transmission rate substantially decreased from 31.8% (25.7% to 38.6%) prior to the programme to 2.3% (1.4% to 3.8%) in 2011. During 2003–2011, among 25 312 (23 995–26 644) infants born to HIV-positive mothers who received ARV prophylaxis, 975 (564–1395) were diagnosed with HIV, corresponding to an average transmission rate of 3.9% (3.2% to 4.6%). However, while including transmissions among HIV-positive pregnant women who were lost along the cascade, the average transmission rate during 2003–2011 was 17.4% (15.8% to 19.0%). Conclusions PMTCT programmes have reduced HIV mother-to-child transmission in China. Further improvements in the continuum of care remain essential in realising the full potential of the programme. PMID:25935929

HIV drug resistance patterns in pregnant women using next generation sequence in Mozambique

PubMed Central

Noguera-Julian, Marc; González, Raquel; Maculuve, Sonia; Bellido, Rocío; Vala, Anifa; Rodríguez, Cristina; Sevene, Esperança; Paredes, Roger; Menéndez, Clara

2018-01-01

Background Few data on HIV resistance in pregnancy are available from Mozambique, one of the countries with the highest HIV toll worldwide. Understanding the patterns of HIV drug resistance in pregnant women might help in tailoring optimal regimens for prevention of mother to child transmission of HIV (pMTCT) and antenatal care. Objectives To describe the frequency and characteristics of HIV drug resistance mutations (HIVDRM) in pregnant women with virological failure at delivery, despite pMTCT or antiretroviral therapy (ART). Methods Samples from HIV-infected pregnant women from a rural area in southern Mozambique were analysed. Only women with HIV-1 RNA >400c/mL at delivery were included in the analysis. HIVDRM were determined using MiSeq® (detection threshold 1%) at the first antenatal care (ANC) visit and at the time of delivery. Results Ninety and 60 samples were available at the first ANC visit and delivery, respectively. At first ANC, 97% of the women had HIV-1 RNA>400c/mL, 39% had CD4+ counts <350 c/mm3 and 30% were previously not on ART. Thirteen women (14%) had at least one HIVDRM of whom 70% were not on previous ART. Eight women (13%) had at least one HIVDRM at delivery. Out of 37 women with data available from the two time points, 8 (21%) developed at least one new HIVDRM during pMTCT or ART. Twenty seven per cent (53/191), 32% (44/138) and 100% (5/5) of the mutations that were present at enrolment, delivery and that emerged during pregnancy, respectively, were minority mutations (frequency <20%). Conclusions Even with ultrasensitive HIV-1 genotyping, less than 20% of women with detectable viremia at delivery had HIVDRM before initiating pMTCT or ART. This suggests that factors other than pre-existing resistance, such as lack of adherence or interruptions of the ANC chain, are also relevant to explain lack of virological suppression at the time of delivery in women receiving antiretrovirals drugs during pregnancy. PMID:29742132

Uptake and performance of prevention of mother-to-child transmission and early infant diagnosis in pregnant HIV-infected women and their exposed infants at seven health centres in Addis Ababa, Ethiopia.

PubMed

Girma, Marshet; Wendaferash, Rahel; Shibru, Hailu; Berhane, Yemane; Hoelscher, Michael; Kroidl, Arne

2017-06-01

To assess the uptake of WHO-recommended PMTCT procedures in Ethiopia's health services. Prospective observational study of HIV-positive pregnant mothers and their newborns attending PMTCT services at seven health centres in Addis Ababa. Women were recruited during antenatal care and followed up with their newborns at delivery, Day 6 and Week 6 post-partum. Retention to PMCTC procedures, self-reported antiretroviral treatment (ART) adherence and HIV infant outcome were assessed. Turnaround times of HIV early infant diagnosis (EID) procedures were extracted from health registers. Of 494 women enrolled, 4.9% did not complete PMTCT procedures due to active denial or loss to follow-up. HIV was first diagnosed in 223 (45.1%) and ART initiated in 321 (65.0%) women during pregnancy. ART was initiated in a median of 1.3 weeks (IQR 0-4.3) after HIV diagnosis. Poor self-reported treatment adherence was higher post-partum than during pregnancy (12.5% vs. 7.0%, P = 0.002) and significantly associated with divorced/separated marital status (RR 2.2, 95% CI 1.3-3.8), low family income (RR 2.1, 95% CI 1.1-4.1), low CD4 count (RR 1.7, 95% CI 1.0-3.0) and ART initiation during delivery (RR 2.5, 95% CI 1.1-5.6). Of 435 infants born alive, 98.6% received nevirapine prophylaxis. The mother-to-child HIV transmission rate was 0.7% after a median of 6.7 weeks (IQR 6.4-10.4), but EID results were received for only 46.6% within 3 months of birth. High retention in PMTCT services, triple maternal ART and high infant nevirapine prophylaxis coverage were associated with low mother-to-child HIV transmission. Declining post-partum ART adherence and challenges of EID linkage require attention. © 2017 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Integration of HIV Testing into Maternal, Newborn, and Child Health Weeks for Improved Case Finding and Linkage to Prevention of Mother-to-Child Transmission Services in Benue State, Nigeria.

PubMed

Akinleye, Olusoji; Dura, Gideon; de Wagt, Arjan; Davies, Abiola; Chamla, Dick

2017-01-01

In Nigeria, maternal, newborn, and child health (MNCH) weeks are campaign-like events designed to accelerate progress toward Millennium Development Goals. The authors examined whether integrating HIV testing into MNCH weeks was feasible and could lead to increased case finding and linkage to prevention of mother-to-child transmission (PMTCT) services. Pregnant women attending MNCH week during the first week of December 2014 in 13 local government areas in Benue State were provided with HIV tests and referrals to PMTCT services. Demographic, past antenatal care (ANC), and HIV testing information were collected using a structured questionnaire. We used routine ANC/PMTCT data from national electronic system (DHIS-2) to compare with the results obtained from MNCH week. A total of 50,271 pregnant women with a median age of 25 years (IQR: 21-29) were offered HIV testing. About 50,253 (99.96%) agreed to get HIV testing, with 1,063 (2.1%) testing positive. Six hundred forty-four (60.6%) of those with positive results were linked to PMTCT. In multivariate analysis, marital status, gestation age, and those with no ANC visit during this pregnancy were associated with a positive HIV test. Approximately 30% (50,253 versus 39,080) more pregnant women received HIV testing in MNCH week compared to those who received HIV testing in routine ANC services in 2013. Of the 50,253 who accepted testing, 15,611 (31.1%) did not attend ANC during this pregnancy, of which 9,615 (61.6%) had not had any previous HIV tests. Four hundred forty-two (4.6%) of these 9,615 tested HIV-positive. Integration of HIV testing into MNCH weeks is feasible and improved uptake of HIV testing and linkage to care. However, the rate of HIV positivity was lower than that reported by previous studies. The findings indicate that MNCH weeks provides opportunity to reach those who do not attend ANC services for HIV care.

Predictors of HIV positivity among pregnant women presenting for obstetric care in South India - a case-control study.

PubMed

Solomon, Eileen; Visnegarwala, Fehmida; Philip, Philimol; Alexander, Glory

2011-10-01

Feminization of the HIV epidemic in India has increasingly burdened the public health infrastructure to provide prevention of mother-to-child transmission (PMTCT) services. A mere 20% of pregnant women in the country receive HIV counseling and testing. One of the strategies, for expansion of PMTCT services is to ascertain an accurate identification of HIV-positive pregnant women. Thus, we sought to characterize a demographic profile of pregnant women at high-risk for HIV infection. We performed a retrospective case-control study. We included as cases, all HIV-positive women identified in a PMTCT program implemented in 23 charitable faith-based hospitals in four states in South India over a period of 75 months, starting in January 2003. Thus a total of 320 HIV-positive cases were frequency matched using stratified random sampling to 365 HIV-negative pregnant women presenting for antenatal care during the same time period. Cases and controls were compared using Chi-square test for categorical variables and Student's t-test for continuous variables. Multivariate step-wise logistic regression analysis was performed. On multivariate analysis, following factors were independently predictive of HIV positivity: age ≤25 years (odds ratio [OR] 0.50; confidence interval [CI] 0.33-0.76; p = 0.001); illiteracy (OR 4.89; CI 2.79-8.57; p <0.0001); woman holding a service and/or professional job (OR 0.27; CI 0.14-0.53; p <0.0001); spouses holding a service or higher job (OR 3.13; CI 2.13-4.59; p <0.0001); being married ≤5 years (OR 2.89; CI 1.68-4.95; p <0.0001); late gestational age at presentation (OR 3.06; CI 2.04-4.59; p <0.0001); history of fetal and/or live born loss (OR 2.36; CI 1.51-3.67; p <0.0001). To our knowledge this is the first large study to evaluate factors predictive of HIV positivity among women presenting for antenatal care in the Indian setting. This type of profiling of HIV-positive pregnant women may help expand PMTCT services in a focused and cost-effective manner in India.

An essential hospital package for South Africa--selection criteria, costs and affordability.

PubMed

Söderlund, N

1999-07-01

In 1995 the Committee of Enquiry into National Health Insurance (NHI) recommended that formally employed individuals and their employers be required to fund at least a minimum package of hospital cover for workers and their dependents. This has recently been echoed in a Department of Health policy paper on social health insurance. This research aims to define and cost a minimum package of essential hospital care for competing (public and private) health insurers in South Africa. CRITERIA FOR PACKAGE DEFINITION: Based on the objectives implict in the NHI Committee report, the following criteria were used to define the essential package: (i) the extent to which there was another appropriate responsible party who should pay for treatment; (ii) the degree of discretion in deciding whether or not to provide treatment (roughly equivalent to 'urgency'); and (iii) the cost and effectiveness of treatment. On the basis of the above criteria, 396 out of 598 possible interventions were included in the package. Using local mine hospital and private sector utilisation rates and mine hospital cost data, it was estimated that the essential inpatient package would cost around R502 per enrollee per year, using 1998 prices, for a working age population and their dependents. Age-sex standardised outpatient care costs in the mine hospital population studied were estimated at R183 per person per year. It was therefore estimated that the total inpatient and outpatient hospital package would cost around R685 per person per year. The results presented in this paper are intended to inform the process of defining a national essential hospital benefit package. Assuming that contributions were proportionally related to income, and that costs should not exceed 6% of wages, the package should be affordable to all of those earning above R20,000 per year. Significant additional work is required, firstly at a technical level to assess the appropriateness of the prioritization approach used here, and secondly to take the debate around essential hospital benefits to broader political and public forums.

HIV-Associated TB: Facts 2013

MedlinePlus

... cause of death among people living with HIV, accounting for one in five HIV- related deaths. In ... in collaboration with partners:  Three interlinked patient monitoring systems for HIV care/ ART, MCH/ PMTCT (including malaria ...

Improving the coverage of prevention of mother-to-child transmission of HIV services in Nigeria: should traditional birth attendants be engaged?

PubMed

O Olakunde, Babayemi; Wakdok, Sabastine; Olaifa, Yewande; Agbo, Francis; Essen, Uduak; Ojo, Mathews; Oke, Maria; Ibi, Sarah

2018-06-01

Traditional birth attendants (TBAs) play an important role in the provision of care to pregnant women in rural parts of Nigeria, but they are barely engaged by the formal healthcare system in expanding the low coverage of prevention of mother-to-child transmission of HIV (PMTCT) services. Using a systematic approach, we engaged TBAs in Abia and Taraba States to scale-up PMTCT services under the National Agency for Control of AIDS Comprehensive AIDS Program with States. We conducted mapping of the TBAs, built their capacities, obtained their buy-in on mobilization of their clients and other pregnant women for HIV testing service outreaches, and established referral and linkage systems. A total of 720 TBAs were mapped (Abia 407; Taraba 313). Three hundred and ninety-nine TBAs who participated in the capacity-building meeting were linked to 115 primary healthcare centers (PHCs) in Abia State, while 245 TBAs were linked to 27 PHCs in Taraba State. From July 2016 to March 2017, the outreaches contributed 20% to the overall total number of pregnant women counseled, tested and received results, and 12% to the total number of HIV-infected women identified. There was a considerable yield of HIV-infected pregnant women among those tested in the TBA outreaches in comparison with the supported antenatal facilities (2% versus 3%, respectively). Engaging TBAs has the potential to improve the coverage of PMTCT services in Nigeria.

Progress towards Elimination of HIV Mother-to-Child Transmission in the Dominican Republic from 1999 to 2011

PubMed Central

Lorenzo, Osvaldo; Beck-Sagué, Consuelo M.; Bautista-Soriano, Claudia; Halpern, Mina; Roman-Poueriet, José; Henderson, Nora; Perez-Then, Eddy; Abreu-Perez, Rosa; Soto, Solange; Martínez, Luis; Rives-Gray, Sarah; Veras, Bienvenido; Connolly, Maureen; Callender, Greer Brittany; Nicholas, Stephen W.

2012-01-01

In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999–2008 and 12/302 (4.0%) in 2009–2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003–2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed. PMID:23251074

Inhibitory effects of cinnamon and clove essential oils on mold growth on baked foods.

PubMed

Ju, Jian; Xu, Xiaomiao; Xie, Yunfei; Guo, Yahui; Cheng, Yuliang; Qian, He; Yao, Weirong

2018-02-01

This study evaluated the minimum inhibition concentration (MIC) and minimum lethal concentration (MLC) of cinnamon and clove essential oils against mold growth on green bean cake and finger citron crisp cake, and also examined the effects of these two essential oils and their application methods on the shelf life of the baked products in normal and vacuum packages by accelerated storage test. The results showed that the MIC of cinnamon and clove essential oils against molds were 0.21-0.83 and 0.21-1.67μL/mL, respectively and the MLC were 0.42-0.83 and 0.83-1.67μL/mL, respectively. In normal package cinnamon and clove essential oils could prolong the shelf life of green bean cake 9-10 and 3-4days, respectively and could prolong the shelf life of finger citron crisp cake 5-6 and 2-3days, respectively. And in vacuum package they were 15-16, 8-9, 10-12 and 7-9days, respectively in turn. Copyright © 2017. Published by Elsevier Ltd.

Further characterisation of rotavirus cores: Ss(+)RNAs can be packaged in vitro but packaging lacks sequence specificity☆

PubMed Central

Desselberger, Ulrich; Richards, James; Tchertanov, Luba; Lepault, Jean; Lever, Andrew; Burrone, Oscar; Cohen, Jean

2013-01-01

Rotavirus (RV) cores were released from double-layered particles (DLPs) by high concentrations of CaCl2, purified and ‘opened’ by treatment with EDTA or EGTA. Under appropriate in vitro conditions DLPs have been shown to have transcriptase and ‘open cores’ replicase activity. Furthermore, it has been demonstrated that transcriptase activity and infectivity of native cores can be restored by transcapsidation with VP6, VP7 and VP4. The missing link for particle reconstitution in vitro has been the manipulation of ‘open cores’ to become functionally active cores again. The experiments described here were undertaken with the aim of exploring packaging of RV RNAs into opened cores in vitro. Rotavirus cores were opened by approximately 200 μM EGTA, leading to the release of genomic dsRNA. Conversely, RV cores were found to be stable in the presence of minimum concentrations of Ca2+, Mg2+, spermidine3+ and cobalthexamine3+ of between 40 and 300 μM. Aggregates of purified cores were resolved in the presence of 0.3 mM deoxycholate (minimum concentration). Core shells opened with EGTA were reconstituted by the addition of di- or trivalent cations within 2 min of the opening procedure. Addition of purified, baculovirus recombinant-expressed VP6 to native and reconstituted cores led to the formation of DLPs or DLP-like particles, which upon transfection into MA104 cells were infectious. The rescued infectivity likely originated in part from unopened and in part from reconstituted cores. Radiolabelled RV (+) ssRNAs could be packaged into reconstituted cores and DLPs, as indicated by resistance to RNase I digestion. The packaging reaction was, however, not RV RNA sequence-specific, since unrelated ssRNAs, such as those transcribed from HIV-2 cDNAs, were also packaged. The kinetics of packaging of homologous and heterologous RNAs were similar, as evidenced by competitive packaging assays. None of the packaged in vitro engineered RNA segments has so far been rescued into infectious virus. PMID:24091366

Associations between Mode of HIV Testing and Consent, Confidentiality, and Referral: A Comparative Analysis in Four African Countries

PubMed Central

Obermeyer, Carla Makhlouf; Neuman, Melissa; Desclaux, Alice; Wanyenze, Rhoda; Ky-Zerbo, Odette; Cherutich, Peter; Namakhoma, Ireen; Hardon, Anita

2012-01-01

Background Recommendations about scaling up HIV testing and counseling highlight the need to provide key services and to protect clients' rights, but it is unclear to what extent different modes of testing differ in this respect. This paper examines whether practices regarding consent, confidentiality, and referral vary depending on whether testing is provided through voluntary counseling and testing (VCT) or provider-initiated testing. Methods and Findings The MATCH (Multi-Country African Testing and Counseling for HIV) study was carried out in Burkina Faso, Kenya, Malawi, and Uganda. Surveys were conducted at selected facilities. We defined eight outcome measures related to pre- and post-test counseling, consent, confidentiality, satisfactory interactions with providers, and (for HIV-positive respondents) referral for care. These were compared across three types of facilities: integrated facilities, where testing is provided along with medical care; stand-alone VCT facilities; and prevention of mother-to-child transmission (PMTCT) facilities, where testing is part of PMTCT services. Tests of bivariate associations and modified Poisson regression were used to assess significance and estimate the unadjusted and adjusted associations between modes of testing and outcome measures. In total, 2,116 respondents tested in 2007 or later reported on their testing experience. High percentages of clients across countries and modes of testing reported receiving recommended services and being satisfied. In the unadjusted analyses, integrated testers were less likely to meet with a counselor before testing (83% compared with 95% of VCT testers; p<0.001), but those who had a pre-test meeting were more likely to have completed consent procedures (89% compared with 83% among VCT testers; p<0.001) and pre-test counseling (78% compared with 73% among VCT testers; p = 0.015). Both integrated and PMTCT testers were more likely to receive complete post-test counseling than were VCT testers (59% among both PMTCT and integrated testers compared with 36% among VCT testers; p<0.001). Adjusted analyses by country show few significant differences by mode of testing: only lower satisfaction among integrated testers in Burkina Faso and Uganda, and lower frequency of referral among PMTCT testers in Malawi. Adjusted analyses of pooled data across countries show a higher likelihood of pre-test meeting for those testing at VCT facilities (adjusted prevalence ratio: 1.22, 95% CI: 1.07–1.38) and higher satisfaction for stand-alone VCT facilities (adjusted prevalence ratio: 1.15; 95% CI: 1.06–1.25), compared to integrated testing, but no other associations were statistically significant. Conclusions Overall, in this study most respondents reported favorable outcomes for consent, confidentiality, and referral. Provider-initiated ways of delivering testing and counseling do not appear to be associated with less favorable outcomes for clients than traditional, client-initiated VCT, suggesting that testing can be scaled up through multiple modes without detriment to clients' rights. Please see later in the article for the Editors' Summary PMID:23109914

Associations between mode of HIV testing and consent, confidentiality, and referral: a comparative analysis in four African countries.

PubMed

Obermeyer, Carla Makhlouf; Neuman, Melissa; Desclaux, Alice; Wanyenze, Rhoda; Ky-Zerbo, Odette; Cherutich, Peter; Namakhoma, Ireen; Hardon, Anita

2012-01-01

Recommendations about scaling up HIV testing and counseling highlight the need to provide key services and to protect clients' rights, but it is unclear to what extent different modes of testing differ in this respect. This paper examines whether practices regarding consent, confidentiality, and referral vary depending on whether testing is provided through voluntary counseling and testing (VCT) or provider-initiated testing. The MATCH (Multi-Country African Testing and Counseling for HIV) study was carried out in Burkina Faso, Kenya, Malawi, and Uganda. Surveys were conducted at selected facilities. We defined eight outcome measures related to pre- and post-test counseling, consent, confidentiality, satisfactory interactions with providers, and (for HIV-positive respondents) referral for care. These were compared across three types of facilities: integrated facilities, where testing is provided along with medical care; stand-alone VCT facilities; and prevention of mother-to-child transmission (PMTCT) facilities, where testing is part of PMTCT services. Tests of bivariate associations and modified Poisson regression were used to assess significance and estimate the unadjusted and adjusted associations between modes of testing and outcome measures. In total, 2,116 respondents tested in 2007 or later reported on their testing experience. High percentages of clients across countries and modes of testing reported receiving recommended services and being satisfied. In the unadjusted analyses, integrated testers were less likely to meet with a counselor before testing (83% compared with 95% of VCT testers; p<0.001), but those who had a pre-test meeting were more likely to have completed consent procedures (89% compared with 83% among VCT testers; p<0.001) and pre-test counseling (78% compared with 73% among VCT testers; p = 0.015). Both integrated and PMTCT testers were more likely to receive complete post-test counseling than were VCT testers (59% among both PMTCT and integrated testers compared with 36% among VCT testers; p<0.001). Adjusted analyses by country show few significant differences by mode of testing: only lower satisfaction among integrated testers in Burkina Faso and Uganda, and lower frequency of referral among PMTCT testers in Malawi. Adjusted analyses of pooled data across countries show a higher likelihood of pre-test meeting for those testing at VCT facilities (adjusted prevalence ratio: 1.22, 95% CI: 1.07-1.38) and higher satisfaction for stand-alone VCT facilities (adjusted prevalence ratio: 1.15; 95% CI: 1.06-1.25), compared to integrated testing, but no other associations were statistically significant. Overall, in this study most respondents reported favorable outcomes for consent, confidentiality, and referral. Provider-initiated ways of delivering testing and counseling do not appear to be associated with less favorable outcomes for clients than traditional, client-initiated VCT, suggesting that testing can be scaled up through multiple modes without detriment to clients' rights. Please see later in the article for the Editors' Summary.

[A study on the effectiveness of prevention of mother-to-child HIV, syphilis, and hepatitis B transmission among pregnant women in Dehong prefecture,Yunnan province, China from 2011 to 2013].

PubMed

Shan, Duo; Wang, Juan; Sun, Jiangping; Duan, Song; Guo, Yunsong

2014-11-01

To demonstrate the effectiveness of prevention of mother-to-child HIV, syphilis, and hepatitis B transmission among pregnant women in Dehong prefecture, Yunnan province, China from 2011 to 2013. Data were collected mainly from the continuous HIV surveillance system and prevention of mother-to-child transmission (PMTCT) reporting system of Dehong prefecture, and supplemented by annual reported data on HIV, syphilis, and hepatitis B PMTCT to know the general demographic characteristics, HIV testing and counseling service, PMTCT service, and other medical services. Data were presented as absolute numbers and proportions. From 2011 to 2013, the number of pregnant women participating in HIV, syphilis, and hepatitis B testing in Dehong prefecture increased and the HIV testing rates were 99.2% (18 694/18 854), 99.9% (22 047/22 060) and 99.9% (21 751/21 756), the syphilis testing rates were 56.0% (10 550/18 854), 99.6% (21 980/22 060) and 99.9% (21 751/21 756), and the hepatitis B testing rates were 60.2% (11 358/18 854), 99.6% (21 974/22 060) and 99.9% (21 751/21 756). From 2011 to 2013, the HIV positive rates were 0.87% (327/37 787),0.82% (319/38 817) and 0.85% (315/37 261), the syphilis positive rates were 0.05% (10/18 520),0.12% (43/36 817) and 0.11% (40/35 888), the hepatitis B positive rates were 2.46% (456/18 520), 2.23% (794/35 547) and 2.14% (739/34 468), respectively. The rates of HIV-positive pregnant women giving birth in hospitals were 99.2% (128/129), 100.0% (141/141) and 100.0% (141/141). From 2011 to 2013, the proportions of HIV-positive pregnant women receiving antiretroviral therapy were 99.2% (128/129), 99.3% (140/141) and 99.3% (140/141), respectively. And the treatment rate of syphilis-positive pregnant women were 71% (5/7), 89% (16/18) and 97% (32/33). The rates of hepatitis B immunoglobulin injection among new-borns of hepatitis B-positive pregnant women were 92.9% (263/283), 99.7% (612/614) and 99.4% (629/633). The estimated rates of mother-to-child transmission of HIV were 2.28%, 2.30% and 3.00%, respectively. There was an increasing trend of HIV, syphilis, and hepatitis B testing rate and the positive rate kept at a low level. The proportions of HIV-positive pregnant women receiving HIV, syphilis, and hepatitis B PMTCT services increased annually, while the proportion of HIV MTCT kept at an overall low level from 2011 to 2013, which indicated its effectiveness of HIV PMTCT work during recent years in Dehong prefecture,Yunnan province, China.

Controlling Blown Pack Spoilage Using Anti-Microbial Packaging

PubMed Central

Reid, Rachael; Tyuftin, Andrey A.; Kerry, Joe P.; Whyte, Paul; Bolton, Declan

2017-01-01

Active (anti-microbial) packaging was prepared using three different formulations; Auranta FV; Inbac-MDA and sodium octanoate at two concentrations (2.5 and 3.5 times their minimum inhibitory concentration (MIC, the lowest concentration that will inhibit the visible growth of the organisms) against Clostridium estertheticum, DSMZ 8809). Inoculated beef samples were packaged using the active packaging and monitored for 100 days storage at 2 °C for blown pack spoilage. The time to the onset of blown pack spoilage was significantly (p < 0.01) increased using Auranta FV and sodium octanoate (caprylic acid sodium salt) at both concentrations. Moreover, sodium octanoate packs had significantly (p < 0.01) delayed blown pack spoilage as compared to Auranta FV. It was therefore concluded that Auranta FV or sodium octanoate, incorporated into the packaging materials used for vacuum packaged beef, would inhibit blown pack spoilage and in the case of the latter, well beyond the 42 days storage period currently required for beef primals. PMID:28805679

Controlling Blown Pack Spoilage Using Anti-Microbial Packaging.

PubMed

Reid, Rachael; Bolton, Declan; Tiuftin, Andrey A; Kerry, Joe P; Fanning, Séamus; Whyte, Paul

2017-08-12

Active (anti-microbial) packaging was prepared using three different formulations; Auranta FV; Inbac-MDA and sodium octanoate at two concentrations (2.5 and 3.5 times their minimum inhibitory concentration (MIC, the lowest concentration that will inhibit the visible growth of the organisms) against Clostridium estertheticum , DSMZ 8809). Inoculated beef samples were packaged using the active packaging and monitored for 100 days storage at 2 °C for blown pack spoilage. The time to the onset of blown pack spoilage was significantly ( p < 0.01) increased using Auranta FV and sodium octanoate (caprylic acid sodium salt) at both concentrations. Moreover, sodium octanoate packs had significantly ( p < 0.01) delayed blown pack spoilage as compared to Auranta FV. It was therefore concluded that Auranta FV or sodium octanoate, incorporated into the packaging materials used for vacuum packaged beef, would inhibit blown pack spoilage and in the case of the latter, well beyond the 42 days storage period currently required for beef primals.

World Health Organization Generic Protocol to Assess Drug-Resistant HIV Among Children <18 Months of Age and Newly Diagnosed With HIV in Resource-Limited Countries

PubMed Central

Penazzato, Martina; Jordan, Michael R.; Persaud, Deborah; Mofenson, Lynne M.; Bennett, Diane E.

2012-01-01

Increased use of nonnucleoside reverse transcriptase inhibitors (NNRTIs) in pregnant and breastfeeding women will result in fewer children infected with human immunodeficiency virus (HIV). However, among children infected despite prevention of mother-to-child transmission (PMTCT), a substantial proportion will acquire NNRTI-resistant HIV, potentially compromising response to NNRTI-based antiretroviral therapy (ART). In countries scaling up PMTCT and pediatric ART programs, it is crucial to assess the proportion of young children with drug-resistant HIV to improve health outcomes and support national and global decision making on optimal selection of pediatric first-line ART. This article summarizes a new World Health Organization surveillance protocol to assess resistance using remnant dried blood spot specimens from a representative sample of children aged <18 months being tested for early infant diagnosis. PMID:22544184

Current good manufacturing practice in manufacturing, packaging, labeling, or holding operations for dietary supplements. Final rule.

PubMed

2007-06-25

The Food and Drug Administration (FDA) is issuing a final rule regarding current good manufacturing practice (CGMP) for dietary supplements. The final rule establishes the minimum CGMPs necessary for activities related to manufacturing, packaging, labeling, or holding dietary supplements to ensure the quality of the dietary supplement. The final rule is one of many actions related to dietary supplements that we are taking to promote and protect the public health.

Early Initiation of ARV During Pregnancy to Move towards Virtual Elimination of Mother-to-Child-Transmission of HIV-1 in Yunnan, China.

PubMed

Meyers, Kathrine; Qian, Haoyu; Wu, Yingfeng; Lao, Yunfei; Chen, Qingling; Dong, Xingqi; Li, Huiqin; Yang, Yiqing; Jiang, Chengqin; Zhou, Zengquan

2015-01-01

To identify factors associated with mother-to-child-transmission and late access to prevention of maternal to child transmission (PMTCT) services among HIV-infected women; and risk factors for infant mortality among HIV-exposed infants in order to assess the feasibility of virtual elimination of vertical transmission and pediatric HIV in this setting. Observational study evaluating the impact of a provincial PMTCT program. The intervention was implemented in 26 counties of Yunnan Province, China at municipal and tertiary health care settings. Log linear regression models with generalized estimating equations were used to identify unadjusted and adjusted correlates for late ARV intervention and MTCT. Cox proportional hazard models with robust sandwich estimation were applied to examine correlates of infant mortality. Mother-to-child- transmission rate of HIV was controlled to 2%, with late initiation of maternal ARV showing a strong association with vertical transmission and infant mortality. Risk factors for late initiation of maternal ARV were age, ethnicity, education, and having a husband not tested for HIV. Mortality rate among HIV-exposed infants was 2.9/100 person-years. In addition to late initiation of maternal ARV, ethnicity, low birth weight and preterm birth were associated with infant mortality. This PMTCT program in Yunnan achieved low rates of MTCT. However the infant mortality rate in this cohort of HIV-exposed children was almost three times the provincial rate. Virtual elimination of MTCT of HIV is an achievable goal in China, but more attention needs to be paid to HIV-free survival.

Home-based HIV testing for men preferred over clinic-based testing by pregnant women and their male partners, a nested cross-sectional study.

PubMed

Osoti, Alfred Onyango; John-Stewart, Grace; Kiarie, James Njogu; Barbra, Richardson; Kinuthia, John; Krakowiak, Daisy; Farquhar, Carey

2015-07-30

Male partner HIV testing and counseling (HTC) is associated with enhanced uptake of prevention of mother-to-child HIV transmission (PMTCT), yet male HTC during pregnancy remains low. Identifying settings preferred by pregnant women and their male partners may improve male involvement in PMTCT. Participants in a randomized clinical trial (NCT01620073) to improve male partner HTC were interviewed to determine whether the preferred male partner HTC setting was the home, antenatal care (ANC) clinic or VCT center. In this nested cross sectional study, responses were evaluated at baseline and after 6 weeks. Differences between the two time points were compared using McNemar's test and correlates of preference were determined using logistic regression. Among 300 pregnant female participants, 54% preferred home over ANC clinic testing (34.0%) or VCT center (12.0%). Among 188 male partners, 68% preferred home-based HTC to antenatal clinic (19%) or VCT (13%). Men who desired more children and women who had less than secondary education or daily income < $2 USD were more likely to prefer home-based over other settings (p < 0.05 for all comparisons). At 6 weeks, the majority of male (81%) and female (65%) participants recommended home over alternative HTC venues. Adjusting for whether or not the partner was tested during follow-up did not significantly alter preferences. Pregnant women and their male partners preferred home-based compared to clinic or VCT-center based male partner HTC. Home-based HTC during pregnancy appears acceptable and may improve male testing and involvement in PMTCT.

Risk factors for postpartum depression in women living with HIV attending Prevention of Mother–to-Child Transmission (PMTCT) Clinic at Kenyatta National Hospital, Nairobi

PubMed Central

Yator, Obadia; Muthoni, Muthoni; Van der Stoep, Ann; Rao, Deepa; Kumar, Manasi

2016-01-01

Mothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) amongst women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending Prevention of Mother to Child transmission (PMTCT) clinic at Kenyatta National Hospital (KNH) located in Nairobi, Kenya. We used the EPDS scale and HIV/AIDS Stigma Instrument – PLWHA (HASI – P). Forty-eight percent (N=59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR=0.14, 95% CI [0.04 – 0.46], p=0.001) and lack of family support (OR=2.49, 95% CI [1.14 – 5.42], p=0.02) were associated with presence of elevated depressive symptoms. The presence of stigma implied more than 9 fold risk of development of PPD (OR=9.44, 95% CI [1.132–78.79], p=0.04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother-baby dyad. PMID:27045273

The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.

PubMed

Lipira, Lauren; Kemp, Christopher; Domercant, Jean Wysler; Honoré, Jean Guy; Francois, Kesner; Puttkammer, Nancy

2018-01-01

Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. In Haiti, attrition from Option B+ is problematic and variable across health care facilities. This study explores service readiness and other facility factors as predictors of Option B+ attrition in Haiti. This analysis used longitudinal data from 2012 to 2014 from the iSanté electronic medical record system and cross-sectional data from Haiti's 2013 Service Provision Assessment. Predictors included Service Availability and Readiness Assessment (SARA) measures for antenatal care (ANC), PMTCT, HIV care services and ART services; general facility characteristics and patient-level factors. Multivariable Cox proportional hazards models modelled the time to first attrition. Analysis of data from 3147 women at 63 health care facilities showed no significant relationships between SARA measures and attrition. Having integrated ANC/PMTCT care and HIV-related training were significant protective factors. Being a public-sector facility, having a greater number of quality improvement activities and training in ANC were significant risk factors. Several facility-level factors were associated with Option B+ attrition. Future research is needed to explore unmeasured facility factors, clarify causal relationships, and incorporate community-level factors into the analysis of Option B+ attrition. © The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Identifying and Prioritizing Implementation Barriers, Gaps, and Strategies Through the Nigeria Implementation Science Alliance: Getting to Zero in the Prevention of Mother-to-Child Transmission of HIV.

PubMed

Ezeanolue, Echezona E; Powell, Byron J; Patel, Dina; Olutola, Ayodotun; Obiefune, Michael; Dakum, Patrick; Okonkwo, Prosper; Gobir, Bola; Akinmurele, Timothy; Nwandu, Anthea; Torpey, Kwasi; Oyeledum, Bolanle; Aina, Muyiwa; Eyo, Andy; Oleribe, Obinna; Ibanga, Ikoedem; Oko, John; Anyaike, Chukwuma; Idoko, John; Aliyu, Muktar H; Sturke, Rachel; Watts, Heather; Siberry, George

2016-08-01

In 2013, Nigeria accounted for 15% of the 1.3 million pregnant women living with HIV in sub-Saharan Africa and 26% of new infections among children worldwide. Despite this, less than 20% of pregnant women in Nigeria received an HIV test during pregnancy, and only 23% of HIV-infected pregnant women received appropriate intervention following HIV diagnosis. This article reports findings from 2 structured group exercises conducted at the first Nigeria Implementation Science Alliance Conference to identify (1) barriers and research gaps related to prevention of mother-to-child transmission (PMTCT) and (2) potential strategies and interventions that could address PMTCT challenges. Two 1-hour structured group exercises were conducted with 10 groups of 14-15 individuals (n = 145), who were asked to brainstorm barriers and strategies and to rank their top 3 in each category. Data analysis eliminated duplicate responses and categorized each of the priorities along the HIV care continuum: HIV diagnosis, linkage to care, or retention in care. Participating stakeholders identified 20 unique barriers and research gaps related to PMTCT across the HIV continuum. Twenty-five unique interventions and implementation strategies were identified. Similar to the barriers and research gaps, these interventions and strategies were distributed across the HIV care continuum. The barriers and strategies identified in this study represent important pathways to progress addressing MTCT. The deliberate involvement of state and federal policy makers, program implementers, and researchers helps ensure that they are relevant and actionable.

Comparative effectiveness of congregation- versus clinic-based approach to prevention of mother-to-child HIV transmission: study protocol for a cluster randomized controlled trial

PubMed Central

2013-01-01

Background A total of 22 priority countries have been identified by the WHO that account for 90% of pregnant women living with HIV. Nigeria is one of only 4 countries among the 22 with an HIV testing rate for pregnant women of less than 20%. Currently, most pregnant women must access a healthcare facility (HF) to be screened and receive available prevention of mother-to-child HIV transmission (PMTCT) interventions. Finding new approaches to increase HIV testing among pregnant women is necessary to realize the WHO/ President's Emergency Plan for AIDS Relief (PEPFAR) goal of eliminating new pediatric infections by 2015. Methods This cluster randomized trial tests the comparative effectiveness of a congregation-based Healthy Beginning Initiative (HBI) versus a clinic-based approach on the rates of HIV testing and PMTCT completion among a cohort of church attending pregnant women. Recruitment occurs at the level of the churches and participants (in that order), while randomization occurs only at the church level. The trial is unblinded, and the churches are informed of their randomization group. Eligible participants, pregnant women attending study churches, are recruited during prayer sessions. HBI is delivered by trained community health nurses and church-based health advisors and provides free, integrated on-site laboratory tests (HIV plus hemoglobin, malaria, hepatitis B, sickle cell gene, syphilis) during a church-organized ‘baby shower.’ The baby shower includes refreshments, gifts exchange, and an educational game show testing participants’ knowledge of healthy pregnancy habits in addition to HIV acquisition modes, and effective PMTCT interventions. Baby receptions provide a contact point for follow-up after delivery. This approach was designed to reduce barriers to screening including knowledge, access, cost and stigma. The primary aim is to evaluate the effect of HBI on the HIV testing rate among pregnant women. The secondary aims are to evaluate the effect of HBI on the rate of HIV testing among male partners of pregnant women and the rate of PMTCT completion among HIV-infected pregnant women. Discussion Results of this study will provide further understanding of the most effective strategies for increasing HIV testing among pregnant women in hard-to-reach communities. Trial Registration Clinicaltrials.gov, NCT01795261 PMID:23758933

Monitoring Prevention Impact of Mother-to-Child Transmission of HIV in Concentrated Epidemics With Program and Survey Data

PubMed Central

Sabin, Keith; Ho, Thi Quynh Trang; Le, Ai Kim Anh; Hayashi, Chika; Kato, Masaya

2017-01-01

Background The prevention of mother-to-child transmission (PMTCT) of HIV program was introduced in Vietnam in 2005. Despite the scaling up of PMTCT programs, the rate of mother-to-child HIV transmission in Vietnam was estimated as high as 20% in 2013. Objective The objective of this study was to assess the outcomes of PMTCT and identified factors associated with mother-to-child transmission and infant survival using survey and program data in a high HIV burden province in Vietnam. Methods This community-based retrospective cohort study observed pregnant women diagnosed with HIV infection in Thai Nguyen province from October 2008 to December 2012. Data were collected through interviews using a structured questionnaire and through reviews of log books and medical charts in antenatal care and HIV clinics. Logistic regression and survival analysis were used to analyze data using Stata (StataCorp). Results A total of 172 pregnant women living with HIV were identified between 2008 and 2012. Most of these women had acquired the HIV infection from their husband (77/119, 64.7%). Significant improvement in the PMTCT program was documented, including reduction in late diagnosis of HIV for pregnant women from 62.5% in 2008 to 30% in 2012. Access to antiretrovirals (ARVs) improved, increasing from a rate of 18.2% (2008) to 70.0% (2011) for mothers and from 36.4% (2008) to 93.3% (2012) for infants. For infants, early diagnosis within 2 months of birth reached 66.7% in 2012 compared with 16.7% in 2009. Transmission rate reduced from 27.3% in 2008 to 6.7% in 2012. Late diagnosis was associated with increased risk for HIV transmission (odds ratio [OR] 14.7, 95% CI 1.8-121.4, P=.01), whereas ARV therapy for mother and infant in combination with infant formula feeding were associated with reduced risk for HIV transmission (OR 0.01, 95% CI 0.001-0.1; P<.001). Overall survival rate for HIV-exposed infants at 12 months was 97.7%. Conclusions A combination of program and survey data measured the impact of prevention of HIV transmission from mother-to-child interventions. Significant improvement in access to the interventions was documented in Thai Nguyen province. However, factors that increased the risk of HIV transmission, such as late diagnosis, remain to be addressed. PMID:29263016

Evaluation of a quality improvement intervention to prevent mother-to-child transmission of HIV (PMTCT) at Zambia defence force facilities.

PubMed

Kim, Young Mi; Chilila, Maureen; Shasulwe, Hildah; Banda, Joseph; Kanjipite, Webby; Sarkar, Supriya; Bazant, Eva; Hiner, Cyndi; Tholandi, Maya; Reinhardt, Stephanie; Mulilo, Joyce Chongo; Kols, Adrienne

2013-09-08

The Zambian Defence Force (ZDF) is working to improve the quality of services to prevent mother-to-child transmission of HIV (PMTCT) at its health facilities. This study evaluates the impact of an intervention that included provider training, supportive supervision, detailed performance standards, repeated assessments of service quality, and task shifting of group education to lay workers. Four ZDF facilities implementing the intervention were matched with four comparison sites. Assessors visited the sites before and after the intervention and completed checklists while observing 387 antenatal care (ANC) consultations and 41 group education sessions. A checklist was used to observe facilities' infrastructure and support systems. Bivariate and multivariate analyses were conducted of findings on provider performance during consultations. Among 137 women observed during their initial ANC visit, 52% came during the first 20 weeks of pregnancy, but 19% waited until the 28th week or later. Overall scores for providers' PMTCT skills rose from 58% at baseline to 73% at endline (p=0.003) at intervention sites, but remained stable at 52% at comparison sites. Especially large gains were seen at intervention sites in family planning counseling (34% to 75%, p=0.026), HIV testing during return visits (13% to 48%, p=0.034), and HIV/AIDS management during visits that did not include an HIV test (1% to 34%, p=0.004). Overall scores for providers' ANC skills rose from 67% to 74% at intervention sites, but declined from 65% to 59% at comparison sites; neither change was significant in the multivariate analysis. Overall scores for group education rose from 87% to 91% at intervention sites and declined from 78% to 57% at comparison sites. The overall facility readiness score rose from 73% to 88% at intervention sites and from 75% to 82% at comparison sites. These findings are relevant to civilian as well as military health systems in Zambia because the two are closely coordinated. Lessons learned include: the ability of detailed performance standards to draw attention to and strengthen areas of weakness; the benefits of training lay workers to take over non-clinical PMTCT tasks; and the need to encourage pregnant women to seek ANC early.

Prevention of mother-to-child HIV transmission cascade in China: a systematic review and meta-analysis.

PubMed

Zeng, Huan; Chow, Eric P F; Zhao, Yong; Wang, Yang; Tang, Maozhi; Li, Leyu; Tang, Xue; Liu, Xi; Zhong, Yi; Wang, Ailing; Lo, Ying-Ru; Zhang, Lei

2016-03-01

The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade. Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003-2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas antiretroviral (ARV) prophylaxis uptake increased from 35.2% (12.2% to 47.3%) and 26.9% (24.3% to 28.9%) to 86.2% (53.2% to 97.2%) and 90.3% (85.5% to 93.7%). HIV vertical transmission rate substantially decreased from 31.8% (25.7% to 38.6%) prior to the programme to 2.3% (1.4% to 3.8%) in 2011. During 2003-2011, among 25,312 (23,995-26,644) infants born to HIV-positive mothers who received ARV prophylaxis, 975 (564-1395) were diagnosed with HIV, corresponding to an average transmission rate of 3.9% (3.2% to 4.6%). However, while including transmissions among HIV-positive pregnant women who were lost along the cascade, the average transmission rate during 2003-2011 was 17.4% (15.8% to 19.0%). PMTCT programmes have reduced HIV mother-to-child transmission in China. Further improvements in the continuum of care remain essential in realising the full potential of the programme. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Research translation to inform national health policies: learning from multiple perspectives in Uganda

PubMed Central

2011-01-01

Background Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally. Methods A case study approach using 30 in-depth interviews with stakeholders involved in two HIV prevention research project was purposively selected. The study sought to analyze the research-to-policy discourses for the prevention of mother-to-child transmission (PMTCT) and safe male circumcision (SMC). The analysis sought to identify entry points, strengths and challenges for research-to-policy processes by interviewing three major groups of stakeholders in Uganda – researchers (8), policy makers (12) and media practitioners (12). Results Among the factors that facilitated PMTCT policy uptake and continued implementation were: shared platforms for learning and decision making among stakeholders, implementation pilots to assess feasibility of intervention, the emerging of agencies to undertake operations research and the high visibility of policy benefits to child survival. In contrast, SMC policy processes were stalled for over two years after the findings of the Uganda study was made public. Among other factors, policy makers demanded additional research to assess implementation feasibility of SMC within ordinary health system context. High level leaders also publicly contested the SMC evidence and the underlying values and messages – a situation that reduced the coalition of policy champions. Conclusions This study shows that effective translation of PMTCT and SMC research results demanded a “360 degree” approach to assembling additional evidence to inform the implementation feasibility for these two HIV prevention interventions. MakCHS and similar institutions should prioritize implementation research to guide the policy processes about the feasibility of implementing new and effective innovations (e.g. PMTCT or SMC) at a large scale in contexts that may be different from the research environments. PMID:21411000

Fabrication of electrospun polylactic acid nanofilm incorporating cinnamon essential oil/β-cyclodextrin inclusion complex for antimicrobial packaging.

PubMed

Wen, Peng; Zhu, Ding-He; Feng, Kun; Liu, Fang-Jun; Lou, Wen-Yong; Li, Ning; Zong, Min-Hua; Wu, Hong

2016-04-01

A novel antimicrobial packaging material was obtained by incorporating cinnamon essential oil/β-cyclodextrin inclusion complex (CEO/β-CD-IC) into polylacticacid (PLA) nanofibers via electrospinning technique. The CEO/β-CD-IC was prepared by the co-precipitation method and SEM and FT-IR spectroscopy analysis indicated the successful formation of CEO/β-CD-IC, which improved the thermal stability of CEO. The CEO/β-CD-IC was then incorporated into PLA nanofibers by electrospinning and the resulting PLA/CEO/β-CD nanofilm showed better antimicrobial activity compared to PLA/CEO nanofilm. The minimum inhibitory concentration (MIC) of PLA/CEO/β-CD nanofilm against Escherichia coli and Staphylococcus aureus was approximately 1 mg/ml (corresponding CEO concentration 11.35 μg/ml) and minimum bactericidal concentration (MBC) was approximately 7 mg/ml (corresponding CEO concentration 79.45 μg/ml). Furthermore, compared with the casting method, the mild electrospinning process was more favorable for maintaining greater CEO in the obtained film. The PLA/CEO/β-CD nanofilm can effectively prolong the shelf life of pork, suggesting it has potential application in active food packaging. Copyright © 2015 Elsevier Ltd. All rights reserved.

Mass decomposition of galaxies using DECA software package

NASA Astrophysics Data System (ADS)

Mosenkov, A. V.

2014-01-01

The new DECA software package, which is designed to perform photometric analysis of the images of disk and elliptical galaxies having a regular structure, is presented. DECA is written in Python interpreted language and combines the capabilities of several widely used packages for astronomical data processing such as IRAF, SExtractor, and the GALFIT code used to perform two-dimensional decomposition of galaxy images into several photometric components (bulge+disk). DECA has the advantage that it can be applied to large samples of galaxies with different orientations with respect to the line of sight (including edge-on galaxies) and requires minimum human intervention. Examples of using the package to study a sample of simulated galaxy images and a sample of real objects are shown to demonstrate that DECA can be a reliable tool for the study of the structure of galaxies.

Quality evaluation of polypropylene packaged corn yogurt during storage

NASA Astrophysics Data System (ADS)

Aini, Nur; Prihananto, V.; Sustriawan, B.; Astuti, Y.; Maulina, M. R.

2018-01-01

Packaging is an important factor to control the process of quality decrease of any food product, including to determine the shelf life. The objective of this study was to determine changes quality of corn yogurt packaged using polypropylene. The method were using was package yogurt polypropylene, then it was stored in a refrigerator at 5, 10, or 15°C during 21 days. The yogurt was analysed every 7 days over a 21-day period. The results indicate that protein content decreased during storage, while the lactic acid bacteria, total acid, pH, viscosity, and total solids were increased. At the end of storage, the amount of lactic acid bacteria still fulfil the minimum requirements of a probiotic food, with a count of 6.407 log CFU/g. Overal scoring by panelist (scores ranged from 0 to 5) have a 4.78 at the beginning of storage. By the 21st day of storage, yogurt was packaging using transparent polypropylene having a score of 3.85, and that stored in opaque white packaging having a value of 3.95.

Integration of Traditional Birth Attendants into Prevention of Mother-to-Child Transmission at Primary Health Facilities in Kaduna, North-West Nigeria.

PubMed

Nsirim, Reward O; Iyongo, Joseph A; Adekugbe, Olayinka; Ugochuku, Maureen

2015-03-31

One of the fundamental challenges to implementing successful prevention of mother-to-child transmission (PMTCT) programs in Nigeria is the uptake of PMTCT services at health facilities. Several issues usually discourage many pregnant women from receiving antenatal care services at designated health facilities within their communities. The CRS Nigeria PMTCT Project funded by the Global Fund in its Round 9 Phase 1 in Nigeria, sought to increase demand for HIV counseling and testing services for pregnant women at 25 supported primary health centers (PHCs) in Kaduna State, North-West Nigeria by integrating traditional birth attendants (TBAs) across the communities where the PHCs were located into the project. Community dialogues were held with the TBAs, community leaders and women groups. These dialogues focused on modes of mother to child transmission of HIV and the need for TBAs to refer their clients to PHCs for testing. Subsequently, data on number of pregnant women who were counseled, tested and received results was collected on a monthly basis from the 25 facilities using the national HIV/AIDS tools. Prior to this integration, the average number of pregnant women that were counseled, tested and received results was 200 pregnant women across all the 25 health facilities monthly. After the integration of TBAs into the program, the number of pregnant women that were counseled, tested and received results kept increasing month after month up to an average of 1500 pregnant women per month across the 25 health facilities. TBAs can thus play a key role in improving service uptake and utilization for pregnant women at primary health centers in the community - especially in the context of HIV/AIDS. They thus need to be integrated, rather than alienated, from primary healthcare service delivery.

Dried Blood Spot Test for HIV Exposed Infants and Children and Their Anti-Retro Viral Treatment Status in Selected Hospitals in Ethiopia.

PubMed

Wondafrash, Beyene; Hiko, Desta

2016-01-01

Infants and children living with HIV receive antiretroviral treatment often late, are exposed to opportunistic infection and quickly develop AIDS. Few hospitals are providing ART service after Dried Blood Spot (DBS)test.The objective of this study is to assess the status of infants and children linked to ART. Descriptive cross-sectional study was conducted in hospitals. Data of 138 infants and children exposed to HIV were collected from registration books and data bases from 2009 to 2011. Data were analyzed using SPSS version 16. Chi-squared test and p-value were computed. In-depth interviews were conducted with key informants. Ninety-eight (71%) infants and children exposed to HIV were diagnosed for HIV infection of which 68(69.4%) initiated ART. Twenty four (35.3%) initiated ART one month after HIV screening results. Thirty-three (50.0%) and 23(35.3%) infants and children dropped from and adhered to ART respectively. Eleven (16.2%) of them who initiated ART died within the study period. HIV infection status (p-value=0.003), dropping from ART (p-value=0.002) and death after ART initiation (p-value=0.010) showed significance with mothers' PMTCT service status. Seven in ten HIV-exposed infants and children were diagnosed with HIV, and almost all of them initiated ART. The overall turnaround time was 10 days. Based up on mothers' PMTCT service status, there was a significant difference among HIV-exposed infants and children in acquiring HIV infection from mothers during pregnancy (p-value=0.003) and dropping from ART (p-value=0.010). There were challenges in sample collection and transportation. Early HIV screening during pregnancy and PMTCT service should be strengthened.

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities: results and lessons learned.

PubMed

Kols, Adrienne; Kim, Young-Mi; Bazant, Eva; Necochea, Edgar; Banda, Joseph; Stender, Stacie

2015-07-01

The Zambia Defence Force adopted the Standards-Based Management and Recognition approach to improve the quality of the HIV-related services at its health facilities. This quality improvement intervention relies on comprehensive, detailed assessment tools to communicate and verify adherence to national standards of care, and to test and implement changes to improve performance. A quasi-experimental evaluation of the intervention was conducted at eight Zambia Defence Force primary health facilities (four facilities implemented the intervention and four did not). Data from three previous analyses are combined to assess the effect of Standards-Based Management and Recognition on three domains: facility readiness to provide services; observed provider performance during antiretroviral therapy (ART) and antenatal care consultations; and provider perceptions of the work environment. Facility readiness scores for ART improved on four of the eight standards at intervention sites, and one standard at comparison sites. Facility readiness scores for prevention of mother-to-child transmission (PMTCT) of HIV increased by 15 percentage points at intervention sites and 7 percentage points at comparison sites. Provider performance improved significantly at intervention sites for both ART services (from 58 to 84%; P < 0.01) and PMTCT services (from 58 to 73%; P = 0.003); there was no significant change at comparison sites. Providers' perceptions of the work environment generally improved at intervention sites and declined at comparison sites; differences in trends between study groups were significant for eight items. A standards-based approach to quality improvement proved effective in supporting healthcare managers and providers to deliver ART and PMTCT services in accordance with evidence-based standards in a health system suffering from staff shortages.

Messages on pregnancy and family planning that providers give women living with HIV in the context of a Positive Health, Dignity, and Prevention intervention in Mozambique

PubMed Central

Hilliard, Starr; Gutin, Sarah A; Dawson Rose, Carol

2014-01-01

Background Family planning is an important HIV prevention tool for women living with HIV (WLHIV). In Mozambique, the prevalence of HIV among women of reproductive age is 13.1% and the average fertility rate is high. However, family planning and reproductive health for WLHIV are under-addressed in Mozambique. This study explores provider descriptions of reproductive health messages in order to identify possible barriers and facilitators to successfully addressing family planning and pregnancy concerns of WLHIV. Methods In 2006, a Positive Health, Dignity, and Prevention program was introduced in Mozambique focused on training health care providers to work with patients to reduce their transmission risks. Providers received training on multiple components, including family planning and prevention of mother-to-child transmission (PMTCT). In-depth interviews were conducted with 31 providers who participated in the training in five rural clinics in three provinces. Data were analyzed using qualitative content analysis. Results Analysis showed that providers’ clinical messages on family planning, pregnancy, and PMTCT for WLHIV could be arranged along a continuum. Provider statements ranged from saying that WLHIV should not become pregnant and condoms are the only valid form of family planning for WLHIV, to suggesting that WLHIV can have safe pregnancies. Conclusion These data indicate that many providers continue to believe that WLHIV should not have children and this represents a challenge for integrating family planning into the care of WLHIV. Also, not offering WLHIV a full selection of family planning methods severely limits their ability to protect themselves from unintended pregnancies and to fully exercise their reproductive rights. Responding to the reproductive health needs of WLHIV is a critical component in HIV prevention and could increase the success of PMTCT programs. PMID:25540599

Conditional cash transfers improve retention in PMTCT services by mitigating the negative effect of not having money to come to the clinic

PubMed Central

Yotebieng, Marcel; Moracco, Kathryn E.; Thirumurthy, Harsha; Edmonds, Andrew; Tabala, Martine; Kawende, Bienvenu; Wenzi, Landry Kipula; Okitolonda, Emile W.; Behets, Frieda

2016-01-01

Objective To elucidate the mechanisms by which a cash incentive intervention increases retention in prevention of mother-to-child transmission (PMTCT) services. Methods We used data from a randomized controlled trial in Kinshasa, Democratic Republic of Congo. Perceptual factors associated with loss-to-follow-up (LTFU) through six weeks postpartum were first identified. Then, binomial models were used to assess interactions between LTFU and identified factors, and the cash incentive intervention. Results Participants were less likely to be LTFU if they perceived HIV as a “very serious” health problem for their baby vs. not (risk difference [RD], −0.13; 95% confidence interval [CI], −0.30, 0.04), if they believed it would be “very likely” to pass HIV on to their baby if they did not take any HIV drug vs. not (RD, −0.15; 95% CI, −0.32, 0.02), and if they anticipated that not having money would make it difficult for them to come to clinic vs. not (RD, 0.12; 95% CI, −0.07, 0.30). The effect of each of the three factors on LTFU was antagonistic to that of receiving the cash incentive intervention. The excess risk due to interaction between the cash incentive intervention and the anticipated difficulty of “not having money” to come to clinic was exactly equal to the effect of removing this perceived barrier (excess risk due to interaction, −0.12; 95% CI, −0.35, 0.10). Conclusions Our analyses show that cash transfers improve retention in PMTCT services mainly by mitigating the negative effect of not having money to come to the clinic. PMID:27787342

Virtual Elimination of Mother-to-Child Transmission of Human Immunodeficiency Virus in Mothers on Highly Active Antiretroviral Therapy in Enugu, South-Eastern Nigeria.

PubMed

Okafor, Ii; Ugwu, Eo; Obi, Sn; Odugu, Bu

2014-07-01

With the current World Health Organization (WHO) "Option B+" for prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV), virtual elimination of mother to child transmission (eMTCT) is highly achievable. The aim of this study is to determine the rate of MTCT of HIV from mothers who started highly active antiretroviral therapy (HAART) for life from diagnosis during pregnancy to the exposed babies who had daily nevirapine in the first 6 weeks of life. HIV positive mothers and their exposed babies who enrolled for the hospital PMTCT protocol from January 1, 2009 to December 31, 2011 were studied. The babies were tested for HIV using deoxyribo nucleic acid polymerase chain reaction test at 6 weeks, and then HIV rapid tests at 18 months. A total of 5,946 booked mothers had HIV testing and counseling (HTC) within the study period. Two hundred and twenty-three (223/5946, 3.7%) were positive, out of which 188 (188/223, 84.3%) enrolled for the PMTCT interventions while 35 (35/223, 15.7%) did not enroll. Three of the enrollees were lost to follow up and two were referred to another PMCT center. Of the remaining 183 enrolled HIV positive mothers, one gave birth to a set of twins, giving a total of 184 exposed babies. There were two cases of intrauterine fetal death of unknown fetal HIV status. None of the 182 remaining babies evaluated for HIV testing tested positive to HIV. With adequate suppression of maternal viral replication with HAART using the WHO Option B+, eMTCT of HIV is achievable in a developing country like Nigeria where infant breastfeeding is a norm.

Knowledge, attitude and practice of infant feeding in the first 6 months among HIV-positive mothers at the Queen Mamohato Memorial hospital clinics, Maseru, Lesotho

PubMed Central

Dudley, Lilian

2018-01-01

Background The balance between the risks of transmission of human immunodeficiency virus (HIV) through breastfeeding and its life-saving benefits complicates decisions about infant feeding among HIV-positive mothers in the first 6 months. Objective The aim of this study was to assess the knowledge, attitude and practice of infant feeding among HIV-positive mothers attending the prevention of mother-to-child transmission services in Maseru, Lesotho. Method and setting This observational cross-sectional study was done by collecting data from HIV-positive mothers attending the filter clinics of Queen Mamohato Memorial hospital in Maseru, Lesotho. HIV-positive mothers with infants below the age of 6 months attending the clinics at the time of the study were interviewed using a standardised questionnaire. We described the sociodemographic profile of the mothers, the information and education received on prevention of mother-to-child transmission (PMTCT) infant feeding options, the mothers’ knowledge, attitudes and practices of infant feeding, and assessed risk factors for improved knowledge, attitudes and practices. Results The majority (96%) of the 191 HIV-positive mothers who participated in the survey knew about the PMTCT programme and related breastfeeding services. Most of the participants chose to breastfeed (89%), while only 8% formula-fed their infants. Knowledge received during the PMTCT programme was significantly associated with the decision to exclusively breastfeed their infants. Earlier infant feeding counselling and education was associated with more exclusively breastfeeding as compared to late infant feeding counselling (p < 0.001). Conclusion The study found that HIV-positive mothers attending health clinics in Maseru, Lesotho, had high knowledge, and appropriate attitudes and practices with respect to infant feeding; and that early counselling and education improved infant feeding methods among these mothers. PMID:29781690

Ebola virus disease outbreak in Guinea: what effects on prevention of mother-to-child transmission of HIV services?

PubMed

Leno, Niouma Nestor; Delamou, Alexandre; Koita, Youssouf; Diallo, Thierno Souleymane; Kaba, Abdoulaye; Delvaux, Therese; Van Damme, Wim; Laga, Marie

2018-04-10

An unprecedented epidemic of Ebola virus disease (EVD) affected Guinea in 2014 and 2015. It weakened the already fragile Guinean health system. This study aimed to assess the effects of the outbreak on Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in 2014. We conducted a cross-sectional retrospective study. Data was collected from 60 public health centers (30 in the EVD affected areas and 30 in the unaffected areas). The comparison of PMTCT indicators between the period before Ebola (2013) and during Ebola (2014) was done using the t- test for the means and the Chi-square test for the proportions. This study showed a substantial and significant reduction in the mean number of antenatal care visits (ANC) in the affected localities, 1617 ± 53 in 2013 versus 1065 ± 29 in 2014, p = 0.0004. This would represent 41% drop in health facilities' performance. On the other hand, in the unaffected localities, the fall was not significant. The same observations were made about the number of HIV tests performed for pregnant women and the number of HIV positive pregnant women initiating ARVs. The study also noted an increase in the proportion of women tested HIV+ but who did not receive ARVs (12% in 2013 versus 44% in 2014) and HIV+ pregnant women who delivered at home (18% in 2014 versus 7% in 2013). This study showed that PMTCT services, which are one of the key services to improve maternal and child health, were affected in Guinea during this Ebola outbreak in 2014 compared to 2013.

Prevention of Mother-to-Child Transmission of HIV in Option B+ Era: Uptake and Adherence During Pregnancy in Western Uganda.

PubMed

Schnack, Alexandra; Rempis, Eva; Decker, Sarah; Braun, Vera; Rubaihayo, John; Busingye, Priscilla; Tumwesigye, Nazarius Mbona; Harms, Gundel; Theuring, Stefanie

2016-03-01

Since 2012, lifelong antiretroviral therapy for all HIV-positive pregnant women ("Option B+") is recommended by WHO for the prevention of mother-to-child transmission of HIV (PMTCT). Many sub-Saharan African countries have since introduced this regimen, but to date, longer-term outcome evaluations are scarce. We conducted an observational study in Fort Portal Municipality, Uganda, to describe uptake and adherence of Option B+ during pregnancy. HIV-positive women approaching antenatal care (ANC) services in two hospitals were enrolled and followed-up at monthly routine ANC visits until delivery. At each visit, next to sociodemographic and clinical data, we assessed drug adherence through pill counts. In total, 124 HIV-positive pregnant women were enrolled in our study; from these, 80.8% had not been aware of their positive serostatus before. Forty-five PMTCT clients (36.3%) never returned to ANC after their first visit. Protective factors (p < 0.05) for immediate loss to care included previous HIV status knowledge, status disclosure before or at first ANC visit, and tertiary education. Among those clients starting Option B+, the median adherence during pregnancy was 95.7% pill intake. Rather low adherence (<80%) was observed in 21.1% of clients, while more than half achieved an adherence level of ≥95%, with 40.8% of all clients being 100% adherent. The cohort's median adherence remained stable throughout the course of pregnancy. Healthcare providers should place high emphasis on individual PMTCT counseling at first ANC encounter, and pay special attention to those women previously unaware of their HIV status. However, after initial uptake, high adherence seems to be feasible for Option B+.

Cost-effectiveness of World Health Organization 2010 Guidelines for Prevention of Mother-to-Child HIV Transmission in Zimbabwe

PubMed Central

Ciaranello, Andrea L.; Perez, Freddy; Engelsmann, Barbara; Walensky, Rochelle P.; Mushavi, Angela; Rusibamayila, Asinath; Keatinge, Jo; Park, Ji-Eun; Maruva, Matthews; Cerda, Rodrigo; Wood, Robin; Dabis, Francois; Freedberg, Kenneth A.

2013-01-01

Background. In 2010, the World Health Organization (WHO) released revised guidelines for prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). We projected clinical impacts, costs, and cost-effectiveness of WHO-recommended PMTCT strategies in Zimbabwe. Methods. We used Zimbabwean data in a validated computer model to simulate a cohort of pregnant, HIV-infected women (mean age, 24 years; mean CD4 count, 451 cells/µL; subsequent 18 months of breastfeeding). We simulated guideline-concordant care for 4 PMTCT regimens: single-dose nevirapine (sdNVP); WHO-recommended Option A, WHO-recommended Option B, and Option B+ (lifelong maternal 3-drug antiretroviral therapy regardless of CD4). Outcomes included maternal and infant life expectancy (LE) and lifetime healthcare costs (2008 US dollars [USD]). Incremental cost-effectiveness ratios (ICERs, in USD per year of life saved [YLS]) were calculated from combined (maternal + infant) discounted costs and LE. Results. Replacing sdNVP with Option A increased combined maternal and infant LE from 36.97 to 37.89 years and would reduce lifetime costs from $5760 to $5710 per mother–infant pair. Compared with Option A, Option B further improved LE (38.32 years), and saved money within 4 years after delivery ($5630 per mother–infant pair). Option B+ (LE, 39.04 years; lifetime cost, $6620 per mother–infant pair) improved maternal and infant health, with an ICER of $1370 per YLS compared with Option B. Conclusions. Replacing sdNVP with Option A or Option B will improve maternal and infant outcomes and save money; Option B increases health benefits and decreases costs compared with Option A. Option B+ further improves maternal outcomes, with an ICER (compared with Option B) similar to many current HIV-related healthcare interventions. PMID:23204035

Universal combination antiretroviral regimens to prevent mother-to-child transmission of HIV in rural Zambia: a two-round cross-sectional study

PubMed Central

Musonda, Patrick; Lembalemba, Mwila K; Chintu, Namwinga T; Gartland, Matthew G; Mulenga, Saziso N; Bweupe, Maximillian; Turnbull, Eleanor; Stringer, Elizabeth M; Stringer, Jeffrey SA

2014-01-01

Abstract Objective To evaluate if a pilot programme to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) was associated with changes in early childhood survival at the population level in rural Zambia. Methods Combination antiretroviral regimens were offered to pregnant and breastfeeding, HIV-infected women, irrespective of immunological status, at four rural health facilities. Twenty-four-month HIV-free survival among children born to HIV-infected mothers was determined before and after PMTCT programme implementation using community surveys. Households were randomly selected and women who had given birth in the previous 24 months were asked to participate. Mothers were tested for HIV antibodies and children born to HIV-infected mothers were tested for viral deoxyribonucleic acid. Multivariable models were used to determine factors associated with child HIV infection or death. Findings In the first survey (2008–2009), 335 of 1778 women (18.8%) tested positive for HIV. In the second (2011), 390 of 2386 (16.3%) tested positive. The 24-month HIV-free survival in HIV-exposed children was 0.66 (95% confidence interval, CI: 0.63–0.76) in the first survey and 0.89 (95% CI: 0.83–0.94) in the second. Combination antiretroviral regimen use was associated with a lower risk of HIV infection or death in children (adjusted hazard ratio: 0.33, 95% CI: 0.15–0.73). Maternal knowledge of HIV status, use of HIV tests and use of combination regimens during pregnancy increased between the surveys. Conclusion The PMTCT programme was associated with an increased HIV-free survival in children born to HIV-infected mothers. Maternal utilization of HIV testing and treatment in the community also increased. PMID:25177073

Messages on pregnancy and family planning that providers give women living with HIV in the context of a Positive Health, Dignity, and Prevention intervention in Mozambique.

PubMed

Hilliard, Starr; Gutin, Sarah A; Dawson Rose, Carol

2014-01-01

Family planning is an important HIV prevention tool for women living with HIV (WLHIV). In Mozambique, the prevalence of HIV among women of reproductive age is 13.1% and the average fertility rate is high. However, family planning and reproductive health for WLHIV are under-addressed in Mozambique. This study explores provider descriptions of reproductive health messages in order to identify possible barriers and facilitators to successfully addressing family planning and pregnancy concerns of WLHIV. In 2006, a Positive Health, Dignity, and Prevention program was introduced in Mozambique focused on training health care providers to work with patients to reduce their transmission risks. Providers received training on multiple components, including family planning and prevention of mother-to-child transmission (PMTCT). In-depth interviews were conducted with 31 providers who participated in the training in five rural clinics in three provinces. Data were analyzed using qualitative content analysis. Analysis showed that providers' clinical messages on family planning, pregnancy, and PMTCT for WLHIV could be arranged along a continuum. Provider statements ranged from saying that WLHIV should not become pregnant and condoms are the only valid form of family planning for WLHIV, to suggesting that WLHIV can have safe pregnancies. These data indicate that many providers continue to believe that WLHIV should not have children and this represents a challenge for integrating family planning into the care of WLHIV. Also, not offering WLHIV a full selection of family planning methods severely limits their ability to protect themselves from unintended pregnancies and to fully exercise their reproductive rights. Responding to the reproductive health needs of WLHIV is a critical component in HIV prevention and could increase the success of PMTCT programs.

Socio-economic determinants of HIV testing and counselling: a comparative study in four African countries.

PubMed

Obermeyer, Carla Makhlouf; Neuman, Melissa; Hardon, Anita; Desclaux, Alice; Wanyenze, Rhoda; Ky-Zerbo, Odette; Cherutich, Peter; Namakhoma, Ireen

2013-09-01

Research indicates that individuals tested for HIV have higher socio-economic status than those not tested, but less is known about how socio-economic status is associated with modes of testing. We compared individuals tested through provider-initiated testing and counselling (PITC), those tested through voluntary counselling and testing (VCT) and those never tested. Cross-sectional surveys were conducted at health facilities in Burkina Faso, Kenya, Malawi and Uganda, as part of the Multi-country African Testing and Counselling for HIV (MATCH) study. A total of 3659 clients were asked about testing status, type of facility of most recent test and socio-economic status. Two outcome measures were analysed: ever tested for HIV and mode of testing. We compared VCT at stand-alone facilities and PITC, which includes integrated facilities where testing is provided with medical care, and prevention of mother-to-child transmission (PMTCT) facilities. The determinants of ever testing and of using a particular mode of testing were analysed using modified Poisson regression and multinomial logistic analyses. Higher socio-economic status was associated with the likelihood of testing at VCT rather than other facilities or not testing. There were no significant differences in socio-economic characteristics between those tested through PITC (integrated and PMTCT facilities) and those not tested. Provider-initiated modes of testing make testing accessible to individuals from lower socio-economic groups to a greater extent than traditional VCT. Expanding testing through PMTCT reduces socio-economic obstacles, especially for women. Continued efforts are needed to encourage testing and counselling among men and the less affluent. © 2013 John Wiley & Sons Ltd.

HIV knowledge and sexual risk behavior among pregnant couples in South Africa: the PartnerPlus project.

PubMed

Villar-Loubet, Olga M; Cook, Ryan; Chakhtoura, Nahida; Peltzer, Karl; Weiss, Stephen M; Shikwane, Molatelo Elisa; Jones, Deborah L

2013-02-01

In sub-Saharan Africa, 60 % of people living with HIV are women and most are of childbearing age. Alarmingly, seroconversion rates during pregnancy are high and increase as pregnancy progresses, highlighting the importance of increasing HIV-knowledge among pregnant women and their partners. This study compared sexual risk behavior, HIV knowledge and condom use pre- to post-partum among South African couples (n = 239 couples) randomly assigned to an intervention or an enhanced standard of care with the PMTCT protocol at rural community health antenatal clinics. Consistent condom use and HIV-related knowledge increased baseline to post-intervention and was maintained at long term follow up post-partum among participants in the intervention condition. HIV knowledge mediated the relationship between the intervention and consistent condom use. Results from this pilot study provide support for the integration of HIV risk reduction interventions for both women and men into existing PMTCT services during and following pregnancy.

Package leaflets of the most consumed medicines in Portugal: safety and regulatory compliance issues. A descriptive study.

PubMed

Pires, Carla; Vigário, Marina; Cavaco, Afonso

2015-01-01

Package leaflets are necessary for safe use of medicines. The aims of the present study were: 1) to assess the compliance between the content of the package leaflets and the specifications of the pharmaceutical regulations; and 2) to identify potential safety issues for patients. Qualitative descriptive study, involving all the package leaflets of branded medicines from the three most consumed therapeutic groups in Portugal, analyzed in the Department of Pharmacoepidemiology, School of Pharmacy, University of Lisbon. A checklist validated through an expert consensus process was used to gather the data. The content of each package leaflet in the sample was classified as compliant or non-compliant with compulsory regulatory issues (i.e. stated dosage and descriptions of adverse reactions) and optional regulatory issues (i.e. adverse reaction frequency, symptoms and procedures in cases of overdose). A total of 651 package leaflets were identified. Overall, the package leaflets were found to be compliant with the compulsory regulatory issues. However, the optional regulatory issues were only addressed in around half of the sample of package leaflets, which made it possible to identify some situations of potentially compromised drug safety. Ideally, the methodologies for package leaflet approval should be reviewed and optimized as a way of ensuring the inclusion of the minimum essential information for safe use of medicines.

49 CFR 175.78 - Stowage compatibility of cargo.

Code of Federal Regulations, 2010 CFR

2010-10-01

... leakage. (b) At a minimum, the segregation instructions prescribed in the following Segregation Table must be followed to maintain acceptable segregation between packages containing hazardous materials with different hazards. The Segregation Table instructions apply whether or not the class or division is the...

Development of post-harvest protocol of okra for export marketing.

PubMed

Dhall, R K; Sharma, S R; Mahajan, B V C

2014-08-01

The study was carried out on the harvesting and handling methods of okra with the objective to maintain the best quality of pods from harvesting to end consumer especially for export marketing. For that purpose okra cv. 'Punjab-8' pods were harvested with minimum handling (least injuries to the pubescence on the ridges of pod) and normal handling (no safety taken to prevent injuries on pods). Pods were precooled at 15 ± 1ºC, 90-95% RH; jumble packed in the CFB boxes of 2.0 Kg capacity and than stored at 8 ± 1ºC, 90-95% RH. The quality parameters of okra namely texture, chlorophyll content, physiological loss in weight, rotting percentage and general appearance were studied. The pods harvested with minimum handling and field packaging can retain their green colour, crisp texture (maximum force to puncture pod = 500.2 g) with minimum rotting (3.0%) and physiological loss in weight (15.8%) and good appearance upto 13 days of cold storage whereas normal handled pods can be stored upto 5 days at 8 ± 1ºC, 90-95% RH and thereafter lost their general appearance on the 7th day of storage and were discarded. Therefore, in order to maintain high quality of okra from harvesting to the final destination (consumer), the okra pods should be harvested with minimum handling followed by field packaging in CFB boxes.

Job satisfaction and turnover intentions among health care staff providing services for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania.

PubMed

Naburi, Helga; Mujinja, Phares; Kilewo, Charles; Orsini, Nicola; Bärnighausen, Till; Manji, Karim; Biberfeld, Gunnel; Sando, David; Geldsetzer, Pascal; Chalamila, Guerino; Ekström, Anna Mia

2017-09-06

Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV (i.e., lifelong antiretroviral treatment for all pregnant and breastfeeding mothers living with HIV) was initiated in Tanzania in 2013. While there is evidence that this policy has benefits for the health of the mother and the child, Option B+ may also increase the workload for health care providers in resource-constrained settings, possibly leading to job dissatisfaction and unwanted workforce turnover. From March to April 2014, a questionnaire asking about job satisfaction and turnover intentions was administered to all nurses at 36 public-sector health facilities offering antenatal and PMTCT services in Dar es Salaam, Tanzania. Multivariable logistic regression models were used to identify factors associated with job dissatisfaction and intention to quit one's job. Slightly over half (54%, 114/213) of the providers were dissatisfied with their current job, and 35% (74/213) intended to leave their job. Most of the providers were dissatisfied with low salaries and high workload, but satisfied with workplace harmony and being able to follow their moral values. The odds of reporting to be globally dissatisfied with one's job were high if the provider was dissatisfied with salary (adjusted odds ratio (aOR) 5.6, 95% CI 1.2-26.8), availability of protective gear (aOR 4.0, 95% CI 1.5-10.6), job description (aOR 4.3, 95% CI 1.2-14.7), and working hours (aOR 3.2, 95% CI 1.3-7.6). Perceiving clients to prefer PMTCT Option B+ reduced job dissatisfaction (aOR 0.2, 95% CI 0.1-0.8). The following factors were associated with providers' intention to leave their current job: job stability dissatisfaction (aOR 3.7, 95% CI 1.3-10.5), not being recognized by one's superior (aOR 3.6, 95% CI 1.7-7.6), and poor feedback on the overall unit performance (aOR 2.7, 95% CI 1.3-5.8). Job dissatisfaction and turnover intentions are comparatively high among nurses in Dar es Salaam's public-sector maternal care facilities. Providing reasonable salaries and working hours, clearer job descriptions, appropriate safety measures, job stability, and improved supervision and feedback will be key to retaining satisfied PMTCT providers and thus to sustain successful implementation of Option B+ in Tanzania.

Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study.

PubMed

Moges, Nurilign Abebe; Kassa, Getachew Mullu; Boneya, Dube Jara

2017-07-06

In 2014, there were 170,000 new HIV-infected children globally. The rate of HIV transmission from mother to child in Ethiopia was 18%. Though there are a number of HIV-related studies conducted in Ethiopia, there is a scarcity of evidence on the rate of mother to child transmission. So, the aim of this study was to determine the rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities in East and West Gojjam Zones, Northwest Ethiopia. Retrospective cohort study design was conducted. A total of 305 exposed infant- and mother pairs were included in this study. Data were collected from seven selected health facilities in East and West Gojjam Zone, Northwest Ethiopia. The study included a four-year duration PMTCT data, registered from July/2011 to July/2015. Data was collected using a prepared checklist. Data was entered using EpiData and analyzed using SPSS software. Descriptive, bivariate and multiple variable logistic regression analysis were conducted. A p-value less than 0.05 were used to declare statistical significant association. Three hundred five infants and their mothers were included in this study. The mean age of mothers was 27.4 with a standard deviation of 4.3 years. The majority, 96.4% of infants were on exclusive breastfeeding before six months. The rate of HIV transmission at the end of 24 months were 5.9% (95% CI: 3.9%-7.9%). The number of positive children was reduced from 14 (10.29%) to 4(2.37%) due to the program shift from option A to option B+. Factors which were associated with transmission of HIV from mother to child were; children who were born from older mothers (AOR = 5.4, 95% CI = 1.15, 25.70), and infants whose mother couldn't get PMTCT intervention (AOR = 15.95, 95% CI = 3.35, 75), and mothers who became pregnant after they knew they were HIV positive (AOR = 0.22, 95%CI = 0.049,096). There is significant progress on the reduction of the rate of HIV transmission from mother to child in Ethiopia. Age of the mother, status of the mother at an entry to PMTCT program and presence of PMTCT interventions were significant factors associated with HIV transmission. Hence, the above factors should be given due emphasis on controlling HIV transmission from mother to child.

Mobilizing for Policy: Using Community-Based Participatory Research to Impose Minimum Packaging Requirements on Small Cigars

PubMed Central

Milam, Adam J.; Bone, Lee; Furr-Holden, Debra; Coylewright, Megan; Dachille, Kathleen; Owings, Kerry; Clay, Eric; Holmes, William; Lambropoulos, Soula; Stillman, Frances

2013-01-01

The Problem Cigarette sales have declined in the United States over the past decade; however, small cigar sales have been rapidly increasing. In most urban areas, small cigars are inexpensive and are sold as singles without health warnings. Purpose of Article This paper describes a community–academic–practice partnership’s (CAPP) efforts to decrease small cigar use in young adults living in Baltimore, Maryland, through legislative strategies. Key Points Survey data among young adults not in school indicated that 20% of individuals reported current small cigar use, often in combination with cigarettes. The community–academic partnership engaged the community in discussion about small cigar use in the fall of 2007. In collaboration with partners, bills were submitted to the legislative bodies for the city and state to impose minimum packaging requirements on small cigars. Conclusion Collaborative partnerships between community-based organizations, public health agencies, and academic institutions can lead to policy initiatives with the potential to improve public health. PMID:22820230

CONCEPTUAL DESIGN STUDY OF A MOBILE GAMMA IRRADIATOR FOR FRUIT PRODUCE

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

1962-05-31

Engineering Drawings report available as CAPE-944. A conceptual design study was made of a mobile irradiator for radiopasteurization of strawberries, grapes, peaches, tomatoes, and lemons. Minimum radiation dose specification for the fruit ranged from 100,000 to 200,000 rads with maximum to minimum dose ratio in the range of 1.5 to 3. Minimum allowable production rates were in the range of 500 to 1000 lb of fruit/hr. The irradiator was required to be mobile, preferably on one truck capable of being put in operation one day after arrival at the site. Preliminary studies compared five types of irradiators, consisting of amore » single source slab, two package pass design; a double slab, single pass design; a single slab, four pass design; a line source rotary design; and a movable source, movable package design. It was concluded that a Co/sup 60/ irradiator can be built to meet the general requirements for radiopasteurization of fruit. The irradiator can be made mobile and can be mounted on a single trailer. The combined weight of the mobile unit would be 70 to 85 tons depending on the type of irradiator. This unit would require a special license from the State Highway Department. (C.H.)« less

Reading the Small Print – Labelling Recommendations for Orthopaedic Implants

PubMed Central

Haene, Roger A; Sandhu, Ranbir S; Baxandall, Richard

2009-01-01

INTRODUCTION There exist, currently, no clear guidelines regarding standards for surgical implant labelling. Dimensions of the laminar flow canopies in orthopaedic use fixes the distance at which implant labels can be read. Mistakes when reading the label on an implant box can pose health risks for patients, and financial consequences for medical institutions. SUBJECTS AND METHODS Using scientifically validated tools such as the Snellen Chart Formula, a theoretical minimum standard for text on implant labels was reached. This theoretical standard was then tested under real operating conditions. After discovering a minimum practical standard for implant labels, the authors then audited current labels in use on a wide range of orthopaedic implant packages. Furthermore, other non-text-related labelling problems were also noted. RESULTS There is a definite minimum standard which should be observed when implant labels are manufactured. Implants in current use bear labels on the packaging that are of an insufficient standard to ensure patient safety in theatre. CONCLUSIONS The authors have established text parameters that will increase the legibility of implant labels. In the interests of improving risk management in theatre, therefore, the authors propose a standard for orthopaedic implant labelling, and believe this will provide a useful foundation for further discussion between the orthopaedic community and implant manufacturers. PMID:19686615

Impact of school health management committees on health services delivery in Ghana: A national level assessment.

PubMed

Bowman, Angela S; Owusu, Andrew; Trueblood, Amber B; Bosumtwi-Sam, Cynthia

2018-05-07

To examine the prevalence, determinants, and impact of local school health management committees on implementation of minimum-recommended school health services delivery among basic and secondary schools in Ghana. National level cross-sectional data from the first-ever assessment of Ghana Global-School Health Policies and Practices Survey was utilized. Complex sample analyses were used to quantify school-level implementation of recommended minimum package for health services delivery. Of 307 schools, 98% were basic and government run, and 33% offered at least half of the recommended health service delivery areas measured. Schools with a school health management committee (53%) were 4.8 (95% CI = 3.23-5.18) times as likely to offer at least 50% of the minimum health services package than schools that did not. There is significant deficit concerning delivery of school health services in schools across Ghana. However, school health management committees positively impact implementation of health service delivery. School health management committees provide a significant impact on delivery of school health services; thus, it is recommended that policy makers and programmers place greater emphasis on the value and need for these advisory boards in all Ghanaian schools. Copyright © 2018 John Wiley & Sons, Ltd.

Preventing Mother-to-Child HIV Transmission among South African Adolescents

ERIC Educational Resources Information Center

Varga, Christine; Brookes, Heather

2008-01-01

Although prevention of mother-to-child HIV transmission (PMTCT) programs are predicated on maternal behavior change, little is known about sociocultural factors affecting maternal-child care practices in this arena. The authors used narrative methods (key informant workshops, questionnaires, focus groups, and case study analysis) to explore how…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kelly, Elizabeth J.; Stone, Timothy Amos; Smith, Paul Herrick

The Packaging Surveillance Program section of the Department of Energy (DOE) Manual 441.1-­1, Nuclear Material Packaging Manual (DOE 2008), requires DOE contractors to “ensure that a surveillance program is established and implemented to ensure the nuclear material storage package continues to meet its design criteria.”This 2017 update reflects changes to the surveillance plan resulting from surveillance findings as documented in Reeves et al. 2016. These findings include observations of corrosion in SAVY and Hagan containers and the indication (in one SAVY container) of possible filter membrane thermal degradation. This surveillance plan update documents the rationale for selecting surveillance containers, specifiesmore » the containers for 2017 surveillance, and identifies a minimum set of containers for 2018 surveillance. This update contains important changes to the previous surveillance plans.« less

How tobacco companies have used package quantity for consumer targeting.

PubMed

Persoskie, Alexander; Donaldson, Elisabeth A; Ryant, Chase

2018-05-31

Package quantity refers to the number of cigarettes or amount of other tobacco product in a package. Many countries restrict minimum cigarette package quantities to avoid low-cost packs that may lower barriers to youth smoking. We reviewed Truth Tobacco Industry Documents to understand tobacco companies' rationales for introducing new package quantities, including companies' expectations and research regarding how package quantity may influence consumer behaviour. A snowball sampling method (phase 1), a static search string (phase 2) and a follow-up snowball search (phase 3) identified 216 documents, mostly from the 1980s and 1990s, concerning cigarettes (200), roll-your-own tobacco (9), smokeless tobacco (6) and 'smokeless cigarettes' (1). Companies introduced small and large packages to motivate brand-switching and continued use among current users when faced with low market share or threats such as tax-induced price increases or competitors' use of price promotions. Companies developed and evaluated package quantities for specific brands and consumer segments. Large packages offered value-for-money and matched long-term, heavy users' consumption rates. Small packages were cheaper, matched consumption rates of newer and lighter users, and increased products' novelty, ease of carrying and perceived freshness. Some users also preferred small packages as a way to try to limit consumption or quit. Industry documents speculated about many potential effects of package quantity on appeal and use, depending on brand and consumer segment. The search was non-exhaustive, and we could not assess the quality of much of the research or other information on which the documents relied. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Development of a CFC Critical Area Response (CAR) package

NASA Technical Reports Server (NTRS)

Mccain, J. Wayne

1995-01-01

During the past two years, the NASA Marshall Space Flight Center (MSFC) has studied means to improve the transfer of technology from a major federal lab to a significant portion of an industrial segment. In the past, technology transfers had taken place with individual firms, or small groups of firms. This method of 'customized' transfer is often time consuming and can reduce the effectiveness of a response. Thus, a method was achieved to develop a standardized package on replacement of Chlorofluorocarbons (CFC's) that could be sent out to a large number of firms with minimum follow-up.

School Bus Driver Instructional Program. Instructor's Guide.

ERIC Educational Resources Information Center

Department of Transportation, Washington, DC. National Highway Safety Bureau.

A standardized and comprehensive school bus driver instructional program has been developed under contract with the Federal Government. The course has been organized to provide in one package a program for developing the minimum skills and knowledge needed by the school bus driver instructor, as well as those supplemental skills and knowledge…

Marketplace analysis demonstrates quality control standards needed for black raspberry dietary supplements

USDA-ARS?s Scientific Manuscript database

There is currently no standard for the minimum anthocyanin concentration a black raspberry dietary supplement must contain for legal sale in the US. All consumer available black raspberry products (n=19), packaged as dietary supplements or otherwise prepared (freeze-dried whole and pre-ground powder...

21 CFR 177.1440 - 4,4′-Isopropylidenediphenol-epichlorohydrin resins minimum molecular weight 10,000.

Code of Federal Regulations, 2014 CFR

2014-04-01

... ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) INDIRECT FOOD ADDITIVES: POLYMERS Substances for Use as Basic Components of Single and Repeated Use Food Contact Surfaces § 177.1440 4,4... articles intended for use in producing, manufacturing, packing, processing, preparing, treating, packaging...

25 CFR 166.905 - Who can get assistance for postgraduate studies?

Code of Federal Regulations, 2010 CFR

2010-04-01

... PERMITS Agriculture Education, Education Assistance, Recruitment, and Training § 166.905 Who can get... who are employed by an approved organization and who wish to pursue advanced levels of education in...) Program applicants must submit application packages to the education committee. At a minimum, such...

21 CFR 1140.16 - Conditions of manufacture, sale, and distribution.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTES AND SMOKELESS TOBACCO Prohibition of Sale and Distribution... product as the trade or brand name for a cigarette or smokeless tobacco product, except for a tobacco... the United States on January 1, 1995. (b) Minimum cigarette package size. Except as otherwise provided...

21 CFR 1140.16 - Conditions of manufacture, sale, and distribution.

Code of Federal Regulations, 2013 CFR

2013-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTES AND SMOKELESS TOBACCO Prohibition of Sale and Distribution... product as the trade or brand name for a cigarette or smokeless tobacco product, except for a tobacco... the United States on January 1, 1995. (b) Minimum cigarette package size. Except as otherwise provided...

21 CFR 1140.16 - Conditions of manufacture, sale, and distribution.

Code of Federal Regulations, 2012 CFR

2012-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTES AND SMOKELESS TOBACCO Prohibition of Sale and Distribution... product as the trade or brand name for a cigarette or smokeless tobacco product, except for a tobacco... the United States on January 1, 1995. (b) Minimum cigarette package size. Except as otherwise provided...

21 CFR 1140.16 - Conditions of manufacture, sale, and distribution.

Code of Federal Regulations, 2014 CFR

2014-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTES AND SMOKELESS TOBACCO Prohibition of Sale and Distribution... product as the trade or brand name for a cigarette or smokeless tobacco product, except for a tobacco... the United States on January 1, 1995. (b) Minimum cigarette package size. Except as otherwise provided...

Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand.

PubMed

Thisyakorn, Usa

2017-05-01

In 1988, the generalised HIV/AIDS epidemic in Thailand began and in the same year the first HIV-exposed infant in Thailand was born at King Chulalongkorn Memorial Hospital, Bangkok. From the early to mid-1990s, an epidemic wave of HIV-infected women and infants occurred. Heterosexual HIV transmission, as described in the Asian Epidemic Model, was the major mode of spread in Thailand, causing an increasing number of HIV-infected pregnant women. The early and concerted multi-sectoral response of Thai society reduced the prevalence of HIV infection in pregnant women from 2% in the mid-1990s to 0.6% in 2015 and mother-to-child transmission of HIV (MTCT) from an estimated 20-40% to 1.9%. Thus, Thailand became the first Asian country to achieve the World Health Organization's (WHO) targets for the elimination of MTCT. In this narrative review, the key historic evolutions of the science and policy of prevention of mother-to-child transmission of HIV (PMTCT) in Thailand that addressed the four prongs of the recommended WHO PMTCT strategy are described, and the lessons learned are discussed.

Antiretroviral drug regimens to prevent mother-to-child transmission of HIV: a review of scientific, program, and policy advances for sub-Saharan Africa.

PubMed

Chi, Benjamin H; Stringer, Jeffrey S A; Moodley, Dhayendre

2013-06-01

Considerable advances have been made in the effort to prevent mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa. Clinical trials have demonstrated the efficacy of antiretroviral regimens to interrupt HIV transmission through the antenatal, intrapartum, and postnatal periods. Scientific discoveries have been rapidly translated into health policy, bolstered by substantial investment in health infrastructure capable of delivering increasingly complex services. A new scientific agenda is also emerging, one that is focused on the challenges of effective and sustainable program implementation. Finally, global campaigns to "virtually eliminate" pediatric HIV and dramatically reduce HIV-related maternal mortality have mobilized new resources and renewed political will. Each of these developments marks a major step in regional PMTCT efforts; their convergence signals a time of rapid progress in the field, characterized by an increased interdependency between clinical research, program implementation, and policy. In this review, we take stock of recent advances across each of these areas, highlighting the challenges--and opportunities--of improving health services for HIV-infected mothers and their children across the region.

High HIV-1 Diversity and Prevalence of Transmitted Drug Resistance Among Antiretroviral-Naive HIV-Infected Pregnant Women from Rio de Janeiro, Brazil.

PubMed

Delatorre, Edson; Silva-de-Jesus, Carlos; Couto-Fernandez, José Carlos; Pilotto, Jose H; Morgado, Mariza G

2017-01-01

Antiretroviral (ARV) resistance mutations in human immunodeficiency virus type 1 (HIV-1) infection may reduce the efficacy of prophylactic therapy to prevent mother-to-child transmission (PMTCT) and future treatment options. This study evaluated the diversity and the prevalence of transmitted drug resistance (TDR) in protease (PR) and reverse transcriptase (RT) regions of HIV-1 pol gene among 87 ARV-naive HIV-1-infected pregnant women from Rio de Janeiro, Brazil, between 2012 and 2015. The viral diversity comprised HIV-1 subtypes B (67.8%), F1 (17.2%), and C (4.6%); the circulating recombinant forms 12_BF (2.3%), 28/29_BF, 39_BF, 02_AG (1.1% each) and unique recombinants forms (4.5%). The overall prevalence of any TDR was 17.2%, of which 5.7% for nucleoside RT inhibitors, 5.7% for non-nucleoside RT inhibitors, and 8% for PR inhibitors. The TDR prevalence found in this population may affect the virological outcome of the standard PMTCT ARV-regimens, reinforcing the importance of continuous monitoring.

Developing content for a mHealth intervention to promote postpartum retention in prevention of mother-to-child HIV transmission programs and early infant diagnosis of HIV: a qualitative study.

PubMed

Odeny, Thomas A; Newman, Maya; Bukusi, Elizabeth A; McClelland, R Scott; Cohen, Craig R; Camlin, Carol S

2014-01-01

Maternal attendance at postnatal clinic visits and timely diagnosis of infant HIV infection are important steps for prevention of mother-to-child transmission (PMTCT) of HIV. We aimed to use theory-informed methods to develop text messages targeted at facilitating these steps. We conducted five focus group discussions with health workers and women attending antenatal, postnatal, and PMTCT clinics to explore aspects of women's engagement in postnatal HIV care and infant testing. Discussion topics were informed by constructs of the Health Belief Model (HBM) and prior empirical research. Qualitative data were coded and analyzed according to the construct of the HBM to which they related. Themes were extracted and used to draft intervention messages. We carried out two stages of further messaging development: messages were presented in a follow-up focus group in order to develop optimal phrasing in local languages. We then further refined the messages, pretested them in individual cognitive interviews with selected health workers, and finalized the messages for the intervention. Findings indicated that brief, personalized, caring, polite, encouraging, and educational text messages would facilitate women bringing their children to clinic after delivery, suggesting that text messages may serve as an important "cue to action." Participants emphasized that messages should not mention HIV due to fear of HIV testing and disclosure. Participants also noted that text messages could capitalize on women's motivation to attend clinic for childhood immunizations. Applying a multi-stage content development approach to crafting text messages--informed by behavioral theory--resulted in message content that was consistent across different focus groups. This approach could help answer "why" and "how" text messaging may be a useful tool to support maternal and child health. We are evaluating the effect of these messages on improving postpartum PMTCT retention and infant HIV testing in a randomized trial.

In-home HIV testing and nevirapine dosing by traditional birth attendants in rural Zambia: a feasibility study.

PubMed

Brennan, Alana T; Thea, Donald M; Semrau, Katherine; Goggin, Caitlin; Scott, Nancy; Pilingana, Portipher; Botha, Belinda; Mazimba, Arthur; Hamomba, Leoda; Seidenberg, Phil

2014-01-01

Access to lifesaving prevention of mother-to-child transmission (PMTCT) services is problematic in rural Zambia. The simplest intervention used in Zambia has been 2-dose nevirapine (NVP) administration in the peripartum period, a regimen of 1 NVP tablet to the mother at the onset of labor and 1 dose in the form of syrup to the newborn within 4 to 72 hours after birth. This 2-dose regimen has been shown to reduce MTCT by nearly 50%. We set out to demonstrate that in-home HIV testing and NVP dosing by traditional birth attendants (TBAs) is feasible and acceptable by women in rural Zambia. This was a pilot program using TBAs to perform rapid saliva-based HIV testing and administer single-dose NVP in tablet form to the mother at the onset of labor and syrup to the infant after birth. A total of 280 pregnant women were consented and enrolled into the program, of whom 124 (44.3%) gave birth at home with the assistance of a trained TBA. Of those, 16 (12.9%) were known to be HIV positive, and 101 of the remaining 108 (93.5%) accepted a rapid HIV test. All these women tested HIV negative. In the subset of 16 mothers who were HIV positive, 13 (81.3%) took single-dose NVP administered by a TBA between 1 and 24 hours prior to birth and 100% of exposed newborns (16 of 16) received NVP syrup within 72 hours after birth, 80% of whom were dosed in the first 24 hours of life. With the substantial shortage of human resources in public health care throughout sub-Saharan Africa, it is extremely valuable to utilize lay health care workers to help extended services beyond the level of the facility. Given the high uptake of PMTCT services we believe that TBAs with proper training and support can successfully provide country-approved PMTCT. © 2013 by the American College of Nurse-Midwives.

Prevention of mother-to-child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000–10

PubMed Central

Thorne, Claire; Semenenko, Igor; Malyuta, Ruslan

2012-01-01

Aims To compare clinical status, mother-to-child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV-infected injecting drug users (IDUs) and non-IDUs. Design and setting Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000–10. Participants Pregnant HIV-infected women, identified before/during pregnancy or intrapartum, and their live-born infants (n = 6200); 1028 women followed post-partum. Measurements Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW). Findings Of 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P < 0.01). Among women with undiagnosed HIV at conception, 20% of IDUs were diagnosed intrapartum versus 4% of non-IDUs (P < 0.01). At enrolment, 14% of IDUs had severe/advanced HIV symptoms versus 6% of non-IDUs (P < 0.001). IDUs had higher rates of PTD and LBW infants than non-IDUs, respectively, 16% versus 7% and 22% versus 10% (P < 0.001). IDUs were more likely to receive no neonatal or intrapartum PMTCT prophylaxis compared with non-IDUs (OR 2.81, p < 0.001). MTCT rates were 10.8% in IDUs versus 5.9% in non-IDUs; IDUs had increased MTCT risk (adjusted odds ratio 1.32, P = 0.049). Fewer IDUs with treatment indications received HAART compared with non-IDUs (58% versus 68%, P = 0.03). Conclusions Pregnant human immunodeficiency virus-infected injecting drug users in Ukraine have worse clinical status, poorer access to prevention of mother-to-child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother-to-child transmission than non-injecting drug user women. PMID:21819473

The infant feeding choices and experiences of women living with HIV in Kinshasa, Democratic Republic of Congo.

PubMed

Maman, Suzanne; Cathcart, Rebecca; Burkhardt, Gillian; Omba, Serge; Thompson, Deidre; Behets, Frieda

2012-01-01

HIV transmission through breastfeeding is a significant public health challenge. While breastfeeding provides important nutrition, and results in reduced morbidity and mortality, there is a risk of HIV transmission through breastfeeding. International prevention of mother-to-child transmission (PMTCT) guidelines recommend exclusive breastfeeding for six months among HIV-infected women on antiretroviral therapy. Promoting exclusive feeding has proved difficult in settings where mixed feeding is a cultural norm. Understanding the factors that influence HIV infected women's infant feeding choices and practices is critical to promoting adherence to PMTCT guidelines. We conducted in-depth interviews with 40 HIV+ pregnant and post-partum women in Kinshasa, Democratic Republic of Congo to understand their infant feeding experiences. Interviews were conducted in Lingala, and transcribed and translated into French for analysis. Deductive and inductive codes were applied, and matrices were created to facilitate cross-case analysis. Women had limited understanding of the specific mechanisms through which their infant feeding practices influenced HIV transmission risk. Clinical staff was the primary source of women's knowledge of HIV mother-to-child-transmission. Among the 24 post-partum women in the sample, seven women adhered to exclusive breastfeeding and two women to exclusive formula feeding for at least six months. Women's beliefs and awareness about HIV transmission through breastfeeding, as well as the information and support from clinical staff and other members of their support networks positively influenced their exclusive feeding. Common barriers to exclusive feeding included financial constraints, breast health problems, misinformation about HIV transmission, local norms, and prior feeding experiences. Health care workers play a key role in providing correct information on PMTCT and supporting women's infant feeding choices to adhere to guidelines of exclusive infant feeding. Optimizing provider-patient communication and creating a supportive environment surrounding infant feeding is critical.

Grassroots community organizations' contribution to the scale-up of HIV testing and counselling services in Zimbabwe.

PubMed

Gregson, Simon; Nyamukapa, Constance A; Sherr, Lorraine; Mugurungi, Owen; Campbell, Catherine

2013-06-19

To investigate whether community engagement (participation in grassroots organizations) contributed to increases in HIV testing in Zimbabwe. Prospective data on membership of local community organizations (e.g. women's groups and burial societies) and uptake of HIV testing and counselling (HTC) and prevention-of-mother-to-child transmission (PMTCT) services were collected from 5260 adults interviewed in two consecutive rounds of a general-population cohort survey in eastern Zimbabwe between 2003 and 2008. The effects of community engagement on uptake of services during the follow-up period were measured using logistic regression to adjust for observed confounding factors. Sixteen percent of men and 47% of women were consistent members of community organizations; 58 and 35% of these people discussed HIV in their meetings and were members of externally sponsored organizations, respectively. Fewer men (10.1%) than women (32.4%) took up HTC during follow-up [adjusted odds ratio (aOR)=4.08, 95% confidence interval (CI) 3.43-4.86, P<0.001]. HTC uptake was higher for members of community organizations than for nonmembers: men, 15.0 versus 9.2% (1.67, 1.15-2.43, P=0.007); women, 35.6 versus 29.6% (1.26, 1.06-1.49, P=0.008). Membership of community organizations showed a nonsignificant association with PMTCT uptake amongst recently pregnant women (42.3 versus 34.2%; 1.30, 0.94-1.78, P=0.1). The most consistent positive associations between community participation and HTC and PMTCT uptake were found in organizations that discussed HIV and when external sponsorship was absent. Grassroots organizations contributed to increased uptake of HTC services in eastern Zimbabwe in the mid-2000s. Partnerships with these organizations could harness community support for the further increases in HIV testing needed in sub-Saharan Africa. © 2013 Creative Common License

Prevalence of maternal HIV infection and knowledge on mother–to–child transmission of HIV and its prevention among antenatal care attendees in a rural area in northwest Cameroon

PubMed Central

Feteh, Vitalis F.; Tindong, Maxime; Tanyi, John T.; Bihle, Nestor Mbinkar; Angwafo, Fru F.

2017-01-01

Background In 2010, an estimated 141 new HIV infections occurred per day in Cameroon and reports suggest an upsurge of these rates by 2020 if current trends continue. Mother—to—child transmission (MTCT) of HIV is a major public health challenge, and maternal knowledge on HIV transmission during pregnancy and its prevention is important in curtailing paediatric HIV acquisition. Objectives We aimed at establishing the prevalence of maternal HIV infection as well as assessing knowledge on HIV, MTCT and prevention of MTCT (PMTCT) of HIV among pregnant women in a rural area of Cameroon. Methods This study was conducted in two phases: a 29 month retrospective analysis of 1866 deliveries within three rural health facilities in the Babessi sub—division, Northwest Cameroon and a 1 month prospective phase wherein 150 consenting pregnant women attending antenatal care (ANC) at the study centres were consecutively recruited. Results Overall, the prevalence of maternal HIV infection was 5.0% (100/2016). All (100%) of the interviewed pregnant women were aware of HIV infection and most (76.7%) had adequate knowledge on its routes of transmission. Meanwhile, only 79.3% (119/150) of them were aware of MTCT with slightly above a third (37.0%) having adequate knowledge on the periods of transmission. The proportions of women correctly stating: during pregnancy, during labour/delivery and during breastfeeding as possible periods of MTCT of HIV were 63.0%, 60.5% and 89.1% respectively. A majority (76.3%) of these women had inadequate knowledge on PMTCT of HIV. Conclusion The overall prevalence of maternal HIV warrants strengthening of current intervention strategies including scaling—up of PMTCT measures. Among others, intensification of HIV—related ANC services to improve the pregnant women’s awareness and knowledge on MTCT and its prevention are vital steps in curbing the growing burden of paediatric HIV. PMID:28199373

Grassroots community organizations’ contribution to the scale-up of HIV testing and counselling services in Zimbabwe

PubMed Central

Gregson, Simon; Nyamukapa, Constance A.; Sherr, Lorraine; Mugurungi, Owen; Campbell, Catherine

2013-01-01

Objective: To investigate whether community engagement (participation in grassroots organizations) contributed to increases in HIV testing in Zimbabwe. Methods: Prospective data on membership of local community organizations (e.g. women's groups and burial societies) and uptake of HIV testing and counselling (HTC) and prevention-of-mother-to-child transmission (PMTCT) services were collected from 5260 adults interviewed in two consecutive rounds of a general-population cohort survey in eastern Zimbabwe between 2003 and 2008. The effects of community engagement on uptake of services during the follow-up period were measured using logistic regression to adjust for observed confounding factors. Results: Sixteen percent of men and 47% of women were consistent members of community organizations; 58 and 35% of these people discussed HIV in their meetings and were members of externally sponsored organizations, respectively. Fewer men (10.1%) than women (32.4%) took up HTC during follow-up [adjusted odds ratio (aOR) = 4.08, 95% confidence interval (CI) 3.43–4.86, P < 0.001]. HTC uptake was higher for members of community organizations than for nonmembers: men, 15.0 versus 9.2% (1.67, 1.15–2.43, P = 0.007); women, 35.6 versus 29.6% (1.26, 1.06–1.49, P = 0.008). Membership of community organizations showed a nonsignificant association with PMTCT uptake amongst recently pregnant women (42.3 versus 34.2%; 1.30, 0.94–1.78, P = 0.1). The most consistent positive associations between community participation and HTC and PMTCT uptake were found in organizations that discussed HIV and when external sponsorship was absent. Conclusion: Grassroots organizations contributed to increased uptake of HTC services in eastern Zimbabwe in the mid-2000s. Partnerships with these organizations could harness community support for the further increases in HIV testing needed in sub-Saharan Africa. PMID:24047764

Unmet need for family planning, contraceptive failure, and unintended pregnancy among HIV-infected and HIV-uninfected women in Zimbabwe.

PubMed

McCoy, Sandra I; Buzdugan, Raluca; Ralph, Lauren J; Mushavi, Angela; Mahomva, Agnes; Hakobyan, Anna; Watadzaushe, Constancia; Dirawo, Jeffrey; Cowan, Frances M; Padian, Nancy S

2014-01-01

Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. We analyzed baseline data from the evaluation of Zimbabwe's Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy. Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.

Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: an exploratory study

PubMed Central

Nachega, Jean B; Skinner, Donald; Jennings, Larissa; Magidson, Jessica F; Altice, Frederick L; Burke, Jessica G; Lester, Richard T; Uthman, Olalekan A; Knowlton, Amy R; Cotton, Mark F; Anderson, Jean R; Theron, Gerhard B

2016-01-01

Objective To examine the acceptability and feasibility of mobile health (mHealth)/short message service (SMS) and community-based directly observed antiretroviral therapy (cDOT) as interventions to improve antiretroviral therapy (ART) adherence for preventing mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). Design and methods A mixed-method approach was used. Two qualitative focus group discussions with HIV-infected pregnant women (n=20) examined the acceptability and feasibility of two ART adherence interventions for PMTCT: 1) SMS text messaging and 2) patient-nominated cDOT supporters. Additionally, 109 HIV-infected, pregnant South African women (18–30 years old) receiving PMTCT services under single-tablet antiretroviral therapy regimen during pregnancy and breastfeeding and continuing for life (“Option B+”) were interviewed about mobile phone access, SMS use, and potential treatment supporters. Setting A community primary care clinic in Cape Town, South Africa. Participants HIV-infected pregnant women. Main outcomes Acceptability and feasibility of mHealth and cDOT interventions. Results Among the 109 women interviewed, individual mobile phone access and SMS use were high (>90%), and 88.1% of women were interested in receiving SMS ART adherence support messages such as reminders, motivation, and medication updates. Nearly all women (95%) identified at least one person close to them to whom they had disclosed their HIV status and would nominate as a cDOT supporter. Focus group discussions revealed that cDOT supporters and adherence text messages were valued, but some concerns regarding supporter time availability and risk of unintended HIV status disclosure were expressed. Conclusion mHealth and/or cDOT supporter as interventions to improve ART adherence are feasible in this setting. However, safe HIV status disclosure to treatment supporters and confidentiality of text messaging content about HIV and ART were deemed crucial. PMID:27175068

Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

PubMed Central

McCoy, Sandra I.; Buzdugan, Raluca; Ralph, Lauren J.; Mushavi, Angela; Mahomva, Agnes; Hakobyan, Anna; Watadzaushe, Constancia; Dirawo, Jeffrey; Cowan, Frances M.; Padian, Nancy S.

2014-01-01

Background Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. Methods We analyzed baseline data from the evaluation of Zimbabwe’s Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. Results Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy. Conclusions Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions. PMID:25144229

Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma

PubMed Central

2011-01-01

Background We set out to determine the relative roles of stigma versus health systems in non-uptake of prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional assessment of all consenting mothers accompanying infants for six-week immunizations. Methods Between September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya's Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy. Stigma was ascertained using a previously published standardized questionnaire and infant HIV-1 status determined by HIV-1 polymerase chain reaction. Results Among 2663 mothers, 2453 (92.1%) reported antenatal HIV-1 testing. Untested mothers were more likely to have less than secondary education (85.2% vs. 74.9%, p = 0.001), be from Nyanza (47.1% vs. 32.2%, p < 0.001) and have lower socio-economic status. Among 318 HIV-1-infected mothers, 90% reported use of maternal or infant antiretrovirals. Facility delivery was less common among HIV-1-infected mothers (69% vs. 76%, p = 0.009) and was associated with antiretroviral use (p < 0.001). Although internal or external stigma indicators were reported by between 12% and 59% of women, stigma was not associated with lower HIV-1 testing or infant HIV-1 infection rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors contributed to about 60% of non-testing among mothers who attended antenatal clinics and to missed opportunities in offering antiretrovirals and utilization of facility delivery. Eight percent of six-week-old HIV-1-exposed infants were HIV-1 infected. Conclusions Antenatal HIV-1 testing and antiretroviral uptake was high (both more than 90%) and infant HIV-1 infection risk was low, reflecting high PMTCT coverage. Investment in health systems to deliver HIV-1 testing and antiretrovirals can effectively prevent infant HIV-1 infection despite substantial HIV-1 stigma. PMID:22204313

Non-disclosure of HIV-positive status to a partner and mother-to-child transmission of HIV: Evidence from a case–control study conducted in a rural county in Kenya

PubMed Central

2017-01-01

Background Many factors contribute to an enhanced risk of infant HIV acquisition, two of which may include failure of a mother to disclose her HIV-positive status to her partner and exclusion of male partners in preventing mother-to-child transmission of HIV (PMTCT) interventions. To justify why HIV programmes need to integrate male partner involvement and partner disclosure, we need to establish an association between the two factors and infant HIV acquisition. Objective To determine whether failure to disclose an HIV-positive status to a male partner is associated with increased risk of infant HIV acquisition, and whether part of the association is explained by exclusion of male partner in PMTCT programmes. Methods Using a case–control study design, we identified a total of 180 mother–baby pairs with HIV-exposed infants. Thirty-six pairs with HIV-positive babies (cases) were compared to 144 pairs with HIV-negative babies (controls) on whether the mothers had disclosed their HIV status to their partner in order to determine whether a disclosure or lack of it contributed to increased risk of mother-to-child transmission of HIV (MTCT). Each case pair was matched to four control pairs from the same facility. Results Overall, 16.7% of mothers had not disclosed their HIV status to their partners, the proportion being significantly more among cases (52.8% vs. 7.6%, p < 0.001). Non-disclosure was significantly associated with infant HIV acquisition (aOR 9.8 (3.0–26.3); p < 0.001) and male partner involvement partially mediated the effect of non-disclosure on infant HIV acquisition (indirect coefficient = 0.17, p < 0.005). Conclusions Failure of an HIV-positive woman to disclose her status to her male partner and exclusion of male partners in PMTCT programmes are two social factors that may curtail success of interventions towards the goal of eliminating MTCT. PMID:29568627

Prevention of mother-to-child transmission of HIV: cost-effectiveness of antiretroviral regimens and feeding options in Rwanda.

PubMed

Binagwaho, Agnes; Pegurri, Elisabetta; Drobac, Peter C; Mugwaneza, Placidie; Stulac, Sara N; Wagner, Claire M; Karema, Corine; Tsague, Landry

2013-01-01

Rwanda's National PMTCT program aims to achieve elimination of new HIV infections in children by 2015. In November 2010, Rwanda adopted the WHO 2010 ARV guidelines for PMTCT recommending Option B (HAART) for all HIV-positive pregnant women extended throughout breastfeeding and discontinued (short course-HAART) only for those not eligible for life treatment. The current study aims to assess the cost-effectiveness of this policy choice. Based on a cohort of HIV-infected pregnant women in Rwanda, we modelled the cost-effectiveness of six regimens: dual ARV prophylaxis with either 12 months breastfeeding or replacement feeding; short course HAART (Sc-HAART) prophylaxis with either 6 months breastfeeding, 12 months breastfeeding, or 18 months breastfeeding; and Sc-HAART prophylaxis with replacement feeding. Direct costs were modelled based on all inputs in each scenario and related unit costs. Effectiveness was evaluated by measuring HIV-free survival at 18 months. Savings correspond to the lifetime costs of HIV treatment and care avoided as a result of all vertical HIV infections averted. All PMTCT scenarios considered are cost saving compared to "no intervention." Sc-HAART with 12 months breastfeeding or 6 months breastfeeding dominate all other scenarios. Sc-HAART with 12 months breastfeeding allows for more children to be alive and HIV-uninfected by 18 months than Sc-HAART with 6 months breastfeeding for an incremental cost per child alive and uninfected of 11,882 USD. This conclusion is sensitive to changes in the relative risk of mortality by 18 months for exposed HIV-uninfected children on replacement feeding from birth and those who were breastfed for only 6 months compared to those breastfeeding for 12 months or more. Our findings support the earlier decision by Rwanda to adopt WHO Option B and could inform alternatives for breastfeeding duration. Local contexts and existing care delivery models should be part of national policy decisions.

Prevention of Mother-To-Child Transmission of HIV: Cost-Effectiveness of Antiretroviral Regimens and Feeding Options in Rwanda

PubMed Central

Binagwaho, Agnes; Pegurri, Elisabetta; Drobac, Peter C.; Mugwaneza, Placidie; Stulac, Sara N.; Wagner, Claire M.; Karema, Corine; Tsague, Landry

2013-01-01

Background Rwanda's National PMTCT program aims to achieve elimination of new HIV infections in children by 2015. In November 2010, Rwanda adopted the WHO 2010 ARV guidelines for PMTCT recommending Option B (HAART) for all HIV-positive pregnant women extended throughout breastfeeding and discontinued (short course-HAART) only for those not eligible for life treatment. The current study aims to assess the cost-effectiveness of this policy choice. Methods Based on a cohort of HIV-infected pregnant women in Rwanda, we modelled the cost-effectiveness of six regimens: dual ARV prophylaxis with either 12 months breastfeeding or replacement feeding; short course HAART (Sc-HAART) prophylaxis with either 6 months breastfeeding, 12 months breastfeeding, or 18 months breastfeeding; and Sc-HAART prophylaxis with replacement feeding. Direct costs were modelled based on all inputs in each scenario and related unit costs. Effectiveness was evaluated by measuring HIV-free survival at 18 months. Savings correspond to the lifetime costs of HIV treatment and care avoided as a result of all vertical HIV infections averted. Results All PMTCT scenarios considered are cost saving compared to “no intervention.” Sc-HAART with 12 months breastfeeding or 6 months breastfeeding dominate all other scenarios. Sc-HAART with 12 months breastfeeding allows for more children to be alive and HIV-uninfected by 18 months than Sc-HAART with 6 months breastfeeding for an incremental cost per child alive and uninfected of 11,882 USD. This conclusion is sensitive to changes in the relative risk of mortality by 18 months for exposed HIV-uninfected children on replacement feeding from birth and those who were breastfed for only 6 months compared to those breastfeeding for 12 months or more. Conclusion Our findings support the earlier decision by Rwanda to adopt WHO Option B and could inform alternatives for breastfeeding duration. Local contexts and existing care delivery models should be part of national policy decisions. PMID:23437040

Documentation of a computer program to simulate aquifer-system compaction using the modular finite-difference ground-water flow model

USGS Publications Warehouse

Leake, S.A.; Prudic, David E.

1988-01-01

The process of permanent compaction is not routinely included in simulations of groundwater flow. To simulate storage changes from both elastic and inelastic compaction, a computer program was written for use with the U. S. Geological Survey modular finite-difference groundwater flow model. The new program is called the Interbed-Storage Package. In the Interbed-Storage Package, elastic compaction or expansion is assumed to be proportional to change in head. The constant of proportionality is the product of skeletal component of elastic specific storage and thickness of the sediments. Similarly, inelastic compaction is assumed to be proportional to decline in head. The constant of proportionality is the product of the skeletal component of inelastic specific storage and the thickness of the sediments. Storage changes are incorporated into the groundwater flow model by adding an additional term to the flow equation. Within a model time step, the package appropriately apportions storage changes between elastic and inelastic components on the basis of the relation of simulated head to the previous minimum head. Another package that allows for a time-varying specified-head boundary is also documented. This package was written to reduce the data requirements for test simulations of the Interbed-Storage Package. (USGS)

Special features of the dayCent modeling package and additional procedures for parameterization, calibration, validation, and applications

USDA-ARS?s Scientific Manuscript database

DayCent (Daily Century) is a biogeochemical model of intermediate complexity used to simulate flows of carbon and nutrients for crop, grassland, forest, and savanna ecosystems. Required model inputs are: soil texture, current and historical land use, vegetation cover, and daily maximum/minimum tempe...

A FORTRAN program for determining aircraft stability and control derivatives from flight data

NASA Technical Reports Server (NTRS)

Maine, R. E.; Iliff, K. W.

1975-01-01

A digital computer program written in FORTRAN IV for the estimation of aircraft stability and control derivatives is presented. The program uses a maximum likelihood estimation method, and two associated programs for routine, related data handling are also included. The three programs form a package that can be used by relatively inexperienced personnel to process large amounts of data with a minimum of manpower. This package was used to successfully analyze 1500 maneuvers on 20 aircraft, and is designed to be used without modification on as many types of computers as feasible. Program listings and sample check cases are included.

77 FR 37421 - Eunice Kennedy Shriver National Institute of Child Health & Human Development; Notice of Closed...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-21

... National Institute of Child Health & Human Development; Notice of Closed Meeting Pursuant to section 10(d... Institute of Child Health and Human Development Special Emphasis Panel; PMTCT. Date: July 17-18, 2012. Time... Institute of Child Health and Human Development, NIH, 6100 Executive Blvd., Room 5b01, Bethesda, MD 20892...

Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision: Moving Toward Age-Equitable Comprehensive Human Immunodeficiency Virus Prevention Measures.

PubMed

Kaufman, Michelle R; Patel, Eshan U; Dam, Kim H; Packman, Zoe R; Van Lith, Lynn M; Hatzold, Karin; Marcell, Arik V; Mavhu, Webster; Kahabuka, Catherine; Mahlasela, Lusanda; Njeuhmeli, Emmanuel; Seifert Ahanda, Kim; Ncube, Getrude; Lija, Gissenge; Bonnecwe, Collen; Tobian, Aaron A R

2018-04-03

The minimum package of voluntary medical male circumcision (VMMC) services, as defined by the World Health Organization, includes human immunodeficiency virus (HIV) testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion, and the VMMC procedure. The current study aimed to assess whether adolescents received these key elements. Quantitative surveys were conducted among male adolescents aged 10-19 years (n = 1293) seeking VMMC in South Africa, Tanzania, and Zimbabwe. We used a summative index score of 8 self-reported binary items to measure receipt of important elements of the World Health Organization-recommended HIV minimum package and the US President's Emergency Plan for AIDS Relief VMMC recommendations. Counseling sessions were observed for a subset of adolescents (n = 44). To evaluate factors associated with counseling content, we used Poisson regression models with generalized estimating equations and robust variance estimation. Although counseling included VMMC benefits, little attention was paid to risks, including how to identify complications, what to do if they arise, and why avoiding sex and masturbation could prevent complications. Overall, older adolescents (aged 15-19 years) reported receiving more items in the recommended minimum package than younger adolescents (aged 10-14 years; adjusted β, 0.17; 95% confidence interval [CI], .12-.21; P < .001). Older adolescents were also more likely to report receiving HIV test education and promotion (42.7% vs 29.5%; adjusted prevalence ratio [aPR], 1.53; 95% CI, 1.16-2.02) and a condom demonstration with condoms to take home (16.8% vs 4.4%; aPR, 2.44; 95% CI, 1.30-4.58). No significant age differences appeared in reports of explanations of VMMC risks and benefits or uptake of HIV testing. These self-reported findings were confirmed during counseling observations. Moving toward age-equitable HIV prevention services during adolescent VMMC likely requires standardizing counseling content, as there are significant age differences in HIV prevention content received by adolescents.

A comprehensive review of available epidemiologic and HIV service data for female sex workers, men who have sex with men, and people who inject drugs in select West and Central African countries.

PubMed

MacAllister, Jack; Sherwood, Jennifer; Galjour, Joshua; Robbins, Sarah; Zhao, Jinkou; Dam, Kim; Grosso, Ashley; Baral, Stefan D

2015-03-01

To identify gaps in epidemiologic and HIV service coverage data for key populations (KP), including men who have sex with men (MSM), female sex workers (FSW), people who inject drugs (PWID), and transgender persons, in 8 West and Central Africa countries: Cameroon, Chad, Cote d'Ivoire, Democratic Republic of Congo, Ghana, Guinea-Bissau, Niger, and Nigeria. A comprehensive search of peer-reviewed literature was conducted using PubMed and MEDLINE. This search was supplemented by an additional search of relevant non-peer-reviewed, or gray, literature. Available data on HIV prevalence, KP size estimates, HIV prevention service targets, and HIV prevention service coverage, including the availability of population-specific minimum packages of services, were included in the review. No data for transgender persons were found. HIV prevalence data and size estimates were more frequently available for FSW, followed by MSM. Only 2 countries (Ghana and Nigeria) had both KP size estimates and HIV prevalence data for PWID. The degree to which HIV prevention service targets were adopted was highly variable across the selected countries, and the collection of relevant HIV prevention service coverage data for those targets that were identified was inconsistent. Population-specific minimum packages of services were identified in 3 countries (Cote d'Ivoire, Ghana, and Nigeria), although only Ghana and Nigeria included services for PWID. Epidemiologic and HIV prevention service data for FSW, MSM, PWID, and transgender persons remain sparse, and these KP are inconsistently accounted for in-service delivery and nationally endorsed minimum packages of HIV services in West and Central Africa. The strengthening of data collection and reporting to consistently include KP and the inclusion of that data in national planning is imperative for effectively addressing the HIV epidemic.

Destructive examination of shipping package 9975-02644

DOE Office of Scientific and Technical Information (OSTI.GOV)

Daugherty, W. L.

Destructive and non-destructive examinations have been performed on the components of shipping package 9975-02644 as part of a comprehensive SRS surveillance program for plutonium material stored in the K-Area Complex (KAC). During the field surveillance inspection of this package in KAC, three non-conforming conditions were noted: the axial gap of 1.389 inch exceeded the 1 inch maximum criterion, the exposed height of the lead shield was greater than the 4.65 inch maximum criterion, and the difference between the upper assembly inside height and the exposed height of the lead shield was less than the 0.425 inch minimum criterion. All threemore » of these observations relate to axial shrinkage of the lower fiberboard assembly. In addition, liquid water (condensation) was observed on the interior of the drum lid, the thermal blanket and the air shield.« less

Sustainable (food) packaging--an overview.

PubMed

Russell, David A M

2014-01-01

Packaging has an increasingly essential role to play in preserving the value invested in products by ensuring that they can deliver their designed service with minimum wastage. Food contact materials that deliver more units of service with increasingly fewer inputs of energy and materials, and increasingly fewer negative social, economic and environmental impacts, e.g., from emission of wastes, will be more sustainable both in the food processing machines of the industrial system and as packaging for food. Buzz words, whether bio-, nano-, degradable, or whatever comes next, must be critically examined per unit of service delivered to determine if, over the whole life cycle of the products to which they are applied, energy and resource use are minimised, pollution is reduced (not relocated), ecological benefits are created, and social and economic well-being are increased. Only when this caution is applied can a new solution be described as more sustainable.

MNE software for processing MEG and EEG data

PubMed Central

Gramfort, A.; Luessi, M.; Larson, E.; Engemann, D.; Strohmeier, D.; Brodbeck, C.; Parkkonen, L.; Hämäläinen, M.

2013-01-01

Magnetoencephalography and electroencephalography (M/EEG) measure the weak electromagnetic signals originating from neural currents in the brain. Using these signals to characterize and locate brain activity is a challenging task, as evidenced by several decades of methodological contributions. MNE, whose name stems from its capability to compute cortically-constrained minimum-norm current estimates from M/EEG data, is a software package that provides comprehensive analysis tools and workflows including preprocessing, source estimation, time–frequency analysis, statistical analysis, and several methods to estimate functional connectivity between distributed brain regions. The present paper gives detailed information about the MNE package and describes typical use cases while also warning about potential caveats in analysis. The MNE package is a collaborative effort of multiple institutes striving to implement and share best methods and to facilitate distribution of analysis pipelines to advance reproducibility of research. Full documentation is available at http://martinos.org/mne. PMID:24161808

Setting a national minimum standard for health benefits: how do state benefit mandates compare with benefits in large-group plans?

PubMed

Frey, Allison; Mika, Stephanie; Nuzum, Rachel; Schoen, Cathy

2009-06-01

Many proposed health insurance reforms would establish a federal minimum benefit standard--a baseline set of benefits to ensure that people have adequate coverage and financial protection when they purchase insurance. Currently, benefit mandates are set at the state level; these vary greatly across states and generally target specific areas rather than set an overall standard for what qualifies as health insurance. This issue brief considers what a broad federal minimum standard might look like by comparing existing state benefit mandates with the services and providers covered under the Federal Employees Health Benefits Program (FEHBP) Blue Cross and Blue Shield standard benefit package, an example of minimum creditable coverage that reflects current standard practice among employer-sponsored health plans. With few exceptions, benefits in the FEHBP standard option either meet or exceed those that state mandates require-indicating that a broad-based national benefit standard would include most existing state benefit mandates.

25 CFR 547.12 - What are the minimum technical standards for downloading on a Class II gaming system?

Code of Federal Regulations, 2013 CFR

2013-04-01

... limited to software, files, data, and prize schedules. (2) Downloads must use secure methodologies that... date of the completion of the download; (iii) The Class II gaming system components to which software was downloaded; (iv) The version(s) of download package and any software downloaded. Logging of the...

25 CFR 547.12 - What are the minimum technical standards for downloading on a Class II gaming system?

Code of Federal Regulations, 2014 CFR

2014-04-01

... limited to software, files, data, and prize schedules. (2) Downloads must use secure methodologies that... date of the completion of the download; (iii) The Class II gaming system components to which software was downloaded; (iv) The version(s) of download package and any software downloaded. Logging of the...

Cluster: Metals. Course: Machine Shop. Research Project.

ERIC Educational Resources Information Center

Sanford - Lee County Schools, NC.

The set of 13 units is designed for use with an instructor in actual machine shop practice and is also keyed to audio visual and textual materials. Each unit contains a series of task packages which: specify prerequisites within the series (minimum is Unit 1); provide a narrative rationale for learning; list both general and specific objectives in…

Cigarette brand diversity and price changes during the implementation of plain packaging in the United Kingdom.

PubMed

Breton, Magdalena Opazo; Britton, John; Huang, Yue; Bogdanovica, Ilze

2018-05-29

Plain packaging of cigarettes appeared in the UK in July 2016 and was ubiquitous by May 2017. The change coincided with another legislative change, raising the minimum pack size from 10 to 20 cigarettes. Laws imposing plain packaging on cigarette packs remove another promotional route from tobacco companies but the effect of such laws on brand diversity, pricing, and sales volume is unknown. This study aimed to 1) describe and quantify changes in brand diversity, price segmentation and sales volumes and 2) estimate the association between the introduction of plain cigarette packaging and cigarette pricing in the UK. We used a natural experiment design to assess the impact of plain packaging legislation on brand diversity and cigarette prices. The data comprised a sample of 76% of sales of cigarettes in the UK between March 2013 and June 2017. United Kingdom MEASUREMENTS: Cigarette prices, number of brands and products, volumes of sales FINDINGS: During the period analysed, there was a slight decrease in the number of cigarette brands. There was also an initial increase observed in the number of cigarette products, mainly due to an increase in the number of products in packs of fewer than 20 cigarettes sold before July 2016, which was then followed by a rapid decrease in the number of products that coincided with the implementation of the new legislation. Cigarette sales volumes during this period did not deviate from the preceding secular trend, but prices rose substantially. Regression results showed that price per cigarette, regardless of pack size, was 5.0 (95% CI 4.8 to 5.3) pence higher in plain than in fully branded packs. For packs of 20 cigarettes, price increases were greater in the lower price quintiles, ranging from 2.6 (95% CI 2.4 to 2.7) GBP in the lowest to 0.3 (95% CI 0.3-0.4) GBP per pack in the highest quintile. The implementation of standardised packaging legislation in the UK, which included minimum pack sizes of 20, was associated with significant increases overall in the price of manufactured cigarettes but no clear deviation in the ongoing downward trend in total volume of cigarette sales. This article is protected by copyright. All rights reserved.

Warning Statements and Safety Practices among Manufacturers and Distributors of Electronic Cigarette Liquids in the United States.

PubMed

Fagan, Pebbles; Pokhrel, Pallav; Herzog, Thaddeus A; Guy, Mignonne C; Sakuma, Kari-Lyn K; Trinidad, Dennis R; Cassel, Kevin; Jorgensen, Dorothy; Lynch, Tania; Felicitas-Perkins, Jamie Q; Palafox, Sherilyn; Hamamura, Faith; Maloney, Sarah; Degree, Kaylah; Sterling, Kymberle; Moolchan, Eric; Clanton, Mark S; Eissenberg, Thomas

2017-05-18

Prior to the Food and Drug Administration's (FDA) regulation of electronic cigarettes and warning statements related to nicotine addiction, there was no critical examination of manufacturer/distributor voluntary practices that could potentially inform FDA actions aimed to protect consumers. This study examined the content of warning statements and safety characteristics of electronic cigarette liquid bottles using a national sample. Research staff randomly selected four electronic cigarette liquid manufacturers/distributors from four U.S. geographic regions. Staff documented the characteristics of product packaging and content of warning statements on 147 electronic cigarette liquids (0-30 mg/ml of nicotine) purchased online from 16 manufacturers/distributors in April of 2016. Data showed that 97.9% of the electronic cigarette liquid bottles included a warning statement, most of which focused on nicotine exposure rather than health. Only 22.4% of bottles used a warning statement that indicated the product "contained nicotine". Of bottles that advertised a nicotine-based concentration of 12 mg/ml, 26% had a warning statements stated that the product "contains nicotine". None of the statements that indicated that the product "contained nicotine" stated that nicotine was "addictive". All bottles had a safety cap and 12% were in plastic shrink-wrap. Fifty-six percent of the websites had a minimum age requirement barrier that prevented under-aged persons from entering. Most manufacturers/distributors printed a warning statement on electronic cigarette liquid bottles, but avoided warning consumers about the presence and the addictiveness of nicotine. Studies are needed to examine manufacturer/distributor modifications to product packaging and how packaging affects consumer behaviors. These data can inform future FDA requirements related to the packaging and advertising of e-cigarette liquids; regulation related to the content of warning statements, including exposure warning statements, which are not currently mandated; and requirements on websites or language on packaging to help manufacturers adhere to the minimum age of purchase regulation. The data can also be used to help FDA develop additional guidance on the framing of statements on packaging that helps consumers make informed decisions about purchasing the product or protecting young people from use or unintentional exposure to the product. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Increasing HIV testing among pregnant women in Nigeria: evaluating the traditional birth attendant and primary health center integration (TAP-In) model.

PubMed

Chizoba, Amara Frances; Pharr, Jennifer R; Oodo, Gina; Ezeobi, Edith; Ilozumb, Jude; Egharevba, Johnbull; Ezeanolue, Echezona E; Nwandu, Anthea

2017-09-01

Engaging Traditional Birth Attendants (TBAs) may be critical to preventing mother-to-child transmission of HIV (PMTCT) in Nigeria. We integrated TBAs into Primary Health Centers (PHCs) and provided the TBAs with HIV counseling and testing (HCT) training for PMTCT (TAP-In). The purpose of this study was to evaluate the impact of TAP-In on HCT uptake among pregnant women. A quasi-experimental design was used for this study. Twenty PHCs were assigned to the intervention group that integrated TAP-In and 20 were assigned to the control group. Data were collected six months prior to the initiation of TAP-In and six months post, using antenatal clinic registries. Intervention PHCs more than doubled the number of pregnant women who received HCT in their catchment area post TAP-In while control PHCs had no significant change. After initiating TAP-In, intervention PHCs provided almost three times more HCT than the control PHCs (p < 0.01) with TBA provided over half of the HCT post TAP-In. The TAP-In model was effective for increasing HCT among pregnant women.

A ‘one-stop shop’ approach in antenatal care: does this improve antiretroviral treatment uptake in Zimbabwe?

PubMed Central

Zachariah, R.; Bissell, K.; Ndebele, W.; Moyo, J.; Mutasa-Apollo, T.

2013-01-01

Setting: Prevention of mother-to-child transmission (PMTCT) programme, Mpilo Hospital antenatal clinic, Zimbabwe. Objective: Before and after the introduction of a one-stop shop approach and task-shifting of antiretroviral treatment (ART) to midwives in the PMTCT programme, 1) to compare ART uptake and 2) to determine socio-demographic and other characteristics associated with non-initiation of ART post integration. Design: Before and after cohort study. Results: A total of 285 women were eligible for ART before the introduction of the one-stop approach and 280 after. Of the 285, 163 (57%) initiated ART before integration; this increased to 244/280 (87%) after integration (RR 1.5, 95% CI 1.4–1.7, P < 0.001). A total of 36 (13%) women did not initiate ART after integration; this was significantly associated with cotrimoxazole uptake (P = 0.03). Conclusion: Integrating ART into antenatal care along with task-shifting to midwives considerably increased the uptake of ART. This provides further evidence for scaling up integration rapidly to other facilities in Zimbabwe, and is in line with the vision of a world where no child will be born with the human immunodeficiency virus by 2015. PMID:26393047

Preventing vertical transmission of HIV in Kinshasa, Democratic Republic of the Congo: a baseline survey of 18 antenatal clinics.

PubMed

Behets, Frieda Mtf; Matendo, Richard; Vaz, Lara Me; Kilese, Nick; Nanlele, Diderot; Kokolomami, Jack; Okitolando, Emile W; Van Rie, Annelies

2006-12-01

To assess the content and delivery of essential antenatal services before implementation of programmes for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). We assessed 18 antenatal care centres (eight public units and ten managed by nongovernmental organizations) in Kinshasa, Democratic Republic of the Congo. We used a survey to capture information about the number and type of antenatal health workers, infrastructure capacity and the delivery of basic antenatal care services such as: nutritional counselling; tetanus toxoid vaccination; prevention and management of anaemia, malaria, sexually transmitted infections, and tuberculosis; and counselling for postpartum contraception. Antenatal care units differed with respect to size, capacity, cost, service delivery systems and content. For instance, 17 of the 18 sites offered anaemia screening but only two sites included the cost in the card that gives access to antenatal care. Nine of the clinics (50%) reported providing the malaria prophyalxis sulfadoxine pyrimethamine as per national policy. Four (22%) of the sites offered syphilis screening. Scaling up PMTCT programmes in under-resourced settings requires evaluation and strengthening of existing basic antenatal care service delivery.

A 'one-stop shop' approach in antenatal care: does this improve antiretroviral treatment uptake in Zimbabwe?

PubMed

Gunguwo, H; Zachariah, R; Bissell, K; Ndebele, W; Moyo, J; Mutasa-Apollo, T

2013-12-21

Prevention of mother-to-child transmission (PMTCT) programme, Mpilo Hospital antenatal clinic, Zimbabwe. Before and after the introduction of a one-stop shop approach and task-shifting of antiretroviral treatment (ART) to midwives in the PMTCT programme, 1) to compare ART uptake and 2) to determine socio-demographic and other characteristics associated with non-initiation of ART post integration. Before and after cohort study. A total of 285 women were eligible for ART before the introduction of the one-stop approach and 280 after. Of the 285, 163 (57%) initiated ART before integration; this increased to 244/280 (87%) after integration (RR 1.5, 95% CI 1.4-1.7, P < 0.001). A total of 36 (13%) women did not initiate ART after integration; this was significantly associated with cotrimoxazole uptake (P = 0.03). Integrating ART into antenatal care along with task-shifting to midwives considerably increased the uptake of ART. This provides further evidence for scaling up integration rapidly to other facilities in Zimbabwe, and is in line with the vision of a world where no child will be born with the human immunodeficiency virus by 2015.

MT3D-USGS version 1: A U.S. Geological Survey release of MT3DMS updated with new and expanded transport capabilities for use with MODFLOW

USGS Publications Warehouse

Bedekar, Vivek; Morway, Eric D.; Langevin, Christian D.; Tonkin, Matthew J.

2016-09-30

MT3D-USGS, a U.S. Geological Survey updated release of the groundwater solute transport code MT3DMS, includes new transport modeling capabilities to accommodate flow terms calculated by MODFLOW packages that were previously unsupported by MT3DMS and to provide greater flexibility in the simulation of solute transport and reactive solute transport. Unsaturated-zone transport and transport within streams and lakes, including solute exchange with connected groundwater, are among the new capabilities included in the MT3D-USGS code. MT3D-USGS also includes the capability to route a solute through dry cells that may occur in the Newton-Raphson formulation of MODFLOW (that is, MODFLOW-NWT). New chemical reaction Package options include the ability to simulate inter-species reactions and parent-daughter chain reactions. A new pump-and-treat recirculation package enables the simulation of dynamic recirculation with or without treatment for combinations of wells that are represented in the flow model, mimicking the above-ground treatment of extracted water. A reformulation of the treatment of transient mass storage improves conservation of mass and yields solutions for better agreement with analytical benchmarks. Several additional features of MT3D-USGS are (1) the separate specification of the partitioning coefficient (Kd) within mobile and immobile domains; (2) the capability to assign prescribed concentrations to the top-most active layer; (3) the change in mass storage owing to the change in water volume now appears as its own budget item in the global mass balance summary; (4) the ability to ignore cross-dispersion terms; (5) the definition of Hydrocarbon Spill-Source Package (HSS) mass loading zones using regular and irregular polygons, in addition to the currently supported circular zones; and (6) the ability to specify an absolute minimum thickness rather than the default percent minimum thickness in dry-cell circumstances.Benchmark problems that implement the new features and packages test the accuracy of new code through comparison to analytical benchmarks, as well as to solutions from other published codes. The input file structure for MT3D-USGS adheres to MT3DMS conventions for backward compatibility: the new capabilities and packages described herein are readily invoked by adding three-letter package name acronyms to the name file or by setting input flags as needed. Memory is managed in MT3D-USGS using FORTRAN modules in order to simplify code development and expansion.

The ViennaRNA web services.

PubMed

Gruber, Andreas R; Bernhart, Stephan H; Lorenz, Ronny

2015-01-01

The ViennaRNA package is a widely used collection of programs for thermodynamic RNA secondary structure prediction. Over the years, many additional tools have been developed building on the core programs of the package to also address issues related to noncoding RNA detection, RNA folding kinetics, or efficient sequence design considering RNA-RNA hybridizations. The ViennaRNA web services provide easy and user-friendly web access to these tools. This chapter describes how to use this online platform to perform tasks such as prediction of minimum free energy structures, prediction of RNA-RNA hybrids, or noncoding RNA detection. The ViennaRNA web services can be used free of charge and can be accessed via http://rna.tbi.univie.ac.at.

Summary of Uranium Solubility Studies in Concrete Waste Forms and Vadose Zone Environments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Golovich, Elizabeth C.; Wellman, Dawn M.; Serne, R. Jeffrey

2011-09-30

One of the methods being considered for safely disposing of Category 3 low-level radioactive wastes is to encase the waste in concrete. Concrete encasement would contain and isolate the waste packages from the hydrologic environment and act as an intrusion barrier. The current plan for waste isolation consists of stacking low-level waste packages on a trench floor, surrounding the stacks with reinforced steel, and encasing these packages in concrete. These concrete-encased waste stacks are expected to vary in size with maximum dimensions of 6.4 m long, 2.7 m wide, and 4 m high. The waste stacks are expected to havemore » a surrounding minimum thickness of 15 cm of concrete encasement. These concrete-encased waste packages are expected to withstand environmental exposure (solar radiation, temperature variations, and precipitation) until an interim soil cover or permanent closure cover is installed and to remain largely intact thereafter. Any failure of concrete encasement may result in water intrusion and consequent mobilization of radionuclides from the waste packages. This report presents the results of investigations elucidating the uranium mineral phases controlling the long-term fate of uranium within concrete waste forms and the solubility of these phases in concrete pore waters and alkaline, circum-neutral vadose zone environments.« less

Using Combinatorica/Mathematica for Student Projects in Random Graph Theory

ERIC Educational Resources Information Center

Pfaff, Thomas J.; Zaret, Michele

2006-01-01

We give an example of a student project that experimentally explores a topic in random graph theory. We use the "Combinatorica" package in "Mathematica" to estimate the minimum number of edges needed in a random graph to have a 50 percent chance that the graph is connected. We provide the "Mathematica" code and compare it to the known theoretical…

Serum lactate levels in infants exposed peripartum to antiretroviral agents to prevent mother-to-child transmission of HIV: Agence Nationale de Recherches Sur le SIDA et les Hépatites Virales 1209 study, Abidjan, Ivory Coast

PubMed Central

Ekouevi, Didier Koumavi; Touré, Ramata; Becquet, Renaud; Viho, Ida; Sakarovitch, Charlotte; Rouet, François; Towne-Gold, Besigin; Fassinou, Patricia; Leroy, Valériane; Blanche, Stéphane; Dabis, François

2006-01-01

Background Mitochondrial toxicity was described in infants exposed to long-term antiretroviral regimens (ARVs) containing nucleoside analogues for the prevention of mother-to-child transmission of HIV (PMTCT). We measured the serum lactate levels in children born to HIV-1 infected (HIV+) African women receiving short-term ARV PMTCT regimens. Methods A prospective study was conducted in women-child pairs from the third trimester of pregnancy to three months of life. The exposed group was formed by children exposed in utero to nucleoside analogue ARVs, zidovudine (ZDV) or ZDV + lamivudine (3TC) from 32–36 weeks of amenorrhea until delivery. All these women received nevirapine single-dose (NVPsd) at the beginning of labor. The children received ZDV during the first 7 days of life and a NVPsd at day 3. The control group was formed by infants born to HIV+ women who had received NVPsd only and not exposed to nucleoside analogue ARVs. Serum lactate levels were measured at 4, 6 and 12 weeks of life by Cobas Integra 400™. Results A total of 836 blood samples from 338 infants were collected (262 exposed and 76 controls). Median lactacidemia was 1.8 mmol/l, Interquartile Range [1.2–2.7 mmol/l]). Overall serum lactate levels ≥2.5 mmol/l, defining hyperlactatemia were observed in 39 of the 292 infants who had at least two serum lactate measurements, 13.4%, 95% confidence Interval [9.6–17.8%]. The three-month period prevalence of hyperlactatemia did not differ between the exposed group (13.1%) and the control group (14.3%) (p=0.84). All serum lactate levels returned to normal values in all subsequent samples No case of symptomatic hyperlactatemia was detected during the study period. Conclusion Increased lactate levels were identified equally in infants whose mother received a short-term of nucleoside analogues or NVPsd for PMTCT. Although not rare, hyperlactatemia was not related to short-term exposure to nucleoside analogue ARVs PMID:16950945

Traditional birth attendants lack basic information on HIV and safe delivery practices in rural Mysore, India

PubMed Central

2010-01-01

Background There is little research on HIV awareness and practices of traditional birth attendants (TBA) in India. This study investigated knowledge and attitudes among rural TBA in Karnataka as part of a project examining how traditional birth attendants could be integrated into prevention-of-mother-to-child transmission of HIV (PMTCT) programs in India. Methods A cross-sectional survey was conducted between March 2008 and January 2009 among TBA in 144 villages in Mysore Taluk, Karnataka. Following informed consent, TBA underwent an interviewer-administered questionnaire in the local language of Kannada on practices and knowledge around birthing and HIV/PMTCT. Results Of the 417 TBA surveyed, the median age was 52 years and 96% were Hindus. A majority (324, 77.7%) had no formal schooling, 88 (21.1%) had up to 7 years and 5 (1%) had more than 7 yrs of education. Only 51 of the 417 TBA (12%) reported hearing about HIV/AIDS. Of those who had heard about HIV/AIDS, only 36 (72%) correctly reported that the virus could be spread from mother to child; 37 (74%) identified unprotected sex as a mode of transmission; and 26 (51%) correctly said healthy looking people could spread HIV. Just 22 (44%) knew that infected mothers could lower the risk of transmitting the virus to their infants. An overwhelming majority of TBA (401, 96.2%) did not provide antenatal care to their clients. Over half (254, 61%) said they would refer the woman to a hospital if she bled before delivery, and only 53 (13%) felt referral was necessary if excessive bleeding occurred after birth. Conclusions Traditional birth attendants will continue to play an important role in maternal child health in India for the foreseeable future. This study demonstrates that a majority of TBA lack basic information about HIV/AIDS and safe delivery practices. Given the ongoing shortage of skilled birth attendance in rural areas, more studies are needed to examine whether TBA should be trained and integrated into PMTCT and maternal child health programs in India. PMID:20860835

The Study of HIV and Antenatal Care Integration in Pregnancy in Kenya: Design, Methods, and Baseline Results of a Cluster-Randomized Controlled Trial

PubMed Central

Turan, Janet M.; Steinfeld, Rachel L.; Onono, Maricianah; Bukusi, Elizabeth A.; Woods, Meghan; Shade, Starley B.; Washington, Sierra; Marima, Reson; Penner, Jeremy; Ackers, Marta L.; Mbori-Ngacha, Dorothy; Cohen, Craig R.

2012-01-01

Background Despite strong evidence for the effectiveness of anti-retroviral therapy for improving the health of women living with HIV and for the prevention of mother-to-child transmission (PMTCT), HIV persists as a major maternal and child health problem in sub-Saharan Africa. In most settings antenatal care (ANC) services and HIV treatment services are offered in separate clinics. Integrating these services may result in better uptake of services, reduction of the time to treatment initiation, better adherence, and reduction of stigma. Methodology/Principal Findings A prospective cluster randomized controlled trial design was used to evaluate the effects of integrating HIV treatment into ANC clinics at government health facilities in rural Kenya. Twelve facilities were randomized to provide either fully integrated services (ANC, PMTCT, and HIV treatment services all delivered in the ANC clinic) or non-integrated services (ANC clinics provided ANC and basic PMTCT services and referred clients to a separate HIV clinic for HIV treatment). During June 2009– March 2011, 1,172 HIV-positive pregnant women were enrolled in the study. The main study outcomes are rates of maternal enrollment in HIV care and treatment, infant HIV testing uptake, and HIV-free infant survival. Baseline results revealed that the intervention and control cohorts were similar with respect to socio-demographics, male partner HIV testing, sero-discordance of the couple, obstetric history, baseline CD4 count, and WHO Stage. Challenges faced while conducting this trial at low-resource rural health facilities included frequent staff turnover, stock-outs of essential supplies, transportation challenges, and changes in national guidelines. Conclusions/Significance This is the first randomized trial of ANC and HIV service integration to be conducted in rural Africa. It is expected that the study will provide critical evidence regarding the implementation and effectiveness of this service delivery strategy, with important implications for programs striving to eliminate vertical transmission of HIV and improve maternal health. Trial Registration ClinicalTrials.gov NCT00931216 NCT00931216. PMID:22970177

Intra-facility linkage of HIV-positive mothers and HIV-exposed babies into HIV chronic care: rural and urban experience in a resource limited setting.

PubMed

Mugasha, Christine; Kigozi, Joanita; Kiragga, Agnes; Muganzi, Alex; Sewankambo, Nelson; Coutinho, Alex; Nakanjako, Damalie

2014-01-01

Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT) and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID) to inform strategic scale up of PMTCT programs. A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI). HIV-infected pregnant mothers, identified through routine antenatal care (ANC) and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery. Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26%) in rural and 743/1,025 (74%) in urban facilities. Of these 375/1,025 (37%) were linked to HIV clinics [67/267(25%) rural and 308/758(41%) urban]. Of 636 HIV-exposed babies, 193 (30%) were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636); 8/179 (4.5%)] in rural and 93/457(20.3%) in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1-3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3-15.1), p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings. Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to antiretroviral therapy for elimination of MTCT.

Integrating Prevention of Mother-to-Child HIV Transmission Programs to Improve Uptake: A Systematic Review

PubMed Central

Tudor Car, Lorainne; Van Velthoven, Michelle H. M. M. T.; Brusamento, Serena; Elmoniry, Hoda; Car, Josip; Majeed, Azeem; Tugwell, Peter; Welch, Vivian; Marusic, Ana; Atun, Rifat

2012-01-01

Background We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries. Methods We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources. Results Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04–1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001). Conclusion Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs. PMID:22558134

Despite Access to Antiretrovirals for Prevention and Treatment, High Rates of Mortality Persist Among HIV-infected Infants and Young Children.

PubMed

Abrams, Elaine J; Woldesenbet, Selamawit; Soares Silva, Juliana; Coovadia, Ashraf; Black, Viviane; Technau, Karl-Günter; Kuhn, Louise

2017-06-01

Outcomes of HIV-infected children before widespread use of antiretroviral therapy (ART) for treatment and prevention of mother-to-child transmission (PMTCT) have been well characterized but less is known about children who acquire HIV infection in the context of good ART access. We enrolled newly diagnosed HIV-infected children ≤24 months of age at 3 hospitals and 2 clinics in Johannesburg, South Africa. We report ART initiation and mortality rates during 6 months from enrollment and factors associated with mortality. Of 272 children enrolled, median age 6.1 months, 69.5% were diagnosed during hospitalization. By 6 months postenrollment, 53 (19.5%) died and 73 (26.8%) were lost-to-follow-up. Using Kaplan-Meier analysis, the probability of death by 6 months after enrollment was 23.5%. The median age of death was 9.1 months [95% confidence interval (CI): 8.6-12.0]. Overall, 226 (83%) children initiated ART which was associated with a 71% reduction in risk of death [hazard ratio (HR) = 0.29 (95% CI: 0.15-0.58)]. In multivariable analysis of infant factors, weight-for-age Z score < -2 standard deviation (SD) [HR = 2.43 (95% CI: 1.03-5.73)], CD4 <20% [HR = 3.29 (95% CI: 1.60-6.76)] and identification during hospitalization [HR = 2.89 (95% CI: 1.16-7.25)] were independently associated with mortality. In multivariable analysis of maternal factors, CD4 ≤350/no maternal ART was associated with increased mortality risk [HR = 2.57 (95% CI: 1.19-5.59)] versus CD4 >350/no maternal ART; exposure to maternal/infant antiretrovirals for PMTCT was associated with reduced mortality risk [HR = 0.53 (95% CI: 0.28-0.99)] versus no PMTCT. ART initiation is highly protective against death in young children. However, despite improved access to ART, young children remain at risk for early death; innovative approaches to rapidly diagnose and initiate treatment as early in life as possible are needed.

Uptake, Outcomes, and Costs of Antenatal, Well-Baby, and Prevention of Mother-to-Child Transmission of HIV Services under Routine Care Conditions in Zambia

PubMed Central

Scott, Callie A.; Iyer, Hari S.; Lembela Bwalya, Deophine; Bweupe, Maximillian; Rosen, Sydney B.; Scott, Nancy; Larson, Bruce A.

2013-01-01

Background Zambia adopted Option A for prevention of mother-to-child transmission of HIV (PMTCT) in 2010 and announced a move to Option B+ in 2013. We evaluated the uptake, outcomes, and costs of antenatal, well-baby, and PMTCT services under routine care conditions in Zambia after the adoption of Option A. Methods We enrolled 99 HIV-infected/HIV-exposed (index) mother/baby pairs with a first antenatal visit in April-September 2011 at four study sites and 99 HIV-uninfected/HIV-unexposed (comparison) mother/baby pairs matched on site, gestational age, and calendar month at first visit. Data on patient outcomes and resources utilized from the first antenatal visit through six months postpartum were extracted from site registers. Costs in 2011 USD were estimated from the provider’s perspective. Results Index mothers presented for antenatal care at a mean 23.6 weeks gestation; 55% were considered to have initiated triple-drug antiretroviral therapy (ART) based on information recorded in site registers. Six months postpartum, 62% of index and 30% of comparison mother/baby pairs were retained in care; 67% of index babies retained had an unknown HIV status. Comparison and index mother/baby pairs utilized fewer resources than under fully guideline-concordant care; index babies utilized more well-baby resources than comparison babies. The average cost per comparison pair retained in care six months postpartum was $52 for antenatal and well-baby services. The average cost per index pair retained was $88 for antenatal, well-baby, and PMTCT services and increased to $185 when costs of triple-drug ART services were included. Conclusions HIV-infected mothers present to care late in pregnancy and many are lost to follow up by six months postpartum. HIV-exposed babies are more likely to remain in care and receive non-HIV, well-baby care than HIV-unexposed babies. Improving retention in care, guideline concordance, and moving to Option B+ will result in increased service delivery costs in the short term. PMID:24015245

Intra-Facility Linkage of HIV-Positive Mothers and HIV-Exposed Babies into HIV Chronic Care: Rural and Urban Experience in a Resource Limited Setting

PubMed Central

Mugasha, Christine; Kigozi, Joanita; Kiragga, Agnes; Muganzi, Alex; Sewankambo, Nelson; Coutinho, Alex; Nakanjako, Damalie

2014-01-01

Introduction Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT) and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID) to inform strategic scale up of PMTCT programs. Methods A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI). HIV-infected pregnant mothers, identified through routine antenatal care (ANC) and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery. Results Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26%) in rural and 743/1,025 (74%) in urban facilities. Of these 375/1,025 (37%) were linked to HIV clinics [67/267(25%) rural and 308/758(41%) urban]. Of 636 HIV-exposed babies, 193 (30%) were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636); 8/179 (4.5%)] in rural and 93/457(20.3%) in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1–3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3–15.1), p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings. Conclusion Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to antiretroviral therapy for elimination of MTCT. PMID:25546453

Traditional birth attendants lack basic information on HIV and safe delivery practices in rural Mysore, India.

PubMed

Madhivanan, Purnima; Kumar, Bhavana N; Adamson, Paul; Krupp, Karl

2010-09-22

There is little research on HIV awareness and practices of traditional birth attendants (TBA) in India. This study investigated knowledge and attitudes among rural TBA in Karnataka as part of a project examining how traditional birth attendants could be integrated into prevention-of-mother-to-child transmission of HIV (PMTCT) programs in India. A cross-sectional survey was conducted between March 2008 and January 2009 among TBA in 144 villages in Mysore Taluk, Karnataka. Following informed consent, TBA underwent an interviewer-administered questionnaire in the local language of Kannada on practices and knowledge around birthing and HIV/PMTCT. Of the 417 TBA surveyed, the median age was 52 years and 96% were Hindus. A majority (324, 77.7%) had no formal schooling, 88 (21.1%) had up to 7 years and 5 (1%) had more than 7 yrs of education. Only 51 of the 417 TBA (12%) reported hearing about HIV/AIDS. Of those who had heard about HIV/AIDS, only 36 (72%) correctly reported that the virus could be spread from mother to child; 37 (74%) identified unprotected sex as a mode of transmission; and 26 (51%) correctly said healthy looking people could spread HIV. Just 22 (44%) knew that infected mothers could lower the risk of transmitting the virus to their infants. An overwhelming majority of TBA (401, 96.2%) did not provide antenatal care to their clients. Over half (254, 61%) said they would refer the woman to a hospital if she bled before delivery, and only 53 (13%) felt referral was necessary if excessive bleeding occurred after birth. Traditional birth attendants will continue to play an important role in maternal child health in India for the foreseeable future. This study demonstrates that a majority of TBA lack basic information about HIV/AIDS and safe delivery practices. Given the ongoing shortage of skilled birth attendance in rural areas, more studies are needed to examine whether TBA should be trained and integrated into PMTCT and maternal child health programs in India.

Obstacles to the coordination of delivering integrated prenatal HIV, syphilis and hepatitis B testing services in Guangdong: using a needs assessment approach.

PubMed

Xia, Jianhong; Rutherford, Shannon; Ma, Yuanzhu; Wu, Li; Gao, Shuang; Chen, Tingting; Lu, Xiao; Zhang, Xiaozhuang; Chu, Cordia

2015-03-24

Integration of services for Prevention of Mother-To-Child Transmission of HIV (PMTCT) into routine maternal and child health care is promoted as a priority strategy by the WHO to facilitate the implementation of PMTCT. Integration of services emphasizes inter-sectoral coordination in the health systems to provide convenient services for clients. China has been integrating prenatal HIV, syphilis and hepatitis B testing services since 2009. However, as the individual health systems are complex, effective coordination among different health agencies is challenging. Few studies have examined the factors that affect the coordination of such complex systems. The aim of this study is to assess the effectiveness of and examine challenges for integrated service delivery. Findings will provide the basis for strategy development to enhance the effective delivery of integrated services. The research was conducted in Guangdong province in 2013 using a needs assessment approach that includes qualitative and quantitative methods. Quantitative data was collected through a survey and from routine monitoring for PMTCT and qualitative data was collected through stakeholder interviews. Routine monitoring data used to assess key indicators of coordination suggested numerous coordination problems. The rates of prenatal HIV (95%), syphilis (47%) and hepatitis B (47%) test were inconsistent. An average of only 20% of the HIV positive mothers was referred in the health systems. There were no regular meetings among different health agencies and the clients indicated complicated service processes. The major obstacles to the coordination of delivering these integrated services are lack of service resource integration; and lack of a mechanism for coordination of the health systems, with no uniform guidelines, clear roles or consistent evaluation. The key obstacles that have been identified in this study hinder the coordination of the delivery of integrated services. Our recommendations include: 1) Facilitate integration of the funding and information systems by fully combining the service resources of different health agencies into one unit; 2) Establish regular meetings to facilitate exchange of information and address problems; 3) Establish a client referral network between different health agencies with agreed guidelines, clear roles and consistent evaluation.

The Integration of an API619 Screw Compressor Package into the Industrial Internet of Things

NASA Astrophysics Data System (ADS)

Milligan, W. J.; Poli, G.; Harrison, D. K.

2017-08-01

The Industrial Internet of Things (IIoT) is the industrial subset of the Internet of Things (IoT). IIoT incorporates big data technology, harnessing the instrumentation data, machine to machine communication and automation technologies that have existed in industrial settings for years. As industry in general trends towards the IIoT and as the screw compressor packages developed by Howden Compressors are designed with a minimum design life of 25 years, it is imperative this technology is embedded immediately. This paper provides the reader with a description on the Industrial Internet of Things before moving onto describing the scope of the problem for an organisation like Howden Compressors who deploy multiple compressor technologies across multiple locations and focuses on the critical measurements particular to high specification screw compressor packages. A brief analysis of how this differs from high volume package manufacturers deploying similar systems is offered. Then follows a description on how the measured information gets from the tip of the instrument in the process pipework or drive train through the different layers, with a description of each layer, into the final presentation layer. The functions available within the presentation layer are taken in turn and the benefits analysed with specific focus on efficiency and availability. The paper concludes with how packagers adopting the IIoT can not only optimise their package but by utilising the machine learning technology and pattern detection applications can adopt completely new business models.

Corrosion of silicon integrated circuits and lifetime predictions in implantable electronic devices.

PubMed

Vanhoestenberghe, A; Donaldson, N

2013-06-01

Corrosion is a prime concern for active implantable devices. In this paper we review the principles underlying the concepts of hermetic packages and encapsulation, used to protect implanted electronics, some of which remain widely overlooked. We discuss how technological advances have created a need to update the way we evaluate the suitability of both protection methods. We demonstrate how lifetime predictability is lost for very small hermetic packages and introduce a single parameter to compare different packages, with an equation to calculate the minimum sensitivity required from a test method to guarantee a given lifetime. In the second part of this paper, we review the literature on the corrosion of encapsulated integrated circuits (ICs) and, following a new analysis of published data, we propose an equation for the pre-corrosion lifetime of implanted ICs, and discuss the influence of the temperature, relative humidity, encapsulation and field-strength. As any new protection will be tested under accelerated conditions, we demonstrate the sensitivity of acceleration factors to some inaccurately known parameters. These results are relevant for any application of electronics working in a moist environment. Our comparison of encapsulation and hermetic packages suggests that both concepts may be suitable for future implants.

Design of a Minimum Surface-Effect Tendon-Based Microactuator for Micromanipulation

NASA Technical Reports Server (NTRS)

Goldfarb, Michael; Lipsey, James H.

1997-01-01

A piezoelectric (PZT) stack-based actuator was developed to provide a means of actuation with dynamic characteristics appropriate for small-scale manipulation. In particular, the design incorporates a highly nonlinear, large-ratio transmission that provides approximately two orders of magnitude motion amplification from the PZT stack. In addition to motion amplification, the nonlinear transmission was designed via optimization methods to distort the highly non-uniform properties of a piezoelectric actuator so that the achievable actuation force is nearly constant throughout the actuator workspace. The package also includes sensors that independently measure actuator output force and displacement, so that a manipulator structure need not incorporate sensors nor the associated wires. Specifically, the actuator was designed to output a maximum force of at least one Newton through a stroke of at least one millimeter. For purposes of small-scale precision position and/or force control, the actuator/sensor package was designed to eliminate stick-slip friction and backlash. The overall dimensions of the actuator/sensor package are approximately 40 x 65 x 25 mm.

Techniques for designing rotorcraft control systems

NASA Technical Reports Server (NTRS)

Yudilevitch, Gil; Levine, William S.

1994-01-01

Over the last two and a half years we have been demonstrating a new methodology for the design of rotorcraft flight control systems (FCS) to meet handling qualities requirements. This method is based on multicriterion optimization as implemented in the optimization package CONSOL-OPTCAD (C-O). This package has been developed at the Institute for Systems Research (ISR) at the University of Maryland at College Park. This design methodology has been applied to the design of a FCS for the UH-60A helicopter in hover having the ADOCS control structure. The controller parameters have been optimized to meet the ADS-33C specifications. Furthermore, using this approach, an optimal (minimum control energy) controller has been obtained and trade-off studies have been performed.

STS-3/OSS-1 Plasma Diagnostics Package (PDP) measurements of Orbiter transmitter and subsystem electromagnetic interference

NASA Technical Reports Server (NTRS)

Shawhan, S. D.; Murphy, G.

1983-01-01

The plasma diagnostics package receiver system is described to identify the various antennas and to characterize the complement of receivers which cover the frequency range of 30 Hz to 800 Hz and S-band at 2200 + or - 300 MHz. Sample results are presented to show the variability of electromagnetic effects associated with the orbiter and the time variability of these effects. The electric field and magnetic field maximum and minimum field strength spectra observed during the mission at the pallet location are plotted. Values are also derived for the maximum UHF transmitter and S-band transmitter field strengths. Calibration data to convert from the survey plots to actual narrowband and broadband field strengths are listed.

National Crime Information Center Mandatory Minimum Standards Curriculum for Full Access Terminal Operators. Volume Two--NCIC "Hot" Files.

ERIC Educational Resources Information Center

Federal Bureau of Investigation, Washington, DC. National Crime Information Center.

This document is the second volume of a two-volume set of lesson plans that together make up a complete training package for full-service terminal operators. The lesson plans are designed to ensure that a state's National Crime Information Center (NCIC) training program meets Advisory Policy Board standards. (NCIC is a nationwide computerized…

Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision: Moving Toward Age-Equitable Comprehensive Human Immunodeficiency Virus Prevention Measures

PubMed Central

Kaufman, Michelle R; Patel, Eshan U; Dam, Kim H; Packman, Zoe R; Van Lith, Lynn M; Hatzold, Karin; Marcell, Arik V; Mavhu, Webster; Kahabuka, Catherine; Mahlasela, Lusanda; Njeuhmeli, Emmanuel; Seifert Ahanda, Kim; Ncube, Getrude; Lija, Gissenge; Bonnecwe, Collen; Tobian, Aaron A R

2018-01-01

Abstract Background The minimum package of voluntary medical male circumcision (VMMC) services, as defined by the World Health Organization, includes human immunodeficiency virus (HIV) testing, HIV prevention counseling, screening/treatment for sexually transmitted infections, condom promotion, and the VMMC procedure. The current study aimed to assess whether adolescents received these key elements. Methods Quantitative surveys were conducted among male adolescents aged 10–19 years (n = 1293) seeking VMMC in South Africa, Tanzania, and Zimbabwe. We used a summative index score of 8 self-reported binary items to measure receipt of important elements of the World Health Organization–recommended HIV minimum package and the US President’s Emergency Plan for AIDS Relief VMMC recommendations. Counseling sessions were observed for a subset of adolescents (n = 44). To evaluate factors associated with counseling content, we used Poisson regression models with generalized estimating equations and robust variance estimation. Results Although counseling included VMMC benefits, little attention was paid to risks, including how to identify complications, what to do if they arise, and why avoiding sex and masturbation could prevent complications. Overall, older adolescents (aged 15–19 years) reported receiving more items in the recommended minimum package than younger adolescents (aged 10–14 years; adjusted β, 0.17; 95% confidence interval [CI], .12–.21; P < .001). Older adolescents were also more likely to report receiving HIV test education and promotion (42.7% vs 29.5%; adjusted prevalence ratio [aPR], 1.53; 95% CI, 1.16–2.02) and a condom demonstration with condoms to take home (16.8% vs 4.4%; aPR, 2.44; 95% CI, 1.30–4.58). No significant age differences appeared in reports of explanations of VMMC risks and benefits or uptake of HIV testing. These self-reported findings were confirmed during counseling observations. Conclusions Moving toward age-equitable HIV prevention services during adolescent VMMC likely requires standardizing counseling content, as there are significant age differences in HIV prevention content received by adolescents. PMID:29617776

The use of mobile phones to deliver acceptance and commitment therapy in the prevention of mother-child HIV transmission in Nigeria.

PubMed

Ishola, A G; Chipps, J

2015-12-01

The objective of this study was to determine if introducing acceptance and commitment therapy in the prevention of mother to child HIV transmission (PMTCT) programme using weekly mobile phone messages would result in improved mental health status of HIV-positive, pregnant women in Nigeria. We used a Solomon four-group (two intervention and two control groups) randomised design. The study population was 144 randomly selected, HIV-positive pregnant women attending four randomly selected PMTCT centres in Nigeria. The intervention groups were exposed to one session of acceptance and commitment therapy with weekly value-based health messages sent by mobile phone for three months during pregnancy. The control groups received only post-HIV test counselling. A total of 132 participants (33 per site) were enrolled in the study from the two intervention and two control sites. In the pre-tests, the intervention and control groups did not differ significantly with regard to demographics. Evaluation of the pre- and post-tests of the intervention group indicated significantly higher Action and Acceptance Questionnaire (AAQ-II) scores. The introduction of a mobile phone acceptance and commitment therapy programme may result in greater psychological flexibility in women diagnosed with HIV. © The Author(s) 2015.

Reasons for loss to follow-up among mothers registered in a prevention-of-mother-to-child transmission program in rural Malawi.

PubMed

Bwirire, L D; Fitzgerald, M; Zachariah, R; Chikafa, V; Massaquoi, M; Moens, M; Kamoto, K; Schouten, E J

2008-12-01

This study was conducted to identify reasons for a high and progressive loss to follow-up among HIV-positive mothers within a prevention-of-mother-to-child HIV transmission (PMTCT) program in a rural district hospital in Malawi. Three focus group discussions were conducted among a total of 25 antenatal and post-natal mothers as well as nurse midwives (median age 39 years, range 22-55 years). The main reasons for loss to follow-up included: (1) not being prepared for HIV testing and its implications before the antenatal clinic (ANC) visit; (2) fear of stigma, discrimination, household conflict and even divorce on disclosure of HIV status; (3) lack of support from husbands who do not want to undergo HIV testing; (4) the feeling that one is obliged to rely on artificial feeding, which is associated with social and cultural taboos; (5) long waiting times at the ANC; and (6) inability to afford transport costs related to the long distances to the hospital. This study reveals a number of community- and provider-related operational and cultural barriers hindering the overall acceptability of PMTCT that need to be addressed urgently. Mothers attending antenatal services need to be better informed and supported, at both community and health-provider level.

What is needed to eliminate new pediatric HIV infections: The contribution of model-based analyses

PubMed Central

Doherty, Katie; Ciaranello, Andrea

2013-01-01

Purpose of Review Computer simulation models can identify key clinical, operational, and economic interventions that will be needed to achieve the elimination of new pediatric HIV infections. In this review, we summarize recent findings from model-based analyses of strategies for prevention of mother-to-child HIV transmission (MTCT). Recent Findings In order to achieve elimination of MTCT (eMTCT), model-based studies suggest that scale-up of services will be needed in several domains: uptake of services and retention in care (the PMTCT “cascade”), interventions to prevent HIV infections in women and reduce unintended pregnancies (the “four-pronged approach”), efforts to support medication adherence through long periods of pregnancy and breastfeeding, and strategies to make breastfeeding safer and/or shorter. Models also project the economic resources that will be needed to achieve these goals in the most efficient ways to allocate limited resources for eMTCT. Results suggest that currently recommended PMTCT regimens (WHO Option A, Option B, and Option B+) will be cost-effective in most settings. Summary Model-based results can guide future implementation science, by highlighting areas in which additional data are needed to make informed decisions and by outlining critical interventions that will be necessary in order to eliminate new pediatric HIV infections. PMID:23743788

Economic evaluation of drug abuse treatment and HIV prevention programs in pregnant women: a systematic review.

PubMed

Ruger, Jennifer Prah; Lazar, Christina M

2012-01-01

Drug abuse and transmission of HIV during pregnancy are public health problems that adversely affect pregnant women, their children and surrounding communities. Programs that address this vulnerable population have the ability to be cost-effective due to resulting cost savings for mother, child and society. Economic evaluations of programs that address these issues are an important tool to better understand the costs of services and create sustainable healthcare systems. This study critically examined economic evaluations of drug abuse treatment and HIV prevention programs in pregnant women. A systematic review was conducted using the criteria recommended by the Panel on Cost-Effectiveness in Health and Medicine and the British Medical Journal (BMJ) checklist for economic evaluations. The search identified 6 economic studies assessing drug abuse treatment for pregnant women, and 12 economic studies assessing programs that focus on prevention of mother-to-child transmission (PMTCT) of HIV. Results show that many programs for drug abuse treatment and PMTCT among pregnant women are cost-effective or even cost-saving. This study identified several shortcomings in methodology and lack of standardization of current economic evaluations. Efforts to address methodological challenges will help make future studies more comparable and have more influence on policy makers, clinicians and the public. Copyright © 2011 Elsevier Ltd. All rights reserved.

What do You Need to Get Male Partners of Pregnant Women Tested for HIV in Resource Limited Settings? The Baby Shower Cluster Randomized Trial.

PubMed

Ezeanolue, Echezona E; Obiefune, Michael C; Yang, Wei; Ezeanolue, Chinenye O; Pharr, Jennifer; Osuji, Alice; Ogidi, Amaka G; Hunt, Aaron T; Patel, Dina; Ogedegbe, Gbenga; Ehiri, John E

2017-02-01

Male partner involvement has the potential to increase uptake of interventions to prevent mother-to-child transmission of HIV (PMTCT). Finding cultural appropriate strategies to promote male partner involvement in PMTCT programs remains an abiding public health challenge. We assessed whether a congregation-based intervention, the Healthy Beginning Initiative (HBI), would lead to increased uptake of HIV testing among male partners of pregnant women during pregnancy. A cluster-randomized controlled trial of forty churches in Southeastern Nigeria randomly assigned to either the HBI (intervention group; IG) or standard of care referral to a health facility (control group; CG) was conducted. Participants in the IG received education and were offered onsite HIV testing. Overall, 2498 male partners enrolled and participated, a participation rate of 88.9%. Results showed that male partners in the IG were 12 times more likely to have had an HIV test compared to male partners of pregnant women in the CG (CG = 37.71% vs. IG = 84.00%; adjusted odds ratio = 11.9; p < .01). Culturally appropriate and community-based interventions can be effective in increasing HIV testing and counseling among male partners of pregnant women.

Use of personal digital assistants for data collection in a multi-site AIDS stigma study in rural south Nyanza, Kenya.

PubMed

Onono, M A; Carraher, N; Cohen, R C; Bukusi, E A; Turan, J M

2011-09-01

To describe the development, cost effectiveness and implementation of a PDA based electronic system to collect, verify and manage data from a multi-site study on HIV/AIDS stigma and pregnancy in a rural, resource-poor area. We worked within a large prevention of mother-to-child-transmission (PMTCT) program in nine rural health facilities to implement a PDA-based data collection system and to study the feasibility of its use in a multisite HIV research study in rural Kenya. The PDAs were programmed for collecting screening and eligibility data, and responses to structured interviews on HIV/AIDS stigma and violence in three local languages. Between November 2007 and December 2008, nine PDAs were used by Clinic and Community Health Assistants to enrol 1,270 participants on to the PMTCT program. Successes included: capacity-building of interviewers, low cost of implementation, quick turnaround time of data entry with good data quality, and convenience. Our study demonstrated the feasibility of utilizing PDAs for data collection in a multi-site observational study on HIV/AIDS stigma conducted in remote rural health facilities in Kenya. However, appropriate and frequent data backup protocols need to be established and paper forms are still needed as backup tools in resource-poor settings.

Variation in commercial smoking mixtures containing third-generation synthetic cannabinoids.

PubMed

Frinculescu, Anca; Lyall, Catherine L; Ramsey, John; Miserez, Bram

2017-02-01

Variation in ingredients (qualitative variation) and in quantity of active compounds (quantitative variation) in herbal smoking mixtures containing synthetic cannabinoids has been shown for older products. This can be dangerous to the user, as accurate and reproducible dosing is impossible. In this study, 69 packages containing third-generation cannabinoids of seven brands on the UK market in 2014 were analyzed both qualitatively and quantitatively for variation. When comparing the labels to actual active ingredients identified in the sample, only one brand was shown to be correctly labelled. The other six brands contained less, more, or ingredients other than those listed on the label. Only two brands were inconsistent, containing different active ingredients in different samples. Quantitative variation was assessed both within one package and between several packages. Within-package variation was within a 10% range for five of the seven brands, but two brands showed larger variation, up to 25% (Relative Standard Deviation). Variation between packages was significantly higher, with variation up to 38% and maximum concentration up to 2.7 times higher than the minimum concentration. Both qualitative and quantitative variation are common in smoking mixtures and endanger the user, as it is impossible to estimate the dose or to know the compound consumed when smoking commercial mixtures. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The R package 'Luminescence': a history of unexpected complexity and concepts to deal with it

NASA Astrophysics Data System (ADS)

Kreutzer, Sebastian; Burow, Christoph; Dietze, Michael; Fuchs, Margret C.; Friedrich, Johannes; Fischer, Manfred; Schmidt, Christoph

2017-04-01

Overcoming limitations in the so far used standard software, developing an efficient solution of low weight for a very specific task or creating graphs of high quality: the reasons that may had initially lead a scientist to work with R are manifold. And as long as developed solutions, e.g., R scripts, are needed for personal use only, code can remain unstructured and a documentation is not compulsory. However, this changes with the first friendly request for help after the code has been reused by others. In contrast to single scripts, written without intention to ever get published, for R packages the CRAN policy demands a more structured and elaborated approach including a minimum of documentation. Nevertheless, growing projects with thousands of lines of code that need to be maintained can become overwhelming, in particular as researchers are not by definition experts on managing software projects. The R package 'Luminescence' (Kreutzer et al., 2017), a collection of tools dealing with the analysis of luminescence data in a geoscientific, geochronological context, started as one single R script, but quickly evolved into a comprehensive solution connected with various other R packages. We present (1) a very brief development history of the package 'Luminescence', before we (2) sketch technical challenges encountered over time and solutions that have been found to deal with it by using various open source tools. Our presentation is considered as a collection of concepts and approaches to set up R projects in geosciences. References. Kreutzer, S., Dietze, M., Burow, C., Fuchs, M. C., Schmidt, C., Fischer, M., Friedrich, J., 2017. Luminescence: Comprehensive Luminescence Dating Data Analysis. R package version 0.6.4. https://CRAN.R-project.org/package=Luminescence

MODFLOW-NWT, A Newton formulation for MODFLOW-2005

USGS Publications Warehouse

Niswonger, Richard G.; Panday, Sorab; Ibaraki, Motomu

2011-01-01

This report documents a Newton formulation of MODFLOW-2005, called MODFLOW-NWT. MODFLOW-NWT is a standalone program that is intended for solving problems involving drying and rewetting nonlinearities of the unconfined groundwater-flow equation. MODFLOW-NWT must be used with the Upstream-Weighting (UPW) Package for calculating intercell conductances in a different manner than is done in the Block-Centered Flow (BCF), Layer Property Flow (LPF), or Hydrogeologic-Unit Flow (HUF; Anderman and Hill, 2000) Packages. The UPW Package treats nonlinearities of cell drying and rewetting by use of a continuous function of groundwater head, rather than the discrete approach of drying and rewetting that is used by the BCF, LPF, and HUF Packages. This further enables application of the Newton formulation for unconfined groundwater-flow problems because conductance derivatives required by the Newton method are smooth over the full range of head for a model cell. The NWT linearization approach generates an asymmetric matrix, which is different from the standard MODFLOW formulation that generates a symmetric matrix. Because all linear solvers presently available for use with MODFLOW-2005 solve only symmetric matrices, MODFLOW-NWT includes two previously developed asymmetric matrix-solver options. The matrix-solver options include a generalized-minimum-residual (GMRES) Solver and an Orthomin / stabilized conjugate-gradient (CGSTAB) Solver. The GMRES Solver is documented in a previously published report, such that only a brief description and input instructions are provided in this report. However, the CGSTAB Solver (called XMD) is documented in this report. Flow-property input for the UPW Package is designed based on the LPF Package and material-property input is identical to that for the LPF Package except that the rewetting and vertical-conductance correction options of the LPF Package are not available with the UPW Package. Input files constructed for the LPF Package can be used with slight modification as input for the UPW Package. This report presents the theory and methods used by MODFLOW-NWT, including the UPW Package. Additionally, this report provides comparisons of the new methodology to analytical solutions of groundwater flow and to standard MODFLOW-2005 results by use of an unconfined aquifer MODFLOW example problem. The standard MODFLOW-2005 simulation uses the LPF Package with the wet/dry option active. A new example problem also is presented to demonstrate MODFLOW-NWT's ability to provide a solution for a difficult unconfined groundwater-flow problem.

Automatic Exposure Iris Control (AEIC) for data acquisition camera

NASA Technical Reports Server (NTRS)

Mcatee, G. E., Jr.; Stoap, L. J.; Solheim, C. D.; Sharpsteen, J. T.

1975-01-01

A lens design capable of operating over a total range of f/1.4 to f/11.0 with through the lens light sensing is presented along with a system which compensates for ASA film speeds as well as shutter openings. The space shuttle camera system package is designed so that it can be assembled on the existing 16 mm DAC with a minimum of alteration to the camera.

Effect of packaging and storage time on survival of Listeria monocytogenes on kippered beef steak and turkey tenders.

PubMed

Uppal, Kamaldeep K; Getty, Kelly J K; Boyle, Elizabeth A E; Harper, Nigel M; Lobaton-Sulabo, April Shayne S; Barry, Bruce

2012-01-01

The objective of our study was to determine effect of packaging method and storage time on reducing Listeria monocytogenes in shelf-stable meat snacks. Commercially available kippered beef steak strips and turkey tenders were dipped into a 5-strain L. monocytogenes cocktail, and dried at 23 °C until a water activity of 0.80 was achieved. Inoculated samples were packaged with 4 treatments: (1) vacuum, (2) nitrogen flushed with oxygen scavenger, (3) heat sealed with oxygen scavenger, and (4) heat sealed without oxygen scavenger. Samples were stored at 23 °C and evaluated for L. monocytogenes levels at 0, 24, 48, and 72 h. Initial levels (time 0) of L. monocytogenes were approximately 5.7 log CFU/cm² for steak and tenders. After 24 h of storage time, a 1 log CFU/cm² reduction of L. monocytogenes was observed for turkey tenders for all packaging treatments. After 48 h, turkey tenders showed >1 log CFU/cm² reduction of L. monocytogenes for all packaging treatments except for vacuum, where only 0.9 log CFU/cm² reduction was observed. After 72 h, reductions for all packaging treatments for turkey tenders ranged from 1.5 to 2.4 log CFU/cm². For kippered beef steak, there was no interaction between the packaging treatments and all storage times (P > 0.05) whereas, time was different (P <0.05). For kippered beef steak, there was 1 log reduction of L. monocytogenes at 24 and 48 h of storage times at 23 °C for all packaging treatments and a 2.1 log CFU/ cm² L. monocytogenes reduction at 72 h of storage time. Processors of kippered beef steak and turkey tenders could use a combination of vacuum or nitrogen-flushing or heat sealed with an oxygen scavenger packaging methods and a holding time of 24 h prior to shipping to reduce potential L. monocytogenes numbers by ≥1 log. However, processors should be encouraged to hold packaged product a minimum of 72 h to enhance the margin of safety for L. monocytogenes control. © 2011 Institute of Food Technologists®

LPmerge: an R package for merging genetic maps by linear programming.

PubMed

Endelman, Jeffrey B; Plomion, Christophe

2014-06-01

Consensus genetic maps constructed from multiple populations are an important resource for both basic and applied research, including genome-wide association analysis, genome sequence assembly and studies of evolution. The LPmerge software uses linear programming to efficiently minimize the mean absolute error between the consensus map and the linkage maps from each population. This minimization is performed subject to linear inequality constraints that ensure the ordering of the markers in the linkage maps is preserved. When marker order is inconsistent between linkage maps, a minimum set of ordinal constraints is deleted to resolve the conflicts. LPmerge is on CRAN at http://cran.r-project.org/web/packages/LPmerge. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

MOBILE GAMMA IRRADIATORS FOR FRUIT PRODUCE (Engineering Materials)

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

1963-10-31

Mobile irradiators used for the radiopasteurization of strawberries, grapes, peaches, tomatoes, and lemons are described. The irradiators are mounted on trailers and each irradiator, including the trailer, weighs 70 to 80 tons. Radiatton doses range from 100,000 to 200,000 rads. Minimum production is 500 lb of fruit per hour. Drawings are included for four types of irradiators: the single-slab twopass, double-slab one-pass, single-slab four-pass, and line-source rotary. In the single-slab two-pass system, the packages make two passes in front of the source. The length of the packages is parallel to the direction of travel. The packages are irradiated on eachmore » side. This system is light in weight, has low capital cost, and is simple to fabricate. The double-slab one- pass system is the same as the above except the source strength is doubled and irradiation time is cut in half. The same arrangement is used in the single-slab four-pass system that is used in the singleslab two-pass system except the packages make two passes on each side of the source. The rotary system combines a linear and rotary motion to provide high dosage. It uses a small Co/sup 60/ source but costs more than a single-slab twopass system. (F.E.S.)« less

Mother-to-child transmission of HIV infection and its associated factors in Ethiopia: a systematic review and meta-analysis.

PubMed

Kassa, Getachew Mullu

2018-05-10

Mother-to-child transmission (MTCT) is the main mode of HIV transmission in children under 15 years old. This problem is significant in the Sub-Saharan African countries, where more than 80% of children living with HIV are found. Previous studies in Ethiopia present inconsistent and inconclusive findings on the prevalence and associated factors of MTCT of HIV. Therefore, this study was conducted to determine the pooled prevalence of MTCT of HIV and its associated factors in Ethiopia. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. All published studies were retrieved using relevant search terms in MEDLINE, PUBMED, Cochrane Library, EMBASE, Google Scholar, CINAHL, and African Journals Online databases. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to critically appraise articles. STATA version 14 software was used to perform the Meta-analysis. The I 2 statistics was used to test heterogeneity and publication bias was assessed using Begg's and Egger's tests. Odds ratio (OR) with 95% confidence interval (CI) was presented using forest plots. A total of nine studies, 3688 mother-baby pairs, were included in this meta-analysis. The pooled prevalence of MTCT of HIV in Ethiopia was 9.93% (95% CI: 7.29, 12.56). The subgroup analysis showed a higher prevalence of MTCT of HIV in Dire Dawa City Administration (15.7%) and lowest in Southern Nations, Nationality and Peoples Region (SNNPR) (4.16%). Associated factors with MTCT of HIV include: mixed feeding, OR = 7.46 (95%CI: 4.71, 11.81), absence of infant ARV prophylaxis, OR = 7.89 (95%CI: 4.32, 14.42), home delivery, OR = 5.08 (95%CI: 2.32, 11.15), and absence of maternal PMTCT intervention, OR = 7.13 (95% CI: 3.31, 15.35). Almost one in ten HIV exposed infants become HIV positive in Ethiopia. Factors like: mixed feeding, the absence of infant ARV prophylaxis, home delivery and absence of mother's PMTCT intervention were significantly associated with MTCT of HIV. Therefore, the governmental and non-governmental organizations need to focus on the identified factors and work towards improving the prevention of mother to child transmission of HIV (PMTCT) program.

Evaluation of the impact of a mobile health system on adherence to antenatal and postnatal care and prevention of mother-to-child transmission of HIV programs in Kenya.

PubMed

Mushamiri, Ivy; Luo, Chibulu; Iiams-Hauser, Casey; Ben Amor, Yanis

2015-02-07

The Millennium Villages Project (MVP) implemented in Western Kenya a mobile Health tool that uses text messages to coordinate Community Health Worker (CHW) activities around antenatal care (ANC) and Prevention of Mother-to-Child Transmission of HIV (PMTCT), named the ANC/PMTCT Adherence System (APAS). End-user changes in health-seeking behavior in ANC and postnatal care (PNC) were investigated following registration of 800 women into APAS. These investigations employed interviews of pregnant women or new mothers (n = 67) and CHWs (n = 20). Ordinal logistic regressions and exact binomial tests were used in the routine data analyses (n = 650, health registers). All CHWs interviewed agreed that APAS helped them track pregnant woman efficiently, compared to paper-based tracking forms. Women registered in APAS reported that CHWs reminded them of appointments more regularly than before its inception. The routine data analysis showed that among women who had their 1(st) ANC visit in the 2(nd) trimester, women who resided in the MVP cluster and were in APAS had: 3 times the odds of going for more ANC visits compared to women who were not registered (but resided in the cluster), after adjusting for the mother's HIV status in the multivariate model (Adjusted OR = 2.58, 95% CI [1.10-6.01]); twice the odds of going for more ANC visits compared to women who were not registered and resided outside the cluster (Adjusted OR = 2.37, 95% CI [0.99-5.67]) Among women not registered, residence inside or outside the cluster did not affect the number of ANC visits made (Adjusted OR = 0.86, 95% CI [0.45-1.69]). The APAS also greatly increased the likelihood of women making the 6 recommended post-delivery baby follow-ups. For women registered in APAS, the MTCT rate at 18 months was significantly different from that of women not registered, and from the global rate of 30%. Women not registered had a 9% MTCT rate at 18 months regardless of residence, while women registered had a 0% transmission rate at both 9 and 18 months. The incorporation of mHealth tools in CHW programs can improve adherence to ANC and PNC and enhance PMTCT efforts.

Delivery Unit Costs for Antiretroviral Treatment and Prevention of Mother-to-Child-Transmission of HIV

PubMed Central

Galárraga, Omar; Wirtz, Veronika J.; Figueroa-Lara, Alejandro; Santa-Ana-Tellez, Yared; Coulibaly, Ibrahima; Viisainen, Kirsi; Medina-Lara, Antonieta; Korenromp, Eline L.

2013-01-01

Background As antiretroviral treatment (ART) for HIV/AIDS is scaled-up globally, information on per-person costs is critical to improve efficiency in service delivery and maximize coverage and health impact. Objective To review studies on delivery unit costs for adult and pediatric ART provision per-patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in low- and middle-income countries. Methods Systematic review of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analyzed by country income level and cost component. All costs were standardized to 2009 US dollars. Results Analyses covered 29 eligible, comprehensive costing studies. In the base case, in low-income countries (LIC), median, ART cost per patient-year was $792 (mean: $839, range: $682-$1089); for lower-middle-income countries (LMIC), the median was $932 (mean: $1246, range: $156-$3904); and for upper-middle-income countries (UMIC) the median was $1454 (mean: $2783, range: $1230-$5667). ARV drugs were largest component of overall ART cost in all settings (62%, 50% and 47% in LIC, LMIC and UMIC respectively). Out of 26 ART studies, 14 report which drug regimes were used, and only one study explicitly reported second line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 19.5%) whereas it was personnel costs in UMIC (26%). Two studies specified the types of laboratory tests costed, and three studies specifically included above-facility-level personnel costs. Three studies reported detailed PMTCT costs, and two studies reported on pediatric ART. Conclusions There is a paucity of data on the full ART and PMTCT delivery unit costs, in particular for low-and middle-income countries. Heterogeneity in activities costed and insufficient detail regarding components included in the costing hampers standardization of unit cost measures. Evaluation of program-level unit costs would benefit from international guidance on standardized costing methods, and expenditure categories and definitions. Future work should help elucidate the sources for the large variations in delivery unit costs across settings with similar income and epidemiological characteristics. PMID:21671687

Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV.

PubMed

Bull, Sheana; Thomas, Deborah Sk; Nyanza, Elias C; Ngallaba, Sospatro E

2018-01-15

The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. ©Sheana Bull, Deborah SK Thomas, Elias C Nyanza, Sospatro E Ngallaba. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 15.01.2018.

Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV

PubMed Central

Bull, Sheana; Nyanza, Elias C; Ngallaba, Sospatro E

2018-01-01

Background The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. Objective The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. Methods We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Results Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. Conclusions T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. PMID:29335236

Applying the theory of planned behaviour to explain HIV testing in antenatal settings in Addis Ababa - a cohort study

PubMed Central

2011-01-01

Background To facilitate access to the prevention of mother-to-child HIV transmission (PMTCT) services, HIV counselling and testing are offered routinely in antenatal care settings. Focusing a cohort of pregnant women attending public and private antenatal care facilities, this study applied an extended version of the Theory of Planned Behaviour (TPB) to explain intended- and actual HIV testing. Methods A sequential exploratory mixed methods study was conducted in Addis Ababa in 2009. The study involved first time antenatal attendees from public- and private health care facilities. Three Focus Group Discussions were conducted to inform the TPB questionnaire. A total of 3033 women completed the baseline TPB interviews, including attitudes, subjective norms, perceived behavioural control and intention with respect to HIV testing, whereas 2928 completed actual HIV testing at follow up. Data were analysed using descriptive statistics, Chi-square tests, Fisher's Exact tests, Internal consistency reliability, Pearson's correlation, Linear regression, Logistic regression and using Epidemiological indices. P-values < 0.05 was considered significant and 95% Confidence Interval (CI) was used for the odds ratio. Results The TPB explained 9.2% and 16.4% of the variance in intention among public- and private health facility attendees. Intention and perceived barriers explained 2.4% and external variables explained 7% of the total variance in HIV testing. Positive and negative predictive values of intention were 96% and 6% respectively. Across both groups, subjective norm explained a substantial amount of variance in intention, followed by attitudes. Women intended to test for HIV if they perceived social support and anticipated positive consequences following test performance. Type of counselling did not modify the link between intended and actual HIV testing. Conclusion The TPB explained substantial amount of variance in intention to test but was less sufficient in explaining actual HIV testing. This low explanatory power of TPB was mainly due to the large proportion of low intenders that ended up being tested contrary to their intention before entering the antenatal clinic. PMTCT programs should strengthen women's intention through social approval and information that testing will provide positive consequences for them. However, women's rights to opt-out should be emphasized in any attempt to improve the PMTCT programs. PMID:21851613

Factors associated with loss to follow-up among women in Option B+ PMTCT programme in northeast Ethiopia: a retrospective cohort study.

PubMed

Mitiku, Israel; Arefayne, Mastewal; Mesfin, Yonatal; Gizaw, Muluken

2016-01-01

Ethiopia has recently adopted lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and breastfeeding women (Option B+ strategy), regardless of CD4 count or clinical stage. However, the exact timing and predictors of loss to follow-up (LFU) are unknown. Thus, we examined the levels and determinants of LFU under Option B+ among pregnant and breastfeeding women initiated on lifelong ART for prevention of mother-to-child transmission (PMTCT) in Ethiopia. We conducted a retrospective cohort study among 346 pregnant and breastfeeding women who started ART at 14 public health facilities in northeast Ethiopia from March 2013 to April 2015. We defined LFU as 90 days since the last clinic visit among those not known to have died or transferred out. We used Kaplan-Meier and Cox proportional hazards regression to estimate cumulative LFU and identify the predictors of LFU, respectively. Of the 346 women included, 88.4% were pregnant and the median follow-up was 13.7 months. Overall, 57 (16.5%) women were LFU. The cumulative proportions of LFU at 6, 12 and 24 months were 11.9, 15.7 and 22.6%, respectively. The risk of LFU was higher in younger women (adjusted hazard ratio (aHR) 18 to 24 years/30 to 40 years: 2.3; 95% confidence interval (CI): 1.2 to 4.5), in those attending hospitals compared to those attending health centres (aHR: 1.8; 95% CI: 1.1 to 3.2), in patients starting ART on the same day of diagnosis (aHR: 1.85; 95% CI: 1.1 to 3.2) and missing CD4 cell counts at ART initiation (aHR: 2.3; 95% CI: 1.2 to 4.4). The level of LFU we found in this study is comparable with previous findings from other resource-limited settings. However, high early LFU shortly after ART initiation is still a major problem. LFU was high among younger women, those initiating ART on the day of HIV diagnosis, those missing baseline CD4 count and those attending hospitals. Thus, targeted HIV care and treatment programmes for these patients should be part of future interventions to improve retention in care under the Option B+ PMTCT programme.

Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (Option B+).

PubMed

van Lettow, Monique; Bedell, Richard; Mayuni, Isabell; Mateyu, Gabriel; Landes, Megan; Chan, Adrienne K; van Schoor, Vanessa; Beyene, Teferi; Harries, Anthony D; Chu, Stephen; Mganga, Andrew; van Oosterhout, Joep J

2014-01-01

Malawi introduced a new strategy to improve the effectiveness of prevention of mother-to-child HIV transmission (PMTCT), the Option B+ strategy. We aimed to (i) describe how Option B+ is provided in health facilities in the South East Zone in Malawi, identifying the diverse approaches to service organization (the "model of care") and (ii) explore associations between the "model of care" and health facility-level uptake and retention rates for pregnant women identified as HIV-positive at antenatal (ANC) clinics. A health facility survey was conducted in all facilities providing PMTCT/antiretroviral therapy (ART) services in six of Malawi's 28 districts to describe and compare Option B+ service delivery models. Associations of identified models with program performance were explored using facility cohort reports. Among 141 health facilities, four "models of care" were identified: A) facilities where newly identified HIV-positive women are initiated and followed on ART at the ANC clinic until delivery; B) facilities where newly identified HIV-positive women receive only the first dose of ART at the ANC clinic, and are referred to the ART clinic for follow-up; C) facilities where newly identified HIV-positive women are referred from ANC to the ART clinic for initiation and follow-up of ART; and D) facilities serving as ART referral sites (not providing ANC). The proportion of women tested for HIV during ANC was highest in facilities applying Model A and lowest in facilities applying Model B. The highest retention rates were reported in Model C and D facilities and lowest in Model B facilities. In multivariable analyses, health facility factors independently associated with uptake of HIV testing and counselling (HTC) in ANC were number of women per HTC counsellor, HIV test kit availability, and the "model of care" applied; factors independently associated with ART retention were district location, patient volume and the "model of care" applied. A large variety exists in the way health facilities have integrated PMTCT Option B+ care into routine service delivery. This study showed that the "model of care" chosen is associated with uptake of HIV testing in ANC and retention in care on ART. Further patient-level research is needed to guide policy recommendations.

Towards elimination of mother-to-child transmission of HIV: performance of different models of care for initiating lifelong antiretroviral therapy for pregnant women in Malawi (Option B+)

PubMed Central

van Lettow, Monique; Bedell, Richard; Mayuni, Isabell; Mateyu, Gabriel; Landes, Megan; Chan, Adrienne K; van Schoor, Vanessa; Beyene, Teferi; Harries, Anthony D; Chu, Stephen; Mganga, Andrew; van Oosterhout, Joep J

2014-01-01

Introduction Malawi introduced a new strategy to improve the effectiveness of prevention of mother-to-child HIV transmission (PMTCT), the Option B+ strategy. We aimed to (i) describe how Option B+ is provided in health facilities in the South East Zone in Malawi, identifying the diverse approaches to service organization (the “model of care”) and (ii) explore associations between the “model of care” and health facility–level uptake and retention rates for pregnant women identified as HIV-positive at antenatal (ANC) clinics. Methods A health facility survey was conducted in all facilities providing PMTCT/antiretroviral therapy (ART) services in six of Malawi's 28 districts to describe and compare Option B+ service delivery models. Associations of identified models with program performance were explored using facility cohort reports. Results Among 141 health facilities, four “models of care” were identified: A) facilities where newly identified HIV-positive women are initiated and followed on ART at the ANC clinic until delivery; B) facilities where newly identified HIV-positive women receive only the first dose of ART at the ANC clinic, and are referred to the ART clinic for follow-up; C) facilities where newly identified HIV-positive women are referred from ANC to the ART clinic for initiation and follow-up of ART; and D) facilities serving as ART referral sites (not providing ANC). The proportion of women tested for HIV during ANC was highest in facilities applying Model A and lowest in facilities applying Model B. The highest retention rates were reported in Model C and D facilities and lowest in Model B facilities. In multivariable analyses, health facility factors independently associated with uptake of HIV testing and counselling (HTC) in ANC were number of women per HTC counsellor, HIV test kit availability, and the “model of care” applied; factors independently associated with ART retention were district location, patient volume and the “model of care” applied. Conclusions A large variety exists in the way health facilities have integrated PMTCT Option B+ care into routine service delivery. This study showed that the “model of care” chosen is associated with uptake of HIV testing in ANC and retention in care on ART. Further patient-level research is needed to guide policy recommendations. PMID:25079437

A Minimum Path Algorithm Among 3D-Polyhedral Objects

NASA Astrophysics Data System (ADS)

Yeltekin, Aysin

1989-03-01

In this work we introduce a minimum path theorem for 3D case. We also develop an algorithm based on the theorem we prove. The algorithm will be implemented on the software package we develop using C language. The theorem we introduce states that; "Given the initial point I, final point F and S be the set of finite number of static obstacles then an optimal path P from I to F, such that PA S = 0 is composed of straight line segments which are perpendicular to the edge segments of the objects." We prove the theorem as well as we develop the following algorithm depending on the theorem to find the minimum path among 3D-polyhedral objects. The algorithm generates the point Qi on edge ei such that at Qi one can find the line which is perpendicular to the edge and the IF line. The algorithm iteratively provides a new set of initial points from Qi and exploits all possible paths. Then the algorithm chooses the minimum path among the possible ones. The flowchart of the program as well as the examination of its numerical properties are included.

Parallel computation and the Basis system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, G.R.

1992-12-16

A software package has been written that can facilitate efforts to develop powerful, flexible, and easy-to-use programs that can run in single-processor, massively parallel, and distributed computing environments. Particular attention has been given to the difficulties posed by a program consisting of many science packages that represent subsystems of a complicated, coupled system. Methods have been found to maintain independence of the packages by hiding data structures without increasing the communication costs in a parallel computing environment. Concepts developed in this work are demonstrated by a prototype program that uses library routines from two existing software systems, Basis and Parallelmore » Virtual Machine (PVM). Most of the details of these libraries have been encapsulated in routines and macros that could be rewritten for alternative libraries that possess certain minimum capabilities. The prototype software uses a flexible master-and-slaves paradigm for parallel computation and supports domain decomposition with message passing for partitioning work among slaves. Facilities are provided for accessing variables that are distributed among the memories of slaves assigned to subdomains. The software is named PROTOPAR.« less

Parallel computation and the basis system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, G.R.

1993-05-01

A software package has been written that can facilitate efforts to develop powerful, flexible, and easy-to use programs that can run in single-processor, massively parallel, and distributed computing environments. Particular attention has been given to the difficulties posed by a program consisting of many science packages that represent subsystems of a complicated, coupled system. Methods have been found to maintain independence of the packages by hiding data structures without increasing the communications costs in a parallel computing environment. Concepts developed in this work are demonstrated by a prototype program that uses library routines from two existing software systems, Basis andmore » Parallel Virtual Machine (PVM). Most of the details of these libraries have been encapsulated in routines and macros that could be rewritten for alternative libraries that possess certain minimum capabilities. The prototype software uses a flexible master-and-slaves paradigm for parallel computation and supports domain decomposition with message passing for partitioning work among slaves. Facilities are provided for accessing variables that are distributed among the memories of slaves assigned to subdomains. The software is named PROTOPAR.« less

Design Analysis of a Prepackaged Nuclear Power Plant for an Ice Cap Location

DTIC Science & Technology

1959-01-15

requirements and heating load 1.3 Site Conditions 1,U Air Transportability 1.5 Standby Power Availability 1.6 Building Structuree and Foundations 2,0...Skid with Reactor and Steam Generator Generator Weight Distribution Foundation Load Diagram (Secondary) Turbine Generator Package - Typical...Requirements and Heating Load The plant shall be capable of producing a minimum of 1500 Kw net ^ electrical energy at 4160/2400 volts, three phase

Designing an Electronics Data Package for Printed Circuit Boards (PCBs)

DTIC Science & Technology

2013-08-01

finished PCB flatness deviation should be less than 0.010 inches per inch. 4  The minimum copper wall thickness of plated-thru holes should be...Memory Card International Association)  IPC-6015 MCM-L (Multi-Chip Module – Laminated )  IPC-6016 HDI (High Density Interconnect)  IPC-6018...Interconnect ICT In Circuit Tester IPC Association Connecting Electronics Industries MCM-L Multi-Chip Module – Laminated MIL Military NEMA National

2008 Annual Report: Department of Defense HIV/AIDS Prevention Program (DHAPP)

DTIC Science & Technology

2009-03-01

of the country’s food must still be imported. The GDP per capita is $9,100, with extensive unemployment and underemployment affecting more than...most food must be imported. The GDP per capita is $3,800. Djibouti hosts the only US military base in sub-Saharan Africa . HIV/AIDS Statistics...13) HIV-positive pregnant or lactating women received food and nutritional supplementation at the PMTCT sites. 40 K E N Y A Care Nine (9

Estimation of minimum ventilation requirement of dairy cattle barns for different outdoor temperature and its affects on indoor temperature: Bursa case.

PubMed

Yaslioglu, Erkan; Simsek, Ercan; Kilic, Ilker

2007-04-15

In the study, 10 different dairy cattle barns with natural ventilation system were investigated in terms of structural aspects. VENTGRAPH software package was used to estimate minimum ventilation requirements for three different outdoor design temperatures (-3, 0 and 1.7 degrees C). Variation in indoor temperatures was also determined according to the above-mentioned conditions. In the investigated dairy cattle barns, on condition that minimum ventilation requirement to be achieved for -3, 0 and 1.7 degrees C outdoor design temperature and 70, 80% Indoor Relative Humidity (IRH), estimated indoor temperature were ranged from 2.2 to 12.2 degrees C for 70% IRH, 4.3 to 15.0 degrees C for 80% IRH. Barn type, outdoor design temperature and indoor relative humidity significantly (p < 0.01) affect the indoor temperature. The highest ventilation requirement was calculated for straw yard (13879 m3 h(-1)) while the lowest was estimated for tie-stall (6169.20 m3 h(-1)). Estimated minimum ventilation requirements per animal were significantly (p < 0.01) different according to the barn types. Effect of outdoor esign temperatures on minimum ventilation requirements and minimum ventilation requirements per animal was found to be significant (p < 0.05, p < 0.01). Estimated indoor temperatures were in thermoneutral zone (-2 to 20 degrees C). Therefore, one can be said that use of naturally ventilated cold dairy barns in the region will not lead to problems associated with animal comfort in winter.

miRNAmeConverter: an R/bioconductor package for translating mature miRNA names to different miRBase versions.

PubMed

Haunsberger, Stefan J; Connolly, Niamh M C; Prehn, Jochen H M

2017-02-15

The miRBase database is the central and official repository for miRNAs and the current release is miRBase version 21.0. Name changes in different miRBase releases cause inconsistencies in miRNA names from version to version. When working with only a small number of miRNAs the translation can be done manually. However, with large sets of miRNAs, the necessary correction of such inconsistencies becomes burdensome and error-prone. We developed miRNAmeConverter , available as a Bioconductor R package and web interface that addresses the challenges associated with mature miRNA name inconsistencies. The main algorithm implemented enables high-throughput automatic translation of species-independent mature miRNA names to user selected miRBase versions. The web interface enables users less familiar with R to translate miRNA names given in form of a list or embedded in text and download of the results. The miRNAmeConverter R package is open source under the Artistic-2.0 license. It is freely available from Bioconductor ( http://bioconductor.org/packages/miRNAmeConverter ). The web interface is based on R Shiny and can be accessed under the URL http://www.systemsmedicineireland.ie/tools/mirna-name-converter/ . The database that miRNAmeConverter depends on is provided by the annotation package miRBaseVersions.db and can be downloaded from Bioconductor ( http://bioconductor.org/packages/miRBaseVersions.db ). Minimum R version 3.3.0 is required. stefanhaunsberger@rcsi.ie. Supplementary data are available at Bioinformatics online. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Development of antioxidant packaging material by applying corn-zein to LLDPE film in combination with phenolic compounds.

PubMed

Park, Hye-Yeon; Kim, Sung-Jin; Kim, Ki Myong; You, Young-Sun; Kim, So Yeon; Han, Jaejoon

2012-10-01

Functional active packaging materials were successfully developed by incorporating antioxidant agents into corn-zein-laminated linear low-density polyethylene (LLDPE) film. The minimum effective concentrations of the active compounds (for example, thymol, carvacrol, eugenol) were determined and these compounds were then laminated into LLDPE films to develop corn-zein-laminated films with antioxidant agents. The release rate of antioxidant agents in gas and liquid media were determined along with the mechanical and water barrier properties of the films containing these compounds. Tensile strength and percentage elongation at break were reduced in the corn-zein-laminated LLDPE films when compared to typical LLDPE film. Furthermore, the ability of the corn-zein-laminated films to repel moisture decreased by approximately 12.2%, but was improved by incorporating hydrophobic antioxidant compounds in the corn-zein layer. Examination of release kinetics in the gas and liquid phases verified that antioxidants were effectively released from the films and inhibited oxidation during testing. Finally, the films were used for fresh ground beef packaging, and effectively inhibited lipid oxidation and had a positive effect on the color stability of beef patties during storage. These results indicate that the developed antioxidant films are a novel active packaging material that can be effectively implemented by the food industry to improve the quality and safety of foods. Zein protein, a by-product of corn processing industry, was laminated into plastic films in combination with natural phenolic compounds to develop antioxidant packaging films. The films demonstrated their efficient release patterns of antioxidant compounds, which are suitable for packaging applications and food protection. © 2012 Institute of Food Technologists®

A surface hopping algorithm for nonadiabatic minimum energy path calculations.

PubMed

Schapiro, Igor; Roca-Sanjuán, Daniel; Lindh, Roland; Olivucci, Massimo

2015-02-15

The article introduces a robust algorithm for the computation of minimum energy paths transiting along regions of near-to or degeneracy of adiabatic states. The method facilitates studies of excited state reactivity involving weakly avoided crossings and conical intersections. Based on the analysis of the change in the multiconfigurational wave function the algorithm takes the decision whether the optimization should continue following the same electronic state or switch to a different state. This algorithm helps to overcome convergence difficulties near degeneracies. The implementation in the MOLCAS quantum chemistry package is discussed. To demonstrate the utility of the proposed procedure four examples of application are provided: thymine, asulam, 1,2-dioxetane, and a three-double-bond model of the 11-cis-retinal protonated Schiff base. © 2015 Wiley Periodicals, Inc.

User Data Package for Compressed Natural Gas (CNG) Vehicles for Navy Applications

DTIC Science & Technology

1991-04-01

already available). GENERAL CONSIDERATIONS The advantages and disadvantages for implementing a CNG-fueled vehicle fleet at a specific site vary. However...at the user’s site , if a guaranteed minimum quantity of CNG will be purchased annually by the fleet operator. Utilities are also establishing special...at low pressure and compressed on- site , several additional charges must be added to the cost charged by the natural gas supplier (see Table 1). The

Ada (Trade Name)/SQL (Structured Query Language) Binding Specification

DTIC Science & Technology

1988-06-01

TYPES iS package ADA-SOL Is type DWPLOYEEyNAME Is new STRING ( 1 .. 30 ); type BOSSNAME is new EMPLOYEENAME; type EMPLOYEE SALARY is digits 7 range 0.00...minimum number of significant decimal digits . All real numbers between the lower and upper bounds, inclusive, belong to the subtype, and are...and the elements of strings. Format <character> -:- < digit > I <letter> ! <special character> < digit > ::- 0111213141516171819 <letter> ::- <upper case

Minimum initial service package (MISP) for sexual and reproductive health in disasters.

PubMed

Lisam, Suchitra

2014-12-01

This paper is based on a presentation given at the Evidence Aid Symposium, on 20 September 2014, at Hyderabad, India. The paper provides background about how the sexual and reproductive health (SRH) got conceived as a humanitarian health response that adopts human right approach, based on core principles driven by needs of adolescent girls and women, and having respect for their values, ethics and morals. Good practices across nations documented by Inter-Agency Working Groups (IAWGs) on Reproductive Health in Humanitarian Crisis has supported the provision of essential SRH care services to adolescent girls and women in humanitarian crisis and in disasters. Secondary desk review is used to document the lessons learnt and good practices followed and documents for SRH. These essential SRH care services are to be provided as "Minimum Initial Service Package (MISP)" for implementation at the outset of disaster. The Sphere Humanitarian Charter and Minimum Standards in Disaster Response incorporated the MISP for SRH as a minimum standard of care in disaster response with a goal to reduce mortality, morbidity and disability among populations affected by crises, particularly women and girls. Disaster prone countries are expected to roll out MISP to improve humanitarian response and emergency preparedness systems. The East Europe and Central Asia (EECA) region including India have rolled out MISP starting from 2011 (EECA) and from 2013-2014 onwards in India across cities such as Chennai, Patna, Bhubaneshwar, Kolkata, Faridabad and Calcutta. Across India, through these national and state level trainings, nearly 600 people from NGOs, institutions, and government agencies were developed as national level trainers and resource persons for MISP who could advocate for RH in emergencies, apply core techniques provided in the MISP, apply coordination skills for the implementation of MISP and develop an action plan to integrate RH and Gender Based Violence (GBV) into Disaster Management Plans of respective agencies. The way forward includes focusing on MISP distance learning module, integration of MISP in Health action plans, and integration into national disaster preparedness and contingency planning of respective agencies and departments and building capacity at various levels. © 2014 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Redesigning the continuous vacuum sealer packaging machine to improve the processing speed

NASA Astrophysics Data System (ADS)

Belo, J. B.; Widyanto, S. A.; Jamari, J.

2017-01-01

Vacuum sealer as a product packaging tool of food products to be able to vacuum air inside the plastic which is filled with food products and it causes the pressure lower. In this condition, the optimal heating temperature is reached in a shorter time, so that damage on plastic sealer of vacuumed food products could be prevented to be more effective and efficient. The purpose of this redesigning is to design a vacuum sealer packaging machine continuously through a conveyor mechanism on the packaging quality, time of processing speed of vacuuming food product in the plastic package. This designing process is conducted through several steps of designing and constructing tools until the products are ready to operate. Data analysis is done through quality test of vacuum and sealer to the plastic thickness of 75 µm, 80 µm, and 100 µm with temperature of 170°C, 180°C, 190°C and vacuum duration of 5 seconds, 8 seconds, and 60 seconds. Results of this designing process indicate that vacuum sealer works practically and more optimally with the time of vacuum processing speed of 0 to 1 minute/s; whereas, the pressure of vacuuming suction is until 1e-5 MPa. The results of tensile strength test are at a maximum of 32,796 (N/mm2) and a minimum of 20,155 (N/mm2) and the analysis of plastic composite with EDX. This result shows that the vacuum pressure and the quality of vacuum sealer are better and more efficient.

Minimum separation distances for natural gas pipeline and boilers in the 300 area, Hanford Site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Daling, P.M.; Graham, T.M.

1997-08-01

The U.S. Department of Energy (DOE) is proposing actions to reduce energy expenditures and improve energy system reliability at the 300 Area of the Hanford Site. These actions include replacing the centralized heating system with heating units for individual buildings or groups of buildings, constructing a new natural gas distribution system to provide a fuel source for many of these units, and constructing a central control building to operate and maintain the system. The individual heating units will include steam boilers that are to be housed in individual annex buildings located at some distance away from nearby 300 Area nuclearmore » facilities. This analysis develops the basis for siting the package boilers and natural gas distribution systems to be used to supply steam to 300 Area nuclear facilities. The effects of four potential fire and explosion scenarios involving the boiler and natural gas pipeline were quantified to determine minimum separation distances that would reduce the risks to nearby nuclear facilities. The resulting minimum separation distances are shown in Table ES.1.« less

An Interpolation Method for Obtaining Thermodynamic Properties Near Saturated Liquid and Saturated Vapor Lines

NASA Technical Reports Server (NTRS)

Nguyen, Huy H.; Martin, Michael A.

2004-01-01

The two most common approaches used to formulate thermodynamic properties of pure substances are fundamental (or characteristic) equations of state (Helmholtz and Gibbs functions) and a piecemeal approach that is described in Adebiyi and Russell (1992). This paper neither presents a different method to formulate thermodynamic properties of pure substances nor validates the aforementioned approaches. Rather its purpose is to present a method to generate property tables from existing property packages and a method to facilitate the accurate interpretation of fluid thermodynamic property data from those tables. There are two parts to this paper. The first part of the paper shows how efficient and usable property tables were generated, with the minimum number of data points, using an aerospace industry standard property package. The second part describes an innovative interpolation technique that has been developed to properly obtain thermodynamic properties near the saturated liquid and saturated vapor lines.

Interactive Visualization of Complex Seismic Data and Models Using Bokeh

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chai, Chengping; Ammon, Charles J.; Maceira, Monica

Visualizing multidimensional data and models becomes more challenging as the volume and resolution of seismic data and models increase. But thanks to the development of powerful and accessible computer systems, a model web browser can be used to visualize complex scientific data and models dynamically. In this paper, we present four examples of seismic model visualization using an open-source Python package Bokeh. One example is a visualization of a surface-wave dispersion data set, another presents a view of three-component seismograms, and two illustrate methods to explore a 3D seismic-velocity model. Unlike other 3D visualization packages, our visualization approach has amore » minimum requirement on users and is relatively easy to develop, provided you have reasonable programming skills. Finally, utilizing familiar web browsing interfaces, the dynamic tools provide us an effective and efficient approach to explore large data sets and models.« less

Destructive testings: dry drilling operations with TruPro system to collect samples in a powder form, from two hulls containing immobilized wastes in a hydraulic binder

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pombet, Denis; Desnoyers, Yvon; Charters, Grant

2013-07-01

The TruPro{sup R} process enables to collect a significant number of samples to characterize radiological materials. This innovative and alternative technique is experimented for the ANDRA quality-control inspection of cemented packages. It proves to be quicker and more prolific than the current methodology. Using classical statistics and geo-statistics approaches, the physical and radiological characteristics of two hulls containing immobilized wastes (sludges or concentrates) in a hydraulic binder are assessed in this paper. The waste homogeneity is also evaluated in comparison to ANDRA criterion. Sensibility to sample size (support effect), presence of extreme values, acceptable deviation rate and minimum number ofmore » data are discussed. The final objectives are to check the homogeneity of the two characterized radwaste packages and also to validate and reinforce this alternative characterization methodology. (authors)« less

Interactive Visualization of Complex Seismic Data and Models Using Bokeh

DOE PAGES

Chai, Chengping; Ammon, Charles J.; Maceira, Monica; ...

2018-02-14

Visualizing multidimensional data and models becomes more challenging as the volume and resolution of seismic data and models increase. But thanks to the development of powerful and accessible computer systems, a model web browser can be used to visualize complex scientific data and models dynamically. In this paper, we present four examples of seismic model visualization using an open-source Python package Bokeh. One example is a visualization of a surface-wave dispersion data set, another presents a view of three-component seismograms, and two illustrate methods to explore a 3D seismic-velocity model. Unlike other 3D visualization packages, our visualization approach has amore » minimum requirement on users and is relatively easy to develop, provided you have reasonable programming skills. Finally, utilizing familiar web browsing interfaces, the dynamic tools provide us an effective and efficient approach to explore large data sets and models.« less

Evaluation of Magnetospheric Internal Magnetic Field models and Existing Software

DTIC Science & Technology

1990-01-31

than an order of magnitude. The polar maxima are still visible, but they are not as distinct. The SAA is still apparent, but apin it is not as...completely overlap each other either. These plots show polar maxima (the right two panels) and the SAA minimum (the lower right panel). Note, that the...coGRF85 83M Contours Year - 1990.0 Atitude 1.5000 to 40 1221020.0 -225 4. DISCUSSION OF SOFWARE 4.1 INTRODUCION iliree basic software packages were used

MSXA packaging

NASA Technical Reports Server (NTRS)

Mcleod, A.

1977-01-01

Marshall Experimental Sprayable Ablator (MXSA) ingredients were compounded into a two part system which requires a minimum of handling by the user. Preweighed two part kits were developed which require that the user supply only the solvent. The kits consist of all of the powdery materials in Part A, and the epoxy resin (AA397) in Part B. Recent aging data on the kits indicates that they are useable for at least 6 months. The acronym MXSA has recently been replaced with MSA (Marshall sprayable ablator).

An ultra-compact processor module based on the R3000

NASA Astrophysics Data System (ADS)

Mullenhoff, D. J.; Kaschmitter, J. L.; Lyke, J. C.; Forman, G. A.

1992-08-01

Viable high density packaging is of critical importance for future military systems, particularly space borne systems which require minimum weight and size and high mechanical integrity. A leading, emerging technology for high density packaging is multi-chip modules (MCM). During the 1980's, a number of different MCM technologies have emerged. In support of Strategic Defense Initiative Organization (SDIO) programs, Lawrence Livermore National Laboratory (LLNL) has developed, utilized, and evaluated several different MCM technologies. Prior LLNL efforts include modules developed in 1986, using hybrid wafer scale packaging, which are still operational in an Air Force satellite mission. More recent efforts have included very high density cache memory modules, developed using laser pantography. As part of the demonstration effort, LLNL and Phillips Laboratory began collaborating in 1990 in the Phase 3 Multi-Chip Module (MCM) technology demonstration project. The goal of this program was to demonstrate the feasibility of General Electric's (GE) High Density Interconnect (HDI) MCM technology. The design chosen for this demonstration was the processor core for a MIPS R3000 based reduced instruction set computer (RISC), which has been described previously. It consists of the R3000 microprocessor, R3010 floating point coprocessor and 128 Kbytes of cache memory.

Compact atom interferometer using single laser

NASA Astrophysics Data System (ADS)

Chiow, Sheng-Wey; Yu, Nan

2017-04-01

Atom interferometer (AI) based sensors exhibit precision and accuracy unattainable with classical sensors, thanks to the inherent stability of atomic properties. The complexity of required laser system and the size of vacuum chamber driven by optical access requirement limit the applicability of such technology in size, weight, and power (SWaP) challenging environments, such as in space. For instance, a typical physics package of AI includes six viewports for laser cooling and trapping, two for AI beams, and two more for detection and a vacuum pump. Similarly, a typical laser system for an AI includes two lasers for cooling and repumping, and two for Raman transitions as AI beam splitters. In this presentation, we report our efforts in developing a miniaturized atomic accelerometer for planetary exploration. We will describe a physics package configuration having minimum optical access (thus small volume), and a laser and optics system utilizing a single laser for the sensor operation. Preliminary results on acceleration sensitivity will be discussed. We will also illustrate a path for further packaging and integration based on the demonstrated concepts. This research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration.

Wall adjustment strategy software for use with the NASA Langley 0.3-meter transonic cryogenic tunnel adaptive wall test section

NASA Technical Reports Server (NTRS)

Wolf, Stephen W. D.

1988-01-01

The Wall Adjustment Strategy (WAS) software provides successful on-line control of the 2-D flexible walled test section of the Langley 0.3-m Transonic Cryogenic Tunnel. This software package allows the level of operator intervention to be regulated as necessary for research and production type 2-D testing using and Adaptive Wall Test Section (AWTS). The software is designed to accept modification for future requirements, such as 3-D testing, with a minimum of complexity. The WAS software described is an attempt to provide a user friendly package which could be used to control any flexible walled AWTS. Control system constraints influence the details of data transfer, not the data type. Then this entire software package could be used in different control systems, if suitable interface software is available. A complete overview of the software highlights the data flow paths, the modular architecture of the software and the various operating and analysis modes available. A detailed description of the software modules includes listings of the code. A user's manual is provided to explain task generation, operating environment, user options and what to expect at execution.

Timely antiretroviral prophylaxis during pregnancy effectively reduces HIV mother-to-child transmission in eight counties in China: a prospective study during 2004-2011.

PubMed

Wang, Qian; Wang, Linhong; Fang, Liwen; Wang, Ailing; Jin, Xi; Wang, Fang; Wang, Xiaoyan; Qiao, Yaping; Sullivan, Sheena G; Rutherford, Shannon; Zhang, Lei

2016-10-10

This study investigates the improvement of the prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) in China during 2004-2011. A clinic-based prospective study was conducted among HIV-positive pregnant women and their children in eight counties across China. Associated factors of mother-to-child transmission were analyzed using regression analysis. A total of 1,387 HIV+ pregnant women and 1,377 HIV-exposed infants were enrolled. The proportion of pregnant women who received HIV testing increased significantly from 45.1% to 98.9% during 2004-2011. Among whom, the proportion that received antiretroviral (ARV) prophylaxis increased from 61% to 96%, and the corresponding coverage in children increased from 85% to 97% during the same period. In contrast, single-dose nevirapine treatment during delivery declined substantially from 97.9% to 12.7%. Vertical transmission of HIV declined from 11.1% (95% confidence interval [CI]: 5.7-23.3%) in 2004 to 1.2% (95% CI: 0.1-5.8%) in 2011. Women who had a vaginal delivery (compared to emergency caesarian section (odds ratio [OR] = 0.46; 0.23-0.96)) and mothers on multi-ARVs (OR = 0.11; 0.04-0.29) were less likely to transmit HIV to their newborns. Increasing HIV screening enabled timely HIV care and prophylaxis to reduce vertical transmission of HIV. Early and consistent treatment with multi-ARVs during pregnancy is vital for PMTCT.

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review.

PubMed

Ngidi, Wilbroda H; Naidoo, Joanne R; Ncama, Busisiwe P; Luvuno, Zamasomi P B; Mashamba-Thompson, Tivani P

2017-05-29

Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV. To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy. Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included 'Sub-Saharan African countries', 'implementation strategies', 'interventions to bridge implementation gap', 'prevention of mother-to-child transmission of HIV' and 'closing implementation gap'. Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1) health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance); (2) health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision); as well as (3) community-level strategies (community health workers, technology use - mHealth, family-centred approaches, male involvement, culturally appropriate interventions). There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency.

Clinically significant anemia in HIV-infected pregnant women in India is not a major barrier to zidovudine use for prevention of maternal-to-child transmission.

PubMed

Sinha, Gita; Choi, Tou J; Nayak, Uma; Gupta, Amita; Nair, Sandeep; Gupte, Nikhil; Bulakh, Pandurang M; Sastry, Jayagowri; Deshmukh, Sanjay D; Khandekar, Medha M; Kulkarni, Vandana; Bhosale, Ramesh A; Bharucha, Kapila E; Phadke, Mrudula A; Kshirsagar, Anandini S; Bollinger, Robert C

2007-06-01

To determine the prevalence of anemia (serum hemoglobin <10 g/dL) and assess zidovudine use and toxicity in HIV-positive pregnant women in India. From 2002 through 2006, 24,105 pregnant women in Pune were screened for HIV and anemia. As part of an infant prevention of mother-to-child transmission (PMTCT) trial, enrolled HIV-positive women (n = 467) were assessed for anemia and associated outcomes, comparing women receiving zidovudine for >or=2 weeks versus no zidovudine. The prevalence of anemia was 38.7% in HIV-positive women. Anemic women were as likely as nonanemic women to receive zidovudine. At delivery, regardless of anemia status at enrollment, women receiving >or=2 weeks of zidovudine were 70% less likely to be anemic compared with women receiving no zidovudine (odds ratio = 0.28, 95% confidence interval: 0.14 to 0.57; P < 0.01), received iron and folic acid supplements for longer periods, and had no increased adverse delivery or newborn birth outcomes. A significant proportion of HIV-positive pregnant women in India present for antenatal care with anemia. With concurrent iron and folic acid supplementation, however, zidovudine use is not associated with persistent or worsening anemia or associated adverse outcomes. In Indian community settings, all pregnant HIV-positive women should receive early anemia treatment. Mild anemia should not limit zidovudine use for PMTCT in India.

Initiation of highly active antiretroviral therapy among pregnant women in Cape Town, South Africa.

PubMed

Stinson, Kathryn; Boulle, Andrew; Coetzee, David; Abrams, Elaine J; Myer, Landon

2010-07-01

To investigate highly active antiretroviral therapy (HAART) initiation among pregnant women and the optimum model of service delivery for integrating HAART services into antenatal care. We analysed clinic records to reconstruct a cohort of all HIV-infected pregnant women eligible for HAART at four antenatal clinics representing three service delivery models in Cape Town, South Africa. To assess HAART coverage, records of women determined to be eligible for HAART in pregnancy were reviewed at corresponding HIV treatment services. Of 13,208 pregnant women tested for HIV, 26% were HIV-infected and 15% were HAART-eligible based on a CD4 cell count of

GRAVTool, a Package to Compute Geoid Model by Remove-Compute-Restore Technique

NASA Astrophysics Data System (ADS)

Marotta, G. S.; Blitzkow, D.; Vidotti, R. M.

2015-12-01

Currently, there are several methods to determine geoid models. They can be based on terrestrial gravity data, geopotential coefficients, astro-geodetic data or a combination of them. Among the techniques to compute a precise geoid model, the Remove-Compute-Restore (RCR) has been widely applied. It considers short, medium and long wavelengths derived from altitude data provided by Digital Terrain Models (DTM), terrestrial gravity data and global geopotential coefficients, respectively. In order to apply this technique, it is necessary to create procedures that compute gravity anomalies and geoid models, by the integration of different wavelengths, and that adjust these models to one local vertical datum. This research presents a developed package called GRAVTool based on MATLAB software to compute local geoid models by RCR technique and its application in a study area. The studied area comprehends the federal district of Brazil, with ~6000 km², wavy relief, heights varying from 600 m to 1340 m, located between the coordinates 48.25ºW, 15.45ºS and 47.33ºW, 16.06ºS. The results of the numerical example on the studied area show the local geoid model computed by the GRAVTool package (Figure), using 1377 terrestrial gravity data, SRTM data with 3 arc second of resolution, and geopotential coefficients of the EIGEN-6C4 model to degree 360. The accuracy of the computed model (σ = ± 0.071 m, RMS = 0.069 m, maximum = 0.178 m and minimum = -0.123 m) matches the uncertainty (σ =± 0.073) of 21 points randomly spaced where the geoid was computed by geometrical leveling technique supported by positioning GNSS. The results were also better than those achieved by Brazilian official regional geoid model (σ = ± 0.099 m, RMS = 0.208 m, maximum = 0.419 m and minimum = -0.040 m).

Growth pattern in Ethiopian infants - the impact of exposure to maternal HIV infection in relation to socio-economic factors.

PubMed

König Walles, John; Balcha, Taye Tolera; Winqvist, Niclas; Björkman, Per

2017-01-01

Infants exposed to maternal HIV infection who remain HIV-uninfected (HIV-exposed/uninfected; HIV-EU) may be at increased risk of growth retardation, which could be due both to directly HIV-related effects and to socio-economic factors overrepresented among HIV-positive women. To investigate growth development at 9-12 months of age in HIV-EU infants participating in prevention of mother-to-child transmission (PMTCT) care compared to HIV unexposed (HIV-U) infants in relation to socio-economic conditions. Anthropometric and socio-economic data were collected retrospectively from PMTCT registers (for HIV-EU infants), with HIV-U controls recruited at measles vaccination at public health facilities in Ethiopia. Growth was compared with regard to HIV exposure and socio-economic variables in multivariate regression analysis. The following growth measurements were found for 302 HIV-EU and 358 HIV-U infants at 9-12 months of age, respectively: mean weight-for-age z-score (WAZ) 0.04 and -0.21, p < 0.001 (proportion underweight 5.7% and 6.7%, p = 0.60); median length-for-age z-score (LAZ) -0.92 and -0.91, p = 0.53 (proportion stunted 25.1% and 20.5%, p = 0.17). In multivariate analysis, lower WAZ was associated with male sex (p = 0.021), lower maternal education (p < 0.001), presence of siblings (p < 0.01) and HIV-U (p < 0.01). Underweight was associated with male sex (p = 0.017) and absence of maternal education (p = 0.019). Lower LAZ was associated with male sex (p < 0.001), presence of siblings (p < 0.001) and poor maternal education (p < 0.01), while stunting was associated with male sex (p < 0.001), presence of siblings (p < 0.001), few rooms in the home (p < 0.01), access to running water (p = 0.026) and low level of maternal education (p = 0.014). At 9-12 months of age, HIV-EU infants had non-inferior growth and higher mean WAZ than HIV-U controls. Poor growth development was associated with socio-economic factors. This suggests health benefits from PMTCT participation for infant growth. Similar interventions could be considered for Ethiopian infants, irrespective of HIV exposure, with a particular focus on children with poor socio-economic status.

Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study.

PubMed

Okanda, John O; Borkowf, Craig B; Girde, Sonali; Thomas, Timothy K; Lecher, Shirley Lee

2014-11-07

One of the most effective ways to promote the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings is to encourage HIV-positive mothers to practice exclusive breastfeeding (EBF) for the first 6 months post-partum while they receive antiretroviral therapy (ARV). Although EBF reduces mortality in this context, its practice has been low. We studied the rate of adherence to EBF and assessed associated maternal and infant characteristics using data from a phase II PMTCT clinical trial conducted in Western Kenya which included a counseling intervention to encourage EBF by all participants. We analyzed data from the Kisumu Breastfeeding Study (KiBS), conducted between July 2003 and February 2009. This study enrolled a total of 522 HIV-1 infected pregnant women. Data on breastfeeding were available for 480 mother-infant pairs. Infant feeding and general nutrition counseling began at 35 weeks gestation and continued throughout the 6 month post-partum intervention period, following World Health Organization (WHO) infant feeding guidelines. Data on infant feeding were collected during routine clinic visits and home visits using food frequency questionnaires and dietary recall methods. Participants were instructed to exclusively breastfeed until initiation of weaning at 5.5 months post-partum. We used Kaplan-Meier methods to estimate the rates of EBF at 5.25 months post-partum, stratified by maternal and infant characteristics measured at enrollment, delivery, and 2 weeks post-partum. The estimated EBF rate at 5.25 months post-partum was 80.4%. Only 3% of women introduced other foods (most commonly water with or without glucose, cow's milk, formula, and fruit) by 2 months; this percentage increased to 5% of women by 4 months. Women who had ≥3 previous births (p < 0.01) and who were not living with the infant's father (p = 0.04) were more likely to exclusively breastfeed. Mixed feeding was more common for male infants than for female infants (p = 0.04). Exclusive breastfeeding was common in this clinical trial, which emphasized EBF as a best practice until infants reached 5.5 months of age. Counseling initiated prior to delivery and continued during the post-partum period provided a consistent message reinforcing the benefits of EBF. The findings from this study suggest high adherence to EBF in resource limited settings can be achieved by a comprehensive counseling intervention that encourages EBF.

Bottlenecks and opportunities for delivering integrated pediatric HIV services in Nepal

PubMed Central

Diese, Mulamba; Shrestha, Lexman; Pradhan, Birendra; Singh, Dipendra; Raaijmakers, Hendrikus; Kisesa, Annefrida; Chamla, Dick; Ntambue, Mukengeshayi Abel

2016-01-01

Background In children, integration of HIV in MNCH services has been shown to incr. ease uptake of early infant diagnosis. This article examines bottlenecks and opportunities for scaling up integrated pediatric HIV services in Nepal. Methods This is a descriptive study using both mixed qualitative and quantitative methods, conducted in January 2015 in 19 facilities in five regions of Nepal most affected by HIV epidemic. The qualitative methods comprised in-depth structured interviews with key informants (leadership of The National Center for AIDS and STD Control and National Public Health Laboratory, district management teams, medical officers in charge of health facilities and HIV clinics, frontline staff at antenatal care and HIV clinics and laboratory). The quantitative methods were used to abstract data of HIV-infected pregnant women seen between January and December 2014, HIV-exposed infants aged less than 12 months, and HIV infected children aged less than 15 years who were initiated HIV treatment from 2010 to 2014. Structured tools were used to collect data which were analysed using IBM SPSS. Results Of the 19 facilities assessed, 18(98%), 18(98%), 14(75%), and 11(58%) provided prevention of mother-to-child transmission (PMTCT), Expanded Program on Immunization (EPI), pediatric ART and nutrition rehabilitation services, respectively. However, only 1(5%) facility collected onsite dried blood spots (DBS) for PCR HIV testing and 6(32%) facilities provided counselling and referral for DBS. In 2014, of the 121 HIV-exposed infants recorded, only 21(17%) received PCR test. The median turnaround time of the PCR test results was 54 days. Of the 21 records with PCR test, 11(52.5%) were from PMTCT clinics, 7(33%) from Nutritional rehabilitation clinics, and 3(14.5%) from pediatric outpatient clinic. Conversely, 934 children were initiated ART between 2010 and 2014, of which 5% were infants and 29% aged between 1 and 5 years. 298(32%) had comorbidities of which 64% had malnutrition. A total of 534(57%) had tuberculosis (TB) status assessed of which 58(11%) had active TB. Infants had lowest retention (63%), high mortality (17.4%), and loss to follow-up (10.9%). Conclusion Few facilities collect DBS and few children receive PCR tests with limited linkage to ART. This has led to late ART initiation, comorbidities, including TB coinfections and poor outcomes. The results indicate that there are opportunities for improving HIV case finding among HIV-exposed infants in PMTCT, EPI, TB, and nutrition services if provider initiated testing and counselling at the point of service delivery is institutionalized in these settings. PMID:26945139

First population-level effectiveness evaluation of a national programme to prevent HIV transmission from mother to child, South Africa.

PubMed

Goga, Ameena E; Dinh, Thu-Ha; Jackson, Debra J; Lombard, Carl; Delaney, Kevin P; Puren, Adrian; Sherman, Gayle; Woldesenbet, Selamawit; Ramokolo, Vundli; Crowley, Siobhan; Doherty, Tanya; Chopra, Mickey; Shaffer, Nathan; Pillay, Yogan

2015-03-01

There is a paucity of data on the national population-level effectiveness of preventing mother-to-child transmission (PMTCT) programmes in high-HIV-prevalence, resource-limited settings. We assessed national PMTCT impact in South Africa (SA), 2010. A facility-based survey was conducted using a stratified multistage, cluster sampling design. A nationally representative sample of 10 178 infants aged 4-8 weeks was recruited from 565 clinics. Data collection included caregiver interviews, record reviews and infant dried blood spots to identify HIV-exposed infants (HEI) and HIV-infected infants. During analysis, self-reported antiretroviral (ARV) use was categorised: 1a: triple ARV treatment; 1b: azidothymidine >10 weeks; 2a: azidothymidine ≤10 weeks; 2b: incomplete ARV prophylaxis; 3a: no antenatal ARV and 3b: missing ARV information. Findings were adjusted for non-response, survey design and weighted for live-birth distributions. Nationally, 32% of live infants were HEI; early mother-to-child transmission (MTCT) was 3.5% (95% CI 2.9% to 4.1%). In total 29.4% HEI were born to mothers on triple ARV treatment (category 1a) 55.6% on prophylaxis (1b, 2a, 2b), 9.5% received no antenatal ARV (3a) and 5.5% had missing ARV information (3b). Controlling for other factors groups, 1b and 2a had similar MTCT to 1a (Ref; adjusted OR (AOR) for 1b, 0.98, 0.52 to 1.83; and 2a, 1.31, 0.69 to 2.48). MTCT was higher in group 2b (AOR 3.68, 1.69 to 7.97). Within group 3a, early MTCT was highest among breastfeeding mothers 11.50% (4.67% to 18.33%) for exclusive breast feeding, 11.90% (7.45% to 16.35%) for mixed breast feeding, and 3.45% (0.53% to 6.35%) for no breast feeding). Antiretroviral therapy or >10 weeks prophylaxis negated this difference (MTCT 3.94%, 1.98% to 5.90%; 2.07%, 0.55% to 3.60% and 2.11%, 1.28% to 2.95%, respectively). SA, a high-HIV-prevalence middle income country achieved <5% MTCT by 4-8 weeks post partum. The long-term impact on PMTCT on HIV-free survival needs urgent assessment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Small Cold Temperature Instrument Packages

NASA Astrophysics Data System (ADS)

Clark, P. E.; Millar, P. S.; Yeh, P. S.; Feng, S.; Brigham, D.; Beaman, B.

We are developing a small cold temperature instrument package concept that integrates a cold temperature power system with ultra low temperature ultra low power electronics components and power supplies now under development into a 'cold temperature surface operational' version of a planetary surface instrument package. We are already in the process of developing a lower power lower temperature version for an instrument of mutual interest to SMD and ESMD to support the search for volatiles (the mass spectrometer VAPoR, Volatile Analysis by Pyrolysis of Regolith) both as a stand alone instrument and as part of an environmental monitoring package. We build on our previous work to develop strategies for incorporating Ultra Low Temperature/Ultra Low Power (ULT/ULP) electronics, lower voltage power supplies, as well as innovative thermal design concepts for instrument packages. Cryotesting has indicated that our small Si RHBD CMOS chips can deliver >80% of room temperature performance at 40K (nominal minimum lunar surface temperature). We leverage collaborations, past and current, with the JPL battery development program to increase power system efficiency in extreme environments. We harness advances in MOSFET technology that provide lower voltage thresholds for power switching circuits incorporated into our low voltage power supply concept. Conventional power conversion has a lower efficiency. Our low power circuit concept based on 'synchronous rectification' could produce stable voltages as low as 0.6 V with 85% efficiency. Our distributed micro-battery-based power supply concept incorporates cold temperature power supplies operating with a 4 V or 8 V battery. This work will allow us to provide guidelines for applying the low temperature, low power system approaches generically to the widest range of surface instruments.

Making software get along: integrating optical and mechanical design programs

NASA Astrophysics Data System (ADS)

Shackelford, Christie J.; Chinnock, Randal B.

2001-03-01

As modern optomechanical engineers, we have the good fortune of having very sophisticated software programs available to us. The current optical design, mechanical design, industrial design, and CAM programs are very powerful tools with some very desirable features. However, no one program can do everything necessary to complete an entire optomechanical system design. Each program has a unique set of features and benefits, and typically two or mo re will be used during the product development process. At a minimum, an optical design program and a mechanical CAD package will be employed. As we strive for efficient, cost-effective, and rapid progress in our development projects, we must use these programs to their full advantage, while keeping redundant tasks to a minimum. Together, these programs offer the promise of a `seamless' flow of data from concept all the way to the download of part designs directly to the machine shop for fabrication. In reality, transferring data from one software package to the next is often frustrating. Overcoming these problems takes some know-how, a bit of creativity, and a lot of persistence. This paper describes a complex optomechanical development effort in which a variety of software tools were used from the concept stage to prototyping. It will describe what software was used for each major design task, how we learned to use them together to best advantage, and how we overcame the frustrations of software that didn't get along.

How much flower-rich habitat is enough for wild pollinators? Answering a key policy question with incomplete knowledge.

PubMed

Dicks, Lynn V; Baude, Mathilde; Roberts, Stuart P M; Phillips, James; Green, Mike; Carvell, Claire

2015-09-01

In 2013, an opportunity arose in England to develop an agri-environment package for wild pollinators, as part of the new Countryside Stewardship scheme launched in 2015. It can be understood as a 'policy window', a rare and time-limited opportunity to change policy, supported by a narrative about pollinator decline and widely supported mitigating actions. An agri-environment package is a bundle of management options that together supply sufficient resources to support a target group of species. This paper documents information that was available at the time to develop such a package for wild pollinators. Four questions needed answering: (1) Which pollinator species should be targeted? (2) Which resources limit these species in farmland? (3) Which management options provide these resources? (4) What area of each option is needed to support populations of the target species? Focussing on wild bees, we provide tentative answers that were used to inform development of the package. There is strong evidence that floral resources can limit wild bee populations, and several sources of evidence identify a set of agri-environment options that provide flowers and other resources for pollinators. The final question could only be answered for floral resources, with a wide range of uncertainty. We show that the areas of some floral resource options in the basic Wild Pollinator and Farmland Wildlife Package (2% flower-rich habitat and 1 km flowering hedgerow), are sufficient to supply a set of six common pollinator species with enough pollen to feed their larvae at lowest estimates, using minimum values for estimated parameters where a range was available. We identify key sources of uncertainty, and stress the importance of keeping the Package flexible, so it can be revised as new evidence emerges about how to achieve the policy aim of supporting pollinators on farmland.

Documentation of a computer program to simulate aquifer-system compaction using the modular finite-difference ground-water flow model

USGS Publications Warehouse

Leake, S.A.; Prudic, David E.

1991-01-01

Removal of ground water by pumping from aquifers may result in compaction of compressible fine-grained beds that are within or adjacent to the aquifers. Compaction of the sediments and resulting land subsidence may be permanent if the head declines result in vertical stresses beyond the previous maximum stress. The process of permanent compaction is not routinely included in simulations of ground-water flow. To simulate storage changes from both elastic and inelastic compaction, a computer program was written for use with the U.S. Geological Survey modular finite-difference ground- water flow model. The new program, the Interbed-Storage Package, is designed to be incorporated into this model. In the Interbed-Storage Package, elastic compaction or expansion is assumed to be proportional to change in head. The constant of proportionality is the product of the skeletal component of elastic specific storage and the thickness of the sediments. Similarly, inelastic compaction is assumed to be proportional to decline in head. The constant of proportionality is the product of the skeletal component of inelastic specific storage and the thickness of the sediments. Storage changes are incorporated into the ground-water flow model by adding an additional term to the right-hand side of the flow equation. Within a model time step, the package appropriately apportions storage changes between elastic and inelastic components on the basis of the relation of simulated head to the previous minimum (preconsolidation) head. Two tests were performed to verify that the package works correctly. The first test compared model-calculated storage and compaction changes to hand-calculated values for a three-dimensional simulation. Model and hand-calculated values were essentially equal. The second test was performed to compare the results of the Interbed-Storage Package with results of the one-dimensional Helm compaction model. This test problem simulated compaction in doubly draining confining beds stressed by head changes in adjacent aquifers. The Interbed-Storage Package and the Helm model computed essentially equal values of compaction. Documentation of the Interbed-Storage Package includes data input instructions, flow charts, narratives, and listings for each of the five modules included in the package. The documentation also includes an appendix describing input instructions and a listing of a computer program for time-variant specified-head boundaries. That package was developed to reduce the amount of data input and output associated with one of the Interbed-Storage Package test problems.

Design consideration for a nuclear electric propulsion system

NASA Technical Reports Server (NTRS)

Phillips, W. M.; Pawlik, E. V.

1978-01-01

A study is currently underway to design a nuclear electric propulsion vehicle capable of performing detailed exploration of the outer-planets. Primary emphasis is on the power subsystem. Secondary emphasis includes integration into a spacecraft, and integration with the thrust subsystem and science package or payload. The results of several design iterations indicate an all-heat-pipe system offers greater reliability, elimination of many technology development areas and a specific weight of under 20 kg/kWe at the 400 kWe power level. The system is compatible with a single Shuttle launch and provides greater safety than could be obtained with designs using pumped liquid metal cooling. Two configurations, one with the reactor and power conversion forward on the spacecraft with the ion engines aft and the other with reactor, power conversion and ion engines aft were selected as dual baseline designs based on minimum weight, minimum required technology development and maximum growth potential and flexibility.

PCIPS 2.0: Powerful multiprofile image processing implemented on PCs

NASA Technical Reports Server (NTRS)

Smirnov, O. M.; Piskunov, N. E.

1992-01-01

Over the years, the processing power of personal computers has steadily increased. Now, 386- and 486-based PC's are fast enough for many image processing applications, and inexpensive enough even for amateur astronomers. PCIPS is an image processing system based on these platforms that was designed to satisfy a broad range of data analysis needs, while requiring minimum hardware and providing maximum expandability. It will run (albeit at a slow pace) even on a 80286 with 640K memory, but will take full advantage of bigger memory and faster CPU's. Because the actual image processing is performed by external modules, the system can be easily upgraded by the user for all sorts of scientific data analysis. PCIPS supports large format lD and 2D images in any numeric type from 8-bit integer to 64-bit floating point. The images can be displayed, overlaid, printed and any part of the data examined via an intuitive graphical user interface that employs buttons, pop-up menus, and a mouse. PCIPS automatically converts images between different types and sizes to satisfy the requirements of various applications. PCIPS features an API that lets users develop custom applications in C or FORTRAN. While doing so, a programmer can concentrate on the actual data processing, because PCIPS assumes responsibility for accessing images and interacting with the user. This also ensures that all applications, even custom ones, have a consistent and user-friendly interface. The API is compatible with factory programming, a metaphor for constructing image processing procedures that will be implemented in future versions of the system. Several application packages were created under PCIPS. The basic package includes elementary arithmetics and statistics, geometric transformations and import/export in various formats (FITS, binary, ASCII, and GIF). The CCD processing package and the spectral analysis package were successfully used to reduce spectra from the Nordic Telescope at La Palma. A photometry package is also available, and other packages are being developed. A multitasking version of PCIPS that utilizes the factory programming concept is currently under development. This version will remain compatible (on the source code level) with existing application packages and custom applications.

A reliable data collection/control system

NASA Technical Reports Server (NTRS)

Maughan, Thom

1988-01-01

The Cal Poly Space Project requires a data collection/control system which must be able to reliably record temperature, pressure and vibration data. It must also schedule the 16 electroplating and 2 immiscible alloy experiments so as to optimize use of the batteries, maintain a safe package temperature profile, and run the experiment during conditions of microgravity (and minimum vibration). This system must operate unattended in the harsh environment of space and consume very little power due to limited battery supply. The design of a system which meets these requirements is addressed.

Microcomputer package for statistical analysis of microbial populations.

PubMed

Lacroix, J M; Lavoie, M C

1987-11-01

We have developed a Pascal system to compare microbial populations from different ecological sites using microcomputers. The values calculated are: the coverage value and its standard error, the minimum similarity and the geometric similarity between two biological samples, and the Lambda test consisting of calculating the ratio of the mean similarity between two subsets by the mean similarity within subsets. This system is written for Apple II, IBM or compatible computers, but it can work for any computer which can use CP/M, if the programs are recompiled for such a system.

Quality assessment of two- and three-dimensional unstructured meshes and validation of an upwind Euler flow solver

NASA Technical Reports Server (NTRS)

Woodard, Paul R.; Batina, John T.; Yang, Henry T. Y.

1992-01-01

Quality assessment procedures are described for two-dimensional unstructured meshes. The procedures include measurement of minimum angles, element aspect ratios, stretching, and element skewness. Meshes about the ONERA M6 wing and the Boeing 747 transport configuration are generated using an advancing front method grid generation package of programs. Solutions of Euler's equations for these meshes are obtained at low angle-of-attack, transonic conditions. Results for these cases, obtained as part of a validation study demonstrate accuracy of an implicit upwind Euler solution algorithm.

Simple geometric algorithms to aid in clearance management for robotic mechanisms

NASA Technical Reports Server (NTRS)

Copeland, E. L.; Ray, L. D.; Peticolas, J. D.

1981-01-01

Global geometric shapes such as lines, planes, circles, spheres, cylinders, and the associated computational algorithms which provide relatively inexpensive estimates of minimum spatial clearance for safe operations were selected. The Space Shuttle, remote manipulator system, and the Power Extension Package are used as an example. Robotic mechanisms operate in quarters limited by external structures and the problem of clearance is often of considerable interest. Safe clearance management is simple and suited to real time calculation, whereas contact prediction requires more precision, sophistication, and computational overhead.

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review

PubMed Central

Naidoo, Joanne R.

2017-01-01

Background Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV. Aim To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy. Methods Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included ‘Sub-Saharan African countries’, ‘implementation strategies’, ‘interventions to bridge implementation gap’, ‘prevention of mother-to-child transmission of HIV’ and ‘closing implementation gap’. Results Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1) health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance); (2) health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision); as well as (3) community-level strategies (community health workers, technology use – mHealth, family-centred approaches, male involvement, culturally appropriate interventions). Conclusion There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency. PMID:28582993

Stigma, Facility Constraints, and Personal Disbelief: Why Women Disengage from HIV Care During and After Pregnancy in Morogoro Region, Tanzania.

PubMed

McMahon, Shannon A; Kennedy, Caitlin E; Winch, Peter J; Kombe, Miriam; Killewo, Japhet; Kilewo, Charles

2017-01-01

Millions of children are living with HIV in sub-Saharan Africa, and the primary mode of these childhood infections is mother-to-child transmission. While existing interventions can virtually eliminate such transmission, in low- and middle-income settings, only 63 % of pregnant women living with HIV accessed medicines necessary to prevent transmission. In Tanzania, HIV prevalence among pregnant women is 3.2 %. Understanding why HIV-positive women disengage from care during and after pregnancy can inform efforts to reduce the impact of HIV on mothers and young children. Informed by the tenets of Grounded Theory, we conducted qualitative interviews with 40 seropositive postpartum women who had disengaged from care to prevent mother-to-child transmission (PMTCT). Nearly all women described antiretroviral treatment (ART) as ultimately beneficial but effectively inaccessible given concerns related to stigma. Many women also described how their feelings of health and vitality coupled with concerns about side effects underscored a desire to forgo ART until they deemed it immediately necessary. Relatively fewer women described not knowing or forgetting that they needed to continue their treatment regimens. We present a theory of PMTCT disengagement outlining primary and ancillary barriers. This study is among the first to examine disengagement by interviewing women who had actually discontinued care. We urge that a combination of intervention approaches such as mother-to-mother support groups, electronic medical records with same-day tracing, task shifting, and mobile technology be adapted, implemented, and evaluated within the Tanzanian setting.

Stigma, facility constraints, and personal disbelief: why women disengage from HIV care during and after pregnancy in Morogoro Region, Tanzania

PubMed Central

McMahon, Shannon A.; Kennedy, Caitlin E.; Winch, Peter J.; Kombe, Miriam; Killewo, Japhet; Kilewo, Charles

2016-01-01

Millions of children are living with HIV in sub-Saharan Africa, and the primary mode of these childhood infections is mother-to-child transmission. While existing interventions can virtually eliminate such transmission, in low- and middle-income settings, only 63% of pregnant women living with HIV accessed medicines necessary to prevent transmission. In Tanzania, HIV prevalence among pregnant women is 3.2%. Understanding why HIV-positive women disengage from care during and after pregnancy can inform efforts to reduce the impact of HIV on mothers and young children. Informed by the tenets of Grounded Theory, we conducted qualitative interviews with 40 seropositive postpartum women who had disengaged from care to prevent mother-to-child transmission (PMTCT). Nearly all women described antiretroviral treatment (ART) as ultimately beneficial but effectively inaccessible given concerns related to stigma. Many women also described how their feelings of health and vitality coupled with concerns about side effects underscored a desire to forgo ART until they deemed it immediately necessary. Relatively fewer women described not knowing or forgetting that they needed to continue their treatment regimens. We present a theory of PMTCT disengagement outlining primary and ancillary barriers. This study is among the first to examine disengagement by interviewing women who had actually discontinued care. We urge that a combination of intervention approaches such as mother-to-mother support groups, electronic medical records with same-day tracing, task shifting, and mobile technology be adapted, implemented, and evaluated within the Tanzanian setting. PMID:27535755

Utilization of HIV testing services among pregnant mothers in low income primary care settings in northern Ethiopia: a cross sectional study.

PubMed

Alemu, Yihun Mulugeta; Ambaw, Fentie; Wilder-Smith, Annelies

2017-06-24

HIV testing of women in child bearing age is an entry point for preventing mother-to-child transmission of HIV (MTCT). This study aims to identify the proportion of women tested for HIV and to determine factors associated with utilization of HIV testing services among pregnant mothers in primary care settings in northern Ethiopia. A cross sectional study was conducted in 416 pregnant women from four primary care centers between October 2, 2012 and May 31, 2013 in East Gojjam, Ethiopia. The proportion of mothers who tested for HIV was 277(67%). Among mothers who were not tested for HIV, lack of HIV risk perception (n = 68, 49%) was a major self-reported barrier for HIV testing. A multivariable logistic regression analysis showed that those pregnant women who had comprehensive knowledge about MTCT had an Adjusted Odd Ratio (AOR) of 3.73 (95% CI: 1.56, 8.94), having comprehensive knowledge on prevention of mother to child transmission (PMTCT) of HIV an AOR of 2.56 (95% CI: 1.26, 5.19), and a favorable attitude towards persons living with HIV an AOR of 2.42 (95%CI, 1.20, 4.86) were more likely to be tested for HIV. One third of pregnant women had never been tested for HIV until the time of the study. Efforts should be made to improve mother's knowledge about MTCT and PMTCT to increase uptake of HIV testing. Enhancing mother's HIV risk perception to scale up HIV testing in resource limited setting is highly recommended.

Urinary Tract Infections among HIV-Positive Pregnant Women in Mwanza City, Tanzania, Are High and Predicted by Low CD4+ Count

PubMed Central

Chaula, Tito; Ng'walida, Nhandi; Kajura, Alphaxaid; Mirambo, Mariam M.; DeVinney, Rebekah

2017-01-01

Introduction. Urinary tract infection (UTI) among pregnant women can lead to adverse maternal and foetal outcomes. UTI has been widely studied in the general obstetric population in Tanzania; the present study evaluated the magnitude, antimicrobial resistance, and predictors of UTI among HIV-positive pregnant women. Methods. Between March and May 2016 midstream urine samples from 234 women attending prevention of mother to child transmission of HIV (PMTCT) clinics were analyzed using standard methods. Data was analyzed by STATA version 11.0. Results. The prevalence of UTI was 21.4%, 50/234 [95% CI: 16.1–26.6]. The asymptomatically significant bacteriuria was higher than symptomatically significant bacteriuria (16.6% versus 4.7%, p < 0.001). On multivariable logistic regression analysis, single marital status (OR: 2.6, 95% CI: 1.1–6.1, and p = 0.026), low CD4+ counts of <200/μL (OR: 2.9, 95% CI: 1.1–7.7, and p = 0.031), and having UTI symptoms (OR: 2.5, 95% CI: 1.1–6.0, and p = 0.03) were independent predictors of UTI. Escherichia coli predominated (57.7%) and exhibited a low prevalence of resistance to nitrofurantoin (16.7%), gentamicin (10.0%), and ceftriaxone (13.3%). Four (13.3%) of these were extended-spectrum beta-lactamase producers. Conclusions. A considerable proportion of HIV-positive pregnant women in Mwanza have significant bacteriuria which calls for the need to introduce routine UTI screening at PMTCT clinics to guide specific treatment and prevent associated complications. PMID:28255302

Reproductive health and family planning needs among HIV-infected women in Sub-Saharan Africa.

PubMed

Sarnquist, Clea C; Rahangdale, Lisa; Maldonado, Yvonne

2013-03-01

Review key topics and recent literature regarding reproductive health and family planning needs for HIV-infected women in Sub-Saharan Africa. Electronic searches performed in PubMed, JSTOR, and Web of Science; identified articles reviewed for inclusion. Most HIV-infected women in Sub-Saharan Africa bear children, and access to antiretroviral therapy may increase childbearing desires and/or fertility, resulting in greater need for contraception. Most contraceptive options can be safely and effectively used by HIV-infected women. Unmet need for contraception is high in this population, with 66- 92% of women reporting not wanting another child (now or ever), but only 20-43% using contraception. During pregnancy and delivery, HIV-infected women need access to prevention of mother-to-child transmission (PMTCT) services, a skilled birth attendant, and quality post-partum care to prevent HIV infection in the infant and maximize maternal health. Providers may lack resources as well as appropriate training and support to provide such services to women with HIV. Innovations in biomedical and behavioral interventions may improve reproductive healthcare for HIV-infected women, but in Sub-Saharan Africa, models of integrating HIV and PMTCT services with family planning and reproductive health services will be important to improve reproductive outcomes. HIV-infected women in Sub-Saharan Africa have myriad needs related to reproductive health, including access to high-quality family planning information and options, high-quality pregnancy care, and trained providers. Integrated services that help prevent unintended pregnancy and optimize maternal and infant health before, during and after pregnancy will both maximize limited resources as well as provide improved reproductive outcomes.

Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi.

PubMed

Cataldo, Fabian; Chiwaula, Levison; Nkhata, Misheck; van Lettow, Monique; Kasende, Florence; Rosenberg, Nora E; Tweya, Hannock; Sampathkumar, Veena; Hosseinipour, Mina; Schouten, Erik; Kapito-Tembo, Atupele; Eliya, Michael; Chimbwandira, Frank; Phiri, Sam

2017-04-15

Malawi has embarked on a "test-and-treat" approach to prevent mother-to-child transmission (PMTCT) of HIV, known as "Option B+," offering all HIV-infected pregnant and breastfeeding women lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage. A cross-sectional qualitative study was conducted to explore early experiences surrounding "Option B+" for patients and health care workers (HCWs) in Malawi. Study participants were purposively selected across 6 health facilities in 3 regional health zones in Malawi. Semi-structured interviews were conducted with women enrolled in "Option B+" (n = 24), and focus group discussions were conducted with HCWs providing Option B+ services (n = 6 groups of 8 HCWs). Data were analyzed using a qualitative thematic coding framework. Patients and HCWs identified the lack of male involvement as a barrier to retention in care and expressed concerns at the rapidity of the test-and-treat process, which makes it difficult for patients to "digest" a positive diagnosis before starting ART. Fear regarding the breach of privacy and confidentiality were also identified as contributing to loss to follow-up of women initiated under the Option B+. Disclosure remains a difficult process within families and couples. Lifelong ART was also perceived as an opportunity to plan future pregnancies. As "Option B+" continues to be rolled out, novel interventions to support and retain women into care must be implemented. These include providing space, time, and support to accept a diagnosis before starting ART, engaging partners and families, and addressing the need for peer support and confidentiality.

The incremental cost of switching from Option B to Option B+ for the prevention of mother-to-child transmission of HIV.

PubMed

O'Brien, Lisa; Shaffer, Nathan; Sangrujee, Nalinee; Abimbola, Taiwo O

2014-03-01

To estimate the incremental cost over 5 years of a policy switch from the Option B to the Option B+ protocol for the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV). Data from cost studies and other published sources were used to determine the cost, per woman and per cohort (1000 breastfeeding and 1000 non-breastfeeding women), of switching from Option B (maternal triple antiretroviral [ARV] regimen during pregnancy and breastfeeding plus daily nevirapine for the infant for 6 weeks) to Option B+ (maternal triple ARV regimen initiated during pregnancy and continued for life). The variables used to model the different scenarios were maternal CD4+ T lymphocyte (CD4+ cell) count (350-500 versus > 500 cells/µl), rate of decline in CD4+ cells (average, rapid, slow), breastfeeding status (yes, no) and breastfeeding duration (12, 18 or 24 months). For women with CD4+ cell counts of 350-500 cells/µl, the incremental cost per 1000 women was 157,345 United States dollars (US$) for breastfeeding women and US$ 92,813 for non-breastfeeding women. For women with CD4+ cell counts > 500 cells/µl, the incremental cost per 1000 women ranged from US$ 363,443 to US$ 484,591 for breastfeeding women and was US$ 605,739 for non-breastfeeding women. From a cost perspective, a policy switch from Option B to Option B+ is feasible in PMTCT programme settings where resources are currently being allocated to Option B.

The comparison of the performance of two screening strategies identifying newly-diagnosed HIV during pregnancy.

PubMed

Boer, Kees; Smit, Colette; van der Flier, Michiel; de Wolf, Frank

2011-10-01

In the Netherlands, a non-selective opt-out instead of a selective opt-in antenatal HIV screening strategy was implemented in 2004. In case of infection, screening was followed by prevention of mother-to-child-transmission (PMTCT). We compared the performance of the two strategies in terms of detection of new cases of HIV and vertical transmission. HIV-infected pregnant women were identified retrospectively from the Dutch HIV cohort ATHENA January 2000 to January 2008. Apart from demographic, virological and immunological data, the date of HIV infection in relation to the index pregnancy was established. Separately, all infants diagnosed with HIV born following implementation of the screening program were identified by a questionnaire via the paediatric HIV centres. 162/481 (33.7%) HIV-positive pregnant women were diagnosed with HIV before 2004 and 172/214 (80.3%) after January 2004. Multivariate analysis showed an 8-fold (95% confidence interval 5.47-11.87) increase in the odds of HIV detection during pregnancy after the national introduction of the opt-out strategy. Still, three children born during a 5-year period after July 2004 were infected due to de novo infection in pregnancy. Implementation of a nation-wide screening strategy based upon non-selective opt-out screening followed by effective PMTCT appeared to detect more HIV-infected women for the first time in pregnancy and to reduce vertical transmission of HIV substantially. Nonetheless, still few children are infected because of maternal infection after the first trimester. We propose the introduction of partner screening on HIV as part of the antenatal screening strategy.

Custom electronic subsystems for the laboratory telerobotic manipulator

NASA Technical Reports Server (NTRS)

Glassell, R. L.; Butler, P. L.; Rowe, J. C.; Zimmermann, S. D.

1990-01-01

The National Aeronautics and Space Administration (NASA) Space Station Program presents new opportunities for the application of telerobotic and robotic systems. The Laboratory Telerobotic Manipulator (LTM) is a highly advanced 7 degrees-of-freedom (DOF) telerobotic/robotic manipulator. It was developed and built for the Automation Technology Branch at NASA's Langley Research Center (LaRC) for work in research and to demonstrate ground-based telerobotic manipulator system hardware and software systems for future NASA applications in the hazardous environment of space. The LTM manipulator uses an embedded wiring design with all electronics, motor power, and control and communication cables passing through the pitch-yaw differential joints. This design requires the number of cables passing through the pitch/yaw joint to be kept to a minimum. To eliminate the cables needed to carry each pitch-yaw joint's sensor data to the VME control computers, a custom-embedded electronics package for each manipulator joint was developed. The electronics package collects and sends the joint's sensor data to the VME control computers over a fiber optic cable. The electronics package consist of five individual subsystems: the VME Link Processor, the Joint Processor and the Joint Processor power supply in the joint module, the fiber optics communications system, and the electronics and motor power cabling.

Post-processing optimization of electrospun submicron poly(3-hydroxybutyrate) fibers to obtain continuous films of interest in food packaging applications.

PubMed

Cherpinski, Adriane; Torres-Giner, Sergio; Cabedo, Luis; Lagaron, Jose M

2017-10-01

Polyhydroxyalkanoates (PHAs) are one of the most researched family of biodegradable polymers based on renewable materials due to their thermoplastic nature and moisture resistance. The present study was targeted to investigate the preparation and characterization of poly(3-hydroxybutyrate) (PHB) films obtained through the electrospinning technique. To convert them into continuous films and then to increase their application interest in packaging, the electrospun fiber mats were subsequently post-processed by different physical treatments. Thus, the effect of annealing time and cooling method on morphology, molecular order, thermal, optical, mechanical, and barrier properties of the electrospun submicron PHB fibers was studied. Annealing at 160°C, well below the homopolyester melting point, was found to be the minimum temperature at which homogeneous transparent films were produced. The film samples that were cooled slowly after annealing showed the lowest permeability to oxygen, water vapor, and limonene. The optimally post-processed electrospun PHB fibers exhibited similar rigidity to conventional compression-molded PHA films, but with enhanced elongation at break and toughness. Films made by this electrospinning technique have many potential applications, such as in the design of barrier layers, adhesive interlayers, and coatings for fiber- and plastic-based food packaging materials.

GENESIS 1.1: A hybrid-parallel molecular dynamics simulator with enhanced sampling algorithms on multiple computational platforms.

PubMed

Kobayashi, Chigusa; Jung, Jaewoon; Matsunaga, Yasuhiro; Mori, Takaharu; Ando, Tadashi; Tamura, Koichi; Kamiya, Motoshi; Sugita, Yuji

2017-09-30

GENeralized-Ensemble SImulation System (GENESIS) is a software package for molecular dynamics (MD) simulation of biological systems. It is designed to extend limitations in system size and accessible time scale by adopting highly parallelized schemes and enhanced conformational sampling algorithms. In this new version, GENESIS 1.1, new functions and advanced algorithms have been added. The all-atom and coarse-grained potential energy functions used in AMBER and GROMACS packages now become available in addition to CHARMM energy functions. The performance of MD simulations has been greatly improved by further optimization, multiple time-step integration, and hybrid (CPU + GPU) computing. The string method and replica-exchange umbrella sampling with flexible collective variable choice are used for finding the minimum free-energy pathway and obtaining free-energy profiles for conformational changes of a macromolecule. These new features increase the usefulness and power of GENESIS for modeling and simulation in biological research. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

An Evaluation of the Healthiness of the Indian Packaged Food and Beverage Supply.

PubMed

Jones, Alexandra; Dunford, Elizabeth; Crossley, Rachel; Thout, Sudhir Raj; Rayner, Mike; Neal, Bruce

2017-10-09

Availability of less-healthy packaged food and beverage products has been implicated as an important driver of obesity and diet-related disease. An increasing number of packaged foods and beverages are sold in India. Our objective was to evaluate the healthiness of packaged foods sold by India's largest manufacturers. Healthiness was assessed using the Australian Health Star Rating (HSR) system and the World Health Organization's European Regional Office (WHO Euro) Nutrient Profile Model. Sales-value-weighted mean healthiness and the proportions of "healthy" products (using a validated HSR cut-off of ≥3.5, and products meeting WHO Euro criteria as healthy enough to market to children) were calculated overall, by company and by food category. Nutrient information for 943 products sold by the 11 largest Indian manufacturers was obtained from nutrient labels, company websites or directly from the manufacturer. Healthiness was low overall (mean HSR 1.8 out of 5.0 stars) with a low proportion defined as "healthy" by both HSR (17%) and also by WHO Euro criteria (8%). There were marked differences in the healthiness of similar products within food categories. Substantial variation between companies (minimum sales-value-weighted mean HSR 0.5 for Company G, versus maximum HSR 3.0 for Company F) was a result of differences in the types of products sold and the nutritional composition of individual products. There are clear opportunities for India's largest food companies to improve both the nutritional quality of individual products and to improve their product mix to include a greater proportion of healthy products.

An Evaluation of the Healthiness of the Indian Packaged Food and Beverage Supply

PubMed Central

Jones, Alexandra; Crossley, Rachel; Thout, Sudhir Raj; Rayner, Mike; Neal, Bruce

2017-01-01

Availability of less-healthy packaged food and beverage products has been implicated as an important driver of obesity and diet-related disease. An increasing number of packaged foods and beverages are sold in India. Our objective was to evaluate the healthiness of packaged foods sold by India’s largest manufacturers. Healthiness was assessed using the Australian Health Star Rating (HSR) system and the World Health Organization’s European Regional Office (WHO Euro) Nutrient Profile Model. Sales-value-weighted mean healthiness and the proportions of “healthy” products (using a validated HSR cut-off of ≥3.5, and products meeting WHO Euro criteria as healthy enough to market to children) were calculated overall, by company and by food category. Nutrient information for 943 products sold by the 11 largest Indian manufacturers was obtained from nutrient labels, company websites or directly from the manufacturer. Healthiness was low overall (mean HSR 1.8 out of 5.0 stars) with a low proportion defined as “healthy” by both HSR (17%) and also by WHO Euro criteria (8%). There were marked differences in the healthiness of similar products within food categories. Substantial variation between companies (minimum sales-value-weighted mean HSR 0.5 for Company G, versus maximum HSR 3.0 for Company F) was a result of differences in the types of products sold and the nutritional composition of individual products. There are clear opportunities for India’s largest food companies to improve both the nutritional quality of individual products and to improve their product mix to include a greater proportion of healthy products. PMID:28991201

Reviewing progress: 7 year trends in characteristics of adults and children enrolled at HIV care and treatment clinics in the United Republic of Tanzania.

PubMed

Nuwagaba-Biribonwoha, Harriet; Kilama, Bonita; Antelman, Gretchen; Khatib, Ahmed; Almeida, Annette; Reidy, William; Ramadhani, Gongo; Lamb, Matthew R; Mbatia, Redempta; Abrams, Elaine J

2013-10-27

To evaluate the on-going scale-up of HIV programs, we assessed trends in patient characteristics at enrolment and ART initiation over 7 years of implementation. Data were from Optimal Models, a prospective open cohort study of HIV-infected (HIV+) adults (≥15 years) and children (<15 years) enrolled from January 2005 to December 2011 at 44 HIV clinics in 3 regions of mainland Tanzania (Kagera, Kigoma, Pwani) and Zanzibar. Comparative statistics for trends in characteristics of patients enrolled in 2005-2007, 2008-2009 and 2010-2011 were examined. Overall 62,801 HIV + patients were enrolled: 58,102(92.5%) adults, (66.5% female); 4,699(7.5%) children.Among adults, pregnant women enrolment increased: 6.8%, 2005-2007; 12.1%, 2008-2009; 17.2%, 2010-2011; as did entry into care from prevention of mother-to-child HIV transmission (PMTCT) programs: 6.6%, 2005-2007; 9.5%, 2008-2009; 12.6%, 2010-2011. WHO stage IV at enrolment declined: 27.1%, 2005-2007; 20.2%, 2008-2009; 11.1% 2010-2011. Of the 42.5% and 29.5% with CD4+ data at enrolment and ART initiation respectively, median CD4+ count increased: 210 cells/μL, 2005-2007; 262 cells/μL, 2008-2009; 266 cells/μL 2010-2011; but median CD4+ at ART initiation did not change (148 cells/μL overall). Stavudine initiation declined: 84.9%, 2005-2007; 43.1%, 2008-2009; 19.7%, 2010-2011.Among children, median age (years) at enrolment decreased from 6.1(IQR:2.7-10.0) in 2005-2007 to 4.8(IQR:1.9-8.6) in 2008-2009, and 4.1(IQR:1.5-8.1) in 2010-2011 and children <24 months increased from 18.5% to 26.1% and 31.5% respectively. Entry from PMTCT was 7.0%, 2005-2007; 10.7%, 2008-2009; 15.0%, 2010-2011. WHO stage IV at enrolment declined from 22.9%, 2005-2007, to 18.3%, 2008-2009 to 13.9%, 2010-2011. Proportion initiating stavudine was 39.8% 2005-2007; 39.5%, 2008-2009; 26.1%, 2010-2011. Median age at ART initiation also declined significantly. Over time, the proportion of pregnant women and of adults and children enrolled from PMTCT programs increased. There was a decline in adults and children with advanced HIV disease at enrolment and initiation of stavudine. Pediatric age at enrolment and ART initiation declined. Results suggest HIV program maturation from an emergency response.

GRAVTool, Advances on the Package to Compute Geoid Model path by the Remove-Compute-Restore Technique, Following Helmert's Condensation Method

NASA Astrophysics Data System (ADS)

Marotta, G. S.

2017-12-01

Currently, there are several methods to determine geoid models. They can be based on terrestrial gravity data, geopotential coefficients, astrogeodetic data or a combination of them. Among the techniques to compute a precise geoid model, the Remove Compute Restore (RCR) has been widely applied. It considers short, medium and long wavelengths derived from altitude data provided by Digital Terrain Models (DTM), terrestrial gravity data and Global Geopotential Model (GGM), respectively. In order to apply this technique, it is necessary to create procedures that compute gravity anomalies and geoid models, by the integration of different wavelengths, and adjust these models to one local vertical datum. This research presents the advances on the package called GRAVTool to compute geoid models path by the RCR, following Helmert's condensation method, and its application in a study area. The studied area comprehends the federal district of Brazil, with 6000 km², wavy relief, heights varying from 600 m to 1340 m, located between the coordinates 48.25ºW, 15.45ºS and 47.33ºW, 16.06ºS. The results of the numerical example on the studied area show a geoid model computed by the GRAVTool package, after analysis of the density, DTM and GGM values, more adequate to the reference values used on the study area. The accuracy of the computed model (σ = ± 0.058 m, RMS = 0.067 m, maximum = 0.124 m and minimum = -0.155 m), using density value of 2.702 g/cm³ ±0.024 g/cm³, DTM SRTM Void Filled 3 arc-second and GGM EIGEN-6C4 up to degree and order 250, matches the uncertainty (σ =± 0.073) of 26 points randomly spaced where the geoid was computed by geometrical leveling technique supported by positioning GNSS. The results were also better than those achieved by Brazilian official regional geoid model (σ = ± 0.076 m, RMS = 0.098 m, maximum = 0.320 m and minimum = -0.061 m).

Reminder packaging for improving adherence to self-administered long-term medications.

PubMed

Heneghan, C J; Glasziou, P; Perera, R

2006-01-25

Current methods of improving medication adherence for health problems are mostly complex, labour-intensive, and not reliably effective. Medication 'reminder packaging' which incorporates a date or time for a medication to be taken in the packaging, can act as a reminder system to improve adherence. The objective of this review was to determine the effects of reminder packaging to enhance patient adherence with self-administered medications taken for one month or more. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library Issue 3, 2004), MEDLINE, EMBASE, CINAHL and PsycINFO from the start of the databases to 1 September 2004. We also searched the internet, contacted packaging manufacturers, and checked abstracts from the Pharm-line database and reference lists from relevant articles. We did not apply any language restrictions. We selected randomised controlled trials with at least 80% follow up, comparing a reminder packaging device with no device in participants taking self-administered medications for a minimum of one month. Two reviewers independently assessed studies for inclusion, assessed quality, and extracted data from included studies. Where considered appropriate, data were combined for meta-analysis, or were reported and discussed in a narrative. Eight studies containing data on 1,137 participants were included. Six intervention groups in four trials provided data on the percentage of pills taken. Reminder packaging showed a significant increase in the percentage of pills taken, weighted mean difference 11% (95% confidence interval (CI) 6% to 17%). Notable heterogeneity occurred among these trials I(2 )= 96.3%. Two trials provided data for the proportion of self-reported adherent patients, reporting a reduction in the intervention group which was not statistically significant, odds ratio = 0.89 (95% CI 0.56 to 1.40). No appropriate data were available for meta-analysis of different clinical outcomes, the most common of these being blood pressure (three out of eight trials). Other clinical outcomes reported were glycated haemoglobin, serum Vitamin C and E levels, and self-reported psychological symptoms (one trial each). Reminder packing may represent a simple method for improving adherence for patients with selected conditions examined to date. Further research is warranted to improve the design and targeting of these devices.

Preliminary study of the reliability of imaging charge coupled devices

NASA Technical Reports Server (NTRS)

Beall, J. R.; Borenstein, M. D.; Homan, R. A.; Johnson, D. L.; Wilson, D. D.; Young, V. F.

1978-01-01

Imaging CCDs are capable of low light level response and high signal-to-noise ratios. In space applications they offer the user the ability to achieve extremely high resolution imaging with minimum circuitry in the photo sensor array. This work relates the CCD121H Fairchild device to the fundamentals of CCDs and the representative technologies. Several failure modes are described, construction is analyzed and test results are reported. In addition, the relationship of the device reliability to packaging principles is analyzed and test data presented. Finally, a test program is defined for more general reliability evaluation of CCDs.

Quality assessment of two- and three-dimensional unstructured meshes and validation of an upwind Euler flow solver

NASA Technical Reports Server (NTRS)

Woodard, Paul R.; Yang, Henry T. Y.; Batina, John T.

1992-01-01

Quality assessment procedures are described for two-dimensional and three-dimensional unstructured meshes. The procedures include measurement of minimum angles, element aspect ratios, stretching, and element skewness. Meshes about the ONERA M6 wing and the Boeing 747 transport configuration are generated using an advancing front method grid generation package of programs. Solutions of Euler's equations for these meshes are obtained at low angle-of-attack, transonic conditions. Results for these cases, obtained as part of a validation study demonstrate the accuracy of an implicit upwind Euler solution algorithm.

Scientific Toy

NASA Technical Reports Server (NTRS)

1989-01-01

Tensegritoy, inspired by the tensegrity concepts of R. Buckminster Fuller, is an erector set like toy designed to give students an understanding of structural stability. It is used by children, architects, engineers, and teachers. The manufacturer, Tensegrity Systems Corporation, also offers a collapsible point of purchase display which incorporates technology developed for space station trusses described in "NASA Tech Briefs." The tech brief described deployable trusses that can be collapsed into small packages for space shuttle transport, then unfolded in space. As a result, the display occupies a minimum amount of floor space, freight cost savings are substantial and assembly can be completed quickly.

Food system galley for Space Shuttle

NASA Technical Reports Server (NTRS)

Murray, R. W.; Hunt, S. R.; Sauer, R. L.; Turner, T. R.

1979-01-01

The Galley, a 42 man-day meal preparation facility (with flexibility to accomodate 210 man-days) is described. The facility is designed for minimum meal preparation and clean-up time in zero g and ease of servicing, maintenance, and removal in one gravity. The Galley provides a centralized location for performing all of the food-related functions (except dining) within the orbiter. Consideration is given to the oven-water heater, personal hygiene station, water dispensers, and water supply subsystem. The Galley is positioned in the orbiting mid deck, interfacing with rehydratable food packages and the waste collector subsystem.

Volume reduction of hot cell plastic wastes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dykes, F W; Henscheid, J P; Lewis, L C

1989-09-19

The disposal of radioactively-contaminated solid wastes has become a national crisis. In such circumstances, it is imperative that this waste be reduced to minimum volume and be packaged to prevent pollution of the environment. The majority of the solid waste generated at the hot cell under consideration is plastic lab ware. Cutting this waste into small pieces with a hot wire technique reduced the volume 66%. Melting the waste, although more time consuming, reduced the volume 90%. The hot wire technique can also be used to cut up damaged master slave manipulator boots, greatly reducing their disposal volume.

Minimum Hamiltonian ascent trajectory evaluation (MASTRE) program (update to automatic flight trajectory design, performance prediction, and vehicle sizing for support of shuttle and shuttle derived vehicles) users manual

NASA Technical Reports Server (NTRS)

Lyons, J. T.; Borchers, William R.

1993-01-01

Documentation for the User Interface Program for the Minimum Hamiltonian Ascent Trajectory Evaluation (MASTRE) is provided. The User Interface Program is a separate software package designed to ease the user input requirements when using the MASTRE Trajectory Program. This document supplements documentation on the MASTRE Program that consists of the MASTRE Engineering Manual and the MASTRE Programmers Guide. The User Interface Program provides a series of menus and tables using the VAX Screen Management Guideline (SMG) software. These menus and tables allow the user to modify the MASTRE Program input without the need for learning the various program dependent mnemonics. In addition, the User Interface Program allows the user to modify and/or review additional input Namelist and data files, to build and review command files, to formulate and calculate mass properties related data, and to have a plotting capability.

Advanced Disease at Enrollment in HIV Care in Four Sub-Saharan African Countries: Change from 2006-2011 and Multi-Level Predictors in 2011

PubMed Central

Hoffman, Susie; Wu, Yingfeng; Lahuerta, Maria; Kulkarni, Sarah Gorrell; Nuwagaba-Biribonwoha, Harriet; Sadr, Wafaa El; Remien, Robert H.; Mugisha, Veronicah; Hawken, Mark; Chuva, Ema; Nash, Denis; Elul, Batya

2015-01-01

Objectives To examine changes between 2006 and 2011 in the proportion of HIV-positive patients newly-enrolled in HIV care with advanced disease and the median CD4+ cell count at enrollment; and identify patient-, facility-, and contextual-level factors associated with late enrollment in care in 2011. Design Cross sectional over time. Methods For time trends analyses, routinely-collected patient-level data (307,110 adults newly-enrolled in 138 HIV clinical care facilities) in Kenya, Mozambique, Rwanda and Tanzania; and for analyses of correlates, patient-level data (46,201 in 195 facilities), and facility- and population-level survey data were used. Late enrollment was defined as CD4+ count ≤350 cells/μl and/or WHO clinical stage 3/4. Results Late enrollment declined from 69.9% to 57.2%, (p<0.0001); median CD4+ count increased from 242 to 292 cells/μL (ptrend<0.0001). In 2011, risk of late enrollment was significantly higher for men and non-pregnant women vs. pregnant women; patients aged >25 vs. 15-25 years; non-married vs. married; and those entering from sites other than prevention of mother to child transmission (PMTCT). More extensive HIV testing coverage in the region of a facility was significantly associated with lower risk of late enrollment. Conclusions Despite improvement, in 2011, 57% of patients entered HIV care already ART-eligible. The lower risk of late enrollment among those referred from PMTCT and in regions where HIV testing coverage was higher suggests that innovative approaches to rapidly increase testing uptake among people living with HIV prior to the development of symptoms have the potential to reduce late enrollment in care. PMID:25136842

Maternal Combination Antiretroviral Therapy is Associated with Improved Retention of HIV-Exposed Infants in Kinshasa, Democratic Republic of Congo

PubMed Central

FEINSTEIN, Lydia; EDMONDS, Andrew; OKITOLONDA, Vitus; COLE, Stephen R; VAN RIE, Annelies; CHI, Benjamin H; NDJIBU, Papy; LUSIAMA, Jean; CHALACHALA, Jean Lambert; BEHETS, Frieda

2015-01-01

Background Programs to prevent mother-to-child HIV transmission (PMTCT) are plagued by loss to follow-up (LTFU) of HIV-exposed infants. We assessed if providing combination antiretroviral therapy (cART) to HIV-infected mothers was associated with reduced LTFU of their HIV-exposed infants in Kinshasa, DR Congo. Methods We constructed a cohort of mother-infant pairs using routinely collected clinical data. Maternal cART eligibility was based on national guidelines in effect at the time. Infants were considered LTFU following three failed tracking attempts after a missed visit or if more than six months passed since they were last seen in clinic. Statistical methods accounted for competing risks (e.g. death). Results 1318 infants enrolled at a median age of 2.6 weeks (interquartile range [IQR]: 2.1-6.9), at which point 24% of mothers were receiving cART. Overall, 5% of infants never returned to care following enrollment and 18% were LTFU by 18 months. The 18-month cumulative incidence of LTFU was 8% among infants whose mothers initiated cART by infant enrollment and 20% among infants whose mothers were not yet on cART. Adjusted for baseline factors, infants whose mothers were not on cART were over twice as likely to be LTFU, with a subdistribution hazard ratio of 2.75 (95% confidence limit: 1.81, 4.16). The association remained strong regardless of maternal CD4 count at infant enrollment. Conclusion Increasing access to cART for pregnant women could improve retention of HIV-exposed infants, thereby increasing the clinical and population-level impacts of PMTCT interventions and access to early cART for HIV-infected infants. PMID:25886922

Fertility desires predictors among people living with HIV/AIDS at art care centers of two teaching hospitals in Addis Ababa.

PubMed

Negash, Shiferaw; Yusuf, Lukman; Tefera, Mengistu

2013-01-01

Studies from different contexts worldwide in both developed and developing countries in the era of wide access to antiretroviral drugs indicate that many HIV positive individuals continue to exhibit high risk sexual behaviors, fertility intentions being one of the many characteristics. Identify the level and determinants of fertility desire among people living with HIV/AIDS (PLWHAs) at antiretroviral treatment (ART) centers. A cross-sectional study was conducted on randomly sampled, 396 PLWHAs. Odds ratio along with 95% confidence intervals were used to measure the association of the study variables with the outcome variable. The majority of respondents were females, 330 (83.3%), and 224 (56.6%) were in the age category of 25-35 years with the mean age of 33.5 +/- 6.61 years. From a total of 396 study subjects interviewed, 172 (43.3%) desired to have children in the future, out of which 123 (71.5%) stated positively that they intended to give birth in the near future, and of these 33 (26.8%) had taken action and are currently pregnant. CD4 count above 350/mm3, partner's desire to have a child, life time history of not having live births and number of alive children are the most important predictors of fertility desire reported in this survey. Fertility desire remains to be high. This will pose serious challenges in areas of high HIV prevalence, like Ethiopia, on the implementation of the PMTCT programs. The strong predictors of fertility desire found in our study on the other hand can be used by policy makers, planners, and health service providers in the planning and implementation of the PMTCT programs. We suggest a large scale studies to be undertaken in the future.

The use of routine monitoring and evaluation systems to assess a referral model of family planning and HIV service integration in Nigeria.

PubMed

Chabikuli, Nzapfurundi O; Awi, Dorka D; Chukwujekwu, Ogo; Abubakar, Zubaida; Gwarzo, Usman; Ibrahim, Mohammed; Merrigan, Mike; Hamelmann, Christoph

2009-11-01

To measure changes in service utilization of a model integrating family planning with HIV counselling and testing (HCT), antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in the Nigerian public health facilities. It is a retrospective survey of attendance and family planning commodity uptake in 71 health facilities in Nigeria that analyzes the preintegration and postintegration periods between March 2007 and January 2009. A prepost retrospective comparison of mean attendance at family planning clinics and couple-years of protection (CYP) compared 6 months preintegration with 9 months postintegration period. An analysis of service ratios was conducted, relating completed referrals at family planning clinics to service utilization at the referring HIV clinics. Mean attendance at family planning clinics increased significantly from 67.6 in preintegration to 87.0 in postintegration. The mean CYP increased significantly from 32.3 preintegration to 38.2 postintegration. Service ratio of referrals from each of the HIV clinics was low but increased in the postintegration period by 4, 34 and 42 per 1000 clients from HCT, ART and PMTCT clinics, respectively. Service ratios were higher in primary healthcare settings than in secondary or tertiary hospitals. Attendance by men at family planning clinics was significantly higher among clients referred from HIV clinics. Family planning-HIV integration using the referral model improved family planning service utilization by clients accessing HIV services, but further improvement is possible. Male utilization of family planning services also improved. The government of Nigeria should review the family planning user fee policy and scale up the integration in primary healthcare facilities.

[Initial evaluation of a programme to prevent mother-to-child transmission of human immunodeficiency virus infection in Equatorial Guinea].

PubMed

Badillo-Navarro, Katie; Prieto-Tato, Luis; Obiang-Esomoyo, Jacinta; Avedillo-Jiménez, Pedro; Vargas-Brizuela, Antonio; Rojo-Conejo, Pablo

2014-01-01

The prevalence of human immunodeficiency virus (HIV)-infected pregnant women in Equatorial Guinea (EG) has been reported as 7.3%. In 2008 an updated version of the PMTCT protocol was accepted according to the current WHO guidelines. The aim of this study was to describe the characteristics and outcome of children exposed to HIV after the introduction of the protocol. A retrospective review was conducted on the clinical characteristics of the infants born to HIV-infected mothers in the Hospital Regional de Bata and Primary Health Care Centre Maria Rafols in Bata (EG) between June 2008 and November 2011. The diagnosis of HIV infection in children was based on rapid serology tests. A total of 103 children were included, of which 47 were males. Fifty three patients (51%) completed the follow-up (51%). Fourteen children (26%) were diagnosed with HIV infection (11 presumptive diagnosis, 3 due to persistence of antibodies at 18 months). Six children (12%) died before a definitive diagnosis. Just over than half (52%) of mothers received antiretroviral therapy (ART) during pregnancy. The transmission rate in children whose mothers received ART was 16% (3/19), compared with 43% (10/23) in children whose mothers did not receive it. Only one child was infected (8%) when the mother received ART, and child received postnatal prophylaxis. The PMTCT protocol compliance was still very low. Antiretroviral therapy in pregnant women decreased the rate of vertical transmission, but the rate still remains very high. Many children were lost to follow-up. Strategies to prevent loss to follow-up and methods for earlier virological diagnostic are needed. Copyright © 2012 Elsevier España, S.L. All rights reserved.

[Early diagnosis of human immunodeficiency virus-1 in infants: The prevention of mother-to-child transmission program in Equatorial Guinea].

PubMed

Prieto-Tato, Luis Manuel; Vargas, Antonio; Álvarez, Patrícia; Avedillo, Pedro; Nzi, Eugenia; Abad, Carlota; Guillén, Sara; Fernández-McPhee, Carolina; Ramos, José Tomás; Holguín, África; Rojo, Pablo; Obiang, Jacinta

2016-11-01

Great efforts have been made in the last few years in order to implement the prevention of mother-to-child transmission (PMTCT) program in Equatorial Guinea (GQ). The aim of this study was to evaluate the rates of mother-to-child HIV transmission based on an HIV early infant diagnosis (EID) program. A prospective observational study was performed in the Regional Hospital of Bata and Primary Health Care Centre Maria Rafols, Bata, GQ. Epidemiological, clinical, and microbiological characteristics of HIV-1-infected mothers and their exposed infants were recorded. Dried blood spots (DBS) for HIV-1 EID were collected from November 2012 to December 2013. HIV-1 genome was detected using Siemens VERSANT HIV-1 RNA 1.0 kPCR assay. Sixty nine pairs of women and infants were included. Sixty women (88.2%) had WHO clinical stage 1. Forty seven women (69.2%) were on antiretroviral treatment during pregnancy. Forty five infants (66.1%) received postnatal antiretroviral prophylaxis. Age at first DBS analysis was 2.4 months (IQR 1.2-4.9). One infant died before a HIV-1 diagnosis could be ruled out. Two infants were HIV-1 infected and started HAART before any symptoms were observed. The rate of HIV-1 transmission observed was 2.9% (95%CI 0.2-10.5). The PMTCT rate was evaluated for the first time in GQ based on EID. EID is the key for early initiation of antiretroviral therapy and to reduce the mortality associated with HIV infection. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

HIV testing among pregnant women living with HIV in India: are private healthcare providers routinely violating women's human rights?

PubMed

Madhivanan, Purnima; Krupp, Karl; Kulkarni, Vinay; Kulkarni, Sanjeevani; Vaidya, Neha; Shaheen, Reshma; Philpott, Sean; Fisher, Celia

2014-03-24

In India, approximately 49,000 women living with HIV become pregnant and deliver each year. While the government of India has made progress increasing the availability of prevention of mother-to-child transmission of HIV (PMTCT) services, only about one quarter of pregnant women received an HIV test in 2010, and about one-in-five that were found positive for HIV received interventions to prevent vertical transmission of HIV. Between February 2012 to March 2013, 14 HIV-positive women who had recently delivered a baby were recruited from HIV positive women support groups, Government of India Integrated Counseling and Testing Centers, and nongovernmental organizations in Mysore and Pune, India. In-depth interviews were conducted to examine their general experiences with antenatal healthcare; specific experiences around HIV counseling and testing; and perceptions about their care and follow-up treatment. Data were analyzed thematically using the human rights framework for HIV testing adopted by the United Nations and India's National AIDS Control Organization. While all of the HIV-positive women in the study received HIV and PMTCT services at a government hospital or antiretroviral therapy center, almost all reported attending a private clinic or hospital at some point in their pregnancy. According to the participants, HIV testing often occurred without consent; there was little privacy; breaches of confidentiality were commonplace; and denial of medical treatment occurred routinely. Among women living with HIV in this study, violations of their human rights occurred more commonly in private rather than public healthcare settings. There is an urgent need for capacity building among private healthcare providers to improve standards of practice with regard to informed consent process, HIV testing, patient confidentiality, treatment, and referral of pregnant women living with HIV.

The potential role of mother-in-law in prevention of mother-to-child transmission of HIV: a mixed methods study from the Kilimanjaro region, northern Tanzania.

PubMed

Falnes, Eli Fjeld; Moland, Karen Marie; Tylleskär, Thorkild; de Paoli, Marina Manuela; Leshabari, Sebalda Charles; Engebretsen, Ingunn M S

2011-07-12

In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT) service utilization and adherence to infant feeding guidelines. The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored.

HIV and the Millennium Development Goals.

PubMed

Prendergast, Andrew J; Essajee, Shaffiq; Penazzato, Martina

2015-02-01

Millennium Development Goal (MDG) 6 has two HIV/AIDS commitments: to have halted and begun to reverse the spread of HIV/AIDS by 2015 and to ensure access to treatment among all those in need by 2010. Given the almost universal lack of access to HIV testing, prevention and treatment for children in high prevalence countries in 2000, the achievements of the past 15 years have been extraordinary, fuelled by massive donor investment, strong political commitment and ambitious global targets; however, MDG 6 is some way from being attained. Prevention of mother-to-child transmission (PMTCT) services have expanded enormously, with new infections among children falling by 58% between 2002 and 2013. There has been a shift towards initiation of lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women, although low HIV testing rates in pregnancy, suboptimal PMTCT coverage and poor retention in care remain barriers to achieving HIV elimination among children. Early infant diagnosis has expanded substantially but, in 2013, only 44% of all HIV-exposed infants were tested before 2 months of age. Diagnosis of HIV, therefore, frequently occurs late, leading to delays in ART initiation. By the end of 2013, approximately 760 000 children were receiving ART, leading to 40% decline in AIDS-related mortality. However, only 24% of HIV-infected children were receiving ART, compared with 36% of adults, leading to a 'treatment gap'. In this review, we summarise progress and remaining challenges in reaching MDG 6 and discuss future strategies to achieve the ambitious goals of paediatric HIV elimination and universal access to treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The potential role of mother-in-law in prevention of mother-to-child transmission of HIV: a mixed methods study from the Kilimanjaro region, northern Tanzania

PubMed Central

2011-01-01

Background In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT) service utilization and adherence to infant feeding guidelines. Methods The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. Results The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Conclusions Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored. PMID:21749685

The incremental cost of switching from Option B to Option B+ for the prevention of mother-to-child transmission of HIV

PubMed Central

Shaffer, Nathan; Sangrujee, Nalinee; Abimbola, Taiwo O

2014-01-01

Abstract Objective To estimate the incremental cost over 5 years of a policy switch from the Option B to the Option B+ protocol for the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV). Methods Data from cost studies and other published sources were used to determine the cost, per woman and per cohort (1000 breastfeeding and 1000 non-breastfeeding women), of switching from Option B (maternal triple antiretroviral [ARV] regimen during pregnancy and breastfeeding plus daily nevirapine for the infant for 6 weeks) to Option B+ (maternal triple ARV regimen initiated during pregnancy and continued for life). The variables used to model the different scenarios were maternal CD4+ T lymphocyte (CD4+ cell) count (350–500 versus > 500 cells/µl), rate of decline in CD4+ cells (average, rapid, slow), breastfeeding status (yes, no) and breastfeeding duration (12, 18 or 24 months). Findings For women with CD4+ cell counts of 350–500 cells/µl, the incremental cost per 1000 women was 157 345 United States dollars (US$) for breastfeeding women and US$ 92 813 for non-breastfeeding women. For women with CD4+ cell counts > 500 cells/µl, the incremental cost per 1000 women ranged from US$ 363 443 to US$ 484 591 for breastfeeding women and was US$ 605 739 for non-breastfeeding women. Conclusion From a cost perspective, a policy switch from Option B to Option B+ is feasible in PMTCT programme settings where resources are currently being allocated to Option B. PMID:24700975

Factors influencing postnatal Option B+ participation and breastfeeding duration among HIV-positive women in Lilongwe District, Malawi: A qualitative study.

PubMed

Flax, Valerie L; Hamela, Gloria; Mofolo, Innocent; Hosseinipour, Mina C; Hoffman, Irving F; Maman, Suzanne

2017-01-01

To ensure the health of mothers and children, prevention of mother-to-child HIV transmission (PMTCT) programs test women for HIV, engage HIV-positive women in care, and promote recommended breastfeeding practices. Under Malawi's Option B+ PMTCT program, ~20% of women are lost-to-follow-up (LTFU) and little is known about their breastfeeding practices. The purpose of this study is to describe facilitators and barriers to Option B+ participation and how participation influences breastfeeding duration. We conducted in-depth interviews with HIV-positive women in Option B+ (n = 32) or LTFU from Option B+ (n = 32). They were recruited from four government clinics in Lilongwe District and had a child aged 0-23 months. Women in Option B+ had better disclosure experiences and more social support than LTFU women. The most common reasons for LTFU were fear of HIV disclosure, anticipated or experienced stigma, and insufficient social support. Other reasons included: non-acceptance of HIV status, antiretroviral therapy (ART) side effects, lack of funds for transport, and negative experiences with clinic staff. Worries about possible transmission, even while on ART, influenced timing of weaning for some women in Option B+. Despite their knowledge of the risk of HIV transmission to the child, most LTFU women continued to breastfeed after stopping ART because they considered breastmilk to be an important source of nutrients for the child. Given that HIV-positive Malawian women LTFU from Option B+ breastfeed in the absence of ART, efforts are needed to use evidence-based strategies to address the barriers to Option B+ participation and avert preventable transmission through breastmilk.

Increasing access to prevention of mother-to-child transmission of HIV services through the private sector in Uganda.

PubMed

Mbonye, A K; Hansen, K S; Wamono, F; Magnussen, P

2009-12-01

To explore whether private midwives can perform HIV counselling and testing, provide antiretroviral treatment and contraceptives, and how this affects access to services especially among young and HIV-positive women. A formative study was conducted between January and April 2009 to assess care-seeking practices and perceptions on the prevention of mother-to-child transmission (PMTCT) and family planning services in Wakiso district, central Uganda. A household survey supplemented by 12 focus group discussions and 66 key informant interviews was carried out between January and April 2009. 10,706 women, mean age 25.8 years (14-49 years) were interviewed. The majority of women, 4786 (57%) were in the lowest wealth quintile; 62.0% were not using family planning (p<0.000); 56.2% did not access HIV counselling and testing because they feared knowing their HIV status (p<0.013), while 66.5% feared spouses knowing their HIV status (p<0.013). Access to these services among the young women and those with no education was also poor. Private midwives provide HIV testing to 7.8% of their clients; 5.9% received antiretroviral drugs and 8.6% received contraceptives. Client satisfaction with services at private midwifery practices was high. Private midwives are trusted and many clients confide in them. An intervention through private midwives was perceived to improve access because of short distances and no transport costs. Adolescents prioritized confidentiality, while subsidizing costs, community sensitisation and focusing on male spouses were overwhelmingly recommended. Private midwives clinics are potential delivery outlets for PMTCT in Uganda. A well-designed intervention linking them to the public sector and the community could increase access to services.

Facility-based delivery in the context of Zimbabwe's HIV epidemic--missed opportunities for improving engagement with care: a community-based serosurvey.

PubMed

Buzdugan, Raluca; McCoy, Sandra I; Webb, Karen; Mushavi, Angela; Mahomva, Agnes; Padian, Nancy S; Cowan, Frances M

2015-12-17

In developing countries, facility-based delivery is recommended for maternal and neonatal health, and for prevention of mother-to-child HIV transmission (PMTCT). However, little is known about whether or not learning one's HIV status affects one's decision to deliver in a health facility. We examined this association in Zimbabwe. We analyzed data from a 2012 cross-sectional community-based serosurvey conducted to evaluate Zimbabwe's accelerated national PMTCT program. Eligible women (≥16 years old and mothers of infants born 9-18 months before the survey) were randomly sampled from the catchment areas of 157 health facilities in five of ten provinces. Participants were interviewed about where they delivered and provided blood samples for HIV testing. Overall 8796 (77 %) mothers reported facility-based delivery; uptake varied by community (30-100%). The likelihood of facility-based delivery was not associated with maternal HIV status. Women who self-reported being HIV-positive before delivery were as likely to deliver in a health facility as women who were HIV-negative, irrespective of when they learned their status - before (adjusted prevalence ratio (PRa) = 1.04, 95% confidence interval (CI) = 1.00-1.09) or during pregnancy (PRa = 1.05, 95% CI = 1.01-1.09). Mothers who had not accessed antenatal care or tested for HIV were most likely to deliver outside a health facility (69%). Overall, however 77% of home deliveries occurred among women who had accessed antenatal care and were HIV-tested. Uptake of facility-based delivery was similar among HIV-infected and HIV-uninfected mothers, which was somewhat unexpected given the substantial technical and financial investment aimed at retaining HIV-positive women in care in Zimbabwe.

The contribution of maternal HIV seroconversion during late pregnancy and breastfeeding to mother-to-child transmission of HIV

PubMed Central

Johnson, Leigh F.; Stinson, Kathryn; Newell, Marie-Louise; Bland, Ruth M.; Moultrie, Harry; Davies, Mary-Ann; Rehle, Thomas M.; Dorrington, Rob E.; Sherman, Gayle G.

2012-01-01

Background The prevention of mother-to-child transmission (PMTCT) of HIV has been focused mainly on women who are HIV-positive at their first antenatal visit, but there is uncertainty regarding the contribution to overall transmission from mothers who seroconvert after their first antenatal visit and before weaning. Method A mathematical model was developed to simulate changes in mother-to-child transmission of HIV over time, in South Africa. The model allows for changes in infant feeding practices as infants age, temporal changes in the provision of antiretroviral prophylaxis and counselling on infant feeding, as well as temporal changes in maternal HIV prevalence and incidence. Results The proportion of MTCT from mothers who seroconverted after their first antenatal visit was 26% (95% CI: 22-30%) in 2008, or 15 000 out of 57 000 infections. It is estimated that by 2014, total MTCT will reduce to 39 000 per annum, and transmission from mothers seroconverting after their first antenatal visit will reduce to 13 000 per annum, accounting for 34% (95% CI: 29-39%) of MTCT. If maternal HIV incidence during late pregnancy and breastfeeding were reduced by 50% after 2010, and HIV screening were repeated in late pregnancy and at 6-week immunization visits after 2010, the average annual number of MTCT cases over the 2010-15 period would reduce by 28% (95% CI: 25-31%), from 39 000 to 28 000 per annum. Conclusion Maternal seroconversion during late pregnancy and breastfeeding contributes significantly to the paediatric HIV burden, and needs greater attention in the planning of PMTCT programmes. PMID:22193774

Fast segmentation and high-quality three-dimensional volume mesh creation from medical images for diffuse optical tomography

NASA Astrophysics Data System (ADS)

Jermyn, Michael; Ghadyani, Hamid; Mastanduno, Michael A.; Turner, Wes; Davis, Scott C.; Dehghani, Hamid; Pogue, Brian W.

2013-08-01

Multimodal approaches that combine near-infrared (NIR) and conventional imaging modalities have been shown to improve optical parameter estimation dramatically and thus represent a prevailing trend in NIR imaging. These approaches typically involve applying anatomical templates from magnetic resonance imaging/computed tomography/ultrasound images to guide the recovery of optical parameters. However, merging these data sets using current technology requires multiple software packages, substantial expertise, significant time-commitment, and often results in unacceptably poor mesh quality for optical image reconstruction, a reality that represents a significant roadblock for translational research of multimodal NIR imaging. This work addresses these challenges directly by introducing automated digital imaging and communications in medicine image stack segmentation and a new one-click three-dimensional mesh generator optimized for multimodal NIR imaging, and combining these capabilities into a single software package (available for free download) with a streamlined workflow. Image processing time and mesh quality benchmarks were examined for four common multimodal NIR use-cases (breast, brain, pancreas, and small animal) and were compared to a commercial image processing package. Applying these tools resulted in a fivefold decrease in image processing time and 62% improvement in minimum mesh quality, in the absence of extra mesh postprocessing. These capabilities represent a significant step toward enabling translational multimodal NIR research for both expert and nonexpert users in an open-source platform.

Packaged FBG sensors for real-time stress monitoring on deep-water riser

NASA Astrophysics Data System (ADS)

Xu, Jian; Yang, Dexing; Jiang, Yajun; Wang, Meirong; Zhai, Huailun; Bai, Yang

2014-11-01

The safety of under-water risers in drilling platform is of great significance. A packaged fiber Bragg grating (FBG) sensor for real-time stress monitoring is designed for the applications on oil drilling risers under 3000 meters deep water. A copper tube which is the main component of the sensor has a small hole along its axes and a groove at its each end. The bare FBG is passed through the small hole and fixed to its ends by epoxy resin. Then the copper tube is packaged by filling the groove with structural adhesive. In order to avoid that the outer water-pressure is applied on the epoxy resin through the structural adhesive, a gap between the two types of glues is left. The relationships between the stress of the riser and the tension, pressure, temperature of the single sensor are discussed, respectively. The measured tension sensitivity is 136.75 pm/KN while the minimum R-square value is 0.99997. The experimental results also show that there is a good linear response between water-pressure and the Bragg wavelength from 0 to 30MPa, and the sensor can even survive under the pressure more than 30MPa. In addition, the Bragg wavelength shifts linearly with the increasing temperature from 0 to 40°C. So, the pressure and temperature can be easily compensated if another sensor without tension is used.

The Supertree Toolkit 2: a new and improved software package with a Graphical User Interface for supertree construction.

PubMed

Hill, Jon; Davis, Katie E

2014-01-01

Building large supertrees involves the collection, storage, and processing of thousands of individual phylogenies to create large phylogenies with thousands to tens of thousands of taxa. Such large phylogenies are useful for macroevolutionary studies, comparative biology and in conservation and biodiversity. No easy to use and fully integrated software package currently exists to carry out this task. Here, we present a new Python-based software package that uses well defined XML schema to manage both data and metadata. It builds on previous versions by 1) including new processing steps, such as Safe Taxonomic Reduction, 2) using a user-friendly GUI that guides the user to complete at least the minimum information required and includes context-sensitive documentation, and 3) a revised storage format that integrates both tree- and meta-data into a single file. These data can then be manipulated according to a well-defined, but flexible, processing pipeline using either the GUI or a command-line based tool. Processing steps include standardising names, deleting or replacing taxa, ensuring adequate taxonomic overlap, ensuring data independence, and safe taxonomic reduction. This software has been successfully used to store and process data consisting of over 1000 trees ready for analyses using standard supertree methods. This software makes large supertree creation a much easier task and provides far greater flexibility for further work.

A nutrient profiling assessment of packaged foods using two star-based front-of-pack labels.

PubMed

Carrad, Amy M; Louie, Jimmy Chun Yu; Yeatman, Heather R; Dunford, Elizabeth K; Neal, Bruce C; Flood, Victoria M

2016-08-01

To compare two front-of-pack nutrition labelling systems for the assessment of packaged foods and drinks with Australian Dietary Guidelines. A cross-sectional nutrient profiling assessment. Food and drink products (n 20 225) were categorised into scoring levels using criteria for the Institute of Medicine (IOM) three-star system and the five-star Australian Health Star Rating (HSR). The effectiveness of these systems to categorise foods in accordance with Australian Dietary Guidelines was explored. The study was conducted in Australia, using a comprehensive food database. Packaged food and drink products (n 20 225) available in Australia. Using the IOM three-star system, the majority (55 %) of products scored the minimum 0 points and 25·5 % scored the maximum 3 points. Using HSR criteria, the greatest proportion of products (15·2 %) scored three-and-a-half stars from a possible five and 12·5 % received the lowest rating of a half-star. Very few products (4·1 %) scored five stars. Products considered core foods and drinks in Australian Dietary Guidelines received higher scores than discretionary foods in all food categories for both labelling systems (all P<0·05; Mann-Whitney U test), with the exception of fish products using IOM three-star criteria (P=0·603). The largest discrepancies in median score between the two systems were for the food categories edible oils, convenience foods and dairy. Both the IOM three-star and Australian HSR front-of-pack labelling systems rated packaged foods and drinks broadly in line with Australian Dietary Guidelines by assigning core foods higher ratings and discretionary foods lower ratings.

Influence of formulation and processing factors on stability of levothyroxine sodium pentahydrate.

PubMed

Collier, Jarrod W; Shah, Rakhi B; Gupta, Abhay; Sayeed, Vilayat; Habib, Muhammad J; Khan, Mansoor A

2010-06-01

Stability of formulations over shelf-life is critical for having a quality product. Choice of excipients, manufacturing process, storage conditions, and packaging can either mitigate or enhance the degradation of the active pharmaceutical ingredient (API), affecting potency and/or stability. The purpose was to investigate the influence of processing and formulation factors on stability of levothyroxine (API). The API was stored at long-term (25 degrees C/60%RH), accelerated (40 degrees C/75%RH), and low-humidity (25 degrees C/0%RH and 40 degrees C/0%RH) conditions for 28 days. Effect of moisture loss was evaluated by drying it (room temperature, N(2)) and placed at 25 degrees C/0%RH and 40 degrees C/0%RH. The API was incubated with various excipients (based on package insert of marketed tablets) in either 1:1, 1:10, or 1:100 ratios with 5% moisture at 60 degrees C. Commonly used ratios for excipients were used. The equilibrium sorption data was collected on the API and excipients. The API was stable in solid state for the study duration under all conditions for both forms (potency between 90% and 110%). Excipients effect on stability varied and crospovidone, povidone, and sodium laurel sulfate (SLS) caused significant API degradation where deiodination and deamination occurred. Moisture sorption values were different across excipients. Crospovidone and povidone were hygroscopic whereas SLS showed deliquescence at high RH. The transient formulation procedures where temperature might go up or humidity might go down would not have major impact on the API stability. Excipients influence stability and if possible, those three should either be avoided or used in minimum quantity which could provide more stable tablet formulations with minimum potency loss throughout its shelf-life.

Conformal Cryogenic Tank Trade Study for Reusable Launch Vehicles

NASA Technical Reports Server (NTRS)

Rivers, H. Kevin

1999-01-01

Future reusable launch vehicles may be lifting bodies with non-circular cross section like the proposed Lockheed-Martin VentureStar(tm). Current designs for the cryogenic tanks of these vehicles are dual-lobed and quad-lobed tanks which are packaged more efficiently than circular tanks, but still have low packaging efficiencies with large gaps existing between the vehicle outer mold line and the outer surfaces of the tanks. In this study, tanks that conform to the outer mold line of a non-circular vehicle were investigated. Four structural concepts for conformal cryogenic tanks and a quad-lobed tank concept were optimized for minimum weight designs. The conformal tank concepts included a sandwich tank stiffened with axial tension webs, a sandwich tank stiffened with transverse tension webs, a sandwich tank stiffened with rings and tension ties, and a sandwich tank stiffened with orthogrid stiffeners and tension ties. For each concept, geometric parameters (such as ring frame spacing, the number and spacing of tension ties or webs, and tank corner radius) and internal pressure loads were varied and the structure was optimized using a finite-element-based optimization procedure. Theoretical volumetric weights were calculated by dividing the weight of the barrel section of the tank concept and its associated frames, webs and tension ties by the volume it circumscribes. This paper describes the four conformal tank concepts and the design assumptions utilized in their optimization. The conformal tank optimization results included theoretical weights, trends and comparisons between the concepts, are also presented, along with results from the optimization of a quad-lobed tank. Also, the effects of minimum gauge values and non-optimum weights on the weight of the optimized structure are described in this paper.

Reversible rigid coupling apparatus and method for borehole seismic transducers

DOEpatents

Owen, Thomas E.; Parra, Jorge O.

1992-01-01

An apparatus and method of high resolution reverse vertical seismic profile (VSP) measurements is shown. By encapsulating the seismic detector and heaters in a meltable substance (such as wax), the seismic detector can be removably secured in a borehole in a manner capable of measuring high resolution signals in the 100 to 1000 hertz range and higher. The meltable substance is selected to match the overall density of the detector package with the underground formation, yet still have relatively low melting point and rigid enough to transmit vibrations to accelerometers in the seismic detector. To minimize voids in the meltable substance upon solidification, the meltable substance is selected for minimum shrinkage, yet still having the other desirable characteristics. Heaters are arranged in the meltable substance in such a manner to allow the lowermost portion of the meltable substance to cool and solidify first. Solidification continues upwards from bottom-to-top until the top of the meltable substance is solidified and the seismic detector is ready for use. To remove, the heaters melt the meltable substance and the detector package is pulled from the borehole.

RBioCloud: A Light-Weight Framework for Bioconductor and R-based Jobs on the Cloud.

PubMed

Varghese, Blesson; Patel, Ishan; Barker, Adam

2015-01-01

Large-scale ad hoc analytics of genomic data is popular using the R-programming language supported by over 700 software packages provided by Bioconductor. More recently, analytical jobs are benefitting from on-demand computing and storage, their scalability and their low maintenance cost, all of which are offered by the cloud. While biologists and bioinformaticists can take an analytical job and execute it on their personal workstations, it remains challenging to seamlessly execute the job on the cloud infrastructure without extensive knowledge of the cloud dashboard. How analytical jobs can not only with minimum effort be executed on the cloud, but also how both the resources and data required by the job can be managed is explored in this paper. An open-source light-weight framework for executing R-scripts using Bioconductor packages, referred to as `RBioCloud', is designed and developed. RBioCloud offers a set of simple command-line tools for managing the cloud resources, the data and the execution of the job. Three biological test cases validate the feasibility of RBioCloud. The framework is available from http://www.rbiocloud.com.

Evaluation of antimicrobial activity of silver nanoparticles for carboxymethylcellulose film applications in food packaging.

PubMed

Siqueira, Maria C; Coelho, Gustavo F; de Moura, Márcia R; Bresolin, Joana D; Hubinger, Silviane Z; Marconcini, José M; Mattoso, Luiz H C

2014-07-01

In this study, silver nanoparticles were prepared and incorporated into carboxymethylcellulose films to evaluate the antimicrobial activity for food packaging applications. The techniques carried out for material characterization were: infrared spectroscopy and thermal analysis for the silver nanoparticles and films, as well as particle size distribution for the nanoparticles and water vapor permeability for the films. The antimicrobial activity of silver nanoparticles prepared by casting method was investigated. The minimum inhibitory concentration (MIC) value of the silver nanoparticles to test Gram-positive (Enterococcus faecalis) and Gram-negative (Escherichia coli) microorganisms was carried out by the serial dilution technique, tested in triplicate to confirm the concentration used. The results were developed using the Mcfarland scale which indicates that the presence or absence of turbidity tube demonstrates the inhibition of bacteria in relation to the substance inoculated. It was found that the silver nanoparticles inhibited the growth of the tested microorganisms. The carboxymethylcellulose film embedded with silver nanoparticles showed the best antimicrobial effect against Gram-positive (E. faecalis) and Gram-negative (E. coli) bacteria (0.1 microg cm(-3)).

A federal tax credit to encourage employers to offer health coverage.

PubMed

Meyer, J A; Wicks, E K

2001-01-01

Many firms that employ low-wage workers cannot afford to offer an employee health plan, and many of the uninsured work for such firms. This article makes the case for an employer tax credit, administered by the Internal Revenue Service, as a way to extend health coverage to uninsured workers and their families. The permanent, fixed-dollar, refundable credit would be available to all low-wage employers (those with average wages of $10 per hour and less), including those already offering coverage. The credit would be graduated depending on average wage: the maximum credit would equal 50% of the cost of a standard benefit package; the minimum would equal 30% of the package. It also would vary by family size and could be used to cover part-time and temporary workers. Participating employers would be required to pay at least 50% of the health insurance premium, proof of which would be shown on firms' tax returns. The paper provides justification for this approach. It closes with a discussion of strengths and weaknesses of this approach and alternative design features.

A minimum price per unit of alcohol: A focus group study to investigate public opinion concerning UK government proposals to introduce new price controls to curb alcohol consumption

PubMed Central

2012-01-01

Background UK drinkers regularly consume alcohol in excess of guideline limits. One reason for this may be the high availability of low-cost alcoholic beverages. The introduction of a minimum price per unit of alcohol policy has been proposed as a means to reduce UK alcohol consumption. However, there is little in-depth research investigating public attitudes and beliefs regarding a minimum pricing policy. The aim of the present research was to investigate people’s attitudes and beliefs toward the introduction of a minimum price per unit of alcohol policy and their views on how the policy could be made acceptable to the general public. Methods Twenty-eight focus groups were conducted to gain in-depth data on attitudes, knowledge, and beliefs regarding the introduction of a minimum price per unit of alcohol policy. Participants (total N = 218) were asked to give their opinions about the policy, its possible outcomes, and how its introduction might be made more acceptable. Transcribed focus-group discussions were analysed for emergent themes using inductive thematic content analysis. Results Analysis indicated that participants’ objections to a minimum price had three main themes: (1) scepticism of minimum pricing as an effective means to reduce harmful alcohol consumption; (2) a dislike of the policy for a number of reasons (e.g., it was perceived to ‘punish’ the moderate drinker); and (3) concern that the policy might create or exacerbate existing social problems. There was a general perception that the policy was aimed at ‘problem’ and underage drinkers. Participants expressed some qualified support for the policy but stated that it would only work as part of a wider campaign including other educational elements. Conclusions There was little evidence to suggest that people would support the introduction of a minimum price per unit of alcohol policy. Scepticism about the effectiveness of the policy is likely to represent the most significant barrier to public support. Findings also suggest that clearer educational messages are needed to dispel misconceptions regarding the effectiveness of the policy and the introduction of the policy as part of a package of government initiatives to address excess alcohol consumption might be the best way to advance support for the policy. PMID:23174016

Lessons learned from the PMTCT program in Swaziland: challenges with accepting lifelong ART for pregnant and lactating women - a qualitative study.

PubMed

Katirayi, Leila; Chouraya, Caspian; Kudiabor, Kwashie; Mahdi, Mohammed Ali; Kieffer, Mary Pat; Moland, Karen Marie; Tylleskar, Thorkild

2016-10-24

Swaziland has one of the highest HIV prevalence rates in sub-Saharan Africa, 26 % of the adult population is infected with HIV. The prevalence is highest among pregnant women, at 41.1 %. According to Swaziland's prevention of mother-to-child transmission (PMTCT) guidelines, approximately 50 % of pregnant women are eligible for antiretroviral therapy (ART) by CD4 criteria (<350 cells/ml). Studies have shown that most mother-to-child transmission and postnatal deaths occur among women who are eligible for ART. Therefore, ensuring that ART eligible women are initiated on ART is critical for PMTCT and for mother and baby survival. This study provides insight into the challenges of lifelong ART initiation among pregnant women under Option A in Swaziland. We believe that these challenges and lessons learned from initiating women on lifelong ART under Option A are relevant and important to consider during implementation of Option B+. HIV-positive, treatment-eligible, postpartum women and nurses were recruited within maternal and child health (MCH) units using convenience and purposive sampling. Participants came from both urban and rural areas. Focus group discussions (FGDs) and structured interviews using a short answer questionnaire were conducted to gain an understanding of the challenges experienced when initiating lifelong ART. Seven FGDs (of 5-11 participants) were conducted, four FGDs with nurses, two FGDs with women who initiated ART, and one FGD with women who did not initiate ART. A total of 83 interviews were conducted; 50 with women who initiated ART and 33 with women who did not initiate. Data collection with the women was conducted in the local language of SiSwati and data collection with the nurses was done in English. FGDs were audio-recorded and simultaneously transcribed and translated into English. Analysis was conducted using thematic analysis. Transcripts were coded by two researchers in the qualitative software program MAXqda v.10. Thematic findings were illustrated using verbatim quotes which were selected on the basis of being representative of a specific theme. The short-answer interview questionnaire included specific questions about the different steps in the woman's experience initiating ART; therefore the responses for each question were analyzed separately. Findings from the study highlight women feeling overwhelmed by the lifetime commitment of ART, feeling "healthy" when asked to initiate ART, preference for short-course prophylaxis and fear of side effects (body changes). Also, the preference for nurses to determine on an individual basis the number of counseling appointments a woman needs before initiating ART, more information about HIV and ART needed at the community level, and the need to educate men about HIV and ART. Women face a myriad of challenges initiating lifelong ART. Understanding women's concerns will aid in developing effective counseling messages, designing appropriate counseling structures, understanding where additional support is needed in the process of initiating ART, and knowing who to target for community level messages.

Standard Engineering Installation Package, Standard Remote Terminals (SRT).

DTIC Science & Technology

1981-10-30

6L L o 0 100 BOLT // M 0 (NOTE 3) N o @ 12 P o 13 NOTE: USE MiTN SAAD-D-4053 AND 0 14 • STD-SD-00SS DWS. 1I USE 3(4 CONDUIT AND BOX CONN. PUNCH OUT 3/4...TERMINAL STRIP. USE # BOLT TO MOUNT CONNECTOR TO DLII. USE OG STD-SO-007 FOR TERMINAL STRIP TERMINA- TION TO 153 PATCH PANEL. *1 f DUS1 is not or’dered... BOLTED TO FLOOR AS PER DUG 3I ®STu-SD-OO69 PROVIDING THERE IS INO CROSS OVLR WITH POWER AND SIGNAL CABLES. CROSSOVER WILL BE SEPERATED BY 4" MINIMUM

SPSS and SAS programs for determining the number of components using parallel analysis and velicer's MAP test.

PubMed

O'Connor, B P

2000-08-01

Popular statistical software packages do not have the proper procedures for determining the number of components in factor and principal components analyses. Parallel analysis and Velicer's minimum average partial (MAP) test are validated procedures, recommended widely by statisticians. However, many researchers continue to use alternative, simpler, but flawed procedures, such as the eigenvalues-greater-than-one rule. Use of the proper procedures might be increased if these procedures could be conducted within familiar software environments. This paper describes brief and efficient programs for using SPSS and SAS to conduct parallel analyses and the MAP test.

New Developments in Nickel-Hydrogen Dependent Pressure Vessel (DPV) Cell and Battery Design

NASA Technical Reports Server (NTRS)

Caldwell, Dwight B.; Fox, Chris L.; Miller, Lee E.

1997-01-01

THe Dependent Pressure Vessel (DPV) Nickel-Hydrogen (NiH2) design is being developed as an advanced battery for military and commercial, aerospace and terrestrial applications. The DPV cell design offers high specific energy and energy density as well as reduced cost, while retaining the established Individual Pressure Vessel (IPV) technology flight heritage and database. This advanced DPV design also offers a more efficient mechanical, electrical and thermal cell and battery configuration and a reduced part count. The DPV battery design promotes compact, minimum volume packaging and weight efficiency, and delivers cost and weight savings with minimal design risk.

Comparison between Measured and Simulated Radiation Doses in the Matoroshka-R Spherical phantom Experiment#1 and Area Monitoring aboard International Space Station using PADLES from May - Sep. 2012

NASA Astrophysics Data System (ADS)

Nagamatsu, Aiko; Tolochek, Raisa; Shurshakov, Vyacheslav; Nikolaev, Igor; Tawara, Hiroko; Kitajo, Keiichi; Shimada, Ken

The measurement of radiation environmental parameters in space is essential to support radiation risk assessments for astronauts and establish a benchmark for space radiation models for present and future human space activities. Since Japanese Experiment Module ‘KIBO’ was attached to the International Space Station (ISS) in 2008, we have been performing continuous space radiation dosimetery using a PADLES (Passive Dosimeter for Life-Science Experiments in Space) consisting of CR-39 PNTDs (Plastic Nuclear track detectors) and TLD-MSOs (Mg2SiO4:Tb) for various space experiments onboard the ‘KIBO’ part of the ISS. The MATROSHKA-R experiments aims to verify of dose distributions in a human body during space flight. The phantom consists of tissue equivalent material covered by a poncho jacket with 32 pockets on the surface. 20 container rods with dosimeters can be struck into the spherical phantom. Its diameter is 370 mm and it is 32 kg in weight. The first experiment onboard the KIBO at Forward No.2 area (JPM1F2 Rack2) was conducted over 114 days from 21 May to 12 September 2012 (the installation schedule inside the phantom) on the way to solar cycle 24th upward curve. 16 PADLES packages were deployed into 16 poncho pockets on the surface of the spherical phantom. Another 12 PADLES packages were deployed inside 4 rods (3 packages per rod in the outer, middle and inner side). Area monitoring in the KIBO was conducted in the same period (Area PADLES series #8 from 15 May to 16 September, 2012). Absorbed doses were measured at 17 area monitoring points in the KIBO and 28 locations (16 packages in poncho pockets and 12 inside 4 rods) in the phantom. The maximum value measured with the PADLES in the poncho pockets on the surface of the spherical phantom facing the outer wall was 0.43 mGy/day and the minimum value measured with the PADLES in the poncho pockets on the surface of the spherical phantom facing the KIBO interior was 0.30 mGy/day. The maximum absorbed doses measured inside rods was 0.28 mGy/day and the minimum value was 0.19 mGy/day. This indicates doses measured from the dosimeters placed in the outer side of each rod are relatively high compared to the doses placed in the center of rod. At this time, we also would like to show the preliminary results of comparative study between measured and Simulated Radiation Doses using the Particle and Heavy Ion Transport code System (PHITS) calculations with well developed shielding model of the KIBO and numerical spherical phantom inside.

Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces, China.

PubMed

Ding, Yan; Smith, Helen J; Fei, Yang; Xu, Biao; Nie, Shaofa; Yan, Weirong; Diwan, Vinod K; Sauerborn, Rainer; Dong, Hengjin

2013-01-01

The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance. To understand village doctors' perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention. The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province. Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts. Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors.

The Supertree Toolkit 2: a new and improved software package with a Graphical User Interface for supertree construction

PubMed Central

2014-01-01

Abstract Building large supertrees involves the collection, storage, and processing of thousands of individual phylogenies to create large phylogenies with thousands to tens of thousands of taxa. Such large phylogenies are useful for macroevolutionary studies, comparative biology and in conservation and biodiversity. No easy to use and fully integrated software package currently exists to carry out this task. Here, we present a new Python-based software package that uses well defined XML schema to manage both data and metadata. It builds on previous versions by 1) including new processing steps, such as Safe Taxonomic Reduction, 2) using a user-friendly GUI that guides the user to complete at least the minimum information required and includes context-sensitive documentation, and 3) a revised storage format that integrates both tree- and meta-data into a single file. These data can then be manipulated according to a well-defined, but flexible, processing pipeline using either the GUI or a command-line based tool. Processing steps include standardising names, deleting or replacing taxa, ensuring adequate taxonomic overlap, ensuring data independence, and safe taxonomic reduction. This software has been successfully used to store and process data consisting of over 1000 trees ready for analyses using standard supertree methods. This software makes large supertree creation a much easier task and provides far greater flexibility for further work. PMID:24891820

Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach.

PubMed

Naimoli, Joseph F; Perry, Henry B; Townsend, John W; Frymus, Diana E; McCaffery, James A

2015-09-01

There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients' health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systems - the formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated. We explore a strategic community health system partnership as one approach to improving CHW programming and performance in countries with or intending to mount large-scale CHW programmes. To identify the components of the approach, we drew on a year-long evidence synthesis exercise on CHW performance, synthesis records, author consultations, documentation on large-scale CHW programmes published after the synthesis and other relevant literature. We also established inclusion and exclusion criteria for the components we considered. We examined as well the challenges and opportunities associated with implementing each component. We identified a minimum package of four strategies that provide opportunities for increased cooperation between communities and health systems and address traditional weaknesses in large-scale CHW programmes, and for which implementation is feasible at sub-national levels over large geographic areas and among vulnerable populations in the greatest need of care. We postulate that the CHW performance benefits resulting from the simultaneous implementation of all four strategies could outweigh those that either the health system or community could produce independently. The strategies are (1) joint ownership and design of CHW programmes, (2) collaborative supervision and constructive feedback, (3) a balanced package of incentives, and (4) a practical monitoring system incorporating data from communities and the health system. We believe that strategic partnership between communities and health systems on a minimum package of simultaneously implemented strategies offers the potential for accelerating progress in improving CHW performance at scale. Comparative, retrospective and prospective research can confirm the potential of these strategies. More experience and evidence on strategic partnership can contribute to our understanding of how to achieve sustainable progress in health with equity.

Robust Platinum Resistor Thermometer (PRT) Sensors and Reliable Bonding for Space Missions

NASA Technical Reports Server (NTRS)

Cucullu, Gordy C., III; Mikhaylov, Rebecca; Rajeshuni, Ramesham; Petkov, Mihail; Hills, David; Uribe, Jose; Okuno, James; De Los Santos, Greg

2013-01-01

Platinum resistance thermometers (PRTs) provide accurate temperature measurements over a wide temperature range and are used extensively on space missions due to their simplicity and linearity. A standard on spacecraft, PRTs are used to provide precision temperature control and vehicle health assessment. This paper reviews the extensive reliability testing of platinum resistor thermometer sensors (PRTs) and bonding methods used on the Mars Science Laboratory (MSL) mission and for the upcoming Soil Moisture Active Passive (SMAP) mission. During the Mars Exploration Rover (MER) mission, several key, JPL-packaged PRTs failed on those rovers prior to and within 1-Sol of landing due to thermally induced stresses. Similar failures can be traced back to other JPL missions dating back thirty years. As a result, MSL sought out a PRT more forgiving to the packaging configurations used at JPL, and extensively tested the Honeywell HRTS-5760-B-U-0-12 sensor to successfully demonstrate suitable robustness to thermal cycling. Specifically, this PRT was cycled 2,000 times, simulating three Martian winters and summers. The PRTs were bonded to six substrate materials (Aluminum 7050, treated Magnesium AZ231-B, Stainless Steel 304, Albemet, Titanium 6AL4V, and G-10), using four different aerospace adhesives--two epoxies and two silicones--that conformed to MSL's low out-gassing requirements. An additional epoxy was tested in a shorter environmental cycling test, when the need for a different temperature range adhesive was necessary for mobility and actuator hardware late in the fabrication process. All of this testing, along with electrostatic discharge (ESD) and destructive part analyses, demonstrate that this PRT is highly robust, and not subject to the failure of PRTs on previous missions. While there were two PRTs that failed during fabrication, to date there have been no in-flight PRT failures on MSL, including those on the Curiosity rover. Since MSL, the sensor has gone through a change in construction such that the manufacturer significantly restricts the minimum temperature. However, significant subsequent testing was performed with this new version of the part to show that it indeed is still robust to at least Mars minimum temperatures of -135(sup o)C. The additional completed testing will be described. This work has resulted in a successful sensor package qualification and a reliable bonding method suitable for use over large temperature extremes.

Robust Platinum Resistor Thermometer (PRT) Sensors and Reliable Bonding for Space Missions

NASA Technical Reports Server (NTRS)

Cucullu, Gordy C. III; Mikhaylov, Rebecca; Ramesham, Rajeshuni; Petkov, Mihail; Hills, David; Uribe, Jose; Okuno, James; De Los Santos, Greg

2013-01-01

Platinum resistance thermometers (PRTs) provide accurate temperature measurements over a wide temperature range and are used extensively on space missions due to their simplicity and linearity. A standard on spacecraft, PRTs are used to provide precision temperature control and vehicle health assessment. This paper reviews the extensive reliability testing of platinum resistor thermometer sensors (PRTs) and bonding methods used on the Mars Science Laboratory (MSL) mission and for the upcoming Soil Moisture Active Passive (SMAP) mission. During the Mars Exploration Rover (MER) mission, several key, JPL-packaged PRTs failed on those rovers prior to and within 1-Sol of landing due to thermally induced stresses. Similar failures can be traced back to other JPL missions dating back thirty years. As a result, MSL sought out a PRT more forgiving to the packaging configurations used at JPL, and extensively tested the Honeywell HRTS-5760-B-U-0-12 sensor to successfully demonstrate suitable robustness to thermal cycling. Specifically, this PRT was cycled 2,000 times, simulating three Martian winters and summers. The PRTs were bonded to six substrate materials (Aluminum 7050, treated Magnesium AZ231-B, Stainless Steel 304, Albemet, Titanium 6AL4V, and G-10), using four different aerospace adhesives--two epoxies and two silicones--that conformed to MSL's low out-gassing requirements. An additional epoxy was tested in a shorter environmental cycling test, when the need for a different temperature range adhesive was necessary for mobility and actuator hardware late in the fabrication process. All of this testing, along with electrostatic discharge (ESD) and destructive part analyses, demonstrate that this PRT is highly robust, and not subject to the failure of PRTs on previous missions. While there were two PRTs that failed during fabrication, to date there have been no in-flight PRT failures on MSL, including those on the Curiosity rover. Since MSL, the sensor has gone through a change in construction such that the manufacturer significantly restricts the minimum temperature. However, significant subsequent testing was performed with this new version of the part to show that it indeed is still robust to at least Mars minimum temperatures of -135 degrees Centigrade. The additional completed testing will be described. This work has resulted in a successful sensor package qualification and a reliable bonding method suitable for use over large temperature extremes

Post-flight Analysis of the Argon Filled Ion Chamber

NASA Technical Reports Server (NTRS)

Tai, H.; Goldhagen, P.; Jones, I. W.; Wilson, J. W.; Maiden, D. L.; Shinn, J. L.

2003-01-01

Atmospheric ionizing radiation is a complex mixture of primary galactic and solar cosmic rays and a multitude of secondary particles produced in collision with air nuclei. The first series of Atmospheric Ionizing Radiation (AIR) measurement flights on the NASA research aircraft ER-2 took place in June 1997. The ER-2 flight package consisted of fifteen instruments from six countries and were chosen to provide varying sensitivity to specific components. These AIR ER-2 flight measurements are to characterize the AIR environment during solar minimum to allow the continued development of environmental models of this complex mixture of ionizing radiation. This will enable scientists to study the ionizing radiation health hazard associated with the high-altitude operation of a commercial supersonic transport and to allow estimates of single event upsets for advanced avionics systems design. The argon filled ion chamber representing about 40 percent of the contributions to radiation risks are analyzed herein and model discrepancies for solar minimum environment are on the order of 5 percent and less. Other biologically significant components remain to be analyzed.

Algorithmic procedures for Bayesian MEG/EEG source reconstruction in SPM☆

PubMed Central

López, J.D.; Litvak, V.; Espinosa, J.J.; Friston, K.; Barnes, G.R.

2014-01-01

The MEG/EEG inverse problem is ill-posed, giving different source reconstructions depending on the initial assumption sets. Parametric Empirical Bayes allows one to implement most popular MEG/EEG inversion schemes (Minimum Norm, LORETA, etc.) within the same generic Bayesian framework. It also provides a cost-function in terms of the variational Free energy—an approximation to the marginal likelihood or evidence of the solution. In this manuscript, we revisit the algorithm for MEG/EEG source reconstruction with a view to providing a didactic and practical guide. The aim is to promote and help standardise the development and consolidation of other schemes within the same framework. We describe the implementation in the Statistical Parametric Mapping (SPM) software package, carefully explaining each of its stages with the help of a simple simulated data example. We focus on the Multiple Sparse Priors (MSP) model, which we compare with the well-known Minimum Norm and LORETA models, using the negative variational Free energy for model comparison. The manuscript is accompanied by Matlab scripts to allow the reader to test and explore the underlying algorithm. PMID:24041874

Rarity-weighted richness: a simple and reliable alternative to integer programming and heuristic algorithms for minimum set and maximum coverage problems in conservation planning.

PubMed

Albuquerque, Fabio; Beier, Paul

2015-01-01

Here we report that prioritizing sites in order of rarity-weighted richness (RWR) is a simple, reliable way to identify sites that represent all species in the fewest number of sites (minimum set problem) or to identify sites that represent the largest number of species within a given number of sites (maximum coverage problem). We compared the number of species represented in sites prioritized by RWR to numbers of species represented in sites prioritized by the Zonation software package for 11 datasets in which the size of individual planning units (sites) ranged from <1 ha to 2,500 km2. On average, RWR solutions were more efficient than Zonation solutions. Integer programming remains the only guaranteed way find an optimal solution, and heuristic algorithms remain superior for conservation prioritizations that consider compactness and multiple near-optimal solutions in addition to species representation. But because RWR can be implemented easily and quickly in R or a spreadsheet, it is an attractive alternative to integer programming or heuristic algorithms in some conservation prioritization contexts.

Physical and Thermal Structure of the Bishop Tuff, California

NASA Astrophysics Data System (ADS)

Wilson, C. J.; Hildreth, W.

2001-12-01

The 0.76 Ma Bishop Tuff, California, includes an ignimbrite constructed from a series of overlapping packages of material erupted sequentially and simultaneously from multiple sources around the ring fracture of Long Valley caldera (Wilson, C.J.N., Hildreth, W., 1997, Journal of Geology 105, 407-439). Exceptionally good continuous exposures of the ignimbrite in the walls of Owens Gorge to the east of Long Valley provide a cross-section through the east-side packages (Ig1E and Ig2E). We have measured 10 sections up the gorge walls to draw up a cross section of the ignimbrite down Owens Gorge, using lithic abundances and lithologies to define the physical eruptive packages and their subdivisions, and measurements of tuff bulk density (as an easily measured proxy for welding intensity) to define the thermal eruptive packages. The physically emplaced bodies of ignimbrite represent an overlapping, shingling suite of material such that successively later ignimbrite occurs most prominently farther away from source. Two major and two lesser zones of maximum density (welding) are present, the lower two (in Ig1Ea and lower Ig1Eb) in upper Owens Gorge, and the two most prominent (upper Ig1Eb and Ig2Eb) in middle and lower parts of the gorge. Welding fluctuations are controlled by bulk temperatures of individual batches of hotter and cooler material, but the intensity of the welding also depends on deposit thickness (i.e. load stress). Physically defined contacts between ignimbrite packages show that time breaks inferred to be of hours may not result in formation of any visible parting or flow unit boundary. Furthermore, positions of density (welding) minima between zones of higher density tuff do not coincide with horizons of stratigraphic significance. These observations lead to two conclusions. (1) The absence of clear partings or flow unit boundaries in an ignimbrite sequence is not diagnostic either of the material representing a single flow unit, or of the material being continuously progressively aggraded. (2) Use of the density (welding) minimum to locate the boundaries of cooling units and in measuring and modelling the emplacement and thermal history of compound cooling units may lead to errors.

DATA MANAGEMENT SYSTEM FOR MOBILE SATELLITE PROPAGATION DATA

NASA Technical Reports Server (NTRS)

Kantak, A. V.

1994-01-01

The "Data Management System for Mobile Satellite Propogation" package is a collection of FORTRAN programs and UNIX shell scripts designed to handle the huge amounts of data resulting from Mobile Satellite propogation experiments. These experiments are designed to assist in defining channels for mobile satellite systems. By understanding multipath fading characteristics of the channel, doppler effects, and blockage due to manmade objects as well as natural surroundings, characterization of the channel can be realized. Propogation experiments, then, are performed using a prototype of the system simulating the ultimate product environment. After the data from these experiments is generated, the researcher must access this data with a minimum of effort and to derive some standard results. The programs included in this package manipulate the data files generated by the NASA/JPL Mobile Satellite propogation experiment on an interactive basis. In the experiment, a transmitter operating at 869 MHz was carried to an altitude of 32Km by a stratospheric balloon. A vehicle within the line-of-sight of the transmitter was then driven around, splitting the incoming signal into I and Q channels, and sampling the resulting signal strength at 1000 samples per second. The data was collected at various antenna elavation angles and different times of day generating the ancillary data for the experiment. This package contains a program to convert the binary format of the data generated into standard ASCII format suitable for use with a wide variety of machine architectures. Also included is a UNIX shell-script designed to parse this ASCII file into those records of data that match the researcher's desired values for the ancillary data parameters. In addition, four FORTRAN programs are included to obtain standard quantities from the data. Quantities such as probability of signal level greater than or equal to a specified signal level, probability density of the signal levels, frequency of fade duration, and Fourier Transforms of the sampled data can be generated from the propogation experiment data. All programs in this package are written in either FORTRAN 77 or UNIX shell-scripts. The package does not include test data. The programs were developed in 1987 for use with a UNIX operating system on a DEC MicroVAX computer.

Availability, Price, and Packaging of Electronic Cigarettes and E-Liquids in Guatemala City Retailers.

PubMed

Chacon, Violeta; Arriaza, Astrid; Cavazos-Rehg, Patricia; Barnoya, Joaquin

2018-01-05

Electronic cigarettes (e-cigarettes) have the potential to normalize smoking and undermine tobacco control efforts. However, if well regulated, they also have a potential as smoking cessation aids. This study sought to determine the availability and types of e-cigarettes and e-liquids in Guatemala. We also assessed packaging characteristics and price. We surveyed a convenient sample of 39 Guatemala City retailers and purchased all e-cigarettes and e-liquids available. Duplicate samples (same brand, e-liquid type, flavor, nicotine content, or packaging) were purchased when prices were different between each other. Country of manufacture, flavor, expiration date, nicotine concentration, and price were recorded. We also documented package marketing strategies and warning labels. We purchased 64 e-cigarettes (53 unique and 11 duplicates) and 57 e-liquids (52 unique and 5 duplicates), mostly found on mall retailers. Most e-cigarettes (42, 66%) were first generation, followed by second (18, 28%) and third generations (4, 6%). Price of e-cigarettes differed significantly by generation. Most e-cigarettes (31, 58%) and 24 (46%) e-liquids did not include warning labels. Nicotine content was reported in 21 (39%) e-cigarettes that included e-liquids and 41 (79%) e-liquids' packages. E-cigarettes and e-liquids are available among a variety of retailers in Guatemala City and the industry is taking advantage of the fact that they are not regulated (eg, health claims, minimum sales age, and taxation). Our findings support the need for further research on e-cigarettes and e-liquids in Guatemala. To the best of our knowledge, this is the first study describing e-cigarettes and e-liquids available in retailers in a low/middle-income country like Guatemala. E-cigarettes and e-liquids were found in a variety of types, flavors, and nicotine concentrations in Guatemalan retailers. Our findings support the need for further research on e-cigarettes and e-liquids in Guatemala. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Simulation of complex pharmacokinetic models in Microsoft Excel.

PubMed

Meineke, Ingolf; Brockmöller, Jürgen

2007-12-01

With the arrival of powerful personal computers in the office numerical methods are accessible to everybody. Simulation of complex processes therefore has become an indispensible tool in research and education. In this paper Microsoft EXCEL is used as a platform for a universal differential equation solver. The software is designed as an add-in aiming at a minimum of required user input to perform a given task. Four examples are included to demonstrate both, the simplicity of use and the versatility of possible applications. While the layout of the program is admittedly geared to the needs of pharmacokineticists, it can be used in any field where sets of differential equations are involved. The software package is available upon request.

Genepleio software for effective estimation of gene pleiotropy from protein sequences.

PubMed

Chen, Wenhai; Chen, Dandan; Zhao, Ming; Zou, Yangyun; Zeng, Yanwu; Gu, Xun

2015-01-01

Though pleiotropy, which refers to the phenomenon of a gene affecting multiple traits, has long played a central role in genetics, development, and evolution, estimation of the number of pleiotropy components remains a hard mission to accomplish. In this paper, we report a newly developed software package, Genepleio, to estimate the effective gene pleiotropy from phylogenetic analysis of protein sequences. Since this estimate can be interpreted as the minimum pleiotropy of a gene, it is used to play a role of reference for many empirical pleiotropy measures. This work would facilitate our understanding of how gene pleiotropy affects the pattern of genotype-phenotype map and the consequence of organismal evolution.

Design optimization studies using COSMIC NASTRAN

NASA Technical Reports Server (NTRS)

Pitrof, Stephen M.; Bharatram, G.; Venkayya, Vipperla B.

1993-01-01

The purpose of this study is to create, test and document a procedure to integrate mathematical optimization algorithms with COSMIC NASTRAN. This procedure is very important to structural design engineers who wish to capitalize on optimization methods to ensure that their design is optimized for its intended application. The OPTNAST computer program was created to link NASTRAN and design optimization codes into one package. This implementation was tested using two truss structure models and optimizing their designs for minimum weight, subject to multiple loading conditions and displacement and stress constraints. However, the process is generalized so that an engineer could design other types of elements by adding to or modifying some parts of the code.

Software-type Wave-Particle Interaction Analyzer (SWPIA) by RPWI for JUICE

NASA Astrophysics Data System (ADS)

Katoh, Y.; Kojima, H.; Asamura, K.; Kasaba, Y.; Tsuchiya, F.; Kasahara, Y.; Ishisaka, S.; Kimura, T.; Miyoshi, Y.; Santolik, O.; Bergman, J.; Puccio, W.; Gill, R.; Wieser, M.; Schmidt, W.; Barabash, S.; Wahlund, J.-E.

2017-09-01

Software-type Wave-Particle Interaction Analyzer (SWPIA) will be realized as a software function of Low-Frequency receiver (LF) running on the DPU of RPWI (Radio and Plasma Waves Investigation) for the ESA JUICE mission. SWPIA conducts onboard computations of physical quantities indicating the energy exchange between plasma waves and energetic ions. Onboard inter-instruments communications are necessary to realize SWPIA, which will be implemented by efforts of RPWI, PEP (Particle Environment Package) and J-MAG (JUICE Magnetometer). By providing the direct evidence of ion energization processes by plasma waves around Jovian satellites, SWPIA contributes scientific output of JUICE as much as possible with keeping its impact on the telemetry data size to a minimum.

Turnaround Time for Early Infant HIV Diagnosis in Rural Zambia: A Chart Review

PubMed Central

Sutcliffe, Catherine G.; van Dijk, Janneke H.; Hamangaba, Francis; Mayani, Felix; Moss, William J.

2014-01-01

Background Early infant HIV diagnosis is challenging in sub-Saharan Africa, particularly in rural areas where laboratory capacity is limited. Specimens must be transported to central laboratories for testing, leading to delays in diagnosis and initiation of antiretroviral therapy. This study was undertaken in rural Zambia to measure the turnaround time for confirmation of HIV infection and identify delays in diagnosis. Methods Chart reviews were conducted from 2010–2012 for children undergoing early infant HIV diagnosis at Macha Hospital in Zambia. Relevant dates, receipt of drugs by mother and child for the prevention of mother-to-child transmission (PMTCT), and test results were abstracted. Results 403 infants provided 476 samples for early infant diagnosis. The median age at the “6-week” and “6-month” assessments was 8.1 weeks and 7.0 months, respectively. The majority of mothers (80%) and infants (67%) received PMTCT. The median time between sample collection and arrival at the central laboratory in Lusaka was 17 days (IQR: 10, 28); arrival at the central laboratory to testing was 6 days (IQR: 5, 11); testing to return of results to the clinic was 29 days (IQR: 17, 36); arrival of results at the clinic to return of results to the caregiver was 45 days (IQR: 24, 79). The total median time from sample collection to return of results to the caregiver was 92 days (IQR: 84, 145). The proportion of HIV PCR positive samples was 12%. The total median turnaround time was shorter for HIV PCR positive as compared to negative or invalid samples (85 vs. 92 days; p = 0.08). Conclusions Delays in processing and communicating test results were identified, particularly in returning results from the central laboratory to the clinic and from the clinic to the caregiver. A more efficient process is needed so that caregivers can be provided test results more rapidly, potentially resulting in earlier treatment initiation and better outcomes for HIV-infected infants. PMID:24475214

Outcomes and Impact of HIV Prevention, ART and TB Programs in Swaziland – Early Evidence from Public Health Triangulation

PubMed Central

van Schalkwyk, Cari; Mndzebele, Sibongile; Hlophe, Thabo; Garcia Calleja, Jesus Maria; Korenromp, Eline L.; Stoneburner, Rand; Pervilhac, Cyril

2013-01-01

Introduction Swaziland’s severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. We assessed effectiveness outcomes and mortality trends in relation to ART, HIV testing and counseling (HTC), tuberculosis (TB) and prevention of mother to child transmission (PMTCT). Methods Data triangulated include intervention coverage and outcomes according to program registries (2001-2010), hospital admissions and deaths disaggregated by age and sex (2001-2010) and population mortality estimates from the 1997 and 2007 censuses and the 2007 demographic and health survey. Results By 2010, ART reached 70% of the estimated number of people living with HIV/AIDS with CD4<350/mm3, with progressively improving patient retention and survival. As of 2010, 88% of health facilities providing antenatal care offered comprehensive PMTCT services. The HTC program recorded a halving in the proportion of adults tested who were HIV-infected; similarly HIV infection rates among HIV-exposed babies halved from 2007 to 2010. Case fatality rates among hospital patients diagnosed with HIV/AIDS started to decrease from 2005–6 in adults and especially in children, contrasting with stable case fatality for other causes including TB. All-cause child in-patient case fatality rates started to decrease from 2005–6. TB case notifications as well as rates of HIV/TB co-infection among notified TB patients continued a steady increase through 2010, while coverage of HIV testing and CPT for co-infected patients increased to above 80%. Conclusion Against a background of high, but stable HIV prevalence and decreasing HIV incidence, we documented early evidence of a mortality decline associated with the expanded national HIV response since 2004. Attribution of impact to specific interventions (versus natural epidemic dynamics) will require additional data from future household surveys, and improved routine (program, surveillance, and hospital) data at district level. PMID:23922711

Acceptance of HIV testing among women attending antenatal care in south-western Uganda: risk factors and reasons for test refusal.

PubMed

Dahl, V; Mellhammar, L; Bajunirwe, F; Björkman, P

2008-07-01

A problem commonly encountered in programs for prevention of mother-to-child-transmission (PMTCT) of HIV in sub-Saharan Africa is low rates of HIV test acceptance among pregnant women. In this study, we examined risk factors and reasons for HIV test refusal among 432 women attending three antenatal care clinics offering PMTCT in urban and semi-urban parts of the Mbarara district, Uganda. Structured interviews were performed following pre-test counselling. Three-hundred-eighty women were included in the study, 323 (85%) of whom accepted HIV testing. In multivariate analysis, testing site (Site A: OR = 1.0; Site B: OR = 3.08; 95%CI: 1.12-8.46; Site C: OR = 5.93; 95%CI: 2.94-11.98), age between 30 and 34 years (<20 years: OR = 1.0; 20-24 years: OR = 1.81; 95%CI: 0.58-5.67; 25-29 years: OR = 2.15; 95%CI: 0.66-6.97; 30-34 years: OR = 3.88; 95%CI: 1.21-13.41), mistrust in reliability of the HIV test (OR = 20.60; 95%CI: 3.24-131.0) and not having been tested for HIV previously (OR = 2.15; 95%CI: 1.02-4.54) were associated with test refusal. Testing sites operating for longer durations had higher rates of acceptance. The most common reasons claimed for test refusal were: lack of access to antiretroviral therapy (ART) for HIV-infected women (88%; n=57), a need to discuss with partner before decision (82%; n=57) and fear of partner's reaction (54%; n=57). Comparison with previous periods showed that the acceptance rate increased with the duration of the program. Our study identified risk factors for HIV test refusal among pregnant women in Uganda and common reasons for not accepting testing. These findings may suggest modifications and improvements in the performance of HIV testing in this and similar populations.

[Viral failure in infants perinatally infected with HIV: A double punishment].

PubMed

Trocmé, N; Courcoux, M-F; Tabone, M-D; Hervé, F; Bui, E; Faucher, P; Selleret, L; Lebrette, M-G; Leverger, G; Dollfus, C

2017-04-01

Considering the remarkable efficacy of the strategies for preventing mother-to-child transmission of HIV infection (PMTCT), failures are rare in high-resource countries and deserve further investigation. Moreover, infants have been found to be at increased risk of viral failure. We analyzed the factors related to the children's environment, including maternal psychological factors that may be associated with viral failure in children diagnosed before the age of 1 year. Retrospective study of all HIV-infected infants, born in France between July 2003 and July 2013, diagnosed before the age of 1 year, cared for in a single reference center, comparing the group of children in viral success to the group of children presenting at least one episode of viral failure, using data available in their medical, psychological and social files. Out of 1061 infants included in the prospective PMTCT follow-up, eight infants were found HIV-positive and an additional six cases were referred from other centers before the age of 1 year, for a total of 14 children born to 13 mothers. Seven children presented durable optimal viral control (VL<50 c/mL) whereas seven others did not reach or maintain optimal viral control over time. The main difference between the two groups was the presence among the mothers of children with viral failure of severe psychological disorders, leading to treatment adherence problems in the mothers who were aware of their HIV status before pregnancy, and difficulties in giving their children's treatments correctly. Although seroconversion during pregnancy is responsible for a significant proportion of residual transmission in high-resource countries, severe psychological or psychiatric conditions in HIV-positive mothers play an important role on the risk of both MTC residual transmission and viral failure in their infants. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya

PubMed Central

2014-01-01

Background The World Health Organization (WHO) recommends that HIV-infected women practice exclusive breastfeeding (EBF) for the first 6 months postpartum to reduce HIV transmission. The aim of this study was to determine the effects of HIV/AIDS knowledge and other psychosocial factors on EBF practice among pregnant and postpartum women in rural Nyanza, Kenya, an area with a high prevalence of HIV. Methods Data on baseline characteristics and knowledge during pregnancy, as well as infant feeding practices 4–8 weeks after the birth were obtained from 281 pregnant women recruited from nine antenatal clinics. Factors examined included: fear of HIV/AIDS stigma, male partner reactions, lack of disclosure to family members, knowledge of prevention of mother-to-child transmission (PMTCT) and mental health. In the analysis, comparisons were made using chi-squared and t-test methods as well as logistic multivariate regression models. Results There were high levels of anticipated stigma 171(61.2%), intimate partner violence 57(20.4%) and postpartum depression 29(10.1%) and low levels of disclosure among HIV positive women 30(31.3%). The most significant factors determining EBF practice were hospital delivery (aOR = 2.1 95% CI 1.14-3.95) HIV positive serostatus (aOR 2.5 95% CI 1.23-5.27), and disclosure of HIV-positive serostatus (aOR 2.9 95% CI 1.31-6.79). Postpartum depression and PMTCT knowledge were not associated with EBF (aOR 1.1 95% CI 0.47-2.62 and aOR 1.2 95% CI 0.64-2.24) respectively. Conclusions Health care workers and counselors need to receive support in order to improve skills required for diagnosing, monitoring and managing psychosocial aspects of the care of pregnant and HIV positive women including facilitating disclosure to male partners in order to improve both maternal and child health outcomes. PMID:24754975

Safety and Efficacy of HIV Hyperimmune Globulin (HIVIGLOB) for Prevention of Mother-to-Child HIV Transmission in HIV-1 infected Pregnant Women and their Infants in Kampala, Uganda (HIVIGLOB/NVP STUDY)

PubMed Central

Onyango-Makumbi, Carolyne; Omer, Saad B.; Mubiru, Michael; Moulton, Lawrence H.; Nakabiito, Clemensia; Musoke, Philippa; Mmiro, Francis; Zwerski, Sheryl; Wigzell, Hans; Falksveden, Lars; Wahren, Britta; Antelman, Gretchen; Fowler, Mary Glenn; Guay, Laura; Jackson, J. Brooks

2011-01-01

Background This phase III randomized clinical trial compared single dose nevirapine (sdNVP) plus HIV immunoglobulin (HIVIGLOB) to sdNVP alone for preventing maternal-to-child transmission (PMTCT) of HIV. Primary objectives were to determine rates of HIV infection among infants, and to assess the safety of HIVIGLOB in combination with sdNVP in HIV-infected Ugandan pregnant women and their infants. Methods Mother-infant pairs were randomized to receive 200mg of NVP to women in labor and 2mg/kg NVP to newborns within 72 hours after birth (sdNVP arm) or to receive sdNVP plus a single intravenous 240ml dose of HIVIGLOB given to women at 36-38 weeks gestation and a single intravenous 24ml dose to newborns within 18 hours of birth (HIVIGLOB/sdNVP arm). Risk of HIV infection was determined using Kaplan-Meier and risk ratio estimates at birth, 2, 6, 14 weeks, 6 and 12 months of age. Results Intent-to-treat analysis included 198 HIVIGLOB/sdNVP and 294 sdNVP mother-infant pairs. At 6 months of age, the primary endpoint, there was no statistically significant difference in HIV transmission in the HIVIGLOB/sdNVP arm versus the sdNVP arm (18.7% vs.15.0%; RR =1.240 [95% CI: 0.833-1.846]; p= 0.290). Similarly, the proportion of serious adverse events in the HIVIGLOB/sdNVP and sdNVP arms, respectively for mothers (18.9% vs. 19.3%; p= 0.91) and infants (62.6% vs. 59.5%; p=0.51), were not significantly different. Conclusion Giving mother-infant pairs an infusion of peripartum HIV hyperimmunoglobulin in addition to sdNVP for PMTCT was as safe as sdNVP alone, but was no more effective than sdNVP alone in preventing HIV transmission. PMID:21826009

The effect of integration of HIV care and treatment into antenatal care clinics on mother-to-child HIV transmission and maternal outcomes in Nyanza, Kenya: results from the SHAIP cluster randomized controlled trial

PubMed Central

Washington, Sierra; Owuor, Kevin; Turan, Janet M.; Steinfeld, Rachel L.; Onono, Maricianah; Shade, Starley B.; Bukusi, Elizabeth A.; Ackers, Marta L.; Cohen, Craig R.

2015-01-01

Background Many HIV-infected pregnant women identified during antenatal care do not enroll in long-term HIV care, resulting in deterioration of maternal health and continued risk of HIV transmission to infants. Methods We performed a cluster-randomized trial to evaluate the effect of integrating HIV care into ANC clinics in rural Kenya. Twelve facilities were randomized to provide either integrated services (ANC, PMTCT, and HIV care delivered in the ANC clinic; n=6 intervention facilities), or standard ANC services (including PMTCT and referral to a separate clinic for HIV care; n=6 control facilities). Results There were high patient attrition rates over the course of this study. Among study participants who enrolled in HIV care, there was twelve month follow up data for 256/611 (41.8%) women, and postpartum data for only 325/1172 (28%) women. By 9 months of age, 382/568 (67.3%) infants at intervention sites and 338/594 (57.0%) at control sites had tested for HIV (OR 1.45, 95% CI 0.71-2.82); 7.3% of infants tested HIV-positive at intervention sites compared to 8.0% of infants at control sites (OR 0.89, 95% CI 0.56-1.43). The composite clinical/immunologic progression into AIDS was similar in both arms (4.9% vs. 5.1 %, OR 0.83, 95% CI 0.41 - 1.68). Conclusions Despite the provision of integrated services, patient attrition was substantial in both arms, suggesting barriers beyond lack of service integration. Integration of HIV services into the ANC clinic was not associated with a reduced risk HIV transmission to infants and did not appear to affect short-term maternal health outcomes. PMID:25886930

High Plasma Concentrations of Zidovudine (AZT) Do Not Parallel Intracellular Concentrations of AZT-Triphosphates in Infants During Prevention of Mother-to-Child HIV-1 Transmission.

PubMed

Kinai, Ei; Kato, Shingo; Hosokawa, Shinichi; Sadatsuki, Miyuki; Gatanaga, Hiroyuki; Kikuchi, Yoshimi; Lam, Nguyen Van; Ha, Do Quan; Kinh, Nguyen Van; Liem, Nguyen Thanh; Oka, Shinichi

2016-07-01

Zidovudine (AZT) is mainly used to prevent mother-to-child HIV-1 transmission (PMTCT). Despite serious concerns on AZT-associated toxicity, there is little information on pharmacokinetics of intracellular AZT metabolites in infants. We conducted a prospective study in 31 HIV-uninfected infants who received AZT for PMTCT. Blood samples were obtained from 14 infants on postdelivery days (PDD) 1, 7, 14, and 28 and from 17 infants at 0 and 4 hours after dosing on PDD-1. Plasma AZT concentrations (pAZT) and intracellular concentrations of AZT-monophosphate (icAZT-MP), diphosphate (icAZT-DP), and triphosphate (icAZT-TP) were determined. Plasma AZT and icAZT-MP concentrations were 2713 nmol/L and 79 fmol/10 cells in PDD-1, but decreased to 1437 nmol/L and 31 fmol/10 cells by PDD-28 (P = 0.02 and P = 0.07 for all PDDs, respectively), whereas those of icAZT-DP and icAZT-TP remained low throughout the sampling period (P = 0.29 and P = 0.61 for all PDDs, respectively) There were no differences in icAZT-TP between infants of the 2 mg/kg 4 times a day dose and 4 mg/kg twice daily dose (P = 0.25), whereas pAZT and icAZT-MP levels were higher in the latter (P < 0.01 and <0.01, respectively). The pAZT and icAZT-MP significantly increased from 0 to 4 hours after dosing (P < 0.001 and <0.001, respectively), whereas icAZT-DP, icAZT-TP levels were not changed (P = 0.41 and 0.33, respectively). The level of icAZT-TP did not change with age, time, or a single dose despite the wide range of pAZT concentration. A safer dosage needs to be determined because high pAZT levels do not parallel those of icAZT-TP.

Does provision of point-of-care CD4 technology and early knowledge of CD4 levels affect early initiation and retention on antiretroviral treatment in HIV-positive pregnant women in the context of Option B+ for PMTCT?

PubMed

Mangwiro, Alexio-Zambezi; Makomva, Kudzai; Bhattacharya, Antoinette; Bhattacharya, Gaurav; Gotora, Tendai; Owen, Mila; Mushavi, Angela; Mangwanya, Douglas; Zinyowera, Sekesai; Rusakaniko, Simbarashe; Mugurungi, Owen; Zizhou, Simukai; Busumani, William; Masuka, Nyasha

2014-11-01

Evidence for Elimination (E4E) is a collaborative project established in 2012 as part of the INSPIRE (INtegrating and Scaling up PMTCT through Implementation REsearch) initiative. E4E is a cluster-randomized trial with 2 arms; Standard of care and "POC Plus" [in which point-of-care (POC) CD4 devices and related counseling support are provided]; aimed at improving retention-in-care of HIV-infected pregnant women and mothers. In November 2013, Zimbabwe adopted Option B+ for HIV-positive pregnant women under which antiretroviral treatment eligibility is no longer based on CD4 count. However, Ministry of Health and Child Care guidelines still require baseline and 6-monthly CD4 testing for treatment monitoring, until viral load testing becomes widely available. Considering the current limited capacity for viral-load testing, the significant investments in CD4 testing already made and the historical reliance on CD4 by health care workers for determining eligibility for antiretroviral treatment, E4E seeks to compare the impact of the provision of POC CD4 technology and early knowledge of CD4 levels on retention-in-care at 12 months, with the current standard of routine, laboratory-based CD4 testing. The study also compares rates of initiation and time-to-initiation between the 2 arms and according to level of maternal CD4 count, the cost of retaining HIV-positive pregnant women in care and the acceptability and feasibility of POC CD4 in the context of Option B+. Outcome measures are derived from routine health systems data. E4E will provide data on POC CD4 testing and retention-in-care associated with Option B+ and serve as an early learning platform to inform implementation of Option B+ in Zimbabwe.

Health Outcomes and Cost Impact of the New WHO 2013 Guidelines on Prevention of Mother-to-Child Transmission of HIV in Zambia

PubMed Central

Ishikawa, Naoko; Shimbo, Takuro; Miyano, Shinsuke; Sikazwe, Izukanji; Mwango, Albert; Ghidinelli, Massimo N.; Syakantu, Gardner

2014-01-01

Background Countries are currently progressing towards the elimination of new paediatric HIV infections by 2015. WHO published new consolidated guidelines in June 2013, which now recommend either ‘Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)’ or ‘Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)’, while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia. Methods A decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of ≤350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined. Results Our analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with ‘ARVs during pregnancy and breastfeeding’ and further reduced by 15% with ‘Lifelong ART’. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners. Conclusion The shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment. PMID:24604067

Determinants of nondisclosure of HIV status among women attending the prevention of mother to child transmission programme, Makonde district, Zimbabwe, 2009.

PubMed

Mucheto, Pride; Chadambuka, Addmore; Shambira, Gerald; Tshimanga, Mufuta; Gombe, Notion; Nyamayaro, Wenceslas

2011-01-01

The 2007 United Nations General Assembly Report on HIV/AIDS in Zimbabwe reported nondisclosure of HIV status as a challenge in the PMTCT programme. Preliminary investigations on nondisclosure among 21 women tested for HIV at Chinhoyi Hospital showed that only six had disclosed their HIV status. We investigated the determinants of nondisclosure of HIV status. A cross sectional analytic study was conducted at six health facilities in Makonde district. The Theory of Planned Behaviour was adapted to guide socio-cultural variables assessed. Antenatal and postnatal women tested for HIV in the PMTCT program who consented to participate were interviewed. We enrolled 334 women. Thirty four percent (114) did not disclose their HIV status. Among HIV positive respondents, 43% (25) did not disclose their status. Women who believed disclosure caused physical abuse (OR=1.81, 95% CI: 1.17-2.90), caused divorce (OR=2.01, 95% CI: 1.25-3.22) and was unimportant (OR= 2.26, 95% CI: 1.33-3.87) were two times less likely to disclose their status. Respondents who received group HIV pre-test counselling were 2.4 times more likely not to disclose. Receiving ANC HIV education at least twice and referral for psychosocial support were significantly protective [OR 0.54 (95% CI 0.24-0.63) and 0.16 (95% CI: 0.06-0.41) respectively. Independent determinants of nondisclosure among HIV positive women were perception that disclosure would cause divorce (AOR=7.82, p=0.03), living with an extended family (AOR=10.3, p=0.01) and needing spousal approval of HIV testing (AOR=0.11, p<0.001). Lack of psychosocial support and counselling for women and belief that disclosure causes divorce, abuse or is unimportant contributes to nondisclosure. Identifying women with social challenges and strengthening their referral for psychosocial support can improve disclosure of HIV status and reduce mother to child transmission of HIV.

Outcomes and impact of HIV prevention, ART and TB programs in Swaziland--early evidence from public health triangulation.

PubMed

van Schalkwyk, Cari; Mndzebele, Sibongile; Hlophe, Thabo; Garcia Calleja, Jesus Maria; Korenromp, Eline L; Stoneburner, Rand; Pervilhac, Cyril

2013-01-01

Swaziland's severe HIV epidemic inspired an early national response since the late 1980s, and regular reporting of program outcomes since the onset of a national antiretroviral treatment (ART) program in 2004. We assessed effectiveness outcomes and mortality trends in relation to ART, HIV testing and counseling (HTC), tuberculosis (TB) and prevention of mother to child transmission (PMTCT). Data triangulated include intervention coverage and outcomes according to program registries (2001-2010), hospital admissions and deaths disaggregated by age and sex (2001-2010) and population mortality estimates from the 1997 and 2007 censuses and the 2007 demographic and health survey. By 2010, ART reached 70% of the estimated number of people living with HIV/AIDS with CD4<350/mm(3), with progressively improving patient retention and survival. As of 2010, 88% of health facilities providing antenatal care offered comprehensive PMTCT services. The HTC program recorded a halving in the proportion of adults tested who were HIV-infected; similarly HIV infection rates among HIV-exposed babies halved from 2007 to 2010. Case fatality rates among hospital patients diagnosed with HIV/AIDS started to decrease from 2005-6 in adults and especially in children, contrasting with stable case fatality for other causes including TB. All-cause child in-patient case fatality rates started to decrease from 2005-6. TB case notifications as well as rates of HIV/TB co-infection among notified TB patients continued a steady increase through 2010, while coverage of HIV testing and CPT for co-infected patients increased to above 80%. Against a background of high, but stable HIV prevalence and decreasing HIV incidence, we documented early evidence of a mortality decline associated with the expanded national HIV response since 2004. Attribution of impact to specific interventions (versus natural epidemic dynamics) will require additional data from future household surveys, and improved routine (program, surveillance, and hospital) data at district level.

Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries.

PubMed

Wall, Kristin M; Rida, Wasima; Haddad, Lisa B; Kamali, Anatoli; Karita, Etienne; Lakhi, Shabir; Kilembe, William; Allen, Susan; Inambao, Mubiana; Yang, Annie H; Latka, Mary H; Anzala, Omu; Sanders, Eduard J; Bekker, Linda-Gail; Edward, Vinodh A; Price, Matt A

2017-03-01

Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women. From 2006 to 2011, women less than age 40 with incident HIV infection were enrolled in an early HIV infection cohort in Kenya, Rwanda, South Africa, Uganda, and Zambia. Time-dependent Cox models evaluated associations between pregnancy and HIV disease progression. Clinical progression was defined as a single CD4 measurement <200 cells/μl, percent CD4 <14%, or category C event, with censoring at antiretroviral (ART) initiation for reasons other than prevention of mother-to-child transmission (PMTCT). Immunologic progression was defined as two consecutive CD4s ≤350 cells/μl or a single CD4 ≤350 cells/μl followed by non-PMTCT ART initiation. Generalized estimating equations assessed changes in CD4 before and after pregnancy. Among 222 women, 63 experienced clinical progression during 783.5 person-years at risk (8.0/100). Among 205 women, 87 experienced immunologic progression during 680.1 person-years at risk (12.8/100). The association between pregnancy and clinical progression was adjusted hazard ratio [aHR] = 0.7; 95% confidence interval (CI): 0.2, 1.8. The association between pregnancy and immunologic progression was aHR = 1.7; 95% CI: 0.9, 3.3. Models controlled for age; human leukocyte antigen alleles A*03:01, B*45, B*57; CD4 set point; and HIV-1 subtype. CD4 measurements before versus after pregnancies were not different. In this cohort, pregnancy was not associated with increased clinical or immunologic HIV progression. Similarly, we did not observe meaningful deleterious associations of pregnancy with CD4s. Our findings suggest that HIV-positive women may become pregnant without harmful health effects occurring during the pregnancy. Evaluation of longer-term impact of pregnancy on progression is warranted.

Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries

PubMed Central

Rida, Wasima; Haddad, Lisa B.; Kamali, Anatoli; Karita, Etienne; Lakhi, Shabir; Kilembe, William; Allen, Susan; Inambao, Mubiana; Yang, Annie H.; Latka, Mary H.; Anzala, Omu; Sanders, Eduard J.; Bekker, Linda-Gail; Edward, Vinodh A.; Price, Matt A.

2017-01-01

Background: Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women. Methods: From 2006 to 2011, women less than age 40 with incident HIV infection were enrolled in an early HIV infection cohort in Kenya, Rwanda, South Africa, Uganda, and Zambia. Time-dependent Cox models evaluated associations between pregnancy and HIV disease progression. Clinical progression was defined as a single CD4 measurement <200 cells/μl, percent CD4 <14%, or category C event, with censoring at antiretroviral (ART) initiation for reasons other than prevention of mother-to-child transmission (PMTCT). Immunologic progression was defined as two consecutive CD4s ≤350 cells/μl or a single CD4 ≤350 cells/μl followed by non-PMTCT ART initiation. Generalized estimating equations assessed changes in CD4 before and after pregnancy. Results: Among 222 women, 63 experienced clinical progression during 783.5 person-years at risk (8.0/100). Among 205 women, 87 experienced immunologic progression during 680.1 person-years at risk (12.8/100). The association between pregnancy and clinical progression was adjusted hazard ratio [aHR] = 0.7; 95% confidence interval (CI): 0.2, 1.8. The association between pregnancy and immunologic progression was aHR = 1.7; 95% CI: 0.9, 3.3. Models controlled for age; human leukocyte antigen alleles A*03:01, B*45, B*57; CD4 set point; and HIV-1 subtype. CD4 measurements before versus after pregnancies were not different. Conclusions: In this cohort, pregnancy was not associated with increased clinical or immunologic HIV progression. Similarly, we did not observe meaningful deleterious associations of pregnancy with CD4s. Our findings suggest that HIV-positive women may become pregnant without harmful health effects occurring during the pregnancy. Evaluation of longer-term impact of pregnancy on progression is warranted. PMID:27893488

Managment and construction of the Large Binocular Telescope enclosure: Meeting unusual challenges with a competitive discipline

NASA Astrophysics Data System (ADS)

Slagle, James H.; Hill, John M.; Davison, Warren B.; Hart, Wood; Teran, Jose U.

1998-08-01

Planning, estimating, and building a telescope and its enclosure within a budget is a challenge to any project staff. The Large Binocular Telescope (LBT) project office goal has been to break every phase of the project into small packages and competitively bid the packages. In this way the project office can minimize costs and keep the project budget from escalating out of control. This paper will discuss both the unique and common problems associated with the building of telescopes into the next millennium. The discussion is centered on the planning and execution phases of construction for the LBT, located on Mt. Graham in Arizona. The paper will discuss the effects of delays on the actual start of the telescope due to environmental issues and the impact the delays had on design and budget. The paper will provide the solutions that have been incorporated by the LBT project office to maximize the quality of construction while holding costs to a minimum. The use of a team approach by the contractors, engineers, and the project office has been successful in maintaining quality construction at a reasonable cost.

78 FR 42159 - Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-15

...This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark- equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

The application of high dose food irradiation in South Africa

NASA Astrophysics Data System (ADS)

de Bruyn, Ingrid Nine

2000-03-01

During the 1950s to the end of the 1970s the United States Army developed the basic methodology to produce shelf-stable irradiated meat, seafood and poultry products. These products are normally packed without gravy, sauce or brine, as liquid is not required to sterilize the product as in the canning process. This leads to the distinctive "dried cooked" taste normally associated with roasts opposed to the casserole taste usually associated with tinned meats. The Biogam group at the Atomic Energy Corporation of South Africa is currently producing shelf-stable irradiated meats on a commercial basis. The meats are cooked, chilled, portioned, vacuum packed and irradiated to the required minimum dose of 45 kGy at a temperature of between -20 and -40°C to ensure absolute sterility even under tropical conditions. The product is packaged in a high quality four layer laminate pouch and will therefore not rust or burst even under adverse weather conditions and can be guaranteed for more than two years as long as the integrity of the packaging is maintained. Safari operators in remote parts of Africa, mountaineers, yachtsmen, canoeists and geological survey teams currently use shelf-stable irradiated meat products produced in South Africa.

Establishing the Common Community Physics Package by Transitioning the GFS Physics to a Collaborative Software Framework

NASA Astrophysics Data System (ADS)

Xue, L.; Firl, G.; Zhang, M.; Jimenez, P. A.; Gill, D.; Carson, L.; Bernardet, L.; Brown, T.; Dudhia, J.; Nance, L. B.; Stark, D. R.

2017-12-01

The Global Model Test Bed (GMTB) has been established to support the evolution of atmospheric physical parameterizations in NCEP global modeling applications. To accelerate the transition to the Next Generation Global Prediction System (NGGPS), a collaborative model development framework known as the Common Community Physics Package (CCPP) is created within the GMTB to facilitate engagement from the broad community on physics experimentation and development. A key component to this Research to Operation (R2O) software framework is the Interoperable Physics Driver (IPD) that hooks the physics parameterizations from one end to the dynamical cores on the other end with minimum implementation effort. To initiate the CCPP, scientists and engineers from the GMTB separated and refactored the GFS physics. This exercise demonstrated the process of creating IPD-compliant code and can serve as an example for other physics schemes to do the same and be considered for inclusion into the CCPP. Further benefits to this process include run-time physics suite configuration and considerably reduced effort for testing modifications to physics suites through GMTB's physics test harness. The implementation will be described and the preliminary results will be presented at the conference.

Tests of the Hardware and Software for the Reconstruction of Trajectories in the Experiment MINERvA (in Portuguese)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Palomino Gallo, Jose Luis; /Rio de Janeiro, CBPF

MINERvA experiment has a highly segmented and high precision neutrino detector able to record events with high statistic (over 13 millions in a four year run). MINERvA uses FERMILAB NuMI beamline. The detector will allow a detailed study of neutrino-nucleon interactions. Moreover, the detector has a target with different materials allowing, for the first time, the study of nuclear effects in neutrino interactions. We present here the work done with the MINERvA reconstruction group that has resulted in: (a) development of new codes to be added to the RecPack package so it can be adapted to the MINERvA detector structure;more » (b) finding optimum values for two of the MegaTracker reconstruction package variables: PEcut = 4 (minimum number of photo electrons for a signal to be accepted) and Chi2Cut = 200 (maximum value of {chi}{sup 2} for a track to be accepted); (c) testing of the multi anode photomultiplier tubes used at MINERvA in order to determine the correlation between different channels and for checking the device's dark counts.« less

Development of a MEMS dual-axis differential capacitance floating element shear stress sensor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barnard, Casey; Griffin, Benjamin

A single-axis MEMS wall shear stress sensor with differential capacitive transduction method is produced. Using a synchronous modulation and demodulation interface circuit, the system is capable of making real time measurements of both mean and fluctuating wall shear stress. A sensitivity of 3.44 mV/Pa is achieved, with linearity in response demonstrated up to testing limit of 2 Pa. Minimum detectable signals of 340 μPa at 100 Hz and 120 μPa at 1 kHz are indicated, with a resonance of 3.5 kHz. Multiple full scale wind tunnel tests are performed, producing spectral measurements of turbulent boundary layers in wind speeds rangingmore » up to 0.5 Ma (18 Pa of mean wall shear stress). The compact packaging allows for minimally invasive installation, and has proven relatively robust over multiple testing events. Temperature sensitivity, likely due to poor CTE matching of packaged materials, is an ongoing concern being addressed. These successes are being directly leveraged into a development plan for a dual-axis wall shear stress sensor, capable of producing true vector estimates at the wall.« less

An Interpolation Method for Obtaining Thermodynamic Properties Near Saturated Liquid and Saturated Vapor Lines

NASA Technical Reports Server (NTRS)

Nguyen, Huy H.; Martin, Michael A.

2003-01-01

The availability and proper utilization of fluid properties is of fundamental importance in the process of mathematical modeling of propulsion systems. Real fluid properties provide the bridge between the realm of pure analytiis and empirical reality. The two most common approaches used to formulate thermodynamic properties of pure substances are fundamental (or characteristic) equations of state (Helmholtz and Gibbs functions) and a piecemeal approach that is described, for example, in Adebiyi and Russell (1992). This paper neither presents a different method to formulate thermodynamic properties of pure substances nor validates the aforementioned approaches. Rather its purpose is to present a method to be used to facilitate the accurate interpretation of fluid thermodynamic property data generated by existing property packages. There are two parts to this paper. The first part of the paper shows how efficient and usable property tables were generated, with the minimum number of data points, using an aerospace industry standard property package (based on fundamental equations of state approach). The second part describes an innovative interpolation technique that has been developed to properly obtain thermodynamic properties near the saturated liquid and saturated vapor lines.

Short wave infrared hyperspectral imaging for recovered post-consumer single and mixed polymers characterization

NASA Astrophysics Data System (ADS)

Bonifazi, Giuseppe; Palmieri, Roberta; Serranti, Silvia

2015-03-01

Postconsumer plastics from packing and packaging represent about the 60% of the total plastic wastes (i.e. 23 million of tons) produced in Europe. The EU Directive (2014/12/EC) fixes as target that the 60%, by weight, of packaging waste has to be recovered, or thermally valorized. When recovered, the same directive established that packaging waste has to be recycled in a percentage ranging between 55% (minimum) and 60% (maximum). The non-respect of these rules can produce that large quantities of end-of-life plastic products, specifically those utilized for packaging, are disposed-off, with a strong environmental impact. The application of recycling strategies, finalized to polymer recovery, can represent an opportunity to reduce: i) not renewable raw materials (i.e. oil) utilization, ii) carbon dioxide emissions and iii) amount of plastic waste disposed-off. Aim of this work was to perform a full characterization of different end-of-life polymers based products, constituted not only by single polymers but also of mixtures, in order to realize their identification for quality control and/or certification assessment. The study was specifically addressed to characterize the different recovered products as resulting from a recycling plant where classical processing flow-sheets, based on milling, classification and separation, are applied. To reach this goal, an innovative sensing technique, based on the utilization of a HyperSpectral[b] I[/b]maging (HSI) device working in the SWIR region (1000-2500 nm), was investigated. Following this strategy, single polymers and/or mixed polymers recovered were correctly recognized. The main advantage of the proposed approach is linked to the possibility to perform "on-line" analyses, that is directly on the different material flow streams, as resulting from processing, without any physical sampling and classical laboratory "off-line" determination.

Eco-friendly biorefractory films of gelatin and TEMPO-oxidized cellulose ester for food packaging application.

PubMed

Zhuang, Chen; Tao, Furong; Cui, Yuezhi

2017-08-01

In recent years, many types of food-packaging films and composites have been prepared using gelatin because of its good film-forming ability, non-toxic nature and cost-effectiveness. However, the relatively weak thermal stability, poor mechanical properties and easily-degradable quality limit the potential application of gelatin as a practical material. Microcrystalline cellulose (MCC), which comprises one of the most abundant biomass resources, has been regarded as a safe and reliable food additive because it has the same ingredients as the cellulose in people's daily intake. Food-packaging films with the excellent properties provided by gelatin and oxidized-cellulose represent a topic of great interest. MCC was modified by 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO)-mediated oxidation and chosen as the base of the macromolecule cross-linker (TMN). After modification of gelatin film by TMN, the minimum amount of free -NH 2 in solution was 4.8 × 10 -4  mol g -1 ). The thermal property obviously increased (from 322.31  o C to 352.63  o C) and was crucial for usage in the food industry. The highest water contact value 123.09° (η = 25%) indicated a better surface hydrophobicity. The higher E ab (58.88%) and lower E m (77.16%) demonstrated that a more flexible and shatter-proof material was obtained. Water vapor uptake studies suggested increased moisture absorption and greater swelling ability. The film material obtained in the present study was safe, stable, eco-friendly and biorefractory and could also be decomposed completely by the environment after disposal as a result of the properties of the ingredients gelatin and cellulose. The incorporation of a cellulosic cross-linker to gelatin-based films was an ideal choice with respect to developing a packaging for the food industry. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Environmental characterization of a coffee processing workplace with obliterative bronchiolitis in former workers

PubMed Central

Duling, Matthew G.; LeBouf, Ryan F.; Cox-Ganser, Jean M.; Kreiss, Kathleen; Martin, Stephen B.; Bailey, Rachel L.

2018-01-01

Obliterative bronchiolitis in five former coffee processing employees at a single workplace prompted an exposure study of current workers. Exposure characterization was performed by observing processes, assessing the ventilation system and pressure relationships, analyzing headspace of flavoring samples, and collecting and analyzing personal breathing zone and area air samples for diacetyl and 2,3-pentanedione vapors and total inhalable dust by work area and job title. Mean airborne concentrations were calculated using the minimum variance unbiased estimator of the arithmetic mean. Workers in the grinding/packaging area for unflavored coffee had the highest mean diacetyl exposures, with personal concentrations averaging 93 parts per billion (ppb). This area was under positive pressure with respect to flavored coffee production (mean personal diacetyl levels of 80 ppb). The 2,3-pentanedione exposures were highest in the flavoring room with mean personal exposures of 122 ppb, followed by exposures in the unflavored coffee grinding/packaging area (53 ppb). Peak 15-min airborne concentrations of 14,300 ppb diacetyl and 13,800 ppb 2,3-pentanedione were measured at a small open hatch in the lid of a hopper containing ground unflavored coffee on the mezzanine over the grinding/packaging area. Three out of the four bulk coffee flavorings tested had at least a factor of two higher 2,3-pentanedione than diacetyl headspace measurements. At a coffee processing facility producing both unflavored and flavored coffee, we found the grinding and packaging of unflavored coffee generate simultaneous exposures to diacetyl and 2,3-pentanedione that were well in excess of the NIOSH proposed RELs and similar in magnitude to those in the areas using a flavoring substitute for diacetyl. These findings require physicians to be alert for obliterative bronchiolitis and employers, government, and public health consultants to assess the similarities and differences across the industry to motivate preventive intervention where indicated by exposures above the proposed RELs for diacetyl and 2,3-pentanedione. PMID:27105025

Factors influencing the provision of public health services by village doctors in Hubei and Jiangxi provinces, China

PubMed Central

Ding, Yan; Smith, Helen J; Fei, Yang; Xu, Biao; Nie, Shaofa; Yan, Weirong; Diwan, Vinod K; Sauerborn, Rainer

2013-01-01

Abstract Problem The Chinese central government launched the Health System Reform Plan in 2009 to strengthen disease control and health promotion and provide a package of basic public health services. Village doctors receive a modest subsidy for providing public health services associated with the package. Their beliefs about this subsidy and providing public health services could influence the quality and effectiveness of preventive health services and disease surveillance. Approach To understand village doctors’ perspectives on the subsidy and their experiences of delivering public health services, we performed 10 focus group discussions with village doctors, 12 in-depth interviews with directors of township health centres and 4 in-depth interviews with directors of county-level Centers for Disease Control and Prevention. Local setting The study was conducted in four counties in central China, two in Hubei province and two in Jiangxi province. Relevant changes Village doctors prioritize medical services but they do their best to manage their time to include public health services. The willingness of township health centre directors and village doctors to provide public health services has improved since the introduction of the package and a minimum subsidy, but village doctors do not find the subsidy to be sufficient remuneration for their efforts. Lessons learnt Improving the delivery of public health services by village doctors is likely to require an increase in the subsidy, improvement in the supervisory relationship between village clinics and township health centres and the creation of a government pension for village doctors. PMID:23397352

Use of computer code for dose distribution studies in A 60CO industrial irradiator

NASA Astrophysics Data System (ADS)

Piña-Villalpando, G.; Sloan, D. P.

1995-09-01

This paper presents a benchmark comparison between calculated and experimental absorbed dose values tor a typical product, in a 60Co industrial irradiator, located at ININ, México. The irradiator is a two levels, two layers system with overlapping product configuration with activity around 300kCi. Experimental values were obtanied from routine dosimetry, using red acrylic pellets. Typical product was Petri dishes packages, apparent density 0.13 g/cm3; that product was chosen because uniform size, large quantity and low density. Minimum dose was fixed in 15 kGy. Calculated values were obtained from QAD-CGGP code. This code uses a point kernel technique, build-up factors fitting was done by geometrical progression and combinatorial geometry is used for system description. Main modifications for the code were related with source sumilation, using punctual sources instead of pencils and an energy and anisotropic emission spectrums were included. Results were, for maximum dose, calculated value (18.2 kGy) was 8% higher than experimental average value (16.8 kGy); for minimum dose, calculated value (13.8 kGy) was 3% higher than experimental average value (14.3 kGy).