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Espinal M, Yee LM, Fisher SA. Advances in HIV Management During Pregnancy and Infant Feeding. Infect Dis Clin North Am 2024; 38:423-452. [PMID: 38969531 DOI: 10.1016/j.idc.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Recent advances in human immunodeficiency virus (HIV) management during pregnancy and infant feeding encompass several key elements: expanded HIV testing guidance; growing evidence of safety, efficacy, and pharmacokinetic data favoring the use of preferred antiretroviral therapy (ART) during pregnancy and breastfeeding; increasing advocacy for the inclusion of pregnant individuals with HIV in clinical trials to expedite access to new ART; and updated guidelines supporting shared decision-making for choice of infant feeding methods in people with HIV.
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Affiliation(s)
- Mariana Espinal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2303, Chicago, IL, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2303, Chicago, IL, USA.
| | - Stephanie A Fisher
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2303, Chicago, IL, USA
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Abuogi L, Noble L, Smith C. Infant Feeding for Persons Living With and at Risk for HIV in the United States: Clinical Report. Pediatrics 2024; 153:e2024066843. [PMID: 38766700 DOI: 10.1542/peds.2024-066843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/22/2024] Open
Abstract
Pediatricians and pediatric health care professionals caring for infants born to people living with and at risk for HIV infection are likely to be involved in providing guidance on recommended infant feeding practices. Care team members need to be aware of the HIV transmission risk from breastfeeding and the recommendations for feeding infants with perinatal HIV exposure in the United States. The risk of HIV transmission via breastfeeding from a parent with HIV who is receiving antiretroviral treatment (ART) and is virally suppressed is estimated to be less than 1%. The American Academy of Pediatrics recommends that for people with HIV in the United States, avoidance of breastfeeding is the only infant feeding option with 0% risk of HIV transmission. However, people with HIV may express a desire to breastfeed, and pediatricians should be prepared to offer a family-centered, nonjudgmental, harm reduction approach to support people with HIV on ART with sustained viral suppression below 50 copies per mL who desire to breastfeed. Pediatric health care professionals who counsel people with HIV who are not on ART or who are on ART but without viral suppression should recommend against breastfeeding. Pediatric health care professionals should recommend HIV testing for all pregnant persons and HIV preexposure prophylaxis to pregnant or breastfeeding persons who test negative for HIV but are at high risk of HIV acquisition.
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Affiliation(s)
- Lisa Abuogi
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York
| | - Christiana Smith
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Humphrey J, Wanjama E, Carlucci JG, Naanyu V, Were E, Muli L, Alera M, McGuire A, Nyandiko W, Songok J, Wools-Kaloustian K, Zimet G. Preferences of Pregnant and Postpartum Women for Differentiated Service Delivery in Kenya. J Acquir Immune Defic Syndr 2023; 94:429-436. [PMID: 37949446 PMCID: PMC10642693 DOI: 10.1097/qai.0000000000003303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/15/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Differentiated service delivery models are implemented by HIV care programs globally, but models for pregnant and postpartum women living with HIV (PPWH) are lacking. We conducted a discrete choice experiment to determine women's preferences for differentiated service delivery. SETTING Five public health facilities in western Kenya. METHODS PPWH were enrolled from April to December 2022 and asked to choose between pairs of hypothetical clinics that differed across 5 attributes: clinic visit frequency during pregnancy (monthly vs. every 2 months), postpartum visit frequency (monthly vs. only with routine infant immunizations), seeing a mentor mother (each visit vs. as needed), seeing a clinician (each visit vs. as needed), and basic consultation cost (0, 50, or 100 Kenya Shillings [KSh]). We used multinomial logit modeling to determine the relative effects (β) of each attribute on clinic choice. RESULTS Among 250 PPWH (median age 31 years, 42% pregnant, 58% postpartum, 20% with a gap in care), preferences were for pregnancy visits every 2 months (β = 0.15), postpartum visits with infant immunizations (β = 0.36), seeing a mentor mother and clinician each visit (β = 0.05 and 0.08, respectively), and 0 KSh cost (β = 0.39). Preferences were similar when stratified by age, pregnancy, and retention status. At the same cost, predicted market choice for a clinic model with fewer pregnant/postpartum visits was 75% versus 25% for the standard of care (ie, monthly visits during pregnancy/postpartum). CONCLUSION PPWH prefer fewer clinic visits than currently provided within the standard of care in Kenya, supporting the need for implementation of differentiated service delivery for this population.
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Affiliation(s)
- John Humphrey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Esther Wanjama
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - James G. Carlucci
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Violet Naanyu
- Department of Sociology Psychology and Anthropology, Moi University School of Arts and Social Science, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Edwin Were
- Department of Reproductive Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Lindah Muli
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Marsha Alera
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Alan McGuire
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN
- Health Services Research and Development, Richard L. Roudebush VAMC, Indianapolis, IN; and
| | - Winstone Nyandiko
- Department of Child Health and Pediatrics, Moi University College of Health Sciences, Eldoret, Kenya
| | - Julia Songok
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Pediatrics, Moi University College of Health Sciences, Eldoret, Kenya
| | | | - Gregory Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Bukkems VE, Finkenflügel RN, Grintjes K, Marneef M, de Haan M, Mielitz I, van Hulzen A, Rokx C, van Leeuwen E, Nellen JF, Burger DM, Colbers A. Exploring the Breastfeeding Desires and Decision-Making of Women Living with HIV in the Netherlands: Implications for Perinatal HIV Management in Developed Countries. Breastfeed Med 2023; 18:356-361. [PMID: 37083439 PMCID: PMC10254968 DOI: 10.1089/bfm.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Introduction: Guidelines in high-income countries recommend women living with human immunodeficiency virus (HIV) to formula feed their newborns, because the possibility of mother-to-child-transmission of HIV during breastfeeding cannot be ruled out. It is an ongoing debate if the possible transmission risk outweighs the medical, cultural, psychological, and social importance of breastfeeding in women stable on current first-line suppressive antiretroviral regimens. The study aim was to explore breastfeeding desires and decision-making of immigrant and nonimmigrant women living with HIV in the Netherlands. Method: A questionnaire was administered orally or online to 82 women living with HIV in the Netherlands. The breastfeeding desires of the participants were collected as categorical data, and breastfeeding decision-making and willingness to adhere to additional monitoring were collected on a 5-point Likert scale. Categorical data were presented as proportions, and Likert scale data were presented in Likert scale bar plots. Results: Seventy-one percent of the participants expressed a desire to breastfeed in the future. The most important factors influencing decision-making to breastfeed were the chance of transmission of HIV to the infant and the advice by the doctor or nurse practitioner. Of the participants, 42% expressed their interest in breastfeeding with a <1/100 transmission risk. More than half of the participants expressed their interest to breastfeed with additional monitoring. Conclusions: A substantial proportion of the women living with HIV in the Netherlands has a desire to breastfeed, of which the majority are willing to adhere to additional monitoring to do so.
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Affiliation(s)
- Vera E. Bukkems
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Karin Grintjes
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Manon Marneef
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martine de Haan
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Astrid van Hulzen
- Department of Internal Medicine, Isala Hospital, Zwolle, the Netherlands
| | - Casper Rokx
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | - Elisabeth van Leeuwen
- Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeannine F. Nellen
- Division of Infectious Diseases, Tropical Medicine and AIDS, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - David M. Burger
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Angela Colbers
- Department of Pharmacy, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
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Crisinel PA, Kusejko K, Kahlert CR, Wagner N, Beyer LS, De Tejada BM, Hösli I, Vasconcelos MK, Baumann M, Darling K, Duppenthaler A, Rauch A, Paioni P, Aebi-Popp K. Successful implementation of new Swiss recommendations on breastfeeding of infants born to women living with HIV. Eur J Obstet Gynecol Reprod Biol 2023; 283:86-89. [PMID: 36801775 DOI: 10.1016/j.ejogrb.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Swiss national recommendations advise, since end of 2018, supporting women with HIV who wish to breastfeed. Our objective is to describe the motivational factors and the outcome of these women and of their infants. METHODS mothers included in MoCHiV with a delivery between January 2019 and February 2021 who fulfilled the criteria of the "optimal scenario" (adherence to cART, regular clinical care, and suppressed HIV plasma viral load (pVL) of <50 RNA copies/ml) and who decided to breastfeed after a shared decision-making process, were approached to participate in this nested study and asked to fill-in a questionnaire exploring the main motivating factors for breastfeeding. RESULTS Between January 9, 2019 and February 7, 2021, 41 women gave birth, and 25 decided to breastfeed of which 20 accepted to participate in the nested study. The three main motivational factors of these women were bonding, neonatal and maternal health benefits. They breastfed for a median duration of 6.3 months (range 0.7-25.7, IQR 2.5-11.1). None of the breastfed neonates received HIV post-exposure prophylaxis. There was no HIV transmission: 24 infants tested negative for HIV at least 3 months after weaning; one mother was still breastfeeding when we analyzed the data. CONCLUSIONS As a result of a shared decision-making process, a high proportion of mothers expressed a desire to breastfeed. No breastfed infant acquired HIV. The surveillance of breastfeeding mother-infant pairs in high resource settings should be continued to help update guidelines and recommendations.
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Affiliation(s)
- Pierre Alex Crisinel
- Unit of Pediatric Infectious Diseases and Vaccinology, Department Women Mother Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Katharina Kusejko
- University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christian R Kahlert
- Infectious Diseases & Hospital Epidemiology, Children's Hospital of Eastern Switzerland and Cantonal Hospital, St. Gallen, Switzerland
| | - Noémie Wagner
- Pediatric Infectious Diseases Unit, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Leila Sultan Beyer
- Department of Obstetrics and Gynecology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Begoña Martinez De Tejada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospitals, of Geneva, Geneva, Switzerland
| | - Irene Hösli
- University Hospital Basel and University of Basel, Basel, Switzerland
| | - Malte Kohns Vasconcelos
- Department for Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Marc Baumann
- Department of Obstetrics and Gynecology, Bern University Hospital, Bern, Switzerland
| | - Katharine Darling
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea Duppenthaler
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andri Rauch
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Switzerland; Department of Obstetrics and Gynecology, Lindenhofspital, Bern, Switzerland.
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Dugdale CM, Ufio O, Alba C, Permar SR, Stranix‐Chibanda L, Cunningham CK, Fouda GG, Myer L, Weinstein MC, Leroy V, McFarland EJ, Freedberg KA, Ciaranello AL. Cost-effectiveness of broadly neutralizing antibody prophylaxis for HIV-exposed infants in sub-Saharan African settings. J Int AIDS Soc 2023; 26:e26052. [PMID: 36604316 PMCID: PMC9816086 DOI: 10.1002/jia2.26052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/28/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Infant HIV prophylaxis with broadly neutralizing anti-HIV antibodies (bNAbs) could provide long-acting protection against vertical transmission. We sought to estimate the potential clinical impact and cost-effectiveness of hypothetical bNAb prophylaxis programmes for children known to be HIV exposed at birth in three sub-Saharan African settings. METHODS We conducted a cost-effectiveness analysis using the CEPAC-Pediatric model, simulating cohorts of infants from birth through death in Côte d'Ivoire, South Africa and Zimbabwe. These settings were selected to reflect a broad range of HIV care cascade characteristics, antenatal HIV prevalence and budgetary constraints. We modelled strategies targeting bNAbs to only WHO-designated "high-risk" HIV-exposed infants (HR-HIVE) or to all HIV-exposed infants (HIVE). We compared four prophylaxis approaches within each target population: standard of care oral antiretroviral prophylaxis (SOC), and SOC plus bNAbs at birth (1-dose), at birth and 3 months (2-doses), or every 3 months throughout breastfeeding (Extended). Base-case model inputs included bNAb efficacy (60%/dose), effect duration (3 months/dose) and costs ($60/dose), based on published literature. Outcomes included paediatric HIV incidence and incremental cost-effectiveness ratios (ICERs) calculated from discounted life expectancy and lifetime HIV-related costs. RESULTS The model projects that bNAbs would reduce absolute infant HIV incidence by 0.3-2.2% (9.6-34.9% relative reduction), varying by country, prophylaxis approach and target population. In all three settings, HR-HIVE-1-dose would be cost-saving compared to SOC. Using a 50% GDP per capita ICER threshold, HIVE-Extended would be cost-effective in all three settings with ICERs of $497/YLS in Côte d'Ivoire, $464/YLS in South Africa and $455/YLS in Zimbabwe. In all three settings, bNAb strategies would remain cost-effective at costs up to $200/dose if efficacy is ≥30%. If the bNAb effect duration were reduced to 1 month, the cost-effective strategy would become HR-HIVE-1-dose in Côte d'Ivoire and Zimbabwe and HR-HIVE-2-doses in South Africa. Findings regarding the cost-effectiveness of bNAb implementation strategies remained robust in sensitivity analyses regarding breastfeeding duration, maternal engagement in postpartum care, early infant diagnosis uptake and antiretroviral treatment costs. CONCLUSIONS At current efficacy and cost estimates, bNAb prophylaxis for HIV-exposed children in sub-Saharan African settings would be a cost-effective intervention to reduce vertical HIV transmission.
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Affiliation(s)
- Caitlin M. Dugdale
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Ogochukwu Ufio
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Christopher Alba
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Sallie R. Permar
- Department of PediatricsWeill Cornell MedicineNew YorkNew YorkUSA
- Department of PediatricsNew York‐Presbyterian/Weill Cornell Medical CenterNew YorkNew YorkUSA
| | - Lynda Stranix‐Chibanda
- Child and Adolescent Health UnitFaculty of Medicine and Health SciencesUniversity of ZimbabweHarareZimbabwe
| | - Coleen K. Cunningham
- Department of PediatricsUniversity of California IrvineIrvineCaliforniaUSA
- Department of PediatricsChildren's Hospital of Orange CountyOrangeCaliforniaUSA
| | - Genevieve G. Fouda
- Department of PediatricsDuke University Medical CenterDurhamNorth CarolinaUSA
- Duke Human Vaccine InstituteDurhamNorth CarolinaUSA
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health & Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Milton C. Weinstein
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Valériane Leroy
- CERPOP, InsermToulouse UniversityUniversité Paul SabatierToulouseFrance
| | - Elizabeth J. McFarland
- Department of PediatricsUniversity of Colorado Anschutz Medical Campus and Children's Hospital ColoradoAuroraColoradoUSA
| | - Kenneth A. Freedberg
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
- Division of General Internal MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Andrea L. Ciaranello
- Medical Practice Evaluation CenterDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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Nsibande DF, Magasana V, Zembe W, Kindra G, Mogashoa M, Goga A, Ramokolo V. Health facility users' knowledge, perceptions, and practices about infant feeding in the context of option B+ in South Africa: a qualitative study. Int Breastfeed J 2022; 17:89. [PMID: 36539742 PMCID: PMC9764699 DOI: 10.1186/s13006-022-00526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND HIV and sub-optimal infant feeding practices remain important threats to child growth, development, and survival in low- and middle-income countries. To our knowledge, few studies have explored health service users' perspective of infant feeding in the context of WHO Option B+ policy to prevent vertical HIV transmission (PMTCT). This paper is a sub-analysis of qualitative data from a mixed-methods multi-level process evaluation of Option B+ implementation in South Africa (SA). In this study we explored health facility users' infant feeding knowledge, perceptions, and practices one year after SA adopted the 2016 updated World Health Organization prevention of mother-to-child transmission of HIV Option B+ infant feeding guidelines. METHODS Nineteen focus group discussions (FGDs) were held with six groups of men and women whose infants were aged < 6 months. Participants were attending randomly selected primary health care facilities within six purposively selected priority districts. The six groups included in the FGDs were: (i) adolescent girls and young women living with HIV (WHIV), (ii) adolescent girls and young women not living with HIV (WNHIV), (iii) older postnatal WHIV (iv) older postnatal WNHIV (v) pregnant women, and (vi) men. Data collection took place between April and December 2018. Data analysis involved coding and thematic framework analysis. RESULTS Women and men have suboptimal knowledge of the recommended breastfeeding duration and exclusive breastfeeding, especially for HIV-exposed infants. Most women received sub-optimal infant feeding counselling and mixed messages from health care workers. Fewer WHIV initiated breastfeeding at birth compared to WNHIV. Most parents believed that HIV-exposed infants should be breastfed for 6 months and many postnatal women on antiretroviral drugs and younger mothers lacked confidence to breastfeed beyond 6 months. Mixed feeding was predominant among all women due to individual, family, and socio-structural barriers. Many men were supportive on infant feeding; however, they lacked the appropriate information and skills to influence their partners' infant feeding decisions. CONCLUSIONS Differences in breastfeeding practices between WHIV and WNHIV are highly influenced by the lack of knowledge of infant feeding policy recommendations. Multiple-level factors deter many mothers from adhering to recommended guidelines. Appropriate ongoing infant feeding counselling and breastfeeding support are required for women and their partners.
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Affiliation(s)
- Duduzile Faith Nsibande
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
| | - Vuyolwethu Magasana
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
| | - Wanga Zembe
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Gurpreet Kindra
- grid.513001.6United States Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Mary Mogashoa
- grid.513001.6United States Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Ameena Goga
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa ,grid.49697.350000 0001 2107 2298Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Vundli Ramokolo
- grid.415021.30000 0000 9155 0024Health Systems Research Unit (HSRU), South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024HIV and other Infectious Diseases Research Unit (HIDRU), SAMRC, Cape Town, South Africa
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Weisser M, Rohacek M, Ndege R, Luoga E, Katende A, Mollel GJ, Gingo W, Vanobberghen F, Paris DH, Hatz C, Battegay M. The Chronic Diseases Clinic of Ifakara (CDCI)—Establishing a Model Clinic for Chronic Care Delivery in Rural Sub-Saharan Africa. Diseases 2022; 10:diseases10040072. [PMID: 36278571 PMCID: PMC9590064 DOI: 10.3390/diseases10040072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
The rollout of antiretroviral drugs in sub-Saharan Africa to address the huge health impact of the HIV pandemic has been one of the largest projects undertaken in medical history and is an unprecedented medical success story. However, the path has been and still is characterized by many far reaching implementational challenges. Here, we report on the building and maintaining of a role model clinic in Ifakara, rural Southwestern Tanzania, within a collaborative project to support HIV services within the national program, training for staff and integrated research to better understand local needs and improve patients’ outcomes.
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Affiliation(s)
- Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4031 Basel, Switzerland
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- Correspondence: (M.W.); (M.B.); Tel.: +41-328-67-42 (M.W.); +41-61-265-50-53 (M.B.)
| | - Martin Rohacek
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
| | - Robert Ndege
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Ezekiel Luoga
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Andrew Katende
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Getrud J. Mollel
- Ifakara Health Institute, Ifakara P.O. Box 53, Tanzania
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Winfrid Gingo
- St. Francis Referral Hospital, Ifakara P.O. Box 73, Tanzania
| | - Fiona Vanobberghen
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
| | - Daniel H. Paris
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
| | - Christoph Hatz
- University of Basel, 4001 Basel, Switzerland
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4031 Basel, Switzerland
- University of Basel, 4001 Basel, Switzerland
- Correspondence: (M.W.); (M.B.); Tel.: +41-328-67-42 (M.W.); +41-61-265-50-53 (M.B.)
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From Undetectable Equals Untransmittable (U=U) to Breastfeeding: Is the Jump Short? Infect Dis Rep 2022; 14:220-227. [PMID: 35447879 PMCID: PMC9030015 DOI: 10.3390/idr14020027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Vertical transmission of HIV infection may occur during pregnancy, at childbirth or through breastfeeding. Recommendations on the safety of breastfeeding of HIV-infected women on effective antiretroviral treatment are not univocal among international guidelines (WHO 2010, EACS 2017, DHHS 2017), leaving space for variability at the patient’s level. Methods: We collected clinical, laboratory and outcome data from 13 HIV-infected pregnant women who, between March 2017 and June 2021, elected to breastfeed their children against specific medical advice. All mothers were on antiretroviral therapy with darunavir or raltegravir plus emtricitabine/tenofovir disoproxil and remained HIV-RNA undetectable and >400 cells/mmc CD4+ lymphocytes during pregnancy and breastfeeding. Prophylactic antiretroviral therapy (zidovudine for 4 weeks) was started immediately after birth in all newborns. The mean duration of breastfeeding was 5.4 months. Newborns were tested for HIV-RNA multiple times: at birth, 1, 3, and 6 months after birth, and 1, 3 and 6 months after the end of breastfeeding. Results: None of the infants were infected by HIV. Conclusions: Our experience, gathered in the setting of freedom of choice on the patient’s side, while insufficient to address the eventual safety of breastfeeding in HIV-infected mothers since the represented cohort is numerically irrelevant, supports the extension of the U=U (Undetectable Equals Untransmittable) paradigm to this setting. Since breastfeeding is often requested by women with HIV planning pregnancy, more extensive comparative studies should be performed.
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10
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Cranmer LM, Chung MH, Chahroudi A. Support for Establishing Best Practices for Breastfeeding in the Current HIV/ART Era. J Pediatric Infect Dis Soc 2022; 11:90-91. [PMID: 34939651 DOI: 10.1093/jpids/piab128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Lisa M Cranmer
- Department of Pediatrics, Division of Pediatric Infectious Disease, Emory School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, Georgia, USA.,Children\'s Healthcare of Atlanta, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Michael H Chung
- Grady Memorial Hospital, Atlanta, Georgia, USA.,Department of Medicine, Division of Infectious Disease, Emory School of Medicine, Atlanta, Georgia, USA.,Departments of Epidemiology and Global Health, Emory Rollins School of Public Health, Atlanta, Georgia, USA
| | - Ann Chahroudi
- Department of Pediatrics, Division of Pediatric Infectious Disease, Emory School of Medicine, Atlanta, Georgia, USA.,Children\'s Healthcare of Atlanta, Atlanta, Georgia, USA.,Grady Memorial Hospital, Atlanta, Georgia, USA
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11
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Volpe LJ, Powis KM, Legbedze J, Sun S, Abrams EJ, Mmasa NK, Kgole S, Masasa G, Makhema J, Mmalane M, Jao J. A Counseling and Monitoring Approach for Supporting Breastfeeding Women Living With HIV in Botswana. J Acquir Immune Defic Syndr 2022; 89:e16. [PMID: 34723927 PMCID: PMC8752495 DOI: 10.1097/qai.0000000000002846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Lena J. Volpe
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Chicago, IL, USA
| | - Kathleen M. Powis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Massachusetts General Hospital, Boston, MA, USA, Departments of Internal Medicine and Pediatrics
- Harvard T.H. Chan School of Public Health, Boston, MA, USA, Department of Immunology and Infectious Diseases
| | - Justine Legbedze
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago IL, USA Department of Pediatrics, Division of Infectious Disease
| | - Shan Sun
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago IL, USA Department of Pediatrics, Division of Infectious Disease
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, Vagellos College of Physicians and Surgeons, Columbia University, New York, NY US
| | | | - Samuel Kgole
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Gosego Masasa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Jennifer Jao
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Chicago, IL, USA
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago IL, USA Department of Pediatrics, Division of Infectious Disease
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12
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Symington A, Chingore-Munazvo N, Moroz S. When law and science part ways: the criminalization of breastfeeding by women living with HIV. Ther Adv Infect Dis 2022; 9:20499361221122481. [PMID: 36105181 PMCID: PMC9465574 DOI: 10.1177/20499361221122481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Stigma and discrimination are a constant reality for the 37.7 million
people living with human immunodeficiency virus (HIV) around the
globe. Fear over vertical transmission has fuelled HIV
criminalization: laws that target people living with HIV for acts
deemed to be a transmission risk. Research has now shown that many of
these behaviours, including breastfeeding, pose an extremely low risk
of transmission when people have proper medical care, access to
treatment and open relationships with medical professionals. Yet, we
are witnessing a wave of criminal cases against women living with HIV
for breastfeeding, an act which is actively promoted worldwide as the
best infant feeding strategy. In this review, we will place the
criminalization of breastfeeding within the context of current medical
recommendations and cultural views of breastfeeding. We will highlight
the criminal cases against women living with HIV for breastfeeding
around the globe and the criteria for justifiable criminalization.
Finally, we will provide recommendations for moving towards
decriminalization, removing this barrier to HIV prevention, treatment
and care.
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13
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Amin O, Powers J, Bricker KM, Chahroudi A. Understanding Viral and Immune Interplay During Vertical Transmission of HIV: Implications for Cure. Front Immunol 2021; 12:757400. [PMID: 34745130 PMCID: PMC8566974 DOI: 10.3389/fimmu.2021.757400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
Despite the significant progress that has been made to eliminate vertical HIV infection, more than 150,000 children were infected with HIV in 2019, emphasizing the continued need for sustainable HIV treatment strategies and ideally a cure for children. Mother-to-child-transmission (MTCT) remains the most important route of pediatric HIV acquisition and, in absence of prevention measures, transmission rates range from 15% to 45% via three distinct routes: in utero, intrapartum, and in the postnatal period through breastfeeding. The exact mechanisms and biological basis of these different routes of transmission are not yet fully understood. Some infants escape infection despite significant virus exposure, while others do not, suggesting possible maternal or fetal immune protective factors including the presence of HIV-specific antibodies. Here we summarize the unique aspects of HIV MTCT including the immunopathogenesis of the different routes of transmission, and how transmission in the antenatal or postnatal periods may affect early life immune responses and HIV persistence. A more refined understanding of the complex interaction between viral, maternal, and fetal/infant factors may enhance the pursuit of strategies to achieve an HIV cure for pediatric populations.
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Affiliation(s)
- Omayma Amin
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Jenna Powers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Katherine M. Bricker
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and Emory University, Atlanta, GA, United States
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14
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Abstract
Advances in perinatal HIV management have averted a significant number of infections in neonates and have made the possibility of elimination of mother-to-child transmission a reality; however, significant gaps in implementation of early testing programs as well as the expansion of therapeutic strategies to neonates are hindering prevention efforts and access to safer, more effective and easier to administer treatment. This article provides insights on the current state of perinatal HIV, recent advances, and future needs.
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Affiliation(s)
- Andres F Camacho-Gonzalez
- Division of Pediatric Infectious Diseases, Children's Healthcare of Atlanta, Emory University School of Medicine, 2015 Uppergate Drive, Suite 500, Atlanta, GA 30322, USA.
| | - Paul Palumbo
- Section of Infectious Diseases and International Health, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH 03756, USA
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15
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Dong Y, Guo W, Gui X, Liu Y, Yan Y, Feng L, Liang K. Preventing mother to child transmission of HIV: lessons learned from China. BMC Infect Dis 2020; 20:792. [PMID: 33106179 PMCID: PMC7586644 DOI: 10.1186/s12879-020-05516-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/15/2020] [Indexed: 01/31/2023] Open
Abstract
Background The program for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) was launched in 2003 in China, but few studies have been conducted to describe the panorama of PMTCT. We investigated the rate and associated factors of mother-to-child transmission (MTCT) in China from 2004 to 2018. Methods HIV-infected pregnant women from two areas in China between 2004 and 2018 were enrolled. Antiretrovirals (ARVs) were provided to the mothers and their babies, and the children were followed and tested for HIV. Results In total, 857 mothers and their 899 children were enrolled, and the overall MTCT rate was 6.6% (95% CI 5.0–8.2). The MTCT rates of nonintervention, only formula feeding (FF), infant prophylaxis (IP) + FF, single dosage antiretrovirals (sdARVs) + IP + FF, zidovudine (AZT) alone+IP + FF and prenatal combination antiretroviral therapy (cART) + IP + FF were 36.4, 9.4, 10.0, 5.7, 3.8 and 0.3%, respectively. The MTCT rate declined over time. No ARVs, CD4 count < 200/μL, low birth weight, and breastfeeding were associated with MTCT of HIV. For different ARVs, a higher MTCT rate was observed for AZT alone, sdARVs, and no ARVs compared to cART for pregnant women. Conclusions Although the overall MTCT rate remains relatively high, the real-world effect of prenatal cART+IP + FF in China has exerted the same protective effects in high-income countries. With the extension of prenatal cART for pregnant women with HIV, the MTCT rate of HIV has gradually declined in China. However, the coverage of prenatal cART for pregnant women should be further improved. The effect of only post-exposure prophylaxis for infants was limited.
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Affiliation(s)
- Yu Dong
- Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Guo
- Department of Pathology, Wuhan University School of Basic Medical Sciences, Wuhan, China.,Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xien Gui
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Yanbin Liu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Yajun Yan
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Ling Feng
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China. .,Center of Preventing Mother-to-child transmission for Infectious Diseases, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, China. .,Department of Nosocomial Infection Management, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China.
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16
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Sandbulte M, Brown M, Wexler C, Maloba M, Gautney B, Goggin K, Muchoki E, Babu S, Maosa N, Finocchario-Kessler S. Maternal viral load monitoring: Coverage and clinical action at 4 Kenyan hospitals. PLoS One 2020; 15:e0232358. [PMID: 32469876 PMCID: PMC7259657 DOI: 10.1371/journal.pone.0232358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Kenya’s guidelines for prevention of mother-to-child transmission of HIV (PMTCT) recommend routine viral load (VL) monitoring for pregnant and breastfeeding women. Method We assessed PMTCT VL monitoring and clinical action occurring between last menstrual period (LMP) and 6 months postpartum at 4 Kenyan government hospitals. Pregnant women enrolled in the HIV Infant Tracking System from May 2016-March 2018 were included. We computed proportions who received VL testing within recommended timeframes and who received clinical action after unsuppressed VL result. Results Of 424 participants, any VL testing was documented for 305 (72%) women and repeat VL testing was documented for 79 (19%). Only 115 women (27%) received a guideline-adherent baseline VL test and 27 (6%) received a guideline-adherent baseline and repeat VL test sequence. Return of baseline and repeat VL test results to the facility was high (average 96%), but patient notification of VL results was low (36% baseline and 49% repeat). Clinical action for unsuppressed VL results was even lower: 11 of 38 (29%) unsuppressed baseline results and 2 of 14 (14%) unsuppressed repeat results triggered clinical action. Discussion Guideline-adherent VL testing and clinical intervention during PMTCT must be prioritized to improve maternal care and reduce the risk of HIV transmission to infants.
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Affiliation(s)
- Matthew Sandbulte
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Brad Gautney
- Global Health Innovations, Dallas, TX, United States of America
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, United States of America.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | | | | | | | - Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America
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17
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Abstract
Guidelines in high-income settings recommend breastfeeding avoidance amongst women living with HIV (WLWH). Increasingly, WLWH in high-income settings, who are well-treated with fully suppressed viral loads, are choosing to breastfeed their infants, even with these recommendations. The purpose of this article is to review existing research and guidance on infant feeding amongst WLWH in high-income countries and to identify gaps in this evidence that require further investigation. Current evidence on the risk of HIV transmission through breastfeeding in the context of antiretroviral therapy (ART), the significance of cell-associated virus, transmission risk factors, retention in care and adherence postpartum, infant prophylaxis and antiretroviral exposure, and monitoring of the breastfeeding WLWH are summarized. A latent HIV reservoir is persistently present in breast milk, even in the context of ART. Thus, suppressive maternal ART significantly reduces, but does not eliminate, the risk of postnatal transmission of HIV. There are currently limited data to guide the optimal frequency of virologic monitoring and the clinical actions to take in case of maternal detectable viral load whilst breastfeeding. Moreover, retention in care and adherence to ART in the postpartum period may be difficult and more research is needed to understand what clinical and psychosocial support would benefit these mothers so that successful engagement in care can be achieved. The long-term effects of antiretroviral drug exposure in the infants also need further exploration. Thus, there is a need for collecting enhanced surveillance data on WLWH who breastfeed and their infants to augment clinical guidance in high-income settings.
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Affiliation(s)
- E Moseholm
- Department of Infectious Disease, Copenhagen University Hospital, Hvidovre, Denmark
| | - N Weis
- Department of Infectious Disease, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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18
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Luoga E, Gamell A. Prevention of Mother-to-Child Transmission of HIV – an Update from Rural Africa. PRAXIS 2019; 108:977-981. [PMID: 31771493 DOI: 10.1024/1661-8157/a003335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sub-Saharan Africa is home of 85 % of pregnant women living with HIV and 90 % of HIV-infected children. WHO issued the first prevention of mother-to-child transmission of HIV (PMTCT) recommendations in 2000. These guidelines have been revised to incorporate new evidence and align with the goal of universal treatment access and zero infections among children. Currently, 82 % of HIV-infected pregnant women receive antiretroviral treatment, and infections among children have halved since 2010. However, in 2018, 160,000 children became infected. Reasons hindering the success of PMTCT are: a) non-universal HIV testing during pregnancy; b) low retention through the PMTCT cascade; and c) missed opportunities to diagnose women who acquire HIV while pregnant or breastfeeding. To address these gaps innovative strategies are needed.
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Affiliation(s)
- Ezekiel Luoga
- Ifakara Health Institute, United Republic of Tanzania
| | - Anna Gamell
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Unitat d'Infeccions, Servei de Pediatria, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
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19
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McFall SM, Maiga M, Glucksberg M, Achenbach CJ, Palamountain KL, Murphy RL. Supporting Diagnosis and Management of HIV/AIDS Patients Through Point-of-Care Technology Development. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2019; 11:9-15. [PMID: 32864521 DOI: 10.1016/j.cobme.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The HIV pandemic disproportionately impacts sub-Saharan Africa where in 2017, 71% of people living with HIV resided, 65% of new infections and 75% of deaths were reported. Prevention, screening and treatment strategies have led to progress in addressing this disease. HIV diagnostics have been crucial for prevention and treatment but more progress is required to reduce HIV infection. The Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University (C-THAN) is a vital partner in the National Institute of Biomedical Imaging and Bioengineering Point-of-Care Technologies Research Network. C-THAN's mission is to develop and commercialize a pipeline of point-of-care technologies critical for improved prevention and management of HIV in low- and middle-income countries with specific emphasis on sub-Saharan Africa.
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Affiliation(s)
- Sally M McFall
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Mamoudou Maiga
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Matthew Glucksberg
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Chad J Achenbach
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Kara L Palamountain
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Kellogg School of Management, Northwestern University, Evanston, IL 60208, USA
| | - Robert L Murphy
- Center for Innovation in Point-of-Care Technologies for HIV/AIDS at Northwestern University, Evanston, IL 60208, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Medicine, Northwestern University, Chicago, IL 60611, USA
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