Implementation of the programmes intended to prevent mother-to-child transmission of HIV/AIDS (PMTCT) is a major challenge, particularly in developing countries. Despite the controversies about Nevirapine (NVP) resistance, safety and efficacy, it is still widely acclaimed and used in most resource-limited countries because it is affordable, easy-to-use and practical.
Mother-to-child transmission is by far the largest source of HIV infection in children below the age of 15. This report presents the results of research conducted at a pilot site in the Eastern Cape into the use of resources associated with the implementation of a PMTCT (prevention of mother-to-child transmission) programme.
Tuyển tập các báo cáo nghiên cứu về hóa học được đăng trên tạp chí sinh học quốc tế đề tài : Outcome of Different Nevirapine Administration Strategies in Preventin g Mother-to-Child Transmission (PMTCT) Programs in Tanzania and Uganda
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Health system weaknesses constrain access to PMTCT and maternal HIV services in South Africa: a qualitative enquiry...
The commitment of the international community and national governments to integrating
PMTCT interventions into maternal and child health services and strengthening linkages
to other health programmes, including other SRH programmes and HIV care, support,
and treatment programmes, was more recently echoed in the Call to Action: Towards an
HIV-Free and AIDS-Free Generation.
Coordination means, at a minimum, that programming within and among U.S. agencies takes advantage of each
agency’s strengths, avoids duplication, and increases the efficiency and effectiveness of each dollar spent. Better coor-
dination of programs and delivery platforms provides opportunities to strengthen the integration of health services
at the point of delivery to meet more of the health care needs of individuals, as well as ensure satisfaction with and
increase demand for those services.
This paper examines the integration of family planning (FP) services with HIV and AIDS services
(voluntary counselling and testing (VCT), prevention of mother-to-child-transmission (PMTCT)
and anti-retroviral therapy (ART)) in Uganda. The paper finds that: FP service integration is more
evident in VCT and PMTCT settings where counselling, provision of contraceptive methods other
than condoms, and information is available in varying degrees.
This programmatic update is meant to provide a current perspective for countries on the important
changes and new considerations arising since publication of WHO’s PMTCT ARV guidelines,
2010 version, especially as a number of countries are now preparing to adopt Option
B+. WHO has begun a comprehensive revision of all ARV guidelines, including guidance on
ARVs for pregnant women, planned for release in early 2013.
In light of global and country commitments to elimination of
new paediatric infections and the changes outlined in this
programmatic update, all countries should examine their own
policy, goals and implementation experiences and assess how
they can better simplify, optimize and integrate their PMTCT
and ART programmes. Countries that are successfully implementing
Option A and achieving their targets of decreasing
mother-to-child transmission of HIV and treating mothers
eligible for ART do not need to plan an immediate change to
Option B or B+.
Bathroom surfaces, such as faucets, handles, and toilet seats should be washed and disinfected
several times a day, if possible, but at least once daily or when obviously soiled. The bleach and
water solution or chlorine-containing scouring powders or other commercial bathroom surface
cleaners/disinfectants can be used in these areas. Surfaces that infants and young toddlers are
likely to touch or mouth, such as crib rails, should be washed with soap and water and disinfected
with a nontoxic disinfectant, such as bleach solution, at least once daily and more often if visibly
the prevalence of HiV/aiDS among pregnant women
is 0.9% (i.e. low for the region). Whilst 57% and 71%
of women and men respectively have ever heard about
aiDS, knowledge of prevention of transmission through
the use of condoms was very low. there are currently
no national guidelines for Prevention of Mother to child
transmission (PMtct) or Highly active antiretroviral
therapy (Haart). coverage for PMtct is accordingly
very low: only 11 pregnant women living with HiV
received PMtct services in 2007, an estimated
coverage of 1% (11/940 women).
Attaining and preserving the rights of HIV-positive women and adolescent girls will help en-
sure that SRH services are of the appropriate range and quality and that they are accessible
to all who need them.
Some female respondents had accessed PMTCT services when pregnant. Among women not on ART,
knowledge of PMTCT and where to obtain services was poorer. Women perceived PMTCT counselling on infant
feeding, contraception, and dual protection to be inadequate. Many women not receiving ART knew that
antiretroviral drugs were available at the clinics they were attending and knew that they did not yet qualify for
the drugs. They knew little of the health effects of the therapy, however.
Indonesia has received GFATM grants since 2003 with 17 grants worth $500 million across the three diseases. Grants have been awarded to the MOH, National AIDS Commission and civil society partners. Grants to the MOH are used to procure all ARVs and many of the ACTs and MDR-TB treatment regimens in Indonesia.
Prevention of mother-to-child transmission of HIV (PMTCT)
is a dynamic and rapidly changing field. Current World Health
Organization (WHO) PMTCT antiretroviral (ARV) guidelines on
treating pregnant women and preventing infection in infants
(1), issued in 2010, were a major step towards more efficacious
The 2010 WHO PMTCT ARV guidelines are based on the need
to distinguish between treatment and prophylaxis. Consistent
with the 2010 WHO adult ART guidelines (2), they recommend
and prioritize starting all women with CD4 counts ≤350 cells/
mm3 or WHO Stage 3 or 4 disease (approximately 40–50% of
all HIV-infected pregnant women) on ART for life for their own
health as well as for the prevention of infant HIV infection.
The cost of ARV drugs was a major determinant in
countries’ choice of a PMTCT option. In 2009 the average
ARV drug cost of Option B was three to five times higher than
the cost of Option A (depending on regimen and assuming
the provision of both ART and prophylaxis). However, by the
end of 2011, this differential had diminished to two times
higher. The annual cost of two-pill formulations of TDF/3TC/
EFV has decreased by 30% over the past three years and
is now US$150; the newer TDF/3TC/EFV single-pill fixeddose
regimen costs approximately US$180 per year (11,12).
There is an urgent need to assess country experiences and
evidence that address the preferences among Options A, B
and B+ outlined here. Evidence on the operational advantages
of providing triple ARVs to all HIV-infected pregnant women
(Options B and B+), on how to best meet the programme
requirements of these approaches, and on the acceptability,
effectiveness and prevention impact of providing lifelong ART
to all HIV-infected pregnant women (Option B+) will help
inform upcoming guidelines revision.
Easier implementation could expand services.
Reported difficulties with implementing PMTCT programmes,
including the challenge of providing ARV
treatment in MCH settings and at the primary care level,
highlight the importance of simplifying drug regimens
and operational delivery, as exemplified by Options B
and B+. Easier implementation should facilitate expansion
of services and more effective programmes. This
will, however, require strengthened antenatal services,
task-shifting, more effective ARV service delivery in MCH
settings and direct linkages with ART programmes.
Recent developments suggest that substantial clinical and programmatic advantages can
come from adopting a single, universal regimen both to treat HIV-infected pregnant women
and to prevent mother-to-child transmission of HIV. This streamlining should maximize PMTCT
programme performance through better alignment and linkages with antiretroviral therapy
(ART) programmes at every level of service delivery. One of WHO’s two currently recommended
PMTCT antiretroviral (ARV) programme options, Option B, takes this unified approach....