Last data update: May 20, 2024. (Total: 46824 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Essajee S [original query] |
---|
Understanding the uptake of prevention of mother-to-child transmission services among adolescent girls in Sub-Saharan Africa: a review of literature
Ng’eno B , Rogers B , Mbori-Ngacha D , Essajee S , Hrapcak S , Modi S . Int J Adolesc Youth 2019 25 (1) 585-598 Despite high pregnancy rates and HIV incidence among adolescents, their uptake of prevention of mother-to-child HIV transmission (PMTCT) services is not well characterized. This paper describes current PMTCT program coverage among adolescents <20 years. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed/MEDLINE (NCBI), SCOPUS (Elsevier), Grey literature and EMBASE and websites of international organizations and conferences were searched for eligible studies published from 2000 to 2017. Adolescents had lower rates of planned pregnancies, were less likely to know their HIV infection status before their first ANC visit, lower use of ARV, higher rates of loss to follow-up and higher rates of MTCT compared to adults. This study identified differential uptake of PMTCT services for adolescents compared to adults. Age-disaggregated data are urgently needed to understand the sub-optimal uptake of HIV services for adolescents in PMTCT and support the design of effective interventions to close these gaps. |
What will it take for the Global Plan priority countries in Sub-Saharan Africa to eliminate mother-to-child transmission of HIV
Goga AE , Dinh TH , Essajee S , Chirinda W , Larsen A , Mogashoa M , Jackson D , Cheyip M , Ngandu N , Modi S , Bhardwaj S , Chirwa E , Pillay Y , Mahy M . BMC Infect Dis 2019 19 783 BACKGROUND: The 2016 'Start Free, Stay Free, AIDS Free' global agenda, builds on the 2011-2015 'Global Plan'. It prioritises 22 countries where 90% of the world's HIV-positive pregnant women live and aims to eliminate vertical transmission of HIV (EMTCT) and to keep mothers alive. By 2019, no Global Plan priority country had achieved EMTCT; however, 11 non-priority countries had. This paper synthesises the characteristics of the first four countries validated for EMTCT, and of the 21 Global Plan priority countries located in Sub-Saharan Africa (SSA). We consider what drives vertical transmission of HIV (MTCT) in the 21 SSA Global Plan priority countries. METHODS: A literature review, using PubMed, Science direct and the google search engine was conducted to obtain global and national-level information on current HIV-related context and health system characteristics of the first four EMTCT-validated countries and the 21 SSA Global Plan priority countries. Data representing only one clinic, hospital or region were excluded. Additionally, key global experts working on EMTCT were contacted to obtain clarification on published data. We applied three theories (the World Health Organisation's building blocks to strengthen health systems, van Olmen's Health System Dynamics framework and Baral's socio-ecological model for HIV risk) to understand and explain the differences between EMTCT-validated and non-validated countries. Additionally, structural equation modelling (SEM) and linear regression were used to explain associations between infant HIV exposure, access to antiretroviral therapy and two outcomes: (i) percent MTCT and (iii) number of new paediatric HIV infections per 100 000 live births (paediatric HIV case rate). RESULTS: EMTCT-validated countries have lower HIV prevalence, less breastfeeding, fewer challenges around leadership, governance within the health sector or country, infrastructure and service delivery compared with Global Plan priority countries. Although by 2016 EMTCT-validated countries and Global Plan priority countries had adopted a public health approach to HIV prevention, recommending lifelong antiretroviral therapy (ART) for all HIV-positive pregnant and lactating women, EMCT-validated countries had also included contact tracing such as assisted partner notification, and had integrated maternal and child health (MCH) and sexual and reproductive health (SRH) services, with services for HIV infection, sexually transmitted infections, and viral hepatitis. Additionally, Global Plan priority countries have limited data on key SRH indicators such as unmet need for family planning, with variable coverage of antenatal care, HIV testing and triple antiretroviral therapy (ART) and very limited contact tracing. Structural equation modelling (SEM) and linear regression analysis demonstrated that ART access protects against percent MTCT (p<0.001); in simple linear regression it is 53% protective against percent MTCT. In contrast, SEM demonstrated that the case rate was driven by the number of HIV exposed infants (HEI) i.e. maternal HIV prevalence (p<0.001). In linear regression models, ART access alone explains only 17% of the case rate while HEI alone explains 81% of the case rate. In multiple regression, HEI and ART access accounts for 83% of the case rate, with HEI making the most contribution (coef. infant HIV exposure=82.8, 95% CI: 64.6, 101.1, p<0.001 vs coef. ART access=-3.0, 95% CI: -6.2, 0.3, p=0.074). CONCLUSION: Reducing infant HIV exposure, is critical to reducing the paediatric HIV case rate; increasing ART access is critical to reduce percent MTCT. Additionally, our study of four validated countries underscores the importance of contact tracing, strengthening programme monitoring, leadership and governance, as these are potentially-modifiable factors. |
Pregnant and breastfeeding women: A priority population for HIV viral load monitoring
Myer L , Essajee S , Broyles LN , Watts DH , Lesosky M , El-Sadr WM , Abrams EJ . PLoS Med 2017 14 (8) e1002375 Landon Myer and colleagues discuss viral load monitoring for pregnant HIV-positive women and those breastfeeding; ART treatments can suppress viral load and are key to preventing transmission to the child. |
Elimination of mother-to-child transmission of HIV and syphilis (EMTCT): Process, progress, and program integration
Taylor M , Newman L , Ishikawa N , Laverty M , Hayashi C , Ghidinelli M , Pendse R , Khotenashvili L , Essajee S . PLoS Med 2017 14 (6) e1002329 Melanie Taylor and colleagues discuss progress towards eliminating vertical transmission of HIV and syphilis. |
Scale-up of early infant HIV diagnosis and improving access to pediatric HIV care in Global Plan countries: Past and future perspectives
Essajee S , Bhairavabhotla R , Penazzato M , Kiragu K , Jani I , Carmona S , Rewari B , Kiyaga C , Nkengasong J , Peter T . J Acquir Immune Defic Syndr 2017 75 Suppl 1 S51-s58 Investment to scale-up early infant diagnosis (EID) of HIV has increased substantially in the last decade. This investment includes physical infrastructure, equipment, human resources, and specimen transportation systems as well as specialized mechanisms to deliver laboratory results to clinics. The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive, as well as related international initiatives to prevent mother-to-child transmission of HIV and treat children living with HIV have been important drivers of this scale-up by mobilizing resources, creating advocacy, developing normative recommendations, and providing direct technical support to countries through the global community of international stakeholders. As a result, the number of early infant diagnosis tests performed annually has increased 10-fold between 2005 and 2015, and many thousands of infants are now receiving life-saving antiretroviral therapy because of this improved access. Despite these efforts and many success stories, timely infant diagnosis remains a challenge in many Global Plan countries. The most recent data (from the end of 2015) suggest a large variation in access. Some countries report that almost 90% of HIV-exposed infants are being tested; others report that the level of access has stagnated at 30%. Still, just over half of all exposed infants in Global Plan countries receive a test in the first 2 months of life. We discuss the key factors that are responsible for this scale-up of diagnostic capacity, highlight some of the challenges that have hampered progress, and describe priorities for the future that can help maintain momentum to achieve true universal access to HIV testing for children. |
Translating technical support into country action: The role of the Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children in the Global Plan era
Luo C , Hirnschall G , Rodrigues J , Romano S , Essajee S , Rogers B , McCarthy E , Mwango A , Sangrujee N , Adler MR , Houston JC , Langa JO , Urso M , Bolu O , Tene G , Elat Nfetam JB , Kembou E , Phelps BR . J Acquir Immune Defic Syndr 2017 75 Suppl 1 S7-s16 While the Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers, and Children (IATT) partnership existed before the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), its reconfiguration was critical to coordinating provision of technical assistance that positively influenced country decision-making and program performance. This article describes how the Global Plan anchored the work of the IATT and, in turn, how the IATT's technical assistance helped to accelerate achievement of the Global Plan targets and milestones. The technical assistance that will be discussed addressed a broad range of priority actions and milestones described in the Global Plan: (1) planning for and implementing Option B+; (2) strengthening monitoring and evaluation systems; (3) translating evidence into action and advocacy; and (4) promoting community engagement. This article also reviews the ongoing challenges and opportunities of providing technical assistance in a rapidly evolving environment that calls for ever more flexible and contextualized responses. The effectiveness of technical assistance facilitated by the IATT was defined by its timeliness, evidence base, and unique global perspective that built on the competencies of its partners and promoted synergies across program areas. Reaching the final goal of eliminating vertical transmission of HIV infection and achieving an AIDS-free generation in countries with the highest HIV burden requires that the IATT partnership and technical assistance remain responsive to country-specific needs while aligning with the current programmatic reality and new global goals such as the Sustainable Development Goals and 90-90-90 targets. |
Elimination of mother-to-child transmission of HIV and syphilis in Cuba and Thailand
Ishikawa N , Newman L , Taylor M , Essajee S , Pendse R , Ghidinelli M . Bull World Health Organ 2016 94 (11) 787-787a Vertical transmission of human immunodeficiency virus (HIV) and syphilis can be effectively controlled through antenatal screening and treatment. However, each year there are still an estimated 150 000 cases of new paediatric HIV infections and 350 000 cases of congenital syphilis globally.1,2 The World Health Organization (WHO) has developed global health sector strategies for 2016–2021 on HIV and sexually transmitted infections that set the targets of achieving zero new HIV infections among infants by 2020 and less than or equal to 50 cases of congenital syphilis per 100 000 live births by 2030.2–4 | WHO has issued a Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis.4 To be validated by WHO as achieving elimination of the vertical transmission of HIV and syphilis, countries must meet three impact and five process targets, have a high-quality monitoring and surveillance system and respect basic human rights considerations, such as voluntary testing and treatment, equality and non-discrimination.4 Validation indicators specify that new paediatric HIV infections and congenital syphilis cases have to be less than or equal to 50 per 100 000 live births, and mother-to-child transmission rates of HIV have to be less than 5% in breastfeeding populations or less than 2% in non-breastfeeding populations for at least one year. When a country successfully meets the targets, it can submit a validation request and a national validation report to WHO. The report is reviewed by independent experts and an in-country assessment is conducted. This assessment involves a programmatic and health system review, in which high-level political commitment to elimination targets, strong maternal and child health and disease control programmes, reliable laboratory services, a robust health information system, compliance with human rights principles, gender equality and civil society engagement must all be demonstrated. |
CD4 enumeration technologies: a systematic review of test performance for determining eligibility for antiretroviral therapy
Peeling RW , Sollis KA , Glover S , Crowe SM , Landay AL , Cheng B , Barnett D , Denny TN , Spira TJ , Stevens WS , Crowley S , Essajee S , Vitoria M , Ford N . PLoS One 2015 10 (3) e0115019 BACKGROUND: Measurement of CD4+ T-lymphocytes (CD4) is a crucial parameter in the management of HIV patients, particularly in determining eligibility to initiate antiretroviral treatment (ART). A number of technologies exist for CD4 enumeration, with considerable variation in cost, complexity, and operational requirements. We conducted a systematic review of the performance of technologies for CD4 enumeration. METHODS AND FINDINGS: Studies were identified by searching electronic databases MEDLINE and EMBASE using a pre-defined search strategy. Data on test accuracy and precision included bias and limits of agreement with a reference standard, and misclassification probabilities around CD4 thresholds of 200 and 350 cells/mul over a clinically relevant range. The secondary outcome measure was test imprecision, expressed as % coefficient of variation. Thirty-two studies evaluating 15 CD4 technologies were included, of which less than half presented data on bias and misclassification compared to the same reference technology. At CD4 counts <350 cells/mul, bias ranged from -35.2 to +13.1 cells/mul while at counts >350 cells/mul, bias ranged from -70.7 to +47 cells/mul, compared to the BD FACSCount as a reference technology. Misclassification around the threshold of 350 cells/mul ranged from 1-29% for upward classification, resulting in under-treatment, and 7-68% for downward classification resulting in overtreatment. Less than half of these studies reported within laboratory precision or reproducibility of the CD4 values obtained. CONCLUSIONS: A wide range of bias and percent misclassification around treatment thresholds were reported on the CD4 enumeration technologies included in this review, with few studies reporting assay precision. The lack of standardised methodology on test evaluation, including the use of different reference standards, is a barrier to assessing relative assay performance and could hinder the introduction of new point-of-care assays in countries where they are most needed. |
Pediatric treatment 2.0: ensuring a holistic response to caring for HIV-exposed and infected children
Essajee SM , Arpadi SM , Dziuban EJ , Gonzalez-Montero R , Heidari S , Jamieson DG , Kellerman SE , Koumans E , Ojoo A , Rivadeneira E , Spector SA , Walkowiak H . AIDS 2013 27 Suppl 2 S215-24 Treatment 2.0 is an initiative launched by UNAIDS and WHO in 2011 to catalyze the next phase of treatment scale-up for HIV. The initiative defines strategic activities in 5 key areas, drugs, diagnostics, commodity costs, service delivery and community engagement in an effort to simplify treatment, expand access and maximize program efficiency. For adults, many of these activities have already been turned into treatment policies. The recent WHO recommendation to use a universal first line regimen regardless of gender, pregnancy and TB status is a treatment simplification very much in line with Treatment 2.0. But despite that fact that Treatment 2.0 encompasses all people living with HIV, we have not seen the same evolution in policy development for children. In this paper we discuss how Treatment 2.0 principles can be adapted for the pediatric population. There are several intrinsic challenges. The need for distinct treatment regimens in children of different ages makes it hard to define a one size fits all approach. In addition, the fact that many providers are reluctant to treat children without the advice of specialists can hamper decentralization of service delivery. But at the same time, there are opportunities that can be availed now and in the future to scale up pediatric treatment along the lines of Treatment 2.0. We examine each of the five pillars of Treatment 2.0 from a pediatric perspective and present eight specific action points that would result in simplification of pediatric treatment and scale up of HIV services for children. |
Opportunities and challenges for cost-efficient implementation of new point-of-care diagnostics for HIV and tuberculosis
Schito M , Peter TF , Cavanaugh S , Piatek AS , Young GJ , Alexander H , Coggin W , Domingo GJ , Ellenberger D , Ermantraut E , Jani IV , Katamba A , Palamountain KM , Essajee S , Dowdy DW . J Infect Dis 2012 205 Suppl 2 S169-80 Stakeholders agree that supporting high-quality diagnostics is essential if we are to continue to make strides in the fight against human immunodeficiency virus (HIV) and tuberculosis. Despite the need to strengthen existing laboratory infrastructure, which includes expanding and developing new laboratories, there are clear diagnostic needs where conventional laboratory support is insufficient. Regarding HIV, rapid point-of-care (POC) testing for initial HIV diagnosis has been successful, but several needs remain. For tuberculosis, several new diagnostic tests have recently been endorsed by the World Health Organization, but a POC test remains elusive. Human immunodeficiency virus and tuberculosis are coendemic in many high prevalence locations, making parallel diagnosis of these conditions an important consideration. Despite its clear advantages, POC testing has important limitations, and laboratory-based testing will continue to be an important component of future diagnostic networks. Ideally, a strategic deployment plan should be used to define where and how POC technologies can be most efficiently and cost effectively integrated into diagnostic algorithms and existing test networks prior to widespread scale-up. In this fashion, the global community can best harness the tremendous capacity of novel diagnostics in fighting these 2 scourges. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 20, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure