Last data update: Jun 11, 2024. (Total: 46992 publications since 2009)
Records 1-14 (of 14 Records) |
Query Trace: Watts DH [original query] |
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Urethrocutaneous fistulas after voluntary medical male circumcision for HIV prevention - 15 African countries, 2015-2019
Lucas T , Hines JZ , Samuelson J , Hargreave T , Davis SM , Fellows I , Prainito A , Watts DH , Kiggundu V , Thomas AG , Ntsuape OC , Dare K , Odoyo-June E , Soo L , Toti-Mokoteli L , Manda R , Kapito M , Msungama W , Odek J , Come J , Canda M , Gaspar N , Mekondjo A , Zemburuka B , Bonnecwe C , Vranken P , Mmbando S , Simbeye D , Rwegerera F , Wamai N , Kyobutungi S , Zulu JE , Chituwo O , Xaba S , Mandisarisa J , Toledo C . BMC Urol 2021 21 (1) 23 BACKGROUND: Voluntary medical male circumcision (VMMC) is an HIV prevention strategy recommended to partially protect men from heterosexually acquired HIV. From 2015 to 2019, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported approximately 14.9 million VMMCs in 15 African countries. Urethrocutaneous fistulas, abnormal openings between the urethra and penile skin through which urine can escape, are rare, severe adverse events (AEs) that can occur with VMMC. This analysis describes fistula cases, identifies possible risks and mechanisms of injury, and offers mitigation actions. METHODS: Demographic and clinical program data were reviewed from all reported fistula cases during 2015 to 2019, descriptive analyses were performed, and an odds ratio was calculated by patient age group. RESULTS: In total, 41 fistula cases were reported. Median patient age for fistula cases was 11 years and 40/41 (98%) occurred in patients aged < 15 years. Fistulas were more often reported among patients < 15 compared to ≥ 15 years old (0.61 vs. 0.01 fistulas per 100,000 VMMCs, odds ratio 50.9 (95% confidence interval [CI] = 8.6-2060.0)). Median time from VMMC surgery to appearance of fistula was 20 days (interquartile range (IQR) 14-27). CONCLUSIONS: Urethral fistulas were significantly more common in patients under age 15 years. Thinner tissue overlying the urethra in immature genitalia may predispose boys to injury. The delay between procedure and symptom onset of 2-3 weeks indicates partial thickness injury or suture violation of the urethral wall as more likely mechanisms of injury than intra-operative urethral transection. This analysis helped to inform PEPFAR's recent decision to change VMMC eligibility policy in 2020, raising the minimum age to 15 years. |
New HIV infections from blood transfusions averted in 28 countries supported by PEPFAR blood safety programs, 2004-2015
Mili FD , Teng Y , Shiraishi RW , Yu J , Bock N , Drammeh B , Watts DH , Benech I . Transfusion 2021 61 (3) 851-861 BACKGROUND: To quantify the impact of the US President's Emergency Plan for AIDS Relief (PEPFAR) on the risk of HIV transmission through infected blood donations in countries supported by PEPFAR blood safety programs. METHODS: Data reported to the World Health Organization Global Database on Blood Safety were analyzed from 28 countries in sub-Saharan Africa (SSA), Asia, and the Caribbean during 2004-2015. We used the Goals model of Spectrum Spectrum System Software, version 5.53, to perform the modeling, assuming laboratory quality for HIV testing had 91.9% sensitivity and 97.7% specificity irrespective of testing method based on results of two external quality assurance and proficiency testing studies of transfusion screening for HIV in SSA blood centers. We calculated the number of new HIV infections from the number of transfusions and the prevalence of HIV infection acquired from blood transfusions with infected blood donations. We determined the impact of laboratory testing programs by estimating the number of new HIV infections averted since PEPFAR implementation. RESULTS: Assuming that HIV testing would not be performed in any of these countries without PEPFAR funding, the number of new HIV infections acquired from blood transfusions averted by laboratory testing increased over time in all 28 countries. The total number of HIV infections averted was estimated at 229 278 out of 20 428 373 blood transfusions during 2004-2015. CONCLUSION: Our mathematical modeling suggests a positive impact achieved over 12 years of PEPFAR support for blood safety. Standardized HIV testing of donated blood has reduced the risk of HIV transmission through blood transfusions in SSA, Asia, and the Caribbean. |
Association of schistosomiasis and HIV infections: a systematic review and meta-analysis
Patel P , Rose CE , Kjetland EF , Downs JA , Mbabazi PS , Sabin K , Chege W , Watts DH , Secor WE . Int J Infect Dis 2020 102 544-553 ![]() BACKGROUND: Female genital schistosomiasis (FGS) affects up to 56 million women in sub-Saharan Africa and may increase risk of HIV infection. METHODS: To assess the association of schistosomiasis with HIV infection, we examined peer-reviewed literature published until December 31, 2018 and generated a pooled estimate for the odds ratio using Bayesian random effects models. RESULTS: Of the 364 abstracts identified, 26 were included in the summary. Eight reported odds ratios of the association between schistosomiasis and HIV; one reported a transmission hazard ratio (HR) of 1·8 (95% confidence interval [CI]: 1·2-2·6) among women and 1·4 (95% CI: 1·0-1·9) among men; 11 described the prevalence of schistosomiasis among HIV-positive persons (range, 1·5%-36·6%); and six reported the prevalence of HIV among persons with schistosomiasis (range, 5·8%-57·3%). Six studies were selected for quantitative analysis. The pooled estimate for the odds ratio of HIV among persons with schistosomiasis was 2·3 (95% CI: 1·2-4·3). CONCLUSIONS: We found a significant association of schistosomiasis with HIV. However, we could not generate a specific summary estimate for FGS. We provide a research agenda to determine the effect of FGS on HIV infection. WHO's policy on mass drug administration for schistosomiasis may prevent HIV. |
Building and sustaining optimized diagnostic networks to scale-up HIV viral load and early infant diagnosis
Alemnji G , Peter T , Vojnov L , Alexander H , Zeh C , Cohn J , Watts DH , de Lussigny S . J Acquir Immune Defic Syndr 2020 84 Suppl 1 S56-s62 BACKGROUND: Progress toward meeting the UNAIDS 2014 HIV treatment (90-90-90) targets has been slow in some countries because of gaps in access to HIV diagnostic tests. Emerging point-of-care (POC) molecular diagnostic technologies for HIV viral load (VL) and early infant diagnosis (EID) may help reduce diagnostic gaps. However, these technologies need to be implemented in a complementary and strategic manner with laboratory-based instruments to ensure optimization. METHOD: Between May 2019 and February 2020, a systemic literature search was conducted in PubMed, the Cochrane Library, MEDLINE, conference abstracts, and other sources such as Unitaid, UNAIDS, WHO, and UNICEF websites to determine factors that would affect VL and EID scale-up. Data relevant to the search themes were reviewed for accuracy and were included. RESULTS: Collaborations among countries, implementing partners, and donors have identified a set of framework for the effective use of both POC-based and laboratory-based technologies in large-scale VL and EID testing programs. These frameworks include (1) updated testing policies on the operational utility of POC and laboratory-based technologies, (2) expanded integrated testing using multidisease diagnostic platforms, (3) laboratory network mapping, (4) use of more efficient procurement and supply chain approaches such as all-inclusive pricing and reagent rental, and (5) addressing systemic issues such as test turnaround time, sample referral, data management, and quality systems. CONCLUSIONS: Achieving and sustaining optimal VL and EID scale-up within tiered diagnostic networks would require better coordination among the ministries of health of countries, donors, implementing partners, diagnostic manufacturers, and strong national laboratory and clinical technical working groups. |
Case series of glans injuries during voluntary medical male circumcision for HIV prevention - eastern and southern Africa, 2015-2018
Lucas TJ , Toledo C , Davis SM , Watts DH , Cavanaugh JS , Kiggundu V , Thomas AG , Odoyo-June E , Bonnecwe C , Maringa TH , Martin E , Juma AW , Xaba S , Balachandra S , Come J , Canda M , Nyirenda R , Msungama W , Odek J , Lija GJI , Mlanga E , Zulu JE , O'Bra H , Chituwo O , Aupokolo M , Mali DA , Zemburuka B , Malaba KD , Ntsuape OC , Hines JZ . BMC Urol 2020 20 (1) 45 BACKGROUND: Male circumcision confers partial protection against heterosexual HIV acquisition among men. The President's Emergency Plan for AIDS Relief (PEPFAR) has supported > 18,900,000 voluntary medical male circumcisions (VMMC). Glans injuries (GIs) are rare but devastating adverse events (AEs) that can occur during circumcision. To address this issue, PEPFAR has supported multiple interventions in the areas of surveillance, policy, education, training, supply chain, and AE management. METHODS: Since 2015, PEPFAR has conducted surveillance of GIs including rapid investigation by the in-country PEPFAR team. This information is collected on standardized forms, which were reviewed for this analysis. RESULTS: Thirty-six GIs were reported from 2015 to 2018; all patients were < 15 years old (~ 0.7 per 100,000 VMMCs in this age group) with a decreasing annual rate (2015: 0.7 per 100,000 VMMCs; 2018: 0.4 per 100,000 VMMC; p = 0.02). Most (64%) GIs were partial or complete amputations. All amputations among 10-14 year-olds occurred using the forceps-guided (FG) method, as opposed to the dorsal-slit (DS) method, and three GIs among infants occurred using a Mogen clamp. Of 19 attempted amputation repairs, reattached tissue was viable in four (21%) in the short term. In some cases, inadequate DS method training and being overworked, were found. CONCLUSION: Following numerous interventions by PEPFAR and other stakeholders, GIs are decreasing; however, they have not been eliminated and remain a challenge for the VMMC program. Preventing further cases of complete and partial amputation will likely require additional interventions that prevent use of the FG method in young patients and the Mogen clamp in infants. Improving management of GIs is critical to optimizing outcomes. |
Trends and gaps in national blood transfusion services - 14 sub-Saharan African countries, 2014-2016
Kanagasabai U , Chevalier MS , Drammeh B , Mili FD , Qualls ML , Bock N , Benech I , Nelson LJ , Alemnji G , Watts DH , Kimani D , Selenic D . MMWR Morb Mortal Wkly Rep 2018 67 (50) 1392-1396 Ensuring availability of safe blood products through recruitment of voluntary, nonremunerated, blood donors (VNRDs) and prevention of transfusion-transmissible infections (TTIs), including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis, is important for public health (1,2). During 2004-2016, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided approximately $468 million in financial support and technical assistance* to 14 sub-Saharan African countries(dagger) with high HIV prevalence to strengthen national blood transfusion services (NBTSs)( section sign) and improve blood safety and availability. CDC analyzed these countries' 2014-2016 blood safety surveillance data to update previous reports (1,2) and summarize achievements and programmatic gaps as some NBTSs begin to transition funding and technical support from PEPFAR to local ministries of health (MOHs) (2,3). Despite a 60% increase in blood supply since 2004 and steady declines in HIV prevalence (to <1% among blood donors in seven of the 14 countries), HIV prevalence among blood donors still remains higher than that recommended by the World Health Organization (WHO) (4). PEPFAR support has contributed to significant reductions in HIV prevalence among blood donors in the majority of PEPFAR-supported countries, and linking donors who screen HIV-positive to confirmatory testing and indicated treatment, as well as further reducing TTIs, remains a public health priority (5). |
Tenofovir versus Placebo to Prevent Perinatal Transmission of Hepatitis B.
Jourdain G , Ngo-Giang-Huong N , Harrison L , Decker L , Khamduang W , Tierney C , Salvadori N , Cressey TR , Sirirungsi W , Achalapong J , Yuthavisuthi P , Kanjanavikai P , Na Ayudhaya OP , Siriwachirachai T , Prommas S , Sabsanong P , Limtrakul A , Varadisai S , Putiyanun C , Suriyachai P , Liampongsabuddhi P , Sangsawang S , Matanasarawut W , Buranabanjasatean S , Puernngooluerm P , Bowonwatanuwong C , Puthanakit T , Klinbuayaem V , Thongsawat S , Thanprasertsuk S , Siberry GK , Watts DH , Chakhtoura N , Murphy TV , Nelson NP , Chung RT , Pol S , Chotivanich N . N Engl J Med 2018 378 (10) 911-923 ![]() BACKGROUND: Pregnant women with an elevated viral load of hepatitis B virus (HBV) have a risk of transmitting infection to their infants, despite the infants' receiving hepatitis B immune globulin. METHODS: In this multicenter, double-blind clinical trial performed in Thailand, we randomly assigned hepatitis B e antigen (HBeAg)-positive pregnant women with an alanine aminotransferase level of 60 IU or less per liter to receive tenofovir disoproxil fumarate (TDF) or placebo from 28 weeks of gestation to 2 months post partum. Infants received hepatitis B immune globulin at birth and hepatitis B vaccine at birth and at 1, 2, 4, and 6 months. The primary end point was a hepatitis B surface antigen (HBsAg)-positive status in the infant, confirmed by the HBV DNA level at 6 months of age. We calculated that a sample of 328 women would provide the trial with 90% power to detect a difference of at least 9 percentage points in the transmission rate (expected rate, 3% in the TDF group vs. 12% in the placebo group). RESULTS: From January 2013 to August 2015, we enrolled 331 women; 168 women were randomly assigned to the TDF group and 163 to the placebo group. At enrollment, the median gestational age was 28.3 weeks, and the median HBV DNA level was 8.0 log10 IU per milliliter. Among 322 deliveries (97% of the participants), there were 319 singleton births, two twin pairs, and one stillborn infant. The median time from birth to administration of hepatitis B immune globulin was 1.3 hours, and the median time from birth to administration of hepatitis B vaccine was 1.2 hours. In the primary analysis, none of the 147 infants (0%; 95% confidence interval [CI], 0 to 2) in the TDF group were infected, as compared with 3 of 147 (2%; 95% CI, 0 to 6) in the placebo group (P=0.12). The rate of adverse events did not differ significantly between groups. The incidence of a maternal alanine aminotransferase level of more than 300 IU per liter after discontinuation of the trial regimen was 6% in the TDF group and 3% in the placebo group (P=0.29). CONCLUSIONS: In a setting in which the rate of mother-to-child HBV transmission was low with the administration of hepatitis B immune globulin and hepatitis B vaccine in infants born to HBeAg-positive mothers, the additional maternal use of TDF did not result in a significantly lower rate of transmission. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; ClinicalTrials.gov number, NCT01745822 .). |
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. |
The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration
Mason J , Medley A , Yeiser S , Nightingale VR , Mani N , Sripipatana T , Abutu A , Johnston B , Watts DH . J Int AIDS Soc 2017 20 4-11 INTRODUCTION: People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. DISCUSSION: Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. CONCLUSION: Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and programme environment to ensure that all PLHIV and serodiscordant couples have access to FP services, including prevention of unintended pregnancy and safer conception counselling. |
Prevention of mother-to-child transmission of hepatitis B virus: a phase III, placebo-controlled, double-blind, randomized clinical trial to assess the efficacy and safety of a short course of tenofovir disoproxil fumarate in women with hepatitis B virus e-antigen
Jourdain G , Ngo-Giang-Huong N , Cressey TR , Hua L , Harrison L , Tierney C , Salvadori N , Decker L , Traisathit P , Sirirungsi W , Khamduang W , Bowonwatanuwong C , Puthanakit T , Siberry GK , Watts DH , Murphy TV , Achalapong J , Hongsiriwon S , Klinbuayaem V , Thongsawat S , Chung RT , Pol S , Chotivanich N . BMC Infect Dis 2016 16 393 BACKGROUND: Chronic hepatitis B virus (HBV) infection is complicated by cirrhosis and liver cancer. In Thailand, 6-7 % of adults are chronically infected with HBV. The risk of mother-to-child transmission (MTCT) of HBV has been estimated to be about 12 % when mothers have a high hepatitis B viral load, even if infants receive passive-active prophylaxis with HBV immunoglobulin (HBIg) and initiate the hepatitis B vaccine series at birth. We designed a study to assess the efficacy and safety of a short course of maternal tenofovir disoproxil fumarate (TDF) among women with a marker of high viral load for the prevention of MTCT of HBV. METHODS: The study is a phase III, multicenter (17 sites in Thailand), placebo-controlled, double-blind, randomized 1:1, two-arm clinical trial of TDF 300 mg once daily versus placebo among pregnant women from 28 weeks' gestation through 2-month post-partum. All infants receive HBIg at birth, and a hepatitis B (HB) vaccination series according to Thai guidelines: birth, and age 1, 2, 4 and 6 months. Participant women at study entry must be age ≥18 years, hepatitis B surface antigen (HBsAg) and e-antigen (HBeAg) positive, have alanine aminotransferase (ALT) level < 30 IU/L at screening (confirmed < 60 IU/L pre-entry), negative hepatitis C serology, creatinine clearance >50 mL/min, and no history of anti-HBV antiviral treatment. The target sample size of 328 mother/infant pairs assumed 156 evaluable cases per arm to detect a ≥9 % difference in MTCT transmission (3 % experimental arm versus 12 % placebo arm) with 90 % power. Mothers and infants are followed until 12 months after delivery. The primary infant endpoint is detection of HBsAg, confirmed by detection of HBV DNA at six months of age. Secondary endpoints are maternal and infant adverse events, acute exacerbations of maternal hepatitis B disease (ALT >300 IU/L, defined as a "flare") following discontinuation of study treatment, infant HBV infection status and growth up to 12 months of age. DISCUSSION: The results of this randomized trial will clarify the efficacy and safety of a short course of antiviral treatment to prevent mother-to-child transmission of HBV and inform international guidelines. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01745822 . |
A systematic review of the effects of visual inspection with acetic acid, cryotherapy, and loop electrosurgical excision procedures for cervical dysplasia in HIV-infected women in low- and middle-income countries
Forhan SE , Godfrey CC , Watts DH , Langley CL . J Acquir Immune Defic Syndr 2015 68 Suppl 3 S350-6 BACKGROUND: Cervical cancer, almost all of which is caused by human papillomavirus, accounts for 12% of female cancers worldwide and is more common among HIV-infected women. Nine of 10 deaths from cervical cancer occur in low- and middle-income countries (LMICs). Simple screening methods and outpatient treatment of precursor lesions save lives but the benefit of these interventions among HIV-infected women is uncertain. OBJECTIVE: We reviewed evidence of the effects of screening with visual inspection with acetic acid (VIA), and outpatient treatment for cervical precancer among HIV-infected women in LMIC. METHODS: A systematic review of articles published from January 1995 through July 2013 was conducted using key terms for VIA cervical screening, cervical precancer treatment with cryotherapy or loop electrosurgical excision procedure, HIV-infected women, low-resource settings, and outcomes, including morbidity and mortality. RESULTS: Of 2159 articles screened, 14 met inclusion criteria; all considered only morbidity outcomes. No articles dealt with the long-term impact of screening/treatment on cervical cancer incidence or mortality among HIV-infected women. Articles reported on performance of VIA, prevalence of cervical dysplasia, and complications and rates of recurrent dysplasia after treatment. CONCLUSIONS: Dysplasia prevalence and recurrence were higher among HIV-infected compared with HIV-uninfected women but morbidity from treatment was similar. Few data exist on long-term outcomes of VIA, cryotherapy, or loop electrosurgical excision procedure interventions among HIV-infected women in LMIC; longer-term outcomes research is needed to assess the effects of VIA or other screening modalities and outpatient treatment on prevention of cervical cancer among HIV-infected women. |
Preconception antiretroviral therapy and birth defects: what is needed?
Bulterys M , Berry RJ , Watts DH . AIDS 2014 28 (18) 2777-2780 Prevention of maternal-to-child transmission (MTCT) of HIV remains a priority, as globally, approximately 700 infants are newly infected with HIV each day [1]. Remarkable progress has been made in the past decade in reducing MTCT, with one million infants prevented from acquiring HIV between 2003 and 2013 because of maternal and infant antiretroviral prophylaxis [2]. However, limited safety data currently exist on potential adverse outcomes among HIV-infected pregnant women and their infants after exposure to combination antiretroviral therapy (cART) before and throughout pregnancy [3]. | In the United States and other high-resource countries, pregnant HIV-infected women receive cART starting usually early in pregnancy and, as a result, MTCT of HIV has been nearly eliminated in the past decade, with rates decreased from approximately 25% to currently 1% [4,5]. The advent of more potent and better-tolerated antiretroviral drugs has led to a strong push toward earlier initiation of cART, including amongst women of reproductive age [6–8]. Thus, an increasing number of HIV-infected women are already taking cART when conception occurs. In resource-limited settings, initiating cART has previously been recommended only for pregnant women with more advanced HIV disease (i.e. CD4+ cell count below 200 cells/μl or symptomatic HIV with CD4+ cell count <350 cells/μl) [9]. However, the 2013 WHO consolidated guidelines recommend that all HIV-infected pregnant women initiate cART regardless of CD4+ cell count, and if breastfeeding, continue cART throughout breastfeeding [10,11]. Women may either continue lifelong treatment regardless of clinical status or stop if they do not yet meet country-specific treatment eligibility criteria (‘option B’). An increasing number of countries are in the process of adopting lifelong treatment (the so-called ‘option B+’) for all pregnant women found to be HIV-infected [12–14]. |
Eliminating preventable HIV-related maternal mortality in sub-Saharan Africa: what do we need to know?
Kendall T , Danel I , Cooper D , Dilmitis S , Kaida A , Kourtis AP , Langer A , Lapidos-Salaiz I , Lathrop E , Moran AC , Sebitloane H , Turan JM , Watts DH , Wegner MN . J Acquir Immune Defic Syndr 2014 67 Suppl 4 S250-8 INTRODUCTION: HIV makes a significant contribution to maternal mortality, and women living in sub-Saharan Africa are most affected. International commitments to eliminate preventable maternal mortality and reduce HIV-related deaths among pregnant and postpartum women by 50% will not be achieved without a better understanding of the links between HIV and poor maternal health outcomes and improved health services for the care of women living with HIV (WLWH) during pregnancy, childbirth, and postpartum. METHODS: This article summarizes priorities for research and evaluation identified through consultation with 30 international researchers and policymakers with experience in maternal health and HIV in sub-Saharan Africa and a review of the published literature. RESULTS: Priorities for improving the evidence about effective interventions to reduce maternal mortality and improve maternal health among WLWH include better quality data about causes of maternal death among WLWH, enhanced and harmonized program monitoring, and research and evaluation that contributes to improving: (1) clinical management of pregnant and postpartum WLWH, including assessment of the impact of expanded antiretroviral therapy on maternal mortality and morbidity, (2) integrated service delivery models, and (3) interventions to create an enabling social environment for women to begin and remain in care. CONCLUSIONS: As the global community evaluates progress and prepares for new maternal mortality and HIV targets, addressing the needs of WLWH must be a priority now and after 2015. Research and evaluation on maternal health and HIV can increase collaboration on these 2 global priorities, strengthen political constituencies and communities of practice, and accelerate progress toward achievement of goals in both areas. |
Rapid intrapartum or postpartum HIV testing at a midwife obstetric unit and a district hospital in South Africa
Theron GB , Shapiro DE , Van Dyke R , Cababasay MP , Louw J , Watts DH , Smith E , Bulterys M , Maupin R . Int J Gynaecol Obstet 2011 113 (1) 44-9 OBJECTIVE: To compare the prepartum and postpartum feasibility and acceptance of voluntary counseling and rapid testing (VCT) among women with unknown HIV status in South Africa. METHODS: Eligible women were randomized according to the calendar week of presentation to receive VCT either while in labor or after delivery. RESULTS: Of 7238 women approached, 542 (7.5%) were eligible, 343 (63%) were enrolled, and 45 (13%) were found to be HIV infected. The proportions of eligible women who accepted VCT were 66.8% (161 of 241) in the intrapartum arm and 60.5% (182 of 301) in the postpartum arm, and the difference of 6.3% (95% CI, -1.8% to 14.5%) was not significant. The median times (44 and 45minutes) required to conduct VCT were also similar in the 2 arms. In the intrapartum arm, all women in true labor received their test results before delivery and all those found to be HIV positive accepted prophylaxis with nevirapine before delivery. CONCLUSIONS: Rapid testing in labor wards for women with an unknown HIV status is feasible and well accepted, and allows for a more timely antiretroviral prophylaxis than postpartum testing. |
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