Background: Early initiation of combination anti-retroviral therapy (cART) for HIV-positive pregnant women can decrease vertical transmission to less than 5%. Programmatic barriers to early cART include decentralized care disease stage assessment delays and loss-to-follow-up. Intervention: Our intervention had 3 components: integrated HIV and antenatal services in one location with one provider; lab courier to expedite CD4 counts; and community-based follow-up of women-infant pairs to improve PMTCT attendance. Pre-intervention HIV-positive pregnant women were referred to HIV clinics for disease stage assessment and cART initiation for advanced disease (CD4 2). Methods: We employed a quasi-experimental design with pre / post-intervention evaluations at 6 government antenatal clinics (ANC) in Southern Province Zambia. Retrospective clinical data were collected from clinic registers during a 7-month baseline period. Post-intervention data were collected from all ART-naive HIV-positive pregnant women and their infants presenting to ANC from December 2011-June 2013. Results: Data from 510 baseline women-infant pairs were analyzed and 624 pregnant women were enrolled during the intervention period. Proportion of HIV-positive pregnant women receiving CD4 counts increased from 50.6% to 77.2% (RR=1.81 95% CI: 1.57-2.08; p<0.01). Proportion of cART-eligible pregnant women initiated on cART increased from 27.5% to 71.5% (RR=2.25 95% CI: 1.78-2.83; p<0.01). Proportion of eligible HIV-exposed infants with documented 6-week HIV PCR test increased from 41.9% to 55.8% (RR=1.33 95% CI: 1.18-1.51; p<0.01). Conclusion: Integration of HIV care into ANC and community-based support improved uptake of CD4 counts proportion of cART-eligible women initiated on cART and infants tested. Copyright © 2015 Wolters Kluwer Health Inc. Unauthorized reproduction of this article is prohibited.

This paper presents a framework to help key stakeholders better understand FP decentralization processes identify potential challenges and opportunities and guide decentralization reforms in directions that will benefit FP clients and support the achievement of international FP commitments. Drawing on the latest research literature the FP and Decentralization Analytical Framework provides a way to conceptualize the interactions between different actors in FP decentralization processes the rules that structure those interactions and how different models of decentralization can affect FP services. The framework does not seek to draw broad generalizations about the impact of decentralization on FP programs and services. Rather it (1) offers its target audiences -- international donors and technical assistance providers; local and national-level FP advocates; and Ministry of Health (MOH) technical managers -- a tool that can be used to analyze the state of FP decentralization reform in individual country contexts and (2) outlines how these three audiences could apply the framework to help them engage more strategically and effectively in policy processes surrounding FP decentralization.

Introduction: We used a sensitive point mutation assay, LigAmp, to detect and quantify K103N-containing variants in African women who received single-dose nevirapine (NVP) to prevent mother-to-child HIV-1 transmission. Methods: Plasma for testing was collected 6 to 8 weeks postpartum from 301 women (144 subtype A, 63 subtype C, and 94 subtype D). Results: The portion of women with 0.5% or more K103N-containing variants was lowest for subtype A (60/144, 41.7%) and highest for subtype C (44/63, 69.8%; P < 0.0001). K103N was rarely detected in pre-NVP samples. In a multivariate model, K103N detection was associated with HIV-1 subtype (C > A), after adjusting for log10 delivery viral load, the number of days between NVP dosing and sample collection, age, and parity. Among women with K103N detected: (1) the median %K103N was lower for subtype A (2.2%) than C (11.7%, P = 0.0001) or D (5.5%, P = 0.04), and (2) in a multivariate linear model, higher log10 (%K103N) was associated with HIV subtype (C > A, P = 0.0001; D > A, P = 0.01; and C vs D, no difference), but not other factors. Conclusions: After administration of single-dose NVP, K103N was detected more frequently and at higher levels in women with subtypes C and D than A. Further studies are needed to evaluate the clinical significance of NVP-resistant variants in this setting.

To describe the incidence of AIDS-defining illnesses within a single large clinic setting, to describe temporal changes over a 10-year period in the overall incidence and of individual AIDS-defining illnesses and to investigate the impact of HIV treatment regimen on the incidence of AIDS-defining illnesses. A person-years analysis was used to determine the incidence of AIDS-defining illnesses according to calendar year and stratification by CD4 lymphocyte count and treatment regimen in 1806 patients from the Royal Free Centre for HIV Medicine with at least one CD4 lymphocyte count and follow-up visit. Prior to 1992, the incidence of all AIDS-defining illnesses was 27.4/100 person-years of follow-up (PYFU; 95% confidence interval [CI], 22.8-32.0) and during 1997 this incidence had dropped to 6.9/100 PYFU (95% CI, 4.7-9.1; p < .0001, test for trend). The decline in incidence over time occurred in esophageal candidiasis, cytomegalovirus disease (including retinitis), Kaposi's sarcoma, lymphoma, wasting syndrome, and Pneumocystis carinii pneumonia (p < .05, test for trend), but there was no evidence of a decline in AIDS dementia or in Mycobacterium avium complex. In 1997, among patients with CD4 lymphocyte counts of < or =200 cells/mm3, the incidence rates for any AIDS-defining illness was 51.1/100 PYFU for patients taking no therapy (95% CI, 27.9-85.7), 34.5 among patients on monotherapy (95% CI, 4.2-124.6), 13.2 among patients taking dual combination therapy (95% CI, 3.6-33.8) and 6.1 among patients taking triple therapy or more complex regimens (95% CI, 0.7-22.0; p < .0001, test for trend). There was a considerable decline in AIDS-defining illnesses during 1996 and 1997, coinciding with the rapid development of new antiretroviral treatments and combinations of treatment. Further follow-up of large observational cohorts is essential to monitor the incidence of diagnoses less common than we were able to consider, such as tuberculosis, cryptosporidiosis, and cryptococcosis, and also to investigate whether the incidence of disease continues to fall, or whether it starts to rise again, as toxicities, compliance, drug resistance, and long-term side effects begin to appear.

In this study, the susceptibility of mature human oocytes to HIV-1 infection has been investigated. We exposed in vitro human oocytes of healthy women using inocula of cell-free HIV-1. We also tested for the presence of HIV-1-specific receptor molecules on the surface of these cells. By applying polymerase chain reaction (PCR) analysis, transmission electron microscopy (TEM), and immunocytochemistry at both light and electron microscopic levels, we did not obtain evidence for HIV DNA production nor for oocyte-associated HIV particles. Experiments of immunostaining for CD4, CCR5, and GalAAG (putative receptor for HIV in sperm), as well as reverse transcriptase (RT)-PCR for CD4, CCR5, and CXCR4, which all suggested the absence of the mentioned receptors in mature oocytes and in follicular cells. This study fills an important gap concerning the information available on the direct HIV infection of human gametes, adds to our basic understanding of HIV infection in human oocytes, provides different results from those obtained with human spermatozoa using comparable methods, and provides a basic contribution to the investigation on HIV infection in human oocytes.

The purpose of this cross-sectional study was to examine relationships between belief in vaccine receipt, motivations for trial participation, and side effects in phase 1 vaccine trials. Anonymous questionnaires were completed by 125 active vaccine volunteers at two vaccine evaluation sites. Participants believing they had received the vaccine reported more side effects (p < .01), were less likely to report knowing someone with HIV/AIDS as a motivation for trial participation (p < .01), and endorsed greater concern about becoming HIV-infected as motivation for participation (p < .05). Results indicate that inferences made by trial participants in vaccine trials should be identified and addressed, and that greater efforts for maintaining the blinded nature of vaccine trials and educating trial participants about the meaning of side effects are warranted.

Objective: To define the incidence of tuberculin skin test (TST) conversion and to evaluate the yield of annual testing in an era of declining tuberculosis incidence rate in the United States. Methods: Annual TSTs were performed on initially TST-negative women (HIV infected, 995; uninfected, 260) from October 1995 through March 2002. Results: A total of 4622 repeat TSTs were performed during 5530 person-years. The incidence of TST conversion was 0.8 case per 100 person-years for HIV-infected and 1.0 case per 100 person-years for uninfected women. Non-Hispanic blacks, women younger than 40 years of age, and HIV-infected women who had recently initiated active therapy were more likely to experience TST conversion. The incidence of conversion decreased over the course of the study from a peak of 21 cases per 937 tests in 1996 to 1 case per 179 tests in 2002 (P = 0.046 for trend). Twenty-one of 47 conversions occurred on the second TST, implying that boosting accounted for a number of conversions. Conclusions: The yield of annual skin testing diminished from 1996 to 2002. Our data suggest that repeating testing after initiation of HIV therapy, regardless of CD4 cell change, is warranted. If serial testing is undertaken, initial 2-step testing should be performed to allow for accurate interpretation of subsequent tests and earlier identification of persons with latent Mycobacterium tuberculosis infection.