Elimination Of New HIV Infections Research Articles

Awareness and use of pre-exposure and postexposure prophylaxes among Nigerian university students: Findings from a cross-sectional survey.

Despite the recent advances in biomedical preventive strategies, young adults—especially adolescent girls— continue to be disproportionately at risk of acquiring HIV. To avert this trend, it is critical that access to HIV preventive strategies, such as pre-exposure prophylaxis (PrEP) and postexposure prophylaxis be expanded, especially in sub-Saharan Africa, where young adults are known to engage in risky sexual practices. This study examined awareness levels and use of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) among Nigerian university students.A cross-sectional survey was conducted among 800 students selected using stratified random sampling at 2 Nigerian universities. Descriptive and inferential statistics were used for data analysis on 784 complete responses.The levels of awareness of PrEP and PEP were 18.9% and 25.4%, respectively. Ever tested for human immunodeficiency virus [HIV] (AOR: 1.58; 95% CI: 1.04–2.42) and knowledge of partner's HIV status (AOR: 1.87; 95% CI: 1.25–2.79) were the significant determinants of awareness to PrEP. In contrast, only ever tested for HIV (AOR: 1.50; 95% CI: 1.02–2.19), knowledge of partner's HIV status (AOR: 1.55; 95% CI: 1.07–2.24), ever used condoms (AOR: 1.65; 95% CI: 1.04–2.62), and nude exchanges (AOR: 1.62; 95% CI: 1.13–2.31) were independent determinants of awareness of PEP. Only a few students had seen (5.6%) or used (1.5%) any prophylaxes.The study findings indicate a low level of awareness and use of PrEP and PEP. To ensure no one is left behind in the goal of elimination of new HIV infections, intervention to expand access to these preventive strategies is needed in the study settings.

Confronting Challenges in Monitoring and Evaluation: Innovation in the Context of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive.

The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), which was launched in 2011, set a series of ambitious targets, including a reduction of new HIV infections among children by 90% by 2015 (from a baseline year of 2009) and AIDS-related maternal mortality by 50% by 2015. To reach these targets, the Global Plan called for unprecedented investments in the prevention of mother-to-child transmission of HIV (PMTCT), innovative new approaches to service delivery, immense collective effort on the programmatic and policy fronts, and importantly, a renewed focus on data collection and use. We provide an overview of major achievements in monitoring and evaluation across Global Plan countries and highlight key challenges and innovative country-driven solutions using PMTCT program data. Specifically, we describe the following: (1) Uganda's development and use of a weekly reporting system for PMTCT using short message service technology that facilitates real-time monitoring and programmatic adjustments throughout the transition to a "treat all" approach for pregnant and breastfeeding women living with HIV (Option B+); (2) Uganda's work to eliminate parallel reporting systems while strengthening the national electronic district health information system; and (3) how routine PMTCT program data in Nigeria can be used to estimate HIV prevalence at the local level and address a critical gap in local descriptive epidemiologic data to better target limited resources. We also identify several ongoing challenges in data collection, analysis, and use, and we suggest potential solutions.

Prevention of HIV in Adolescent Girls and Young Women: Key to an AIDS-Free Generation.

The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan) has ensured that more infants in high-HIV burden countries survive childhood HIV-free. Although equal numbers of boy and girl children have survived to age 10, a gender divergence starts to emerge as they enter adolescence. Up to 3 times as many young women aged 15-24 years in eastern and southern Africa are living with HIV compared with their male peers. Further, more adolescent girls and young women are sick and/or dying from AIDS-related or HIV-related complications during pregnancy and in the postpartum period, underscoring the importance of strengthening HIV treatment and prevention services for this group. Failure to prevent HIV in adolescent girls and young women and keep them alive will reverse the infant HIV prevention and survival gains made under the Global Plan. The promising global declines in HIV infection in young women need to be strengthened to realize the goals of an AIDS-free generation. The DREAMS initiative of the United States President's Emergency Plan for AIDS Relief (PEPFAR), which specifically addresses adolescent girls and young women at highest risk of HIV acquisition, brings new hope for meeting the prevention and care needs of this important and vulnerable population through political commitment, leadership, financial and human resource investments, advocacy efforts, and a focus on the highest priority settings. Importantly, to achieve the goal of keeping mothers alive, we have to place more emphasis on access to sexual and reproductive health services that (1) include HIV prevention and treatment services for adolescent girls and young women; (2) increase male/paternal responsibility in mother and infant health; and (3) ensure a supportive social environment that enables young women to grow up into young adults who are free to graduate from high school and plan their pregnancies, ultimately entering adulthood safe, healthy, and free from HIV.

Realizing the Promise of the Global Plan: Engaging Communities and Promoting the Health and Human Rights of Women Living With HIV.

The Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive highlighted the need to put the health and well-being of women and mothers at the center of efforts to prevent vertical transmission. This article will examine a selection of community engagement practices in 3 key areas: (1) as an accountability tool, (2) in service delivery, and (3) as a facilitator of human rights. The lived experiences of women living with HIV as recipients of and participants in services for the prevention of vertical transmission provide both the framework for an exploration of best community engagement practices and suggestions for the way forward.

A Comprehensive Response: The Role of Nonstate Actors in the Global Plan.

Nonstate actors-especially faith-based organizations, other nongovernmental organizations, groups of people living with HIV and AIDS, and private sector organizations-have been deeply committed to supporting governments reach the goals of the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan). This article highlights the role and contributions of select faith-based organizations and some private sector and philanthropic partners, as well as the work of other organizations. The success and impact of the Global Plan was in no small part a result of large-scale country-led collaboration in the provision of health care and implementation of programs. As the world grapples with meeting the ambitious United Nations Joint Programme on AIDS targets to end the AIDS epidemic by 2030-at a time when it also faces many other emerging health crises-the lessons learned from the Global Plan in harnessing the strengths of nonstate partners are the ones that should be replicated, enhanced, and taken to scale.

Scale-up of Early Infant HIV Diagnosis and Improving Access to Pediatric HIV Care in Global Plan Countries: Past and Future Perspectives.

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.

Foreword.

In 2011, when the Joint United Nations Programme on HIV/AIDS (UNAIDS), the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and our many partners joined forces to launch the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan), the goal of an AIDS-free generation was still distant. Today, the outlook for millions of pregnant women living with HIV, their children, and families, particularly in sub-Saharan Africa, has been dramatically transformed. In just 5 years under the framework of the Global Plan, 21 high-burden priority countries in sub-Saharan Africa reduced annual HIV infections among children by 60 percent. Across these countries, 1.2 million new HIV infections among children were averted, and over 2 million more pregnant women started receiving lifesaving antiretroviral therapy. Over the course of the Global Plan, 7 of the countries reduced new HIV infections among children by more than 70 percent (Uganda, 86 percent; Burundi, 84 percent; South Africa, 84 percent; Swaziland, 80 percent; Namibia, 79 percent; Mozambique, 75 percent; and Malawi, 71 percent). These are far more than just facts and figures; each infection averted and life saved means another child or mother who is healthy, thriving, and able to pursue their dreams. This did not happen automatically or easily. The Global Plan demonstrated that if we are ambitious, if we stay focused on the goal, and if we work together, we can make the impossible possible. The Global Plan's success depended on the extraordinary efforts and leadership of numerous partners across multiple sectors. Everyone played a critical role—host country governments and inspirational leaders, civil society and community organizations, faith-based organizations, health care providers, the private sector, women living with HIV, families and other loved ones, donors and technical agencies—and all were instrumental in what we achieved together. We are deeply grateful for, and profoundly humbled by, the countless contributions that so many have made—and continue to make—to this work. This diverse coalition of compassionate individuals brought us far closer to the day when no child is born with HIV, when every child who is already living with HIV receives lifesaving treatment, when every girl and boy can remain HIV-free throughout adolescence and young adulthood, and when every woman living with HIV—pregnant or not—receives the treatment and care that she needs and deserves. Yet, there is vital unfinished business and no time to waste. In a number of countries (Angola, Côte d'Ivoire, and Nigeria), progress has been slow, with less than a 40 percent reduction in new pediatric HIV infections over this same period. Every year, 110,000 children are still acquiring HIV in the 21 Global Plan priority countries, and 150,000 worldwide. More than half of new pediatric HIV infections occur during the breastfeeding period. Testing and treatment coverage among children remains too low. Alarming numbers of adolescent girls and young women are still being infected. That is why, in June 2016, PEPFAR and UNAIDS once again joined forces and launched Start Free Stay Free AIDS Free to accelerate the momentum driving this ambitious agenda, and bring even greater urgency and focus to the work ahead. The articles that comprise this Supplement trace the tremendous evolution and impact of the Global Plan across various domains, highlighting examples of bold leadership, innovation, and activism. They also capture the growth of a learning agenda, continually building on new developments in science, and translating these into lifesaving services. Together, they represent a living legacy of what has been done—and what must still be done—to reach our ultimate goals: controlling and then, finally, ending the AIDS epidemic as a public health threat by 2030 within the framework of the Sustainable Development Goals.

Integrating PMTCT Into Maternal, Newborn, and Child Health and Related Services: Experiences From the Global Plan Priority Countries.

The urgency to scale-up sustainable programs for the prevention of mother-to-child transmission of HIV (PMTCT) prompted priority countries of the Global Plan Toward the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan) to expand the delivery of PMTCT services through greater integration with sexual and reproductive health and child health services. Countries approached integration-what, where, and how services are provided-in diverse ways, with predominantly favorable results. Approaches to integrated services have increased access to a broader range of PMTCT interventions, and they also have proved to be largely acceptable to clients and providers. The integration of PMTCT interventions with maternal, newborn, and child health settings was supported by strategies to reconfigure service delivery to provide additional services, including shifting tasks to nurses (such as initiating antiretroviral therapy and providing long-term follow-up). This was complemented by supporting community outreach and integrating HIV and sexual and reproductive health services bidirectionally, including by providing family planning through antiretroviral therapy clinics and HIV testing in family planning clinics. A systematic and rigorous study of country experiences integrating HIV and maternal, newborn, and child health services, including maternal and pediatric TB services, cost analysis, could provide valuable lessons and demonstrate how such integration can improve systems for health care delivery.

Overcoming Health System Challenges for Women and Children Living With HIV Through the Global Plan.

To meet the ambitious targets set by the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan), the initial 22 priority countries quickly developed innovative approaches for overcoming long-standing health systems challenges and providing HIV testing and treatment to pregnant and breastfeeding women and their infants. The Global Plan spurred programs for prevention of mother-to-child HIV transmission to integrate HIV-related care and treatment into broader maternal, newborn, and child health services; expand the effectiveness of the health workforce through task sharing; extend health services into communities; strengthen supply chain and commodity management systems; reduce diagnostic and laboratory hurdles; and strengthen strategic supervision and mentorship. The article reviews the ongoing challenges for prevention of mother-to-child HIV transmission programs as they continue to strive for elimination of vertical transmission of HIV infection in the post-Global Plan era. Although progress has been rapid, health systems still face important challenges, particularly follow-up and diagnosis of HIV-exposed infants, continuity of care, and the promotion of services that are respectful and client centered.

Pediatric Treatment Scale-Up: The Unfinished Agenda of the Global Plan.

Five million children have died of AIDS-related causes since the beginning of the epidemic. In 2011, the Global Plan Towards the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan) created the political environment to catalyze both the resources and commitment to end pediatric AIDS. Implementation and scale-up have encountered substantial hurdles, however, which have resulted in slow progress. Reasons include a lack of emphasis on testing outside of prevention of mother-to-child transmission services, an overall lack of integration and coordination with other services, a lack of training among providers, low confidence in caring for children living with HIV, and a lack of appropriate formulations for pediatric antiretrovirals. During the Global Plan period, we have learned that simplification is essential to successful decentralization, integration, and task shifting of services; that innovations require careful planning; and that the family is an important unit for delivering HIV care and treatment services. The post-Global Plan phase presents a number of noteworthy challenges that all stakeholders, national programs, and communities must tackle to guarantee universal treatment for children living with HIV. Accelerated action is essential in ensuring that HIV diagnosis and linkage to treatment happen as quickly and effectively as possible. As fewer infants are infected because of effective prevention of mother-to-child transmission interventions and the population of children living with HIV will age into adolescence adapting service delivery models to the epidemic context, and engaging the community will be critical to finding new efficiencies and allowing us to realize a true HIV-free generation-and to end AIDS by 2030.

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.

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.

Understanding the Role and Impact of Effective Country and Community Leadership in Progress Toward the Global Plan.

Individual leadership and leaders have played pivotal roles in the history of efforts to end the AIDS epidemic. The goal of this article is to reflect on and understand how leadership and leaders have impacted and enabled the success of the Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive (Global Plan). To accomplish this goal, multiple interviews were conducted with individuals in positions of leadership who had been identified as people whose actions drove progress. Interviewees were selected from all levels of traditional hierarchies and sectors to provide a more complete account and representation of leadership, with a particular emphasis on the community, district, and country levels. The leaders interviewed provide insight into their work, motivations, and approaches to effective leadership. Through their experiences, they shed light on the strategies they used to drive changes in policy, programs, practice, and communities that allowed for progress toward the goals of the Global Plan. Leaders also identify future challenges and areas of improvement in the effort to end the AIDS epidemic that they feel require leadership and urgent action. In conclusion, this article identifies common characteristics of effective leadership and reflects on the experiences of individuals who are leaders in the effort to end the AIDS epidemic, and how their lessons learned can be applied to help realize future global public health goals.

Development and Impact of the Global Plan.

:The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan) was transformative, helping drive a 60% reduction in new HIV infections among children in 21 priority countries in sub-Saharan Africa from 2009 to 2015. It mobilized unprecedented political, technical, and community leadership at all levels to accelerate progress toward its ambitious targets. This progress is well documented, many specific elements of which are explained in greater detail across this JAIDS supplement. What is often less well or widely understood are the critical aspects of the Global Plan that shaped its structure and determined its impact; the factors and forces that coalesced to form a deep and diverse coalition of contributing partners committed to catalyzing change and action; and the critical lessons that the Global Plan leaves behind, a living legacy to inform and improve ongoing efforts to achieve its ultimate goals.

Variations in the elimination of new HIV infections among children in Africa

Variations in the elimination of new HIV infections among children in Africa

Fundamental concerns of women living with HIV around the implementation of Option B+.

IntroductionIn 2011, the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive was launched to scale up efforts to comprehensively end vertical HIV transmission and support mothers living with HIV in remaining healthy. Amidst excitement around using treatment as prevention, Malawi's Ministry of Health conceived Option B+, a strategy used to prevent vertical transmission by initiating all pregnant and breastfeeding women living with HIV on lifelong antiretroviral therapy, irrespective of CD4 count. In 2013, for programmatic and operational reasons, the WHO officially recommended Option B+ to countries with generalized epidemics, limited access to CD4 testing, limited partner testing, long breastfeeding duration or high fertility rates.DiscussionWhile acknowledging the opportunity to increase treatment access globally and its potential, this commentary reviews the concerns of women living with HIV about human rights, community-based support and other barriers to service uptake and retention in the Option B+ context. Option B+ intensifies many of the pre-existing challenges of HIV prevention and treatment programmes. As women seek comprehensive services to prevent vertical transmission, they can experience various human rights violations, including lack of informed consent, involuntary or coercive HIV testing, limited treatment options, termination of pregnancy or coerced sterilization and pressure to start treatment. Yet, peer and community support strategies can promote treatment readiness, uptake, adherence and lifelong retention in care; reduce stigma and discrimination; and mitigate potential violence stemming from HIV disclosure. Ensuring available and accessible quality care, offering food support and improving linkages to care could increase service uptake and retention. With the heightened focus on interventions to reach pregnant and breastfeeding women living with HIV, a parallel increase in vigilance to secure their health and rights is critical.ConclusionThe authors conclude that real progress towards reducing vertical transmission and achieving viral load suppression can only be made by upholding the human rights of women living with HIV, investing in community-based responses, and ensuring universal access to quality healthcare. Only then will the opportunity of accessing lifelong treatment result in improving the health, dignity and lives of women living with HIV, their children and families.

S16.1 Eliminating mother to child transmission of hiv and syphilis

The Initiative for Global Elimination of Congenital Syphilis was launched in 2007, and the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping Their Mothers Alive was launched in 2010. In 2014, the World Health Organization, jointly with UNAIDS, UNICEF, UNFPA, and other global partners released guidance on the processes and criteria for dual elimination of mother-to-child transmission (MTCT) of HIV and syphilis. Countries all over the world are now striving for dual elimination. This presentation will address recent successes like Cuba and current strategies and new tools that can help to overcome barriers in the dual elimination of MTCT HIV and syphilis with a particular focus on MTCT of syphilis.

Elimination of mother-to-child transmission of HIV and syphilis: A dual approach in the African Region to improve quality of antenatal care and integrated disease control

The World Health Organization’s (WHO) Strategic Framework for the Elimination of New HIV Infections among Children in Africa by 2015 identifies important synergies for the elimination of mother-to-child transmission of HIV and syphilis in terms of prevention interventions, implementation logistics and service delivery, monitoring and evaluation systems, and need for sustained political commitment. The WHO advocates the use of an integrated, rights-based dual approach with partnerships and collaboration to make the best use of available resources. Through a consultative approach, six countries in the African Region committed to dual elimination and developed and implemented action plans for this purpose. Where interest and commitment are high, this may also be possible and effective in other African countries.

Gender Inclusiveness in Prevention of Mother to Child Transmission Programme in KwaZulu-Natal: Male Perspectives

Background: Most developing and developed countries require PMTCT to preserve humanity and children’s survival. All dynamics around PMTCT implementation seek commitment from all stakeholders at different levels to ensure elimination of new HIV infections in children. In 2010, 48% of pregnant women living with HIV in low and middle income countries (716 500 of 1.49 million) received effective antiretroviral regimens excluding single dose nevarapine. An estimated 35% of pregnant women living with HIV in low and middle countries received an HIV test in 2010, up from 7% in 2005. HAART coverage has increased from 1.48 million infants born to mothers living with HIV to 32% to 42%. Objectives: The purpose of the study was to explore and describe the range of barriers and motivational factors for gender inclusiveness within the (Prevention of mother to child transmission) PMTCT programme in public hospitals in KwaZulu-Natal as perceived by males. Methodology: A qualitative, descriptive, explorative study was conducted through individual interview of males until data saturation. Results: The findings of the study reveal that; males were not aware of their role in the prevention of mother to child transmission and did not feel comfortable to be in the mist of pregnant women. Conclusion: The study recommends intense male recruitment into PMTCT to ensure effective management of HIV in pregnancy and to prevent MTCT. This will ensure a holistic support needed by pregnant women on PMTCT.

Realization of an AIDS-free generation: ensuring sustainable treatment for children.

According to a 2011 statement from the Joint United Nations Program on HIV/AIDS (UNAIDS), “by 2015 children everywhere can be born free of HIV and their mothers remain alive.” These ambitious goals were defined to provide renewed energy and to reinvigorate programs to realize the vision of an AIDS-free generation.1 Since the launch of the Global Plan Toward the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (focused on 22 countries with the highest estimated numbers of pregnant women, with a goal to reduce new HIV infection by 90% and HIV-related maternal deaths by 5%), there has been a substantive expansion of investments resulting in improved access to antiretroviral therapy (ART) in pregnant women as a means to eliminate vertical HIV transmission. As a result, at the end of 2012, 62% of pregnant women with HIV in low- and middle-income countries were receiving ART for prevention of vertical transmission, a significant increase from 14% in 2005.2 This progress has led to a reduction of new infections among children; between 2009 and 2012, it is estimated that 670 000 children in these countries were prevented from acquiring HIV infection.2

Commentary: Antiretroviral treatment for pregnant and breastfeeding women--the shifting paradigm.

The global community has called for the elimination of new HIV infections among children by 2015 and keeping their mothers alive [1]. Though viewed by some as overly optimistic and aspirational, this call to action has generated unprecedented momentum and transformed the global dialogue around prevention of mother-to-child HIV transmission (PMTCT) to emphasize efficiency, effectiveness and measurable impact of efforts to prevent new pediatric HIV infections. The 2013 WHO guidelines for the use of antiretroviral drugs in pregnant and breastfeeding women also represent a major paradigm shift from previous recommendations for PMTCT in low and middle-income settings (Table 1) [2].