Prevention Of Mother-to-child Transmission Research Articles

Patriarchy, couple counselling and testing in preventing mother-to-child transmission of HIV in Zimbabwe

The World Health Organization (WHO) recommends couple human immunodeficiency virus (HIV) counselling and testing (CHCT) as one of the beneficial and cost-effective means for the prevention of mother-to-child transmission (PMTCT) of HIV within couple’s relationships. However, CHCT within the PMTCT of HIV settings in Zimbabwe remains low. This study explored adult men and women’s views from a rural district of Zimbabwe regarding the possible factors that facilitate or inhibit the uptake of CHCT for the PMTCT of HIV. The study utilised qualitative methods. Data were collected by conducting eight focus group discussions among adult men and women, as well as eight in-depth interviews with pregnant women admitted in antenatal wards in local hospitals. Thematic analysis was used for analysing the data with the aid of NVivo software. The study revealed that CHCT initiatives were hampered by certain patriarchal behaviours and beliefs that make it acceptable for men to have multiple sexual partners, thereby exposing their marriages and relationships to HIV. Social constructions around gender roles tend to prescribe women as the sole custodians of children’s health, and this led to stigmatisation against men who participated in PMTCT programmes. In addition, certain religious practices do not allow the use of medicine, which makes CHCT a nonevent. However, engaging men on platforms that advocate for progressive masculinities and raising awareness of this practice through information dissemination were identified as enablers in increasing CHCT.Contribution: The significant contribution of this study is that it demonstrated the importance of acknowledging the societal, cultural and religious practices inherent in a community, as they are central to their responses to HIV prevention interventions.

Attempt to Optimize the Role of Peer Support Group (PSG) in Increasing the Quality-of-Life Persons Living With HIV/AIDS (PLWHA) Through the Revitalization of Peer Support Activities Program in Pati Regency

It is well-known that People Living With HIV/AIDS (PLWHA) are denied and avoided by their own families. This is a very heavy social burden that must be borne by PLWHA. Therefore, the role of Peer Support Groups (PSG) as community empowerment is very important to improve the living quality of PLWHA. In this study, community service activities were conducted to optimize the role of PSG in improving the living quality of PLWHA in Pati Regency. Currently, Pati is the fourth highest city with PLWHA in Central Java, Indonesia. The community service utilized guidance participation, which prioritizes the involvement of the community in the activities. The implementation involved analytical methods for problem-solving and completion of the study. Two meetings were held at the Voluntary Counselling and Testing (VCT) Clinic of Soewondo Pati Hospital. In average, one activity was attended by 5-8 participants. They are the volunteer members from PSG Rumah Matahari. The meetings focused on brainstorming sessions and on providing counselling about the Prevention of Mother to Child Transmission (PMTCT) program, which aimed to enhance knowledge about PMTCT among PSG Rumah Matahari volunteers, especially in assisting pregnant women with PLWHA. The results show that the community service activities successfully highlighted the importance of PSG in improving the quality of life for PLWHA. The PMTCT program was well understood by the PSG Rumah Matahari volunteers, indicating the effectiveness of the training.

The state of the pediatric HIV epidemic in Lesotho.

Lesotho does not have reliable data on HIV prevalence in children, relying on estimates generated from program data. The 2016 Lesotho Population-based HIV Impact Assessment (LePHIA) aimed to determine HIV prevalence among children 0-14 years to assess the effectiveness of the prevention of mother-to-child transmission (PMTCT) program and guide future policy. A nationally representative sample of children under 15 years underwent household-based, two-stage HIV testing from November 2016-May 2017. Children <18 months with a reactive screening test were tested for HIV infection using total nucleic acid (TNA) PCR. Parents (61.1%) or legal guardians (38.9%) provided information on children's clinical history. Children aged 10-14 years also answered a questionnaire on knowledge and behaviors. HIV prevalence was 2.1% [95% confidence interval (CI): 1.5-2.6]. Prevalence in 10-14 year olds (3.2%; 95% CI: 2.1, 4.2) was significantly greater compared to 0-4 year olds (1.0%; 95% CI: 0.5, 1.6). HIV prevalence in girls and boys was 2.6% (95% CI: 1.8-3.3) and 1.5% (95% CI: 1.0-2.1), respectively. Based on reported status and/or the presence of detectable antiretrovirals, 81.1% (95% CI: 71.7-90.4) of HIV-positive children were aware of their status, 98.2% (95% CI: 90.7-100.0) of those aware were on antiretroviral therapy (ART) and 73.9% (95% CI: 62.1-85.8) of those on ART were virally suppressed. Despite the roll-out of Option B+ in Lesotho in 2013, pediatric HIV prevalence remains high. Further research is required to understand the greater prevalence among girls, barriers to PMTCT, and how to better achieve viral suppression in children with HIV.

Birth Preparedness Plans and Status Disclosure Among Pregnant Women Living with HIV Who are Receiving Antiretroviral Therapy in Ibadan, Southwest, Nigeria.

Promoting the maternal health of pregnant women who are living with human immunodeficiency virus (HIV; [PWLH]) is key to reducing maternal mortality and morbidity. Thus, inadequate birth preparedness plans, non-institutional delivery, and status concealment among PWLH contribute to the spread of HIV infection and threaten the prevention of mother-to-child transmission (PMTCT). Therefore, this study aimed to assess the birth preparedness plan and status disclosure among PWLH, as well as the prevalence of HIV infection among pregnant women. The study adopted a descriptive cross-sectional research design; a quantitative approach was used for data collection. Three healthcare facilities that represented the three levels of healthcare institutions and referral centers for the care of PWLH in the Ibadan metropolis were selected for the recruitment process. A validated questionnaire was used to collect data from 77 participants within the targeted population. Ethical approval was obtained prior to the commencement of data collection. The prevalence rate of HIV infection among the participants was 3.7%. Only 37.1% of the participants had a birth preparedness plan. A total of 40% of the participants tested for HIV, because testing was compulsory for antenatal registration. Only 7.1% of the participants had their status disclosed to their partners. Although 90% of the participants proposed delivering their babies in a hospital, only 80% of these participants had their status known in their proposed place of birth. The prevalence of HIV infection among pregnant women is very low, which is an indication of improved maternal health. However, the level of birth preparedness plan and status disclosure to partners are equally low, and these factors can hinder PMTCT. Institutional delivery should be encouraged among all PWLH, and their HIV status must be disclosed at their place of birth.

Incidence of HIV Infection among HIV-Exposed Iinfants at Gondar University Hospital from 2019-2021: A Prospective Cohort Study.

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is decreasing worldwide; however, achieving the MTCT elimination target of 2% by 2020 and 0% by 2030 is challenging in resource-limited countries. Preventing mother-to-child transmission (PMTCT) is a key strategy in eliminating new pediatric human immunodeficiency virus (HIV) infection Strengthening PMTCT program is one of the key mechanisms for the elimination of Pediatric HIV infection and improving maternal and newborn survival. Assessing the incidence of HIV infection among HIV exposed infants is critical to devise an important preventive strategy which was the main objective of this study. A prospective Cohort study was conducted at Gondar University Comprehensive Specialized Hospital, PMTCT clinic to assess the incidence of HIV infection among HIV exposed infants from 2019-2021. The overall incidence of HIV infection among HIV exposed infants was 3.6%. HIV infection rate was significantly increased among HIV exposed infants coming out of Gondar, Infants with developmental failure and Infants with Unknown fathers' HIV status compared to their counterpart. The incidence of HIV infection among 307 HIV-exposed infants was 3.6% which is higher than the expected standard. The lost to follow up rate was also significant (9.4%). These finding showed that strengthening the PMCT service is mandatory.

Increasing Prevention of Mother to Child Transmission (PMTCT) Uptake through Facility-Based Health Promotion: Intervention Development

In Sudan, the HIV testing rates during pregnancy remain low. Limitations in scaling and uptake of PMTCT services are linked to several factors within the healthcare system, including the motivation of healthcare providers. This article describes how a health facility-based health promotion intervention plan was developed, implemented, and evaluated to increase the uptake of PMTCT services using the Intervention Mapping approach. Individual-level and environmental determinants were previously identified and included in the intervention plan. Some factors that impacted the intention of women to test for HIV during pregnancy include level of knowledge on MTCT, who offers the HIV test, the fear and tension experienced when thinking about HIV/AIDS, the non-confidentiality of the HIV test results, and self-efficacy. This provides insights into how to develop, implement, and evaluate a facility-based health promotion intervention. The pre-assessment was critical in shaping the intervention and making it relevant and evidence based. The Intervention Mapping approach that was applied facilitated the systematic design of the intervention and supported guiding the implementation.

Recommend Guideline on Prevention of Mother-to-Child Transmission of HIV in China in 2020

Abstract In China, a pilot project for the prevention of mother-to-child transmission (PMTCT) of the HIV was initiated in 2001. For the PMTCT of HIV, the Chinese government has released versions of the guidelines since 2004. In 2014, the World Health Organization released guidance on global processes and criteria for the validation of elimination of mother-to-child transmission of HIV and syphilis. To promote the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B virus in China, the Chinese government updated the Guideline for PMTCT of HIV, Syphilis, and Hepatitis B in 2020 (briefly as Guideline-2020). The Guideline-2020 comprises 5 parts: goals, interventions, support measures, duties and cooperation of departments, and definition indicators for PMTCT of HIV and corresponding calculation formulas. Compared with the previous versions, the key points updated in the Guideline-2020 are that the goals are set again, and health education and promotion, the procedure of HIV testing for pregnant women, and the antiretroviral therapy regimen for HIV-positive pregnant women and antiretroviral) prophylaxis regimen for infants are all updated. The antiretroviral prophylaxis regimen as zidovudine-lamivudine-nevirapine/lopinavir/ritonavir twice per day for 6 weeks is recommended for infants at high exposure risk to HIV, whereas the third antiretroviral therapy regimen as tenofovir-lamivudine-lopinavir/ritonavir is recommended for HIV-positive pregnant women, and indicators for PMTCT of HIV and corresponding calculation formulas are defined.

Platelet activities in pregnant women living with Human Immunodeficiency Virus on HAART in Lagos , Nigeria.

Introduction:Thrombocytopenia due to insufficient thromboxane A2 activation has been an independent predictor associated with bleeding in some pregnant women living with HIV. More so, the elevation in the systemic vasoconstriction by the abnormal activation of platelets through thromboxane A2 is a multi-system disorder during pregnancy resulting in maternal hypertension which is one of the major underlying pathophysiological occurrences in women with preeclampsia. Materials and Method: A cross-sectional, descriptive study to determine platelet activities in pregnant women living with Human Immunodeficiency Virus on HAART residing in Lagos State, was carried out. A total of 80 samples were collected; 40 from pregnant women on HAART (group A), 20 samples from HIV negative pregnant women (group B) and 20 from non-pregnant HIV positive women on HAART (group C). The samples were analyzed using automated haematology analyzer (MIDRAY BC 10), platelets morphology was reviewed from blood films stained by Leishman stain and thromboxane A2 was quantified using standard ELISA technique. Data was analyzed with SPSS version 23.0. Values were considered significantly different at P &lt; 0.05. Results:The platelets count results revealed the mean ± standard error of mean (SEM) in group A, group B and group C as 236.27 ± 11.40, 227.26 ± 16.44 and 246.21 ± 21.54 respectively ( p = 0.743). The Platelet distribution width (PDW) revealed the mean ± SEM in group A, group B and group C as 13.50 ± 0.42 ,13.36 ± 0.53 and 12.56 ± 0.52 ( p = 0.390 ) . As for mean platelet volume (MPV), the mean ± SEM for group A, group B and group C were 12.36 ± 1.96, 10.71 ± 0.37, and 10.45 ± 1.78 respectively(p = 0.671). The mean ± SEM of thromboxane A2 in group A, group B and group C were 367.65 ± 37.74, 135.85 ± 51.69 and 276.10 ± 50.90 (p = 0.02). Conclusion and Recommendation: This study showed platelet aggregation in group A, group B and group C were 7.5% , 0%, and 2%; and this could be one of the suggestive factors in the increase in coagulation activities found in pregnancy. Thromboxane A2 level reflects a recent activation of platelets, thus it serves as a good biomarker. It is recommended that research be conducted to establish reference ranges of Thromboxane A2 for categories of normal individuals, including pregnant women in Lagos while attention should be paid to platelet activity studies in the Prevention of Mother to Child Transmission (PMTCT) programmes, to prevent mortality of participants on account of platelet aberrations.

Uptake of prevention of mother-to-child transmission cascade services in Burkina Faso between 2013 and 2020: are we on the right track?

BackgroundThe use of services to prevent mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV) remains a serious challenge in sub-Saharan Africa. In the last decade, Burkina Faso has implemented numerous policies to increase the use of PMTCT services by pregnant women and their partners, as well as children. This study assesses trends in the uptake of PMTCT services in Burkina Faso from 2013 to 2020 in order to study the progress and gaps in achieving the national and international targets set for 2020.MethodsA repeated cross-sectional analysis was performed using data extracted from district health information software version 2. Percentages were computed for each PMTCT indicator and comparisons between the years were made using a chi-square test for trends with a significance threshold of 5%. Regions were not compared with each other.ResultsThe proportion of pregnant women who were tested and received their results significantly increased from 47.9% in 2013 to 84.6% in 2020 (p value < 0.001). Of the 13 regions in the country, only 1 region met the 95% national targets whereas, 6 regions met the 90% international targets for this indicator. The proportions of HIV-positive women receiving antiretroviral therapy (ART) increased from 90.8% in 2013 to 100% in 2020. In the same period, the proportion of exposed infants who received antiretroviral prophylaxis increased from 64.3% in 2013 to 86.8% in 2020. Only 3 regions reached the national and international targets for this indicator. A positive trend was also observed for the indicator related to screening at 2 months or later of exposed infants using Polymerase Chain Reaction (PCR) technic; with the rate rising from 7.4% in 2013 to 75.7% in 2020. However, for this indicator, the national and international targets were not achieved considering the national and regional settings. Concerning the women’s partners, the proportion of those who tested for HIV increased from 0.9% in 2013 to 4.5% in 2020, with only 1 region that fully met the national target of 10% in 2020. The prevalence of HIV in this particular group was 0.5% in 2020.ConclusionsPMTCT indicators show an increase from 2013 to 2020 but with a strong disparity between regions. National and international targets have not been achieved for any indicator; except for those related to women receiving ART. Strengthening strategies to effectively engage women and their partners on the use of PMTCT cascade services could help reduce mother-to-child transmission in Burkina Faso.

Effects of M-DEPTH Model of Depression Care on Maternal HIV Viral Suppression and Adherence to the PMTCT Care Continuum Among HIV-Infected Pregnant Women in Uganda: Results from a Cluster Randomized Controlled Trial at Pregnancy Completion

Perinatal depression has been shown to impede adherence to antiretroviral therapy (ART) and the prevention of mother-to-child transmission (PMTCT) care continuum; therefore, treating perinatal depression may result in increased viral suppression and PMTCT adherence. We examined the effects of the M-DEPTH (Maternal Depression Treatment in HIV) depression care model (including antidepressants and individual Problem Solving Therapy) on depression, maternal viral suppression and adherence to PMTCT care processes in an ongoing cluster-randomized controlled trial of 391 HIV-infected pregnant women (200 usual care; 191 intervention) with at least mild depressive symptoms enrolled across 8 antenatal care clinics in Uganda. At baseline, 68.3% had clinical depression and 41.7% had detectable HIV viral load. Adjusted repeated-measures multivariable regression models found that the intervention group was nearly 80% less likely to be clinically depressed [Adjusted OR (95% CI) 0.22 (0.05, 0.89)] at the 2-month post-pregnancy assessment, compared to the control group. However, the intervention and control groups did not differ meaningfully on maternal viral suppression, ART adherence, and other PMTCT care processes and outcomes. In this sample of women who were mostly virally suppressed and ART adherent at baseline, the depression care model had a strong effect on depression alleviation, but no downstream effects on viral suppression or other PMTCT care processes.Trial Registration NIH Clinical Trial Registry NCT03892915 (clinicaltrials.gov).

Eliminating mother-to-child transmission of HIV in Tanzania calls for efforts to address factors associated with a low confirmatory test.

Option B+ approach for prevention of mother-to-child transmission (PMTCT) has demonstrated the potential to eliminate pediatric HIV infections. Its success depends on early infant diagnosis (EID) of HIV among the exposed infants within the first 6 weeks, and a subsequent confirmatory HIV test within 18 months. However, most mothers enrolling in option B+ in Tanzania do not come for such confirmatory tests. We examined factors associated with the turning-up of mother-baby pairs on the PMTCT program for a confirmatory HIV testing 18 months post-delivery in Tanzania. This study utilized longitudinal data collected between 2015 and 2017, from 751 mother-baby pairs enrolled in the PMTCT-option B+ approach in 79 health facilities from the 12 regions of Tanzania-mainland. Only 44.2% of 751 mother-baby records observed received the HIV confirmatory test by the 18th month. Mothers aged 25 years or above (adults' mothers) were 1.44 more likely to turn up for confirmatory HIV testing than young mothers; mothers with partners tested for HIV were 1.74 more likely to have confirmatory HIV testing compared with partners not tested for HIV. Newly diagnosed HIV-positive mothers were 28% less likely to bring their babies for a confirmatory HIV-testing compared to known HIV-positive mothers. Mothers with treatment supporters were 1.58 more likely to receive confirmatory HIV-testing compared to mothers without one. Mother-baby pairs who collected DBS-PCR-1 were 3.61 more likely to have confirmatory HIV-testing than those who didn't collect DBS-PCR-1. In conclusion, the confirmatory HIV testing within 18 months among mother-baby pairs enrolled in the Option B+ approach is still low in Tanzania. This is associated with low maternal age, having a male partner not tested for HIV, lack of experience with HIV services, lack of treatment supporters, and failure to take the DBS-PCR-1 HIV test within the first two months post-delivery.

Strategies to Prevent Mother-to-child Transmission of Hepatitis B Virus.

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is the primary cause of chronic HBV infection worldwide. MTCT prevention and antiviral treatment of infected individuals could eliminate this public health burden. Antiviral treatment of hepatitis B surface antigen (HBsAg)-positive pregnant women and immunoprophylaxis with HBV vaccine and hepatitis B immune globulin are the most effective strategies to interfere with MTCT of HBV. However, for worldwide application of those strategies, feasibility, availability, cost, safety, and effectiveness should be considered. Cesarean section and breastfeeding avoidance in hepatitis B e antigen-positive mothers with a high viral load and without antiviral therapy during pregnancy could be an option, but more supporting evidence is needed. HBsAg screening of all pregnant women is recommended when initiating antiviral therapy and immunoprophylaxis for MTCT prevention, except in areas with limited resources. Timely HBV vaccination series administered soon after birth might be the mainstay of prevention. This review aimed to provide a concise update on the effectiveness of available strategies to prevent MTCT of HBV.

Short-term Effect of Training in Increasing Midwives’ Knowledge, Attitudes, and Practices Related to HIV and AIDS Prevention

Introduction: The study aims to analyse the effect of the training intervention program on midwives’ HIV-related knowledge, attitudes, and practices in Central Java. The training focused on HIV epidemiology, transmissions, co-infections, PITC, risk contacts, and prevention of mother-to-child transmission (PMTCT). It was designed to improve midwives’ knowledge, positive attitudes, and HIV/AIDS prevention practices, including reducing fear and stigma concerning people living with HIV/AIDS (PLWHA). Material and Methods: This study employed a Quasi-experimental pre-post-test design. The respondents are 50 village midwives equally divided into experimental and control groups. Data were collected using a questionnaire adapted from WHO, and it included questions about participant demographic characteristics, knowledge, attitudes, and practices on HIV and AIDS prevention programs. Furthermore, training consists of lecturing, group discussion, simulation, conversation with PLWHA, and watching a film about HIV including practicum. Results: There was a positive effect on midwife knowledge, attitudes, and practices in the early detection of HIV cases for pregnant women and reproductive age groups and HIV/AIDS prevention programs. The improvement in knowledge, attitudes, and practices occurred significantly in the intervention compared to the control. The adjustment intervention effects were beneficial and statistically significant (p-value &lt;0.05), particularly the magnitude of the treatment effect for the knowledge score, which increased of 7.73% of the baseline mean knowledge. There was a significant association between knowledge and practices with a p-value of 0.002. Conclusion: Training midwives in HIV prevention was a beneficial program and positively impacted knowledge, attitudes, and practices. This study recommended the need for comprehensive training for village midwives, especially those related to their tasks in HIV prevention.

Uptake of perinatal immunoprophylaxis for infants born to women with a record of hepatitis B in Victoria (2009-2017).

Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains one of the leading causes of transmission worldwide. An estimated 90% of infants who are exposed to HBV and do not receive appropriate post exposure immunoprophylaxis will go on to develop chronic hepatitis B (CHB). In Australia, universal birth dose vaccination was adopted in 2000 and universal antenatal screening for hepatitis B was introduced in the 1990s, however up to 10% of women may have missed screening. There is no coordinated care or data collection that systematically reports the access to interventions to prevent mother-to-child transmission (PMTCT) for women with CHB. Therefore, the incidence rate of MTCT is unknown. We conducted retrospective data linkage of perinatal records, public health notification and hospital admission data to identify women with a record of HBV infection who had given birth to a live infant(s) in Victoria between 2009 and 2017. We assessed uptake of birth dose vaccination and hepatitis B immunoglobulin (HBIG) and explored factors associated with administration of birth dose recorded as administered within 7days. Among 690,052 live births, 6118 births (0.90%) were linked to 4196 women with a record of HBV infection. 89.4% of all Victorian infants (n=616,879), and 96.8% of infants linked to women with a positive record of CHB (n=5,925) received birth dose within 7days. Infants born in private hospitals had reduced odds of receiving birth dose when compared to public hospitals births (Victorian population, aOR=0.67, 95%CI=0.66, 0.69; CHB linked records aOR=0.17, 95%CI=0.11, 0.25). Of the 6118 infants linked to a positive maternal record of CHB, discrepant recording of maternal CHB status between the three datasets was identified in 72.4% of records and HBIG administration was recorded for only 2.3% of births. An approach that involves coordinated care and integrates data collection for women with CHB and their infants is required to support the elimination of MTCT of hepatitis B in Victoria.

Infant-Feeding Practices Among Women Living With Human Immunodeficiency Virus (HIV) in a Southern Nigerian Region: A Mixed Comparative Study.

Background and objective Infant survival depends on proper nutrition. Breastfeeding enhances infant health and offers some benefits to the mother as well. However, in the setting of the HIV pandemic, it is important to assess the benefits and the risk for each individual in choosing a feeding option. The purpose of this research was to determine the infant-feeding practices among women living with HIV/AIDS (WLWHA) and compare them with the general population of women. Methods A mixed comparative survey was conducted among 246 HIV-positive mothers nursing infants of at least one year of age. An equal number of matched HIV-negative women from the same locality were selected as controls. Quantitative data were analyzed using IBM SPSS Statistics version 23(IBM Corp., Armonk, NY) while qualitative findings were presented in a thematic approach. Results The prevalence of exclusive breastfeeding (EBF) among WLWHA was 73.6% compared to 55.2% in the controls [p=0.002; chi-square (X2)=5.264]. Only 6.5% of WLWHA practiced exclusive replacement feeding (ERF). Vaginal birth was associated with increased odds for early initiation of breastfeeding [p=0.001; odds ratio (OR): 3.135; 95% confidence interval (CI): 2.130 to 4.616]. Also, urban dwellers commenced breastfeeding earlier thanwomen residing in rural communities (p=0.002; OR: 5.58; 95% CI: 3.85 to 8.07).Based on in-depth interviews, cultural influencesand non-disclosure of HIV status to family members promoted mixed feeding. Concomitant intake of anti-tuberculosis drugs was a major reason for adopting ERF in some women. Conclusion There was a high prevalence of EBF among WLWHA. Counseling on infant feeding is an effective component of the Prevention of Mother-to-Child Transmission (PMTCT) programs. Cultural beliefs and fear of stigmatization are major challenges to infant nutrition in sero-exposed babies.

Knowledge, attitude, and practice towards prevention of mother-to-child transmission of HIV among antenatal care attendees in Ethiopia, 2020.

In 2020, globally approximately 37.6 million people living with HIV and 700,000 children are born infected from their parents. Every day there are nearly 1800 new Human Immune Virus (HIV) infections in children, more than 90% occurring in the developing world. Approximately 90% of these infections are associated with mother-to-child transmission (MTCT). In 2019, Ethiopia had over 100,000 pregnancies in HIV-positive women and over 12,000 HIV-positive. Therefore, this study aimed to assess the knowledge, attitude, and practice of pregnant mothers toward the prevention of mother-to-child transmission of HIV.ss. An institutional-based cross-sectional study was conducted among 216 antenatal care (ANC) attendees in Gurage zone hospitals from June to July 2020. Data were collected using a structured and pre-tested questionnaire through face-to-face interviews. A Systematic random sampling technique with proportional allocation to size was used to select study subjects. Data entry and analysis were performed using Epi Data version 4.1 and SPSS version 25 respectively. The level of good knowledge, attitude, and practice towards Prevention of mother to child transmission (PMTCT) of HIV among antenatal care attendees was found to be 72.2%, 79%, and 62% respectively. This study has also shown that at the time of transmission of the virus from the infected mother to her child, 38.9% of the respondents responded that it could be through breastfeeding, 38.9% during pregnancy, 16.5% during labor and 5.7% did not know respectively. All the respondents have been tested and 0.92% was positive. Nearly half, 99 (45.8%) of the respondents had tested for HIV/AIDS with their partner/husband during their ANC follow-up. In this study, the level of good knowledge, attitude, and practice towards PMTCT of HIV among antenatal care attendees were low. This finding also suggests that healthcare providers should consider the potential risk of mother-to-child transmission of HIV while providing clinical health assessments during antenatal care visits. Thus, improvement of counseling sessions and knowledge of PMTCT for pregnant women attending antenatal care is needed to increase their acceptance and use of PMTCT for HIV services.

Human Immunodeficiency Virus management in pregnant women at Kupang City Hospital East Nusa Tenggara

Introduction: Human Immunodeficiency Virus (HIV), syphilis, and hepatitis B are sexually transmitted infections (STIs) that can pass from pregnant women to their babies. Transmission of HIV, syphilis, and Hepatitis B to children from mothers’ results in morbidity, disability, and death. Indonesia has adopted the Prevention of Mother-to-Child Transmission (PMTCT) as a national policy, following a voluntary counseling and testing approach.

Effects of hepatitis B virus infection and strategies for preventing mother-to-child transmission on maternal and fetal T-cell immunity.

One of the most common routes of chronic hepatitis B virus (HBV) infection is mother-to-child transmission (MTCT). Approximately 6.4 million children under the age of five have chronic HBV infections worldwide. HBV DNA high level, HBeAg positivity, placental barrier failure, and immaturity of the fetal immune are the possible causes of chronic HBV infection. The passive-active immune program for children, which consists of the hepatitis B vaccine and hepatitis B immunoglobulin, and antiviral therapy for pregnant women who have a high HBV DNA load (greater than 2 × 105 IU/ml), are currently two of the most important ways to prevent the transmission of HBV from mother to child. Unfortunately, some infants still have chronic HBV infections. Some studies have also found that some supplementation during pregnancy can increase cytokine levels and then affect the level of HBsAb in infants. For example, IL-4 can mediate the beneficial effect on infants' HBsAb levels when maternal folic acid supplementation. In addition, new research has indicated that HBV infection in the mother may also be linked to unfavorable outcomes such as gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, and premature rupture of membranes. The changes in the immune environment during pregnancy and the hepatotropic nature of HBV may be the main reasons for the adverse maternal outcomes. It is interesting to note that after delivery, the women who had a chronic HBV infection may spontaneously achieve HBeAg seroconversion and HBsAg seroclearance. The maternal and fetal T-cell immunity in HBV infection is important because adaptive immune responses, especially virus-specific CD8 T-cell responses, are largely responsible for viral clearance and disease pathogenesis during HBV infection. Meanwhile, HBV humoral and T-cell responses are important for the durability of protection after fetal vaccination. This article reviews the literature on immunological characteristics of chronic HBV-infected patients during pregnancy and postpartum, blocking mother-to-child transmissions and related immune mechanisms, hoping to provide new insights for the prevention of HBV MTCT and antiviral intervention during pregnancy and postpartum.

Triple Benefit: Impact of an Integrated Early Childhood Development and PMTCT Intervention on ART Outcomes Among Mothers Living with HIV and Infants in Malawi—An Endline Evaluation

We conducted a programmatic, observational cohort study with mother-infant pairs (MIPs) enrolled in prevention-of-mother-to-child-transmission (PMTCT) programs in Malawi to assess the feasibility and potential HIV-related benefits of integrating Early Childhood Development (ECD) services into PMTCT programs. Six health facilities were included in the intervention. We offered ECD counseling from the WHO/UNICEF Care for Child Development package in PMTCT waiting spaces while MIPs waited for PMTCT and broader treatment consultations. Primary outcomes were mothers’ retention in HIV care at 12 months and infant HIV testing at 6 weeks and 12 months after birth. Routine facility-level data from six comparison health facilities were collected as an adhoc standard of care comparison and used to calculate the cost of delivering the intervention. A total of 607 MIPs were enrolled in the integrated ECD-PMTCT intervention between June 2018 and December 2019. The average age of MIPs was 30 years and 7 weeks respectively. We found that 86% of mothers attended ≥ 5 of the 8 ECD sessions over the course of 12 months; 88% of intervention mothers were retained in PMTCT versus 59% of mothers in comparison health facilities, and 96% of intervention infants were tested for HIV by six weeks compared to 66% of infants in comparison health facilities. Costing data demonstrated the financial feasibility of integrating ECD and PMTCT programs in government health facilities in Malawi. Integrating ECD into PMTCT programs was feasible, acceptable, resulted in better programmatic outcomes for both mothers and infants. Further investigation is required to determine optimal delivery design for scale-up.

Experiences of HIV/AIDS women in planning their pregnancies during the COVID-19 pandemic

Introduction: HIV/AIDS has become a public health problem in many countries along with the increasing number of reported cases and the high mortality rate due to the HIV virus. The HIV virus can infect pregnant women, where pregnant women are at high risk of transmitting the virus to their babies. Transmission of HIV/AIDS from mother to child can be prevented by planning a pregnancy for HIV/AIDS women who want to get pregnant through the PMTCT (Prevention Mother to Child Transmission) program. In the midst of implementing the PMTCT program, the government is faced with the COVID-19 pandemic which causes the public to be advised to postpone pregnancy until the pandemic ends and counseling or consultation regarding family planning is done via telephone. The study aimed to determine the experiences of HIV/AIDS women in planning their pregnancies during the Covid-19 pandemic. Methods: This research is a Qualitative research with a phenomenological approach which was conducted in March-April 2022 at the Victory Plus Foundation Yogyakarta. Data collection using in-depth interviews. The sampling technique used was purposive sampling. Participants in this study were women with HIV/AIDS who were pregnant during the Covid-19 pandemic and women with HIV/AIDS who had given birth with a maximum age of 6 months. Results: Researchers found 4 themes, which are the experience of women when diagnosed with HIV/AIDS, planning for pregnancy during the Covid-19 pandemic, the condition of pregnancy for women with HIV/AIDS, and social support for women with HIV/AIDS during pregnancy. Conclusion: Based on the results of the study, it can be concluded that some women with HIV/AIDS plan their pregnancies during the COVID-19 pandemic by discussing with their husbands, regularly taking ARVs, using the Calendar application to calculate the fertile period, and checking viral load and CD4 levels.