Prevention Of Parent To Child Transmission Research Articles

Trend of HIV Prevalence in Antenatal Women in a Tertiary Care Hospital in the Western Region of India.

Background The severity of AIDS and the social and personal implications of HIV makes the epidemiological study of HIV more difficult. Surveillance studies remain the mainstay of understanding thetrends of HIV infection. In this study, we aimed to determine the trend in the prevalence of HIV in the antenatal women attending our hospital situated in the western region of India over the period of the last nine years and theART adherence and the viral loads of the cluster of positive patients identified from this antenatal HIV testing. Methodology A retrospective study was conducted by collecting data fornine years from January 2015 to December 2023 from the PPTCT (Prevention of Parent to Child Transmission) Centre and ART (Anti-Retroviral Treatment) Centre of the hospital. All pregnant women attending antenatal clinics and being admitted to the labor room are counseled for HIV testing as per the National AIDS Control Organisation (NACO) guidelines of India. The data of the total antenatal women counseled for HIV testing and who tested HIV positivewere collected. The HIV prevalence rate was derived and the trend of HIV prevalence in antenatal women attending the hospital was determined over the study period. The data on ART adherence and the viral load of these HIV-positive women detected antenatally and their seropositive spouseand children were collected and analyzed. Results A total of 22,584 antenatal women were counseled for HIV testing during the study period. No women opted out and there was 100% testing of these 22,584 antenatal women for HIV. Fifty antenatal women tested positive for HIV, resulting in an overall HIV prevalence of 0.22% (50/22,584) during the study period. There was adeclining trend of HIV prevalence among antenatal women from 2020 to 2023 (from 0.37% to 0.19%). Of the 50 seropositive antenatal women, 42remained bookedat our ART Centre for treatment. Thirty (71%) women are still adhered to taking ART. Of their 20 seropositive spouses, 14 (70%) have remained adhered to ART. Twenty-eight (93%) female patients on ART and 13 (93%) spouses on ART have suppressed viral loads. Two children of these seropositive mothers had tested HIV positive. ART adherence and suppressed viral load were seen in both seropositive children. Conclusion The study reflects a decline in antenatal seroprevalence in recent years in our region. The antenatal HIV prevalence trends have major implications on mother-to-child transmission and these positive antenatal cases serveas index cases bringing the testing opportunity for the so-called identified as the non-high-risk population. ART adherence of positive female patients, after the completion of the antenatal period, remains the challenge in our region, which requires improvement in the outreach activities and increased motivation and awareness of these patients regarding the importance of taking lifelong ART.

Declining Trend of HIV Seroprevalence in Pregnant Women: A Retrospective Observational Analysis of 12 Years’ Experience at a Tertiary Care Hospital in Central India

Introduction: Human Immunodeficiency Virus (HIV) infection among antenatal women has been reported throughout the country, with a relatively high prevalence in the state of Maharashtra. Data on HIV seroprevalence in antenatal women serve as an indirect indicator of the HIV epidemic's burden in the general population and aid in predicting the same in young children. Diagnostic and treatment services for HIV are concentrated in selected states and districts with high seroprevalence, making it necessary to accurately calculate the prevalence of HIV. Aim: To assess the effectiveness of Prevention of Parentto-Child Transmission (PPTCT) services and to study the effectiveness of the National Acquired Immunodeficiency Syndrome (AIDS) Control Programme (NACP) in the functioning of PPTCT services. Materials and Methods: A retrospective observational analysis of 12-year data, from January 2007 to December 2018, was conducted in the Department of Microbiology at the Government Medical College and Hospital, Nagpur, Maharashtra, representing Central India. Data collection took place from June 2019 to December 2019, and analysis occurred over the subsequent two months (January 2020 to February 2020). The total sample size was 101,865 patients. All pregnant women registered in the Antenatal Clinic (ANC) under the PPTCT Program were included in the present study, and Strategy III of the National HIV testing algorithm was followed. The women's ages, their partners' serostatus, and records of babies born to HIV seropositive mothers were obtained and analysed. The statistical analysis of the data was performed using Stata (version 10.4.2009, STATA Corp., Texas, USA) and Epi Info 7 (version 7.1.06, 2012, CDC, Atlanta, USA), employing the Chi-square test for linear trend (Extended Mantel-Haenszel). A p-value <0.05 was considered significant. Results: The seroprevalence of HIV infection among pregnant women was 1.04% in 2007, decreasing to 0.23% by 2017. In 2009, 88.9% of women were counselled, and 100% were tested for HIV, with pretest counselling steadily increasing to 100% by 2012. The trend in HIV testing, however, remained at 100% over the span of 10 years. Post-test counselling varied from 89.6% to 99.9%, whereas the trend of HIV testing among partners fluctuated from 50% to 94.44%. The overall HIV positivity among babies, after 18 months of follow-up, was 4.77%. Conclusion: The HIV seroprevalence among the pregnant population is steadily declining. More and more women are availing themselves of the facilities at Integrated Counselling and Testing Centre (ICTC). Intensive health education and the availability of diagnostic and therapeutic services across the country have reduced the burden of the HIV/AIDS problem in the country

Comparison of prevention of parent-to-child HIV transmission programme & national biennial HIV sentinel surveillance data for tracking HIV epidemic in India.

HIV sentinel surveillance (HSS) among antenatal women in India has been used to track the epidemic for many years. However, reliable tracking at the local level is not possible as ANC sentinel sites are limited in number and cover a smaller sample size at each site. Prevention of parent-to-child-transmission (PPTCT) programme data has a potential advantage due to better geographical coverage, which could provide more precise HIV case estimates; therefore, we compared HSS ANC data with PPTCT programme data for HIV tracking. Out of the 499 surveillance sites, where HSS and PPTCT programme was being conducted in 2015, 210 sites (140 urban and 70 rural) were selected using a stratified random sampling method. HSS (n=72,981) and PPTCT (n=112,832) data records were linked confidentially. The sociodemographic characteristics of HSS and PPTCT attendees were compared. HIV prevalence from HSS ANC was compared with the PPTCT programme data using Chi-square test. State- and site-level correlation of HIV prevalence was also done. Concordance between HSS and PPTCT HIV positivity was estimated using kappa statistics. The age distribution of HSS and PPTCT attendees was similar (range: 23 to 27 yr); however, HSS ANC participants were better educated, whereas PPTCT recorded a higher proportion of homemakers. The correlation of HIV prevalence between HSS and PPTCT was high (r=0.9) at the State level and moderate at the site level (r=0.7). The HIV positivity agreement between HSS ANC and PPTCT was good (kappa=0.633). A similar prevalence was reported across 26 States, whereas PPTCT had a significantly lower prevalence than HSS in three States where PPTCT coverage was low. Overall HIV prevalence was 0.31 per cent in HSS and 0.22 per cent in PPTCT (P<0.001). High-quality PPTCT programme data can provide reliable HIV trends in India. An operational framework for PPTCT-based surveillance should be pilot-tested in a phased manner before replacing HSS with PPTCT.

Cost-effectiveness of the prevention of parent-to-child transmission guidelines of HIV in India

BackgroundOne of the modes of transmission of HIV infection in India is from mother-to-child. In 2014, Prevention of Parent-to-child Transmission (PPTCT) guidelines of HIV in India were implemented which included shifting from Option A to Option B and B+. The aim of the present study was to evaluate health and cost related outcomes after implementation of these new guidelines. MethodsA decision analytical model was used to compare the PPTCT Option A with the new WHO Option of B and B+. Transmissions in serodiscordant couples and infants at 18 months were considered as health outcomes. The estimation of the cost for PPTCT services and HIV treatment was done using Costing Tool for Elimination Initiatives (CTEI) developed by National Center for Global Health and Medicine (NCGM). ResultsThe reduction in transmission rates in HIV infants was 33%. In serodiscordant couples the reduction in risk of HIV transmission from Option A to Option B and B+ was 72% and 87%, respectively. The incremental cost-effectiveness ratio (ICER) per quality adjusted life years (QALY) gained by averting infant infection, and for both infant and partner was US$ 238 and US$ 181 for Option B and US$ 1265 and US$ 947 for Option B+, respectively. ConclusionIt was found that Options B and B+ are more cost-effective as compared to option A. This effectiveness further increases when prevention of partner infections in Option B and B+ is taken into account.

Epidemiological drivers of mother to child HIV transmission in West Bengal, India: A retrospective cohort study.

HIV transmission through vertical route can be reduced to a large extent with combination of medical interventions. Apart from maternal HIV status several other epidemiological attributes determine this transmission dynamics.Objective: The objective of this study was to identify various associated factors that determine and modify the risk of HIV transmission from a mother living with HIV to her child.Materials and method: A retrospective cohort-study was conducted with 518 HIV-positive pregnant women with delivering live babies between April 2016 - September 2018. The HIV status of the children was ascertained with polymerase chain reaction. A number of socio-demographic and medical attributes were compared between HIV-positive (41) and HIV-negative babies (477) using bivariate and multivariate methods to identify disease modifying factors. Maternal HIV detection during the postnatal period (AOR = 11.2; 5.2 - 23.8), low birth weight (AOR = 2.7; 1.2 - 5.9), and vaginal delivery (AOR = 2.8; 1.01 - 7.7) were significantly associated with vertical transmission of HIV. Lower duration of maternal antiretroviral treatment and higher maternal age (>25years) were also associated in bivariate analysis. The battery of PPTCT (Prevention of Parent to Child Transmission) interventions should be tailored in such a way to address all the epidemiological attributes influencing vertical transmission.

Uptake of PPTCT services among HIV sero-positive pregnant women in Mumbai, India - A descriptive study

BackgroundPrevention of parent to child transmission of HIV is a major programme to control the main cause of new HIV infections among children. The successful implementation of the programme requires timely linkages to testing, ART treatment, follow-up and care at various levels of the cascade. The study measures these key points in the Prevention of Parent to Child Transmission (PPTCT) programme which are crucial for achievement of elimination of neonatal HIV transmission. MethodsThe study is a retrospective observational cohort study based on records of services provided to HIV sero-positive pregnant women enrolled for antenatal care at the 36 PPTCT centres across Mumbai during the period April 2014 to March 2015 and their follow-up till pregnancy outcome till October 2015. ResultsIn the Antenatal clinics, 1,20,892 pregnant women were tested for HIV during the study period, of which 520 (0.43%; 95% CI: 0.39–0.47) women tested positive. The median time of ANC registration is 22 weeks of gestation, median time to ART linkage following testing is 5 days and median duration of ART received by the ANC mother is 17.4 weeks. Of the total pregnancies (523), 85.1% resulted in live births, 3.1% were induced abortions, 2.5% ended in spontaneous abortions and 2.7% in still births. ConclusionThe successful implementation of the PPTCT programme is mainly dependent on the important linkages and follow-up for eliminating the transmission of HIV to newborns and for providing reproductive rights to HIV sero-positive parents without fear of transmitting the infection to the child.

KNOWLEDGE &amp; AWARENESS OF HIV TESTING IN PREGNANT WOMEN AND THEIR HUSBAND ATTENDING OBSTETRICS &amp; GYNAECOLOGY DEPARTMENT AT A TERTIARY CARE CENTRE IN CENTRAL INDIA DURING ANTENATAL CARE

Background: 3.4 million people worldwide are estimated to be living with HIV in 2009. In 2007, only 33 percent of HIV-positive women received antiretroviral drugs to minimise the risk of infection from mother to child.&#x0D; Aims and Objective: To study Awareness of HIV testing in pregnant women and their husband during ANC attending in OBGY Department.&#x0D; Methodology: This was a cross-sectional analysis carried out over the one-year period of the ANC women attending the OBGY department. By taking the written consent included in the report, there were 108 ANC women in the one year period. By interviewing the pair, knowledge of HIV testing and HIV transmission was assessed. The responses were noted and evaluated by excel software for Windows 10 in the excel sheet.&#x0D; Result: In our study we have seen that the majority of the ANC women were in the age group of 26-30 were 32 %. The awareness regarding the various questions like Does HIV transmitted to foetus by mother?- 9 % were Yes, 22 %-No, 69 %-Don’t Know; Do you know tests are there for detection of HIV?- 7 %-Yes, 13 %-No, 80 %-Don’t know; Are you at a risk of Infection?- 4% were Yes, 52% -No, 44 % were Don’t know; Can the disease prevented ? 6 %- Yes, 22 % were No, 72 % were don’t know; Is HIV a Sexually transmitted disease? 33 %-Yes, 22 %-No, 45 %-Don’t know; Can HIV be transmitted by contaminated blood? 32 %-Yes, 20 %-No, 48 %-Don’t know; Can HIV be transmitted by Kissing ?-35 % say Yes, 17 % -No, 48 %-Don’t know; Can HIV be transmitted by sharing food ?- 24 % Yes , 35 %-No, 41 %-Don’t know. From our research, we found that while there is good understanding of the HIV disease, the availability of preventive services through HIV testing is very poor, so subsequent prevention administration drugs are very low, although some myths about the transmission of the disease still remain, such as transmitting through sharing food or transmitting casual hugging or shaking.&#x0D; Conclusion: From our research, it can be concluded that the awareness of the PPTCT services with respect to HIV testing during the ANC era was very low, so that the awareness of it should be increased so that HIV transmission from mother to foetus can be effectively carried out.&#x0D; Key words: HIV testing during pregnancy, PPTCT (Prevention of Parent to Child Transmission)

Vertical transmission of HIV, Where do we stand ? Study done in PPTCT center - in a tertiary level of hospital of Western Rajasthan.

Background:Human immunodeficiency virus (HIV) infection in pregnant women has an important role in its spread to the pediatric population through vertical transmission. Effective utilization of Prevention of Parent to Child Transmission (PPTCT) services can reduce this spread. This study aims to determine the vertical transmission of HIV, the seroprevalence of HIV in antenatal women, demographic factors of seropositive women, and utilization of PPTCT services to minimize the risk of mother-to-child transmission.Methods:This study was conducted to assess vertical transmission of HIV in the newborn of HIV pregnant women attending antenatal clinic (ANC) of a tertiary care hospital from August 2014 to December 2020. Pretest counseling, HIV testing, and posttest counseling were done as per National AIDS Control Organization (NACO) guidelines. Antiretroviral prophylaxis was given to seropositive women and their children. Analysis of demographic data of seropositive women and assessment of the utilization of PPTCT services were done according to available records.Results:In the study time, 139,619 new antenatal registrations were there, 68.21% of women attended pretest counseling and of them, 95.28% gave consent for HIV testing. Out of which, 0.14% were reported as HIV seropositive in PPTCT (tested according to NACO guidelines). In the study time, a total of 188 HIV-positive deliveries were conducted in our institute. Out of which, 144 (76.6%) were ANC-booked patients and 44 (23.4%) were unbooked patients and directly came in labor, deliveries were conducted according to NACO guidelines and all newborns were given nevirapine syrup. All newborns were followed up until 18 months and in study time, 78 dry blood samples (DBSs) were sent for DNA polymerase chain reaction (PCR) detection and all were reported negative by the reference laboratory at AIIMS, New Delhi.Conclusions:Adherence to testing, treatment, and follow-up in the antenatal and postnatal period can minimize the risk of HIV transmission from mother to child.

Safety and Efficacy of Fixed Drug Combination Tenofovir, Lamivudine and Efavirenz to Prevent Transmission of HIV

Introduction: Mother-to-child transmission of HIV can occur during pregnancy, labour, or breastfeeding. The first-line regimen for prophylaxis in HIV infected pregnant women is combination of Tenofovir, Lamivudine and Efavirenz (TLE). Aim: To evaluate the safety and efficacy of the TLE regimen in the Prevention of Mother-To-Child Transmission (PMTCT) of HIV. Materials and Methods: The present hospital-based, retrospective cohort study was conducted at ART centre, Prevention of Parent to Child Transmission (PPTCT) centre, and Department of Medicine, SP Medical College, Bikaner from July 2016 to June 2019. HIV positive gravidas, on triple-drug regimen TLE (Tenofovir 300 mg, Lamivudine 300 mg, Efavirenz 600 mg) before conception and, those detected HIV reactive antenatally during study period were included in this study and started on TLE regimen. After delivery, these newborns were given syrup Nevirapine as per the PPTCT guidelines. Infants were tested with Rapid test and PCR for HIV, at six weeks, six months, 12 months, and 18 months of life. Results: Out of 87 pregnant women, enrolled and delivered at the study institute, 85 were live births and two were stillbirths. Out of 85 live-born babies, four have died during infancy and two were lost to follow-up despite repeated counselling. Five babies were referred to nearby Anti-Retroviral Therapy (ART) centers. So, the study followed 74 babies out of which one girl child was found to be positive for HIV-1 at 18 months of age (transmission rate of HIV was 1.35 and efficacy of TLE 98.65%). No major adverse effects of TLE were noted and all women continued TLE. Conclusion: The use of a triple-drug regimen (TLE) declined the risk of transmission of HIV from mother-to-child at negligible level, without drug resistance and with safety and tolerability as compared to single drug.

Confined vulnerability of HIV infection among pregnant women attending antenatal care clinics in Karnataka, India: Analysis of data from the HIV sentinel surveillance 2017

BackgroundHIV Sentinel Surveillance among pregnant women attending antenatal care clinics, ANC-HSS, is used to estimate HIV prevalence among the general population. Despite the declining trend, HIV prevalence among the general population in Karnataka is still higher than the national average (0.22%), with a recent, noticeable stabilization. Demographic analysis on concentrated HIV infection among pregnant women could be potential indicators for targeted HIV interventions among general population as well as and prevention of parent to child transmission (PPTCT). ObjectivesTo analyse the demographics of HIV-positive pregnant mothers in Karnataka, thereby identifying the most-at-risk populations (MARP) within the general population. MethodsIn total, 24800 eligible pregnant women aged 15–49 attending the ANC clinic for the first time during the surveillance period (Jan–Mar, 2017) were enrolled. Demographic data and blood samples were collected, recorded and tested for HIV. Age-specific factors associated with HIV prevalence, besides the demographics of the HIV positive pregnant women, were analysed to identify the MARP for targeted HIV interventions. ResultsComprehensively, none of the demographic factors was significantly associated with HIV prevalence. Nevertheless, analysis of demographics, HIV test history and ART status of HIV-positive pregnant women reveals prominent prevalence patterns. The epidemic was majorly confined within young, less educated, primigravida and rural mothers of low economic status. ConclusionANC-HSS is designed to estimate the HIV prevalence among general population at national, state and district levels and is not reflective of the concentrated epidemic confined to MARP. Identifying the disease pattern specific to MARP is essential for effective targeted interventions and disease management.

Pregnancy outcomes following exposure to efavirenz based antiretroviral therapy in indian women.

OBJECTIVES:Mother-to-child transmission of HIV has witnessed a significant reduction due to effective antiretroviral therapy (ART). Efavirenz has been introduced as a part of ART since last few years in the national Prevention of Parent to Child Transmission (PPTCT) program for pregnant women living with HIV. However, data related to adverse pregnancy outcomes associated with efavirenz-based ART are limited in the Indian scenario. The present study evaluated pregnancy outcomes in HIV-infected pregnant women who were given efavirenz-based ART during pregnancy.MATERIALS AND METHODS:It is a retrospective, observational, analytic study carried out at a referral hospital in Western India. Collection of data was done for a period of 5 years, and various adverse outcomes were studied which included preterm delivery, low birth weight (LBW), stillbirths, congenital anomaly, and neonatal death.RESULTS:This study showed a preterm birth rate of 19% and LBW in 36% of cases. There was no significant association with congenital anomaly, stillbirth, or neonatal death.CONCLUSION:There was an association of exposure to efavirenz with an increased incidence of adverse pregnancy outcomes, especially LBW infants. This study emphasizes the requirement of large prospective studies to investigate fetomaternal outcomes in pregnant women exposed to efavirenz.

A retrospective cohort study on effect of literacy status of HIV-positive pregnant women on possibility of child getting HIV infected.

Introduction:Prevention of parent-to-child transmission (PPTCT) program aims at reduction of HIV transmission through vertical route. Although medical intervention reduces chance of HIV transmission substantially, several demographic factors are often contributory. Minimum literacy is required for HIV-infected individuals to understand the course of medicine and to ensure compliance to the treatment which may have impact on vertical transmission. The objective of this study is to analyze relationship between maternal education and possibility of her babies to get HIV infected.Materials and Methods:A retrospective cohort study was carried out through analysis of secondary data during the period from April 13 to September 16 from all stand-alone integrated counseling and testing centers in West Bengal. A total number of 326 HIV-exposed babies, whose 6th week HIV-Polymerase Chain Reaction (PCR) reports are available and both the mother-baby received PPTCT services, were recruited in the study, and their maternal literacy status was substantiated and analyzed.Results:HIV positivity among HIV-exposed babies was found to be 6.67% whose mothers were illiterate as compared to 5.55% whose mothers were literate up to primary standard and 3.93% whose mothers were educated up to secondary standard. HIV positivity among the exposed babies whose mothers studied higher secondary standard or above showed zero HIV positivity. Chi-square was done to ascertain statistical significance but result was inconclusive although the trend shows increasing chance of HIV-exposed babies to get infected with decreasing literacy.Conclusion:Maternal literacy status favorably influences vertical transmission of HIV.

Awareness of HIV/AIDS among the pregnant women and their husbands attending ANC clinic in a tertiary care centre in Chennai

Background: In India the total number of people living with HIV (PLHIV) was estimated to be 2.1 million in 2015 and number of new cases estimated at 86,000. The prevalence of HIV among pregnant women in India is high and the awareness on HIV/AIDs is low among women in India .Awareness of HIV is important in antenatal mothers as they are vulnerable and encouraging early HIV testing will augment the PPTCT (Prevention of Parent to Child Transmission) services. Hence it is prime importance to create awareness among pregnant women to protect them from HIV infection. This study was conducted to find out the awareness level among pregnant women and their husbands as husbands play an important role in prevention of HIV in their spouses.Methods: A cross-sectional study was conducted at ANC clinic in Sri Ramachandra Medical College, Porur, Chennai. All antenatal women who visited the ANC clinic for the first time along with their husbands were selected as the subjects. Sample size was 200 (100 couples). After obtaining Informed Consent from the subjects, a semi structured questionnaire was administered. Data was collected and analysed using SPSS software version 21.Results: One hundred couples were included in the study. Seventy five percent of subjects did not accept that they are at risk and majority of them were husbands (79%) when compared to wives (71%). Above 75% of wives knew mother to child transmission whereas only 65% of husbands knew it. Willingness to undergo HIV test was more among wives (83%) than husbands (75%).Conclusions: A large effort to be taken to impart the information about the HIV/AIDS to husbands to change their attitude. At least one ANC visit by pregnant women should be made mandatory to have their husbands with them to sensitise them on HIV/AIDS.

Programmes for the prevention of parent-to-child transmission of HIV in Papua New Guinea: Health system challenges and opportunities.

Prevention of parent-to-child transmission (PPTCT) of HIV is a highly complex package of interventions, which spans services in both maternal and child health programmes. In Papua New Guinea (PNG), a commitment to ensure that all pregnant women and their partners have access to the full range of PPTCT interventions exists; however, efforts to increase access and utilisation of PPTCT remain far from optimal. The aim of this paper is to examine health care worker (HCW) perception of health system factors impacting on the performance of PPTCT programmes. Sixteen interviews were undertaken with HCWs involved in the PPTCT programme. Application of the WHO 6 building blocks of a health system was applied, and further thematic analysis was conducted on the data with assistance from the analysis software NVivo. Broken equipment, problems with access to medication and supplies, and poorly supported workforce were reported as barriers for implementing a successful PPTCT programme. The absence of central coordination of this complex, multistaged programme was also recognised as a key issue. The study findings highlight an important need for investment in appropriately trained and supported HCWs and integration of services at each stage of the PPTCT programme. Lessons from the PPTCT experience in PNG may inform policy discussions and considerations in other similar contexts.

STIGMA AND DISCRIMINATION OF HIV POSITIVE PREGNANT WOMEN AND MOTHERS IN THE HOME, COMMUNITY AND HEALTH CARE SETTINGS.

25Aug 2017 STIGMA AND DISCRIMINATION OF HIV POSITIVE PREGNANT WOMEN AND MOTHERS IN THE HOME, COMMUNITY AND HEALTH CARE SETTINGS. Juvina Caren Hannah , Rajan Patil Background: Adult HIV prevalence in India is estimated at 0.30% among males and 0.22% among females. More than 90% of women acquire HIV from their husbands or their sexual partners, not due to their own sexual behavior. The NACO Technical Estimate Report (2015) estimated that 35 thousand HIV positive pregnant women in India needed Prevention of Parent to child transmission(PPTCT) services. Experience worldwideconfirms that women tend to suffer more than men from HIV related stigma in terms of loss of respect, employment, protection and property rights that places women at a greater disadvantage in communities, largely so in developing nations.(1) Objective: The first objective of the study is to identify the day to day challenges that the women living with HIV face in terms of physical dimension ,psychological dimension, socio-economic dimension, health care dimension and how the stigma associated with the disease makes it all the more complex for them in their livelihood. The second objective is to study the stigma and discrimination faced by HIV positive pregnant women and mothers in the home, community and health care settings. Method: Key informant interviews were conducted with 11 HIV positive women who were either pregnant or mothers. The interviews were conducted in two public health care settings. Semi- structured questionnaire was used. The interviews were audio recorded and extensive notes were also taken. These were translated from Tamil language, transcribed and openly coded. It was next organized into domains, themes and sub-themes. Results: Stigma and discrimination, at the home, community and health care settings, do exist against the HIV positive women. Poverty and other challenges combined with stigma make it worse and increase the suffering of the women with HIV all the more. Stigma is a disease in itself. Conclusion:It is a known fact that HIV/AIDS has no cure. But stigma and discrimination against the women infected with HIV is preventable, creating a supportive environment for them for the rest of their life. Combined efforts to reduce the stigma and discrimination need to be taken along with measures to eradicate HIV/ AIDS in order to yield the best outcome.

Implementation of prevention of parent–to–child transmission (PPTCT) programme in a rural tertiary referral centre – an evaluation of three years

Implementation of prevention of parent–to–child transmission (PPTCT) programme in a rural tertiary referral centre – an evaluation of three years

Web-based intervention to increase uptake of prevention of parent-to-child transmission (PPTCT) service - An experience from the state of West Bengal, India

Background : To track human immunodeficiency virus (HIV)-infected pregnant women in every step of prevention of parent-to-child transmission (PPTCT) needs a line listing approach and a software-based line listing approach seems to be the best possible way to successful follow-up and linking the HIV-positive pregnant women with care, support, treatment, and other services. Objective: The purpose of this study is to assess the utility of web-based PPTCT line list software and to increase the uptake of PPTCT services by HIV-infected pregnant women. Methodology : The “web-based PPTCT line list software” was designed as a tool for monitoring uptake of PPTCT services by each HIV-positive pregnant woman detected in West Bengal in every step of PPTCT program. In collaboration with state IT cell, a software was developed where information of all positive pregnant women could be computed and based on the computed information, it could generate automatic SMS alerts regarding upcoming events to the counselor of the respective Integrated Counseling and Testing Center, the counselor of antiretroviral treatment (ART) center, outreach workers, and HIV-infected pregnant women. Simultaneously, entire state database can be viewed by program supervisor to monitor the program and to devise new strategies as per need. Results : Before the introduction of this software in August 2015, 92.8% (181/195) of the HIV-infected pregnant women could be linked to ART center during April 2015-August 2016. However, after its introduction, 98.8% (250/253) of them could be linked to ART center during September 2015-March 2016. This increase was statistically significant. Conclusion : The replicable software-based initiative would help in strengthening PPTCT linkages which could ultimately reduce the chance of HIV transmission through vertical route and to decrease the morbidity and mortality of HIV-exposed children.

Prevention of Parent to Child Transmission of HIV: Single Centre Experience of 14 years at Tertiary Care Hospital in Delhi, India.

Prevention of Parent To Child Transmission (PPTCT) of HIV/AIDS is an integral component of AIDS control programme. PPTCT is an ongoing programme since last 15 years. The aim of the study was to evaluate the reduction in the burden of disease in newborn and infants by prevention of parents to child transmission of HIV/AIDS. This retrospective study was conducted at Department of Obstetrics and Gynecology in a tertiary care hospital of Delhi from May 2002 to May 2015. The data was collected from records of maternal details registered at PPTCT clinic as well as list of infants undergoing Early Infant Diagnosis (EID) recorded in the standard format as per instructions from National AIDS Control Organization (NACO) of India. The Programme performance was assessed against performance indicators stated by NACO, India. Evaluation was done by dividing study period into two halves of seven years each. Out of 2,52,447 new antenatal case registration, overall, 43% received pretest of which, 91% were tested. Antenatal seropositivity rate varied from 0.1%-0.25%. Of 243 seropositive antenatal women 187 partners tested positive. While 25 women opted for MTP, 15 had still births. There were 17 neonatal deaths at 3-12 months attributable to respiratory infections and diarrheal diseases. Operative delivery rates declined from 50% to 31% over the years. Most women opted for breast feeding. The lost to follow up rate of newborns was quite high with details of only 43.5% being available at 18 months of infant's age. A total of three infants tested HIV positive at 18 months of age. The study highlights the practical aspects of policy implementation and operational issues involved in low resource country.

A Retrospective Cohort Study on Protective Efficacy of Intrapartum Nevirapine Prophylaxis to Prevent Parent to Child Transmission of Human Immunodeficiency Virus in West Bengal

Background: : In Prevention of Parent to Child Transmission (PPTCT) program in India, single dose Nevirapine was used for prevention of intrapartum transmission of HIV, but the protective efficacy of this regimen in Indian population is not beyond question. Objective: To analyze the protective efficacy of single dose Nevirapine prophylaxis in preventing mother to child transmission of HIV and comparing the effect of Nevirapine prophylaxis in different types of infant feeding practices and modes of delivery. Methods: A retrospective cohort study was carried out through analysis of secondary data during October 2010 to September 2011 from 16 Integrated Counseling and Testing Centers (ICTCs) having DNAPCR (Polymerase Chain Reaction) collection facility in West Bengal among 224 babies born of HIV infected mothers, 168 unexposed (covered with intrapartum Nevirapine) and 56 exposed (not covered with intrapartum Nevirapine) to risk of transmission. HIV reactivity in babies was confirmed by DNA PCR of Dry Blood spot from 6 weeks age onwards. Data was entered and analyzed using Epi Info version 3.5.1 and Statistical Package for Social Sciences software version (SPSS 16.0). Results: About 10.12% of those received Nevirapine were found HIV reactive compared to 26.79% of those who did not. Overall Relative Risk of non coverage of Nevirapine for vertical transmission of HIV was 2.65 (95% CI : 1.42 ‐ 4.95). Overall Attributable Risk was 62.22%. Conclusion: Since in 62.2% cases vertical transmission of HIV was prevented, additional regimen may be thought of for rest 37.8% cases.

Can we replace HIV sentinel surveillance platform with prevention of parent-to-child transmission (PPTCT) program data to assess HIV burden and trends in India?

Estimates of HIV burden in India are based on HIV sentinel surveillance (HSS), which has limitations such as insufficient sample size for district level analysis and ethical concerns. We analysed prevention of parent-to-child transmission (PPTCT) program data, for its suitability for HIV surveillance in India. Correlation and differences in ante-natal clinic (ANC) attendees' HIV prevalence from the last four rounds of HSS (2007-2012) and PPTCT data for the corresponding years were analysed at national, state and district levels. Sensitivity and region wise analysis were also done. The PPTCT program covered a higher number of districts and ANC attendees than HSS. Correlation of HIV prevalence from PPTCT data with HSS was high (0.99) at national level, moderate (0.66-0.86) at state level, and low (0.43-0.62) at district level. HIV prevalence levels from HSS were generally higher than those from PPTCT data. As the coverage of PPTCT program and HSS improved, the differences between HIV prevalence from these two data sources increased. Sensitivity analysis showed significant differences in ANC attendees' HIV prevalence from HSS and PPTCT, even among districts with high HIV test uptake level in PPTCT program. PPTCT program data can be utilised for HIV surveillance in India as it has better coverage and will avoid ethical issues and expenditures related to HSS.