Article

Provision of care following prevention of mother-to-child HIV transmission services in resource-limited settings.

Elizabeth Glaser Pediatric AIDS Foundation, Santa Monica, CA, USA.
AIDS (London, England) (Impact Factor: 6.56). 12/2007; 21(18):2529-32. DOI: 10.1097/QAD.0b013e3282f155f4
Source: PubMed

ABSTRACT To evaluate the provision of care for mother and child after institution of prevention of mother-to-child transmission (PMTCT) of HIV services.
As part of an effort to improve services, we undertook a review of our multicountry PMTCT program.
Review of key indicators from our PMTCT database and reporting practices from January 2005 to June 2006 throughout 18 resource-limited countries.
1 066 606 pregnant women were counseled and tested, and 102 336 tested HIV-positive. Antiretroviral prophylaxis was dispensed to 81 384 mothers and 52 342 HIV-exposed infants. From available reporting, 1388 pregnant women were dispensed antiretroviral drugs for treatment and 9060 children received cotrimoxazole prophylaxis at 6 weeks.
PMTCT services are integrated into maternal-child health services but adult and pediatric care and treatment programs often function independently, without coordination or linkages. Integrating care into maternal-child health services and linking mother's HIV status to child are necessary for HIV-infected mothers and HIV-exposed children to receive appropriate follow-up and treatment.

1 Bookmark
 · 
82 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion. Yet aggregate gains mask stark inequalities, with low coverage of services for the poorest women. Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 80 developing countries highlight persistent disparities in skilled birth attendance by household wealth: in 70 of 80 countries (88%), ≥80% of women in the highest quintile were attended by a skilled provider at last birth; in only 23 of the same countries (29%) was this the case for women in the lowest wealth quintile. While there have been notable declines in HIV incidence and prevalence, women affected by HIV are too often bereft of other SRH services, including family planning. Achieving universal access to SRH will require substantially greater investment in comprehensive and integrated services that reach the poor.
    Global Public Health 01/2015; · 0.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Since 2008 children infected with HIV in Malawi have had access to free adult fixed-dose combination antiretroviral treatment (ART). After four years, more than 33,000 children now have access to these life-saving medicines and the chance to transition into adolescence. However, little is known about the lived reality of growing up HIV positive in resource poor contexts and the long term therapeutic efficacy of ART regimens remain mostly speculative (Mills et al. 2010). Drawing on two years of ethnographic fieldwork conducted at a rural hospital and with HIV positive children on treatment in Malawi, I examine the daily grind within households trying to raise healthy children in precarious circumstances. While most service delivery organisations base their understandings of children’s care on the model of the “family” or the “household”, I argue that they need to consider more seriously the ways that everyday social relationships in specific contexts shape long term treatment success for children. To that end, I propose that Janzen’s (1978) concept of the “therapy management group” (TMG), is a more accurate, fluid and inclusive way to think about the care and treatment of children living with HIV. By drawing on specific treatment trajectories I explore how gendered and intergenerational dynamics influence the timing of HIV treatment initiation, the ability to find “good food” for children on treatment and how high mortality rates among elderly and HIV positive caregivers can both impede and promote early diagnosis and treatment adherence. Findings from this research will help paediatric and adolescent HIV care and treatment services develop community based approaches to the long term care and treatment of infected children by highlighting how important it is to avoid preconceived conceptions about how child care works in specific settings.
    Children and Youth Services Review 10/2014; · 1.27 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Strong laboratory services and systems are critical for delivering timely and quality health services that are vital to reduce patient attrition in the HIV treatment and prevention cascade. However, challenges exist in ensuring effective laboratory health systems strengthening and linkages. In particular, linkages and referrals between laboratory testing and other services need to be considered in the context of an integrated health system that includes prevention, treatment, and strategic information. Key components of laboratory health systems that are essential for effective linkages include an adequate workforce, appropriate point-of-care (POC) technology, available financing, supply chain management systems, and quality systems improvement, including accreditation. In this review, we highlight weaknesses of and gaps between laboratory testing and other program services. We propose a model for strengthening these systems to ensure effective linkages of laboratory services for improved access and retention in care of HIV/AIDS patients, particularly in low- and middle-income countries.
    AIDS patient care and STDs 04/2014; · 2.68 Impact Factor