Interventions for preventing late postnatal mother-to-child transmission of HIV

Global Health Sciences, University of California, San Francisco, Box 1224, San Francisco, California 94143, USA.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 01/2009; 1(1):CD006734. DOI: 10.1002/14651858.CD006734.pub2
Source: PubMed

ABSTRACT

Mother-to-child transmission (MTCT) of HIV is the primary way that children become infected with HIV. Such transmission can take place when the child is still in the mother’s womb, around the time of birth, or through breastfeeding after birth. Hundreds of thousands of children are infected this way every year, with most of them in developing countries. Major progress has been made in preventing MTCT when the baby is still in the mother’s womb, or around the time the baby is born. In many resource-rich settings, mothers with HIV infection are counseled not to breastfeed their children, and there are feasible and affordable alternatives to breastfeeding. However, in parts of the world where the vast majority of mothers with HIV infection live, complete avoidance of breastfeeding is often not feasible (for example, because of the lack of availability of clean water and of affordable replacement feeding). Therefore, interventions to prevent transmission of HIV infection through breast milk are urgently needed. The authors found that, in addition to complete avoidance of breastfeeding if safe and affordable, exclusive breastfeeding (where the baby receives only breast milk) for the first few months of life helps prevent transmission (as compared to breastfeeding supplemented by feeding the baby other liquids or solids). Another intervention, giving the baby an anti-HIV medicine (antiretroviral) while breastfeeding, decreases the risk of transmission of HIV from mother to child. Implementation of such interventions, as well as developing more and better interventions, is essential.

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    • "also found to reduce the amount of HIV-1 shedding in genital secretions (Graham et al. 2007) leading to lower sexual transmission (Attia et al. 2009). Mother to child HIV transmission during pregnancy, delivery, or breastfeeding was intervened with HAART and till date PMTCT remained one of the most successful HIV preventive strategies globally (Rutenberg et al. 2003, Horvath et al. 2009, Doherty et al. 2003). The success of ART inspired the idea that PrEP with HAART could be effective for HIV prevention (Baird et al. 2003). "
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    ABSTRACT: Antiretroviral drugs are being tried as candidates for the pre-exposure prophylaxis (PrEP) against HIV for a considerable period, due to their potential for immediate inhibition of viral replication. Discrepancies in the findings called for a critical review of the relevant efforts and their outcomes. A systematic literature search identified 143 eligible articles of which only 5 reported complete findings while another 11 were still on-going. Observed moderate efficacy and good safety profile seemed to identify PrEP as a promising step for minimizing the spread of HIV to relatively unaffected population and controlling the epidemic among high risk population groups. But the duration of this efficacy was found to depend heavily on the availability, adherence and other related issues like cost, political commitment, ethical consideration etc. To prevent potential cultural and behavioral modifications, proper pre-administration counseling also seemed critical for the success of PrEP as a cost-effective intervention with adequate coverage.
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    • "In combination with prenatal HIV testing, antiretroviral therapy (ART) for mother and newborn, and caesarean section delivery, formula feeding has decreased rates of vertical transmission of HIV to less than 1% (Horvath et al., 2009). A systematic review by Horvath and colleagues (2009) demonstrates that breastfeeding almost doubles the risk of HIV transmission from 21% in formula-fed infants to 37% in infants who were exclusively breastfed (Horvath et al., 2009). In settings where access to clean water for infant formula cannot be guaranteed, practice guidelines have balanced HIV prevention with meeting the nutritional requirements of the infant while ensuring protection against non-HIV morbidity and mortality (WHO, 2010). "
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    ABSTRACT: ABSTRACT Infant feeding raises unique concerns for mothers living with HIV in Canada where they are recommended to avoid breastfeeding yet live in a social context of "breast is best." In narrative interviews with HIV-positive mothers from across Ontario, Canada a range of feelings regarding not breastfeeding was expressed balancing feelings of loss and self-blame with the view of responsibility and "good mothering" under the current Canadian guidelines. Acknowledging responsibility to put their child's health first, participants revealed their choices were influenced by variations in social and cultural norms, messaging and guidelines regarding breastfeeding across geographical contexts. This qualitative study raises key questions about the impact of breastfeeding messaging and guidelines for HIV-positive women in Canada.
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    • "Without intervention, HIV can infect 25–45% of births from HIV-positive mothers during pregnancy , delivery and/or breastfeeding in developing countries. The efficacy of antiretroviral (ARV) drugs has been shown (Chigwedere et al., 2008; Horvath et al., 2010). Approximately 53% of 1.4 million pregnant women in low-and middle-income countries received antiretroviral treatment (ART) to reduce the risk of motherto-child transmission (MTCT) of HIV. "
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    ABSTRACT: Male participation in the prevention of mother-to-child transmission (PMTCT) of HIV has been determined as one of the key factors in sub-Saharan African countries, but its realization is challenging because of male-related and institutional factors. The purpose of this study is two-fold: first, we explored the views of Luba-Kasai men, living in Zambia in the Lusaka Province, on the factors that encourage, inconvenience or inhibit them in accompanying their wives to the antenatal clinic and their ideas to improve their experience. Secondly, the study considered their knowledge of the PMTCT program and how such knowledge conformed to the Zambian National Protocol Guidelines Integrated PMTCT of HIV/AIDS. Twenty-one interviews were analyzed using qualitative inductive content analysis. The National Protocol Guidelines Integrated PMTCT of HIV/AIDS were analyzed using the deductive content analysis. The encouraging factors that emerged were involvement in the program, the time of delivery, love and care, and also the suspicion of corruption. The inconveniencing factors were the arrangements and working culture of the clinic, together with stigma and guilt. A lack of motivation, fear of death, socioeconomic circumstances and again the arrangements and working culture at the clinic were held as inhibiting factors. The ideas to remove inconvenient factors were maintaining a spiritual outlook on life, education, interaction, a good mood and a sense of meaningfulness. Considering such male views and paying attention to minorities in the development of national PMTCT of HIV Programs may enhance male participation in the process.
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