Measuring coverage in MNCH: population HIV-free survival among children under two years of age in four African countries.

Background: Population-based evaluations of programs for prevention of mother-to-child HIV transmission (PMTCT) are scarce. We measured PMTCT service coverage, regimen use, and HIV-free survival among children ≤24 mo of age in Cameroon, Côte D'Ivoire, South Africa, and Zambia.

Methods And Findings: We randomly sampled households in 26 communities and offered participation if a child had been born to a woman living there during the prior 24 mo.

Presumptive diagnosis of severe HIV infection to determine the need for antiretroviral therapy in children less than 18 months of age.

Objective: To develop a new algorithm for the presumptive diagnosis of severe disease associated with human immunodeficiency virus (HIV) infection in children less than 18 months of age for the purpose of identifying children who require antiretroviral therapy (ART).

Methods: A conditional probability model was constructed and non-virologic parameters in various combinations were tested in a hypothetical cohort of 1000 children aged 6 weeks, 6 months and 12 months to assess the sensitivity, specificity, and positive and negative predictive values of these algorithms for identifying children in need of ART. The modelled parameters consisted of clinical criteria, rapid HIV antibody testing and CD4+ T-lymphocyte (CD4) count.

Improved detection of incident HIV infection and uptake of PMTCT services in labor and delivery in a high HIV prevalence setting.

Objective: To maximize prevention of mother-to-child transmission of HIV (PMTCT) effectiveness and increase identification of HIV status in maternity units in Swaziland.

Design: With a quasi-experimental design, 3 maternity units were randomly assigned to the training intervention and 3 units were controls.

Methods: Targeted on-site training was provided to nurse-midwives in intervention sites.

Coverage of nevirapine-based services to prevent mother-to-child HIV transmission in 4 African countries.

Context: Few studies have objectively evaluated the coverage of services to prevent transmission of human immunodeficiency virus (HIV) from mother to child.

Objective: To measure the coverage of services to prevent mother-to-child HIV transmission in 4 African countries.

Design, Setting, And Patients: Cross-sectional surveillance study of mother-infant pairs using umbilical cord blood samples collected between June 10, 2007, and October 30, 2008, from 43 randomly selected facilities (grouped as 25 service clusters) providing delivery services in Cameroon, Côte d'Ivoire, South Africa, and Zambia.

Preventing mother-to-child transmission of HIV in resource-limited settings: the Elizabeth Glaser Pediatric AIDS Foundation experience.

Objectives: In September 1999, the Elizabeth Glaser Pediatric AIDS Foundation initiated a multicountry, service-based programmatic effort in the developing world to reduce perinatally acquired HIV infection. We review 6(1/2) years of one of the world's largest programs for the prevention of mother-to-child transmission (PMTCT) of HIV.

Methods: Each PMTCT facility records patient data in antenatal clinics and labor and delivery settings about counseling, testing, HIV status, and antiretroviral prophylaxis and submits the data to foundation staff.

HIV, infant feeding and more perils for poor people: new WHO guidelines encourage review of formula milk policies.

The release of the new WHO guidelines on HIV and infant feeding, in a global context of widespread impoverishment, requires countries to re-examine their infant-feeding policies in relation to broader socioeconomic issues. This widening scope is necessitated by compelling new reports on the scale of global underdevelopment in developing countries. This paper explores these issues by addressing feeding choices made by HIV-infected mothers and programmes supplying free formula milks within a global environment of persistent poverty.

Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries.

Ambitious goals for paediatric AIDS control have been set by various international bodies, including a 50% reduction in new paediatric infections by 2010. While these goals are clearly appropriate in their scope, the lack of clarity and consensus around how to monitor the effectiveness of programmes to prevent mother-to-child HIV transmission (PMTCT) makes it difficult for policy-makers to mount a coordinated response. In this paper, we develop the case for using population HIV-free child survival as a gold standard metric to measure the effectiveness of PMTCT programmes, and go on to consider multiple study designs and source populations.

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

Objective: To evaluate the provision of care for mother and child after institution of prevention of mother-to-child transmission (PMTCT) of HIV services.

Design: As part of an effort to improve services, we undertook a review of our multicountry PMTCT program.

Methods: Review of key indicators from our PMTCT database and reporting practices from January 2005 to June 2006 throughout 18 resource-limited countries.

Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia.

Context: The Zambian Ministry of Health provides pediatric antiretroviral therapy (ART) at primary care clinics in Lusaka, where, despite scale-up of perinatal prevention efforts, many children are already infected with the human immunodeficiency virus (HIV).

Objective: To report early clinical and immunologic outcomes of children enrolled in the pediatric treatment program.

Design, Setting, And Patients: Open cohort assessment using routinely collected clinical and outcome data from an electronic medical record system in use at 18 government primary health facilities in Lusaka, Zambia.

Site-specific interventions to improve prevention of mother-to-child transmission of human immunodeficiency virus programs in less developed settings.

This article reviews the experiences of programs designed to provide access to prevention of mother-to-child transmission services with the goal of improving services in resource-constrained settings. The article reports new data from the Elizabeth Glaser Pediatric AIDS Foundation's prevention of mother-to-child transmission program in sub-Saharan Africa, which has provided human immunodeficiency virus testing to more than 1,300,000 pregnant women and antiretroviral prophylaxis to 134,000 human immunodeficiency virus-infected pregnant women and more than 78,000 human immunodeficiency virus-exposed infants. Review of qualitative program data highlights the practical innovations that sites are implementing to improve the uptake of prevention of mother-to-child transmission services.

Early clinical and immune response to NNRTI-based antiretroviral therapy among women with prior exposure to single-dose nevirapine.

Objective: To determine whether prior exposure to single-dose nevirapine (NVP) for prevention of mother-to-child HIV transmission (PMTCT) is associated with attenuated CD4 cell response, death, or clinical treatment failure in women starting antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTI).

Methods: Open cohort evaluation of outcomes for women in program sites across Zambia. HIV treatment was provided according to Zambian/World Health Organization guidelines.

Diagnosis of pediatric human immunodeficiency virus infection in resource-constrained settings.

The majority of children infected with human immunodeficiency virus live in resource-constrained settings and die without an established diagnosis. Definitive laboratory diagnosis in children younger than 12-18 months requires virologic testing; however, antibody testing is often the only option available. Antibody testing provides a definitive diagnosis in older children but is frequently not used.

Integrating prevention of mother-to-child HIV transmission into routine antenatal care: the key to program expansion in Cameroon.

With funds from Elizabeth Glaser Pediatric AIDS Foundation, the Cameroon Baptist Convention Health Board implemented a program to prevent mother-to-child transmission of HIV-1 (PMTCT) as part of its routine antenatal care, with single-dose maternal and infant peripartum nevirapine (NVP) prophylaxis of HIV-positive mothers and their babies. Nurses, midwives, nurse aides, and trained birth attendants counseled pregnant women, obtained risk factor data, and offered free HIV testing with same-day results. From February 2000 through December 2004, this program rapidly expanded to 115 facilities in 6 of Cameroon's 10 provinces, not only to large hospitals but to remote health centers staffed by trained birth attendants.

Trends in interventions to reduce perinatal human immunodeficiency virus type 1 transmission in North Carolina.

Background: Mother-to-child transmission of HIV has decreased in industrialized countries because of widespread use of antiretroviral therapy (ART) by HIV-infected pregnant women and perhaps to increased use of elective cesarean section. We evaluated changes in the use of ART and mode of delivery among HIV positive pregnant women in North Carolina.

Methods: We reviewed the medical records of HIV-exposed infants born in North Carolina between January 1, 1998, and December 31, 1999, who were tested for HIV DNA.