Dataset Information

Population-level benefits from providing effective HIV prevention means to pregnant women in high prevalence settings.

ABSTRACT:

Background

HIV prevalence among pregnant women in Southern Africa is extremely high. Epidemiological studies suggest that pregnancy increases the risk of HIV sexual acquisition and that HIV infections acquired during pregnancy carry higher risk of mother-to-child transmission (MTCT). We analyze the potential benefits from extending the availability of effective microbicide to pregnant women (in addition to non-pregnant women) in a wide-scale intervention.

Methods and findings

A transmission dynamic model was designed to assess the impact of microbicide use in high HIV prevalence settings and to estimate proportions of new HIV infections, infections acquired during pregnancy, and MTCT prevented over 10 years. Our analysis suggests that consistent use of microbicide with 70% efficacy by 60% of non-pregnant women may prevent approximately 40% and 15% of new infections in women and men respectively over 10 years, assuming no additional increase in HIV risk to either partner during pregnancy (RR(HIV/preg) = 1). It may also prevent 8-15% MTCT depending on the increase in MTCT risk when HIV is acquired during pregnancy compared to before pregnancy (RRMTCT/preg). Extending the microbicides use during pregnancy may improve the effectiveness of the intervention by 10% (RR(HIV/preg) = 1) to 25% (RR(HIV/preg) = 2) and reduce the number of HIV infections acquired during pregnancy by 40% to 70% in different scenarios. It may add between 6% (RR(HIV/preg) = 1, RR(MTCT/preg) = 1) and 25% (RR(HIV/preg) = 2, RR(MTCT/preg) = 4) to the reduction in the residual MTCT.

Conclusion

Providing safe and effective microbicide to pregnant women in the context of wide-scale interventions would be desirable as it would increase the effectiveness of the intervention and significantly reduce the number of HIV infections acquired during pregnancy. The projected benefits from covering pregnant women by the HIV prevention programs is more substantial in communities in which the sexual risk during pregnancy is elevated.

SUBMITTER: Dimitrov D

PROVIDER: S-EPMC3774771 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Publications

Population-level benefits from providing effective HIV prevention means to pregnant women in high prevalence settings.

Dimitrov Dobromir D Boily Marie-Claude MC Marrazzo Jeannie J Beigi Richard R Brown Elizabeth R ER

PloS one 20130916 9

<h4>Background</h4>HIV prevalence among pregnant women in Southern Africa is extremely high. Epidemiological studies suggest that pregnancy increases the risk of HIV sexual acquisition and that HIV infections acquired during pregnancy carry higher risk of mother-to-child transmission (MTCT). We analyze the potential benefits from extending the availability of effective microbicide to pregnant women (in addition to non-pregnant women) in a wide-scale intervention.<h4>Methods and findings</h4>A tr ...[more]

PMID: 24066069

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Project description:IntroductionCommunity pharmacies play an important role in the healthcare system: they are frequently accessed and have increasing capacity to deliver HIV prevention services. In communities where the prevalence of HIV is high and access to antenatal care clinics is delayed or irregular, there is a unique opportunity to leverage pharmacies to enhance early and sustained access to HIV prevention among pregnant women. This study will identify women's preferences for delivery of HIV prevention services and provider-level and system-level strategies to design a new pharmacy-based model of care for pregnant women. The overall objective of this study is to design and evaluate strategies to implement HIV prevention interventions for pregnant women in community pharmacy settings in western Kenya.Methods and analysisWe propose to conduct a discrete choice experiment to quantify preferences for delivery of HIV prevention interventions (including pre-exposure prophylaxis, partner testing and sexually transmitted infection screening and treatment) for pregnant women in community pharmacy settings. Latent class analysis will be used to quantify women's stated preferences and identify packages of intervention components that will optimise uptake among different subgroups of women. We will apply the Theoretical Domains Framework to identify provider-level and system-level factors that might influence the implementation of the optimal intervention packages. We will then use the Behaviour Change Wheel and survey a panel of experts to select and gain consensus on strategies to improve implementation. Finally, we will evaluate the potential costs of extending the implementation of HIV prevention interventions from the clinic to community pharmacy settings.Ethics and disseminationThe protocol was approved by the Kenyatta National Hospital-University of Nairobi Ethics Research Committee and the University of Washington Institutional Review Board. The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policymakers and researchers, through local and international conferences.

Project description:Vitamin A plays an important role in the periods of rapid cellular growth and differentiation, especially during pregnancy, which is supplied by the mother to the fetus. The aim of this study is to assess the prevalence and potential influence factors of prenatal VAD of Chinese pregnant women.China National Nutrition and Health Survey 2010-2013(CHNNS2010-2013) is a nationally representative cross-sectional study. It involved the random selection of 150 districts (urban) or counties (rural). Each site randomly selected 30 pregnant women. Because volume of blood and incomplete data was taken into consideration,the final sample was formed by 1209 participants. Serum retinol concentrations were measured by high performance liquid chromatography. Characteristics of the pregnant women were collected by a questionnaire. Comparing retinol level across categories of independent variables was tested by the Mann-Whitney U test. Logistic and linear regression analyses were used to identify influence factors of Chinese pregnant women.The mean serum retinol level of the pregnant women was 1.63 μmol/L (95 % CI 1.60-1.67) and 64[5.3 % (95 % CI 4.03-6.56)] had VAD. The odds of VAD were significantly higher among the pregnant women in the poor rural areas and without college or university education and low- income. Pregnant women in the second and third trimester had 2.40 (95 % CI 1.05-5.46) and 2.82 (95 % CI 1.34-5.93) times increased odds of VAD compared with those in the first trimester respectively. Pregnant women of drinker had 3.10(1.65-5.81) times increased odds of VAD compared with those no drinker. Pregnant smokers had 5.68 (95 % CI 2.23-14.49) times higher odds of VAD compared with pregnant with non-smoker without passive smoking.VAD is of mild public-health issue in Chinese pregnant women. Such as : in the poor rural areas and without received college or university education and low- income and advanced gestational age and unhealthy lifestyles of pregnant women such as smoking and drinking. These were pertinent influence factors of VAD.

Dataset Information

Population-level benefits from providing effective HIV prevention means to pregnant women in high prevalence settings.

Background

Methods and findings

Conclusion

Publications

Population-level benefits from providing effective HIV prevention means to pregnant women in high prevalence settings.

Similar Datasets

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