Examining Effective Teaching Methods for Prevention of Mother to Child Transmission of HIV/AIDS during Pregnancy

Examining Effective Teaching Methods for Prevention of Mother to Child Transmission of HIV/AIDS during Pregnancy
Student’s Name
Institutional Affiliation
Examining Effective Teaching Methods for Prevention of Mother to Child Transmission of HIV/AIDS during Pregnancy
1 Chopra, M. (2008). Prevention of mother to child transmission of HIV in Africa; Operational research to reduce post-natal transmission and infant mortality. Acta Universtatis Upsaliensis. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 389. -portal.org/smash/get/diva2:172691/FULLTEXT01.pdf
Purpose
The overall purpose of this study was to assess the effectiveness of PMTCT programme. More emphasis was on the reduction of HIV transmission from mother to child after birth and reduce infant mortality rates.
Methods
This study was as a result of two larger studies, the first was a prospective cohort study of mother to child HIV transmission that was conducted in South Africa whereas the second was an evaluation of PMTCT programmes in different countries. Therefore, a cohort study design was used in this research where visits were made to both HIV positive and negative mothers to establish infant feeding patterns. The total number of participants in this study were 665. Semi-structured and structured interviews were used to collect data from both mothers and caregivers. MS ACCESS was used to sort the quantitative data before being analyzed by Sata (v8).
Results
The results of the study indicate that the implementation of PMTCT programmes is different across areas this might be due to differences in health systems. Consequently, the HIV rates and mortality rates differs across locations.
Discussion
The results from the study suggested that the implementation of PMTCT programmes in disadvantaged areas requires extra attention to the socio-economic conditions of the people. This study emphasizes on the interventions that can be used to prevent mother to child HIV transmission and reduce the infant mortality rates in the society.
Future Research Implications
This research indicates that more needs to be done to reduce the gap between the efficacy and effectiveness of PMTCT programmes. Researchers need to focus on socio-economic conditions of people in disadvantaged areas. Also more ways improving the effectiveness of PMTCT programs need to be identified.
2 Abdula, M. (2015). Assessment of effectiveness of prevention of mother to child transmission of human immunodeficiency virus in Asella teaching and referral hospital. Colleges of Health Sciences, Aris University: Ethiopia. http://etd.aau.edu.et/bitstream/123456789/8318/1/Mama%20Abdula.pdf
Purpose
The purpose of this study was to assess the effectiveness of PMTCT programmes by establishing the outcomes of the infants who have already been exposed to HIV. More emphasis was given to the chances of survival especially within the first 18 months.
Methods
This was carried in Asella teaching and referral hospital, College of health sciences, Arsi University, Ethiopia. A retrospective cross-sectional study design was employed in this research. The study included all HIV positive mothers with less than 18 months old children and were attending the ANC and ART clinics from 2012 to 2015. From the hospital’s records, HIV positive mothers within the years were 267.
A structured questionnaire that was adapted from ‘the national standard HIV exposed infant follow up chart and PMTCT registration logbook’. The collected data was cleaned and sorted into both soft and hard. After the data was cleaned it was analyzed using the statistical package for social sciences computer package version 21.
Results
From the results, 7.7% of infants born with HIV tested positive after 18 months. However, the number of deaths among HIV positive infants was low at the end of 18 months. However, the mortality rates of HIV positive infants was high in those with more than 18 months. Moreover, during the study period, there were no deaths recorded for HIV positive mothers.
Discussion
Infants born by mothers who never received either ART or ARV treatment were at higher risks of being infected with HIV than those whose mothers received the prophylaxis. Therefore, there is a need for ART and ARV counselling and more involvement in PMTCT activities.
Future Research Implications
Since the ARV and ART services reduces the risks of HIV infections, barriers to these services should be identified and addressed to reduce the risks to the infants. Consequently, safe breastfeeding campaigns should be carried throughout the country. Counseling need to be incorporated into future studies in PMTCT programs.
3 Anoje, C., Aiyenigba, B., Suzuki, C., Badru, T., Akpoigbe, K., Odo, M., ... & Chabikuli, O. N. (2012). Reducing mother-to-child transmission of HIV: findings from an early infant diagnosis program in south-south region of Nigeria. BMC Public Health, 12(1), 184.
http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-184
Purpose
The purpose of this study was to evaluate the effectiveness of PMTCT intervention programmes in reducing infant HIV transmission and to establish the challenges faced when caring for HIV positive children.
Methods
The study followed a retrospective approach where 702 children aged between 6 weeks and 18 months were included in the study. Only those children who had a DNA PCR test between November 2007 and July 2009 were included. Also, all the methods that are being used to prevent mother-to-child HIV transmission were analyzed.
Results
The results indicated that two-thirds of mothers and babies had received ARV treatment and 80% of the children were breastfed. Consequently, the transmission rate was lower for mothers and children who had received ARVs than those who had not. The transmission rate for babies between six weeks and six months who were in a mixed feeding programme was higher than that of children who were exclusively breastfed regardless of the intervention. Consequently, vertical transmission was higher in mother-babies who did not receive ARV treatment than those who had received. Another finding was that 7% of the children had died before their DNA PCR results were out and 85% were not traceable.
Discussion
For effective prevention of vertical HIV transmission between mother and child, pregnant women must follow the PMTCT. The services offered by PMTCT have been proved to be feasible in disadvantaged areas.
Future Research Implications
The use of facility records included biasness in the study. Those who never sought services in facilities were not included in the study; therefore, the findings might not present the whole population. Future studies may try to include the whole population and ensure that biasness is eliminated.
4 Iliff, P. J., Piwoz, E. G., Tavengwa, N. V., Zunguza, C. D., Marinda, E. T., Nathoo, K. J., ... & ZVITAMBO Study Group. (2005). Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. Aids, 19(7), 699-708. http://journals.lww.com/aidsonline/Abstract/2005/04290/Early_exclusive_breastfeeding_reduces_the_risk_of.7.aspx
Purpose
This study was aimed to investigate the role played by infant feeding practices in breastfeeding in the prevention of mother to child HIV transmission.
Methods
This was a retrospective study. Interviews were used to collect data and SAS version 8.2 for analysis.
Results
4,495 HIV positive mothers were enrolled in the study. 128 children who were born to HIV positive mothers did not record any follow up, 918 tested positive at six weeks and 6 of them died before the end of the sixth week. 64 children were negative at birth but died before their sixth week and 515 infants were alive but their PCR results were missing at the sixth week visit. 810 of the remaining 2870 infants missed feeding data. Therefore, 2060 of the remaining children were included in the analysis of this study.
The results indicated that 199 children contracted HIV between 6 weeks and 18 months and 48 infants died with negative results.
Discussion
Effects of EBF (early breastfeeding) are still significant in the prevention of HIV transmission between mothers and children. However, this is so when the women are provided with the necessary social and nutritional support. Moreover, mother to child HIV transmission is higher in women with CD4 cells counts below 200 than those with more than 500 counts.
Future Research Implications
In this study, breastfeeding patterns were selected by mothers; therefore, those mothers who chose EBF might have had lower risks of transmitting HIV to their children. In future studies, the patterns should be distributed among the mothers. Also, future studies should try to establish why those who practice mixed feeding have high mortality rates than those who exercise exclusive breastfeeding.
5 Stringer, E. M., Sinkala, M., Stringer, J. S., Mzyece, E., Makuka, I., Goldenberg, R. L., ... & Vermund, S. H. (2003). Prevention of mother-to-child transmission of HIV in Africa: successes and challenges in scaling-up a nevirapine-based program in Lusaka, Zambia. AIDS (London, England), 17(9), 1377. /pmc/articles/PMC2745990/
Purpose
The study was aimed at establishing the progress and challenges of expanding voluntary HIV and testing and the availability of NVP at clinics.
Methods
This was a training program for the NVP perinatal HIV prevention program that was initiated in Lusaka, Zambia.
Results
$221,000 was used to train 178 health employees in voluntary counseling and testing during the first one year. 17,263 pregnant women also received counseling on HIV where only 12,438 were tested. 2924 of the women who were tested were found to be HIV positive. The programme was taken by 57% of the mothers and 40% of children. The results indicated that at least 190 infants were not infected.
Discussion
Zambia has got the highest HIV rates in the world. Although cos-effective HIV prevention measures are available, their implementation is a challenge to many. This is due to lack of qualified personnel, skills, and infrastructure for effective implementation. In the program the major challenge was determining the population. Most Sub-Saharan Africa women walk around with their antenatal records making it straightforward in determining the population that has agreed to be tested after counselling though it is difficult to determine eligible population that is getting tested in the clinics. From the study, it has been demonstrated that mother-to-child HIV prevention is possible and cost-effective in limited-resource areas. The population that will accept testing will increase with “continued community mobilization and improved counseling skills of nurses.”
Future Research Implications
The study focused on HIV testing and counselling of women. The future studies should consider increasing program coverage and find ways of integrating antiretroviral therapy into the programs. This can also help to identify ways of improving the PMTCT programs.
6 Temmerman, M., Quaghebeur, A., Mwanyumba, F., & Mandaliya, K. (2003). Mother-to-child HIV transmission in resource poor settings: how to improve coverage?. Aids, 17(8), 1239-1242.
http://journals.lww.com/aidsonline/Fulltext/2003/05230/Mother_to_child_HIV_transmission_in_resource_poor.16.aspx
Purpose
The aim of the study was to review the coverage of nevirapine prevention model in Coast Provincial General Hospital (CPGH) in Kenya and establish alternative models that can be used to prevent mother-to-child HIV transmission.
Methods
This was an observation study for women who tested HIV positive. The study population consisted of pregnant women who were attending antenatal services for the first time in CPGH. There was a general counselling for the women while they waited to be attended. Those who tested positive were provided with a 200 mg nevirapine tablet for themselves and ‘0.6 ml nevirapine in a luer lock syringe for the babies’. Data was collected from delivery registers and antenatal records.
Results
3456 pregnant women visited the hospital for health education where only 71% of them were counseled. Out of the counseled women, 97% were tested and 14% of them tested positive. 106 women were provided with nevirapine during labor representing a coverage of 20%. During the study period, around 6000 women gave birth at the hospital where 20% of them had visited the hospital for VCT services.
Discussion
From the study, it was discovered that some organizational constraints need to be resolved for effective administration of the programme. The study proposes that for the progamme to be effective there must be at least one antenatal visit with VCT. It was also discovered that a large proportion of women who seek health education during their pregnancy end up delivering at homes while those who do not seek the services deliver at hospitals. Also, it was established that 30% of the women who received the general counseling did not proceed to get individual pre-test counselling. This was due to lack of skilled staff personnel at the hospital facility. The study demonstrates that the coverage of perinatal mother-to-child HIV transmission is low due to elements that need to be addressed in the progamme.
Future Research Implications
The study does not provide adequate solutions on how the various elements of the programme can be upgraded to improve the outcome. Therefore, future studies should address the issues that result in this study and establish other alternative methods alongside those that have been identified by this study.
7 Stringer, J. S. A., Sinkala, M., Maclean, C. C., Levy, J., Kankasa, C., DeGroot, A., … Vermund, S. H. (2005). Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia. AIDS (London, England),19(12), 1309–1315. /pmc/articles/PMC2745046/
Purpose
The purpose of the study was to “determine the population effectiveness of a city-wide perinatal HIV prevention program.”
Methods
The study was conducted in Lusaka District, Zambia. 10 clinics that provide delivery services in the District took part in the study. Also, the labor ward of the University Hospital also participated in the study. Between 7 June and 31 August 2003, cord blood specimens were collected from “the discarded placentas of live-born public sector deliveries in the city of Lusaka.” Serial antibody algorithm that consisted of a highly sensitive screening test was used to analyze the specimens for HIV antibodies.
Results
8787 women took part in the research where only 82% of them were offered antenatal HIV testing. 71% of the women accepted to be tested, of which 99% of them were provided with the results. 26% of the total population that participated in the study were cord seropositive where only 55% of them received the antenatal HIV test results, the results of 89% of them was positive while the remaining 134 consisted of some clerical errors. 68% of the 1112 women whose results were positive received a NVP tablet during labor. 675 infants of the 68% of the women who received NVP tablet at labor received NVP before they were discharged from the facilities. Therefore, only 675 infants of the seropositive women who participated in the study received both a maternal and infant dose of NVP.
Discussion
This study demonstrates that despite the presence of an effective PMTCT program in the city only a few of the exposed infants receive the appropriate treatment. For the infants to receive the appropriate care, several steps must be take place starting with provision of PMTCT services and HIV testing. The large population that fails to receive testing after the counseling may test positive than those that accept to be tested after being counseled. The results has demonstrated the significance of early steps in improving the effectiveness of the program.
Future Research Implications
The study focuses on urban population and ignores the rural settings that may be facing their own unique challenges in the implementation of the PMTCT program. Therefore, future studies should take the rural setting into considerations to address these challenges in the sparsely populated African rural settings.
8 Workneh, N. G., & Kevany, S. (2016). Maternal Health Service Disparities across Incomes and Implications on Prevention of Mother-to-Child Transmission Service Coverage: Current Context in Sub-Saharan Africa. Journal of Public Health in Africa, 7(2), 402. http://doi.org/10.4081/jphia.2016.402
Purpose
The aim of this paper was to analyze the effects of income disparities in the utilization of antenatal services across the Sub-Saharan African countries. It also analyzed how the utilization of antenatal care services differed among women according to their financial status.
Methods
This was an analysis of recent demographic and Health Surveys in Africa. All countries that conducted the surveys between 2008 and 2015 were considered and if a country had conducted more than one survey, only the recent one was chosen for the analysis. The data was analyzed by SPSS program. Linear analysis regression was performed to establish the disparities in the utilization of ANC services.
Results
31 Sub-Saharan African countries were considered in the study. The results indicated that women in the upper quantile are likely to use ANC services than those in the lower quantile. The coverage of the services differ across the countries and ranges from 3% in Madagascar and 95% in most countries such as Namibia and Uganda. The average coverage of PMTCT in these countries is about 71%. \The regression analysis indicates that the disparity in the use of ANC is linked to income and it is a significant predictor (p<0.05).
Discussion
Several issues that are of great concern were identified from the study. Although PMTCT coverage in the Sub-Saharan African countries is low, access of these services by poorer women is worse which affects the whole continent at large. The results indicates that wealthy women are three times more likely to access the services than poor women. The studies also shows that most poor women are unaware of the health and maternal services during the different stages of the delivery process. The study suggests that for all the women to have equal access of ANC services, maternal health services should be eliminated especially during the delivery time.
Future Research Implications
There is insufficient literature that explains why women in the lower wealth quartile lower access to ANC services. Therefore, future studies should try to provide enough literature to help in addressing this disparity issue.
9 Taylor, A. W., Nesheim, S. R., Zhang, X., Song, R., FitzHarris, L. F., Lampe, M. A., ... & Sweeney, P. Estimated Perinatal HIV Infection Among Infants Born in the United States, 2002-2013. JAMA Pediatrics. http://jamanetwork.com/journals/jamapediatrics/fullarticle/2611945
Purpose
The aim of the study was to estimate the total number mother-to-child HIV transmission cases in the United States.
Methods
The data for this study was obtained from the National HIV Surveillance System on infants that are born with HIV in the United States together with their mothers between 2002 and 2013. There were adjustments delays in diagnosis as well reporting by weighing the reported cases using a model that incorporated the time between birth, diagnosis and reporting. The analysis of this data was done from 1st April to 15th August, 2016.
Results
The results indicated that there was a decrease in prenatally infected infants from 216 in 2002 to 69 in 2013. Among the infected children from 2002 to 2013, 836 were of African American mothers and 243 were of Hispanic mothers. Between 2002 to 2005, 243 mothers were diagnosed of HIV before pregnancy compared to 120 in 2010 to 2013. In 2002 to 2005, 22.4% of mother-infant pairs received all the recommended dose of antiretroviral prophylaxis and 31.8% in 2010 to 2013. An approximate of 179 and 94 received the treatment during pregnancy in 2002 to 2005 and 2010 to 2015 respectively. Texas, Louisiana, Florida, and Maryland accounted for 38.0% of infants who were born with HIV infection during the study period.
Discussion
The decrease in the number of infants born with HIV infections in the United States may be as a result of improved health care services in the country.
Future Research Implications
Although there was a significant reduction in the number of mother-to-child HIV infections in the US, cases of missed prevention opportunities were reported. Therefore, future studies should try to establish the factors that contributed to these missed opportunities and design models that will ensure that those cases do not arise again in the country.
10 Coutsoudis, A., Pillay, K., Spooner, E., Kuhn, L., Coovadia, H. M., & South African Vitamin A Study Group. (1999). Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. The Lancet, 354(9177), 471-476. /science/article/pii/S0140673699011010
Purpose
The study aimed at establishing the impact infant-feeding patterns have on mother –to-child HIV transmission. Although, there are more studies in this topic, the study aimed at either confirming or disputing earlier findings.
Methods
This was a cohort study where infant-feeding practices were assessed in 549 HIV-1-infected women who were participating in Vitamin A intervention trial in Durban South Africa. The feeding patterns of infected infants after three months was compared in three different feeding groups.
Results
After three months, 18.8% of the 156 infants who were never breastfed were estimated to be infected compared to 21.3% of 393 children who were breastfed. The estimated number of children who were infected at the end of three months was much lower in those infants who received exclusive breastfeeding up to three months than those who received mixed feeding.
Discussion
Infant feeding methods of many mothers need a review across the world. From the findings, exclusive feeding pattern may provide infected mothers with an affordable and effective way of reducing mother-to-child HIV infections. This findings supported earlier findings in the topic that concluded the same. However, it is not clear as to why this is so. Researchers have never tried to explain what effect the breastfeeding have in preventing mother-to-child HIV transmissions.
Future Research Implications
Further research is required in the infant feeding patterns and mother-to-child HIV prevention. A new sense of direction in this topic is required to give researchers another area of focus. Therefore, the role breastfeeding plays in the prevention of mother-to-child HIV transmission need to be established. The findings can either give exclusive breastfeeding a stronger base or probe more research into it.
Kuhn, L., Kasonde, P., Sinkala, M., Kankasa, C., Semrau, K., Vwalika, C., … Thea, D. M. (2005). Prolonged breast-feeding and mortality up to two years post-partum among HIV-positive women in Zambia. AIDS (London, England),19(15), 1677–1681. /pmc/articles/PMC1393280/
Purpose
The aim of the study was to evaluate the effects of prolonged breast-feeding and mortality among HIV positive women in Zambia. No enough literature in this topic, therefore, the study also aimed at providing more insights into the breastfeeding of infants in PMTCT programs.
Methods
This was a randomized study. This was a trial case that was conducted in Lusaka, Zambia, where 653 HIV infected women were either assigned to a counseling program that encouraged them to stop breastfeeding their children at the end of four months or to a program that encouraged them to continue breastfeeding them up to a period which they will choose.
Results
No difference was identified in mortality 12 months after delivery in the number of women who were assigned to the short-term breastfeeding and those who were assigned to a long-term breastfeeding. The findings also demonstrated that mortality rate does not increase due to breastfeeding.
Discussions
The results from the study contradicts those that were found from a similar study that was carried in Kenya. The study reported no mortality cases associated with prolonged breastfeeding. However, the effects of prolonged breastfeeding were identified but they was no evidence that they contribute to mortality during prolonged breast-feeding.
Future Research Implications
Most studies have been focusing on the infants only and ignored their mothers. This is a new way of thinking and approach to PMTCT area as well. This study ignores the counselling services of HIV infected mothers during pregnancy and after delivery. Therefore, future studies should consider both the women who had received counselling and testing services and those who do not receive both. Consequently, future studies should also consider incorporating the sexual partners into this area.
Bahl, R., Frost, C., Kirkwood, B. R., Edmond, K., Martines, J., Bhandari, N., & Arthur, P. (2005). Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study. Bulletin of the World Health Organization, 83(6), 418-426. /scielo.php?pid=S0042-96862005000600009&script=sci_arttext
Purpose
The major purpose of the study was to determine the relationship between infant-feeding patterns, mortality and hospital admissions during the first six months.
Methods
This was a secondary analysis paper that analyzed data from a “multicenter randomized controlled trial on immunization-lined vitamin A supplementation.” A total of 9424 population of mothers and infants was enrolled (2919 from Ghana, 4000, from India and 2505 from Peru). Children who were 18-42 days old were selected for this analysis. The selected mother-infant pairs received visits at their homes after every four weeks from the time the infants received their first dose of polio. During the visits, the mothers were asked of what they have given their infants to eat or drink during the week. Data was also collected from hospital admissions deaths that occurred “between the ages of 6 weeks and 6 months.” The collected data was analyzed using Stata software, version 8.2.
Results
The resul...