En 2015, l’Organisation Mondiale de la Santé a mis en oeuvre des nouvelles lignes directrices sur la prévention de la transmission de la mère à l'enfant (PTME) du VIH recommandant à toutes les femmes enceintes et allaitantes séropositives, d'initier la trithérapie antirétrovirale à titre de traitement à vie (option B+). Cependant, il existe de plus en plus d'inquiétudes quant à l'efficacité de cette stratégie pour réduire réellement la transmission verticale du VIH à la lumière des défis programmatiques de sa mise en oeuvre ; on observe en particulier des niveaux sous-optimaux de suivi dans les soins chez le couple mère/enfant en Afrique sub-Saharienne. Notre thèse vise à évaluer, d’un point de vue de santé publique, l’engagement dans les soins du couple mère/enfant en prenant l’exemple du Mozambique, pays connu pour avoir l'une des prévalences du VIH les plus élevées au monde. Nous analysons, plus particulièrement trois aspects importants de l’engagement dans les soins : la cascade de soins prénatale, la rétention des femmes enceintes séropositives initiant la trithérapie antirétrovirale et la couverture dudépistage du VIH chez l’enfant exposé.Nous observons dans ce contexte mozambicain une couverture élevée du dépistage du VIH, une amélioration significative de la couverture du traitement antirétroviral au cours du temps et une meilleure acceptation du traitement chez les femmes enceintes séropositives. Cependant,la rétention dans les soins à la fin de la première année du traitement antirétroviral chez les femmes enceintes VIH+ et la couverture du dépistage du VIH chez les nourrissons exposés restent sous-optimales. Nous concluons que les interventions visant à améliorer l’engagementdans les soins du couple mère-enfant doivent être systématiquement encouragées. Enfin, nous soulignons la grande hétérogénéité des définitions des indicateurs utilisées dans les différents programmes de PTME.Ce travail met en évidence les lacunes dans l'engagement du couple mère-enfant dans les soins pour la PTME et ses conséquences sur l'élimination virtuelle de la transmission vertical du VIH. Nous soulignons également l’importance d’une approche consensuelle pour mesurer les indicateurs clés afin de permettre des comparaisons à l’échelle nationale et internationale. Les efforts visant à suivre les femmes sous traitement tout au long de leur vie, en veillant à ce que leurs nourrissons exposés au VIH reçoivent les soins attendus jusqu'à ce que leur statut VIH définitif soit déterminé, constituent la pierre angulaire de l’obtention d'une génération sans Sida pédiatrique d'ici 2030. / In 2015, the World Health Organization published new guidelines for the prevention of motherto- child transmission (PMTCT) of HIV and recommended that all seropositive pregnant and breastfeeding women be provided with lifelong anti-retroviral therapy (ART) (option B+).However, there are rising concerns about the effectiveness of the strategy in truly reducing the number of vertical HIV transmissions; there are indeed programmatic challenges related to its implementation; in particular, the sub-optimal levels of engagement in care of mother/infantpairs observed mainly in sub-Saharan Africa. The aim of the present thesis was to discuss, from a public health perspective, the programmatic challenges of engagement in care under option B+ strategy, with the example of Mozambique, a country known to have one of the highest HIVprevalence figures in the world. More specifically, we focused on three important aspects of engagement in care: the antenatal cascade of care, the maternal ART retention and the HIV exposed infant (HEI) testing coverage.We observed a high uptake of HIV testing, significant improvement in ART coverage over time and a better acceptance of ART at initiation in HIV+ pregnant women. Retention in care by the end of the first year of ART in HIV+ pregnant women and HIV testing coverage in HEI remainsub-optimal. Therefore, interventions to improve the mother-infant pair’s engagement in care should be systematically promoted. Finally, we underscore the considerable heterogeneity of definitions of outcomes used across various PMTCT programs.This work has highlighted the gaps in optimal engagement care of the mother-infant pair and its consequences on achieving virtual elimination of MTCT of HIV. We also highlighted the importance of having a consensus approach to measure PMTCT programme outcomes to allow national and international comparisons. Efforts to retain women under lifelong ART, ensuring their HIV-exposed infants receive the expected PMTCT services at the right moments along the continuum until final HIV status is determined, is the cornerstone of achieving an AIDS free generation by 2030.

L’objectif de cette thèse était d’étudier les associations potentielles entre les traitements antirétroviraux reçus par les femmes enceintes infectées par le VIH et les complications pouvant survenir au cours de la grossesse ou être diagnostiquées dans la période néonatale. Ce travail est issu en majeure partie des données de l’Enquête Périnatale Française (ANRS-EPF), cohorte nationale multicentrique ayant inclus plus de 20 000 couples mères-enfants depuis 1986. Actuellement, presque toutes les femmes sont traitées par combinaisons antirétrovirales puissantes (cART ; 98% en 2013) et le taux de transmission est inférieur à 1% : 0.6% (IC95% : 0.4%-0.8% pour la période 2005-2013). La première partie portait sur le risque d’accouchement prématuré dont le taux a augmenté significativement entre la période 1990-1993 et 2005-2009, passant de 9.2% à 14.3%. Le risque d’accouchement prématuré était significativement associé au traitement par cART, par rapport aux monothérapies et bithérapies d’INTI, et au traitement débuté avant la conception par rapport aux traitements débutés en cours de grossesse. La survenue d’une cytolyse hépatique était fréquente (17%), et était liée à la fois à la prématurité, et au type de traitement, plus fréquentes avec les IP qu’avec les inhibiteurs non nucléosidiques de la transcriptase inverse. La perturbation du bilan hépatique pourrait être un facteur intermédiaire dans la relation entre traitements et accouchement prématuré. La seconde partie portait sur les malformations congénitales. D’une part, elle a permis de mettre en évidence une association entre exposition à l’efavirenz au premier trimestre de grossesse et les malformations neurologiques, bien que concernant peu de cas (n=4) et n’atteignant la significativité que dans une analyse de sensibilité. Cette association incite à maintenir une vigilance chez les enfants exposés in utero à cette molécule classée tératogène par la FDA mais prescrite de plus en plus largement. D’autre part, l’exposition au premier trimestre à la zidovudine était associée à la survenue de malformations cardiaques. La troisième partie a complété cette étude par une analyse de la fonction cardiaque, des modifications infracliniques de la contractilité et de l’épaisseur des parois du ventricule gauche ont été mises en évidence chez les enfants exposés in utero à une combinaison de traitement contenant la zidovudine et la lamivudine. Ces résultats ne remettent pas en question l’efficacité majeure des traitements antirétroviraux pour la prévention de la transmission de la mère à l’enfant du VIH, mais incitent à la poursuite d’une surveillance épidémiologique des effets indésirables potentiels, de manière à optimiser les prescriptions pour un meilleur rapport bénéfice/risque. / Our objective was to study potential associations between antiretroviral treatment and obstetrical or neonatal complications in a population of HIV-positive pregnant women. Most of the analyses were conducted with data from the French Perinatal Cohort (ANRS-EPF), an ongoing multicenter national cohort with more than 20 000 mother-infant pairs included since 1986. In the recent years, most women receive combination antiretroviral therapies (cART ; 98% en 2013) and the trasnsmission rate is consistently under 1% : 0.6% (IC95% : 0.4%-0.8% for 2005-2013). Risk of preterm birth was significantly associated with cART, when compared to NRTI monotherapy or dual therapy, and with timing of treatment, higher for women treated at conception than for those initiating treatment during pregnancy. The occurrence of liver enzyme elevation was frequent (17%), and was associated both with preterm birth and with PI-based treatment, when compared to NNRTIs. LEE could be an intermediate factor between cART and preterm birth. The second part of this work was a study of congenital birth defect in the cohort, and showed an association between first trimester-exposure to efavirenz and neurological defects, but this concerned small numbers (n=4), and reached significance only in a sensitivity analysis. This association encourages us to maintain awareness concerning this molecule, considered teratogenic by the FDA but more and more largely prescribed. We also reported an association between first-trimester exposure to zidovudine and congenital heart defects. In a third part, we studied heart function, differences in contractility and septum thickness of the left ventricle was found, among girls exposed to a combination containing zidovudine and lamivudineThese results do not question the great progress of antiretroviral treatment in the prevention of mother-to-child transmission, but they encourage us to continue epidemiologic surveillance of potential side effects, in order to optimize prescriptions for an improved benefit/risk ratio.

Background: Given the rapid expansion of antiretroviral therapy (ART) services in South Africa, there is growing recognition of the importance of fertility intentions, contraceptive use and childbearing among women living with HIV (WLHIV). With the integration of family planning services in the prevention of mother-to-child transmission of HIV (PMTCT) services, understanding fertility intentions and contraceptive use is crucial in evaluating such programs. We investigated the relationship between future fertility intentions, contraceptive use and repeat pregnancies among WLHIV in Cape Town, South Africa. Methodology: We analyzed data from the MCH-ART study conducted at the Gugulethu Midwife Obstetric Unit (MOU) in Cape Town, South Africa, which followed women initiating ART during pregnancy through 36-60 months postpartum. Self-report data were collected using standardized questionnaires at repeated study visits. Data on repeat pregnancies were abstracted from the Western Cape Provincial Data Centre. Associations between maternal characteristics and repeat pregnancies were examined using Cox proportional hazards models. Results: Overall, 109 incident repeat pregnancies were recorded among the 471 women included in this analysis. The median time at risk per individual was 4.27 years. The rate of repeat pregnancies was 5.72 per 100 person-years (PY). This rate was significantly lower among women aged 35-45 years (2.11/100PY) compared to women aged 18-24 years [7.56/100 PY; adjusted hazard ratio (aHR), 0.26: 95% confidence interval [CI], 0.09, 0.81). A total of 333 women contributed data on future fertility intentions and contraceptive use at 12 months postpartum, with 9% reporting that they wanted another child in the future, and 82% reporting current contraceptive use; 16% (n=54) reported not wanting another child but no contraceptive use. The rate of repeat pregnancies was 3 folds higher among women who reported wanting a child in the future (12.59/100 PY) compared to women who did not want 5 a child in the future (4.31/100 PY; aHR, 3.46: 95% CI, 1.83, 6.50). Contraceptive use at 12 months postpartum was not associated with repeat pregnancies. Women who did not want a child and used contraceptives had a 45% decreased hazard of repeat pregnancies compared to women who did not want a child and did not use contraceptives (aHR 0.55: 95% CI [0.32, 0.94]. Conclusion: Among women initiating ART during pregnancy, a repeat pregnancy incidence rate of 5.72/100 PY was observed through 36-60 months postpartum, with the incidence lower among older women. At 12 months postpartum, a notable proportion of women reported not wanting another child but no contraceptive use. Wanting a child in the future was associated with a higher rate of repeat pregnancy, but contraceptive use at 12 months postpartum was not associated with repeat pregnancies. These results highlight the importance of understanding factors associated with the dissonance between fertility intentions and contraceptive use and childbearing to ensure delivery of quality integrated reproductive health services in the PMTCT framework.

Background: The vertical transmission of HIV from mother to child ranges from 15 to 40%. The preventing mothers to child transmission programme (PMTCT) services have been introduced during the past five years in South Africa; however vertical transmission of HIV remains high. Objectives: The objectives of the study were: 1. To describe the clinical and demographic characteristics of women attending the ANC clinic and delivering at the Germiston Hospital; 2. To determine the proportion of women who were offered voluntary counselling and testing (VCT) in 2004; 3. To determine the proportion of women who subsequently received PMTCT. Methods: This is a cross-sectional study I which a sample of 776 patient files were retrospectively, systematically and randomly sampled from 1, 500 antenatal files for the period 2004 (Jan-Dec), in an urban district hospital in the Gauteng Province. A checklist was used to extract specific information. Data was entered into EpiData and analysed using STATA version 8. Pearson's chi-square test was used to obtain measures of association for all categorical variables. The multiple logistic regression method was used to investigate predictors for missed PMTCT opportunities. Results: The pre_yalence proportion of syphilis was 14.19% {95%CI (11.81-16.85)}; prevalence proportion ofHIV was 33.76% {95% CI (27.53-37.13)}. The mean age ofthe sample population was 26.37 years (min=22, max=30). Forty eight per cent of the sample had registered late in the third trimester of pregnancy. Pregnant women presenting with syphilis were more likely to have a missed PMTCT opportunity {OR=2.2, 95%CI (1.16- 4.20), p=0.02}. Women having made fewer than two ANC visits were more likely to have a missed PMTCT/VCT opportunity than women having made more than two visits {OR=O.Sl, 95%CI (0.30-0.86), p=O.Ol}. Conclusions: The prevalence proportion of HIV is high in this setting (33%) and the prevalence of syphilis is seven times greater than the national prevalence. Every antenatal care visit is an opportunity for the healthcare worker to offer voluntary counselling and testing. All women identified as having syphilis infection are at high risk of acquiring HIV. Therefore every woman identified and treated for syphilis should be counselled and tested for HIV. Women must be offered HIV and AIDS education at every ANC visit. Routine opt-out counselling should be offered at every ANC visit for those who have not been previously tested. Recommendation: In order to increase the uptake of the PMTCT programme healthcare workers should have training and re-orientation on: 1. The need to use every opportunity in antenatal care and maternity wards to offer HIV counselling and testing to mothers; 2. HIV and AIDS in pregnancy, PMTCT, as well as the treatment and care of pregnant women. / Dissertation (MPH)--University of Pretoria, 2006. / School of Health Systems and Public Health (SHSPH) / MPH / Unrestricted

Masters of Public Health - see Magister Public Health / Introduction: Mother-to-child transmission (MTCT) is the cause of most HIV acquisition among children. Prevention of mother-to-child transmission (PMTCT) of HIV programs aim to enable pregnant women to attain viral suppression so that they are unlikely to pass HIV to the foetus in utero or during birth, and to the neonate during breastfeeding. The Option B+ treatment regimen - initiating pregnant and breastfeeding women, diagnosed with HIV, on lifelong triple antiretroviral therapy (ART) regardless of their WHO clinical stage – was introduced in 2013 in Zambia but to date, no evaluation of this program has been done. Study Aim: The current study described factors associated with adherence and retention in care(RIC) among postnatal women initiated on ART during the antenatal and postnatal period at five PMTCT centres in Lusaka District, Zambia in 2017 and 2018. Methodology: A quantitative, retrospective cohort analysis of 311 postnatal women who were initiated on option B+ regimen at five PMTCT centres in Lusaka District between 1 January 2017 and 30 April 2018 was done. Adherence to treatment was measured by analysing data on patients’ missed clinic appointments and self-reported missed medication doses. Kaplan-Meier survival analysis was used to calculate RIC at 6, 12, 18, and 24 months. Bivariate analysis was conducted to determine the significance of associations between adherence and RIC, and sociodemographic and clinical characteristics, respectively. Results: Retention in care decreased over time, from 92% at the time of delivery to 81%, 77%, 74% and 70% at 6, 12, 18 and 24 months postnatal, respectively. Higher retention in care was observed amongst married women (p=0.012); who stayed within one kilometer from the health facility (p=0.018); whose spouses were on ART (p=0.027); who knew their HIV status before pregnancy (p=0.005); who were commenced on ART in the first trimester (p=<0.001); and the postnatal period (p=<0.001); who were on other medication, in addition to ART (p=0.001); who did not miss a dose of medication in the week before the last appointment (p=<0.001); and who did not miss any clinic appointment since commencing ART (p=<0.001). Half of the study participants (50.2%; n=155) reported optimal adherence (did not miss a scheduled clinic appointment since commencing ART). Optimal adherence to ART was significantly associated with women who lived within 1 km from the health facility (p=0.012) and who had a treatment supporter (p=0.030). Conclusion: Half of the study participants had optimal adherence to their scheduled clinic visits since enrolment into the Option B+ program, and 30% were lost to follow up over the first two years. Staying closer to the health facility where the woman received ART, knowing one’s HIV status before pregnancy or earlier in pregnancy, and initiating ART earlier in pregnancy, increased the likelihood of optimal adherence to ART and RIC at 24 months postnatal. Additionally, having a treatment supporter increased the likelihood of optimal adherence.

225 leaves printed on single pages, preliminary pages i- xxiii and numbered pages 1-203. Includes bibliography, list of abbreviations, list of definitions, list of tables and figures and list of appendices. / Digitized at 330 dpi color PDF format (OCR), using KODAK i 1220 PLUS scanner. / Thesis (MNutr (Interdisciplinary Health Sciences))--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: "A comprehensive package of care for the Prevention of Mother- To-Child Transmission (PMTCT) of HIV" states that all mothers participating in the PMTCT Programme should receive education that will enable them to make informed decisions about infant feeding options. Rapid, same-day HIV testing and results that are available immediately, enable health care workers to be responsible for providing pre- and post-test counselling (which includes infant feeding options) on the same day. This could place a tremendous workload and time pressure on the health care workers. The aim of this study was to determine how "informed" is the literate mother's decision regarding infant feeding options, who participated in the PMTCT Programme, in the Gert Sibande District, Mpumalanga, South Africa. Method: Data was collected from health care workers and mothers on the PMTCT Programme at 23 PMTCT sites in the Gert Sibande District, with the help of 6 field workers and the PMTCT site manager at each PMTCT site, by means of once-off, self-administered questionnaires, which had been previously tested and validated. Results: Health care workers' attitude towards the PMTCT Programme was positive, although some (14%) indicated that what was expected of them was not achievable in their working environment. The most prominent change relating to the personal preferences of health care workers regarding infant feeding options for HIV-infected mothers, after attending the 5-day PMTCT course, was from formula-feeding to breast-feeding. Most (65%) indicated it was possible to stay neutral in a counselling session regardless of personal preference for infant feeding and 60% of those who could not stay neutral, still thought it was in the mother's best interest to be counselled by them. Most (98%) agreed mothers had the right to make informed decisions and 80% agreed mothers were able to make such a decision. Most (67%) health care workers indicated that not enough staff was stationed at PMTCT sites, only 53% used the feeding option cards when counselling mothers and indicated that more educational material was needed. Sixty one percent of the health care workers demonstrated the preparation of the formula to the mothers and allowed the mothers to demonstrate back to them. Between 49-82% and 37-56% of the health care workers knew the correct answers to knowledge questions relating to breastfeeding and formula-feeding, respectively. Not one health care worker, nor mother, knew all the steps in preparing a formula feed. Most (80%) mothers made decisions based on information provided to them by health care workers and only a small (13%) percentage were influenced by the community to practise a different feeding option than what they had chosen. Conclusions: The attitude, personal preferences, knowledge of and resources available to health care workers, influenced the decision made by mothers regarding infant feeding options and seeing that most mothers made their decision, based on information provided by health care workers, it is concluded that mothers can only make an informed decision about infant feeding options if they are advised appropriately by well trained, equipped and informed health care workers. / AFRIKAANSE OPSOMMING: "A comprehensive package of care for the Prevention of Mother-To-Child Transmission of HIV", vermeld dat moeders, wat deelneem aan die Voorkoming van Moeder-Tot-Kind Oordrag (VMTKO) progam, voorligting behoort te ontvang ten opsigte van voedingsopsies vir hul babas, sodat hulle in staat sal wees om 'n ingeligte keuse te maak. Gesondheidswerkers is verantwoordelik om voorligting voor en na die HIV toets te gee, wat die voedingsopsies vir babas insluit, op dieselfde dag. Dit kan 'n ontsaglike werkslading op die gesondheidswerkers plaas. Die doel van die studie was om te bepaal hoe "ingelig" is die geletterde moeder se keuse ten opsigte van voedingsopsies, wat deelneem aan die VMTKO program, in die Gert Sibande distrik, Mpumalanga, Suid-Afrika. Metode: Die data is ingesamel by 23 VMTKO-klinieke en -hospitale in die Gert Sibande distrik onder gesondheidswerkers en moeders op die VMTKO-program, met behulp van 6 veldwerkers en VMTKO-bestuurders, deur middel van eenmalige, selfvoltooide vraelyste, wat van tevore getoets en gevalideer was. Resultate: Die gesondheidswerkers se houding teenoor die VMTKO-program was positief, alhoewel 14% aangedui het dat wat van hulle verwag word nie prakties of moontlik is in hul werksomgewing nie. Die prominentste verandering rakende die persoonlike voorkeure van die gesonheidswerkers teenoor voedingsopsies vir HIV -geinfekteerde moeders, na die 5-dag VMTKO kursus, was van formulevoeding na borsvoeding. Meeste (65%) het aangedui dit is moontlik om neutraal te bly gedurende 'n voorligtingssessie, ten spyte van persoonlike voorkeure vir voedingsopsies en 60% van die wat nie neutraal kon bly nie, het steeds gedink dit is in die beste belang van die moeder om deur hulle voorgelig te word. Meeste (98%) het saamgestem dat dit die moeder se reg is om 'n ingeligte keuse te maak en 80% het saamgestem dat die moeder wel in staat is om so 'n besluit te neem. Meeste (67%) gesondheidswerkers het aangedui dat personeel tekorte bestaan by die VMTKO klinieke en hospitale. Slegs 53% gebruik die voedingsopsie kaarte gedurende 'n voorligtingsessie met die moeder en het aangedui dat meer voorligtingsmateriaal benodig word. Een en sestig persent van die gesondheidswerkers het die voorbereiding van die formulevoeding aan die moeders gedemonstreer en het moeders toegelaat om ook die demonstrasie te doen. Nege en veertig tot twee en tagtig persent en 37-56% van die gesondheidswerkers kon die korrekte antwoorde verskaf vir vrae oor borsvoeding en formulevoeding, afsonderlik. Nie een gesondheidswerker of moeder kon al die stappe vir die voorbereiding van die formulevoeding noem nie. Meeste (80%) moeders maak keuses gebaseer op inligting wat aan hulle verskaf word deur die gesondheidswerkers en slegs 'n klein persentasie (13%) word beinvloed deur familielede om die teenoorgestelde voedingsopsie te praktiseer as wat hulle gekies het. Gevolgtrekking: Die houding, persoonlike voorkeure, kennis van en hulpbronne beskikbaar aan die gesongheidswerkers, beinvloed die besluit wat moeders neem ten op sigte van voedingsopsies en aangesien die moeders hulle besluit baseer op inligting wat deur die gesondheidswerkers aan hulle gegee word, word die gevolgtrekking gemaak dat moeders slegs 'n ingeligte keuse aangaande voedingsopsies kan maak indien hulle voorligting ontvang deur goed opgeleide en ingeligte gesondheidswerkers.

<p>Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services.</p>

<p>Disclosure of HIV positive status to male partners is well established as a key element in the success of prevention of mother to child transmission of HIV programmes, as it helps improve adherence to ARVs by the women within these programme. However, partner notification rates remain low in the urban areas of Lusaka, Zambia against a high HIV prevalence of 25%. The purpose of this study was to explore the timing of disclosure as part of the process of disclosure amongst women who were part of the PMTCT services at Kaulu health centre in Lusaka. An exploratory descriptive study using qualitative research methods was conducted. 15 women, who were attending the Kaulu health centre PMTCT programme, were requested to participate in a semi-structured interview. The women, who were purposively selected with the aid of the health centre‟s PMTCT focal point nurse, had to have disclosed their HIV positive status to their partner, either before or during the course of their pregnancy or after delivery. To increase rigour,&nbsp / individual interviews were conducted with 5 health workers associated with the PMTCT programme so as to obtain their perspective and experiences on the issue of HIV disclosure amongst their PMTCT patients. Participation in the study was voluntary and all information obtained during the course of the interviews remained confidential and secure. Potential participants were each provided with an explanation of the purpose and process of the study and their informed written consent obtained before the researcher embarked on the interviews. Content analysis of the transcripts was done so as to develop coding categories and identify emerging themes. Disclosure to male partners is an important step in PMTCT and facilitates adherence to HIV care for the family and should be done as early as possible after the woman receives her HIV test result, though there exists a range of alternative times when it can be done. The relationship existing between a couple is very important in determining the timing of when a woman chooses to disclose. PMTCT services need to provide ongoing counselling for HIV positive women during pregnancy and after giving birth that supports, informs and equips them with the necessary skills to make an informed and timely decision about disclosure to a partner. In addition, the PMTCT service providers need to be encouraged to implement couple counselling as a strategy to facilitate disclosure as well as establishment of a peer support network for HIV positive pregnant women. The study findings will be used to contribute to health workers‟ capacity to support women manage the disclosure process to their male partners, thus helping to increase the disclosure rate and also contributing to improving the positive effect of the PMTCT services, in Lusaka, Zambia</p>

ABSTRACT Background: Worldwide HIV is going through a feminization and rejuvenation as more women are living with HIV/AIDS, increasing the risk of vertical transmission. Despite the efforts in Latin America and the Caribbean (LAC) by 2010, Panama was the third most affected country in the region with HIV/AIDS, with females aged 15-24 twice as affected as men. Methods: This descriptive epidemiological study of HIV vertical transmission in Panama reviewed clinical charts to identify health care personnel's practices during pregnancies in 2008. This study also examines the impact of interventions comparing the HIV outcome of the children at the end of the 18-month follow-up period (March 2011). Results: This study found 290 clinical charts; 116 from women and girls living with HIV who were pregnant in 2008 and 174 clinical charts of prenatally exposed children to HIV in 2008. During pregnancy, 58.05% of the mothers received HAART, and 68.39% received intravenous zidovudine during labor. The 81.03% of the children received oral zidovudine six weeks after birth, and 54.02% were fed with infant-adapted formula. During the follow-up period 12.64% of children studied were diagnosed as HIV positive and 36.36% of those children had an older seropositive sibling. Discussion: The Republic of Panama has made efforts to prevent vertical HIV transmission. The current study shows early interventions such as receiving HAART during pregnancy, intravenous zidovudine during labor, caesarean section birth, receiving oral zidovudine six weeks after birth, and feeding with infant-adapted formula that show statistical significance when compared to final diagnosis of the prenatally exposed children to HIV.

<p>Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services.</p>