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The article presents a study that seeks indicators of successful adoption of HIV testing and nevirapine treatment in maternity wards in Zambia. The study uses counseling and testing to women who are unaware of their status, and nevirapine is given to those positive and calcium medication to those who are negative. Moreover, the study shows that HIV testing is viable in this kind of setting where resources are limited and HIV is prominent to women who is pregnant for the first time.

The article presents a preparedness study aimed at evaluating the suitability of sites and populations in urban Zambia following the same study procedures intended for a larger scale microbicide efficacy trial. In this study, researchers evaluated human immunodeficiency virus (HIV) incidence, prevalence, and risk profiles for HIV-acquisition among young women of the said country. Researchers conclude that their general population sample, characterized by high HIV prevalence and ongoing incidence rates despite receiving regular risk reduction counseling and free condoms, qualifies for future microbicide studies. They also found that a microbicide preparedness study in Lusaka have high HIV prevalence and appreciable HIV incidence in a population of women in an urban setting.

The article reports on results of a study of predictors of adherence to antiretroviral therapy in rural Zambia. A description of the study design and methods is presented. The study concluded that patients in Zambia can achieve adherence rates compatible with good clinical outcomes despite long travel distances. It adds that the Macha Mission Hospital was able to provide quality HIV/AIDS care.

The article discusses a study which examines whether targeted HIV programs improve overall care for pregnant women in Lusaka, Zambia. Documented syphilis rapid plasma reagin (RPR) screening improved after the implementation of prevention of mother-to-child (PMTCT) research. The simultaneous operation of PMTCT research and service programs in antenatal clinics was associated with improved antenal RPR screening coverage.

Reports on the conference in Zambia that discusses priorities for highly active antiretroviral therapy (HAART) research. Impact of the declining drug cost on the access to HAART; Relation of HAART to CD4 cell count; Adverse effects of the drug.

Focuses on the relationship of personal risk perception, HIV knowledge and risk avoidance behavior to actual HIV serostatus in an urban African obstetric population. Infection of pregnant women with HIV in Zambia; Survey of postpartum women who had been tested for HIV; Implementation of population-based strategies.

Compares two strategies for administering nevirapine (NVP) to prevent perinatal HIV transmission in low-resource, high-prevalence settings in Lusaka, Zambia. Assessment of adherence by liquid chromatographic assay for NVP of cord blood; Number of infants from perinatal HIV acquisition; Details on the optimal choice between the universal and targeted approach to NVP therapy.

Objective: We sought to investigate the progression of human papillomaviruses (HPV) infection in HIV-positive women after cryotherapy., Methods: We examined changes in detection of high-risk HPV (hrHPV) cervical infections among HIV-infected women over a 12-week period after cryotherapy using stored specimens from a cohort study conducted between June 2009 and March 2011 in Lusaka, Zambia. Samples from visits at baseline and weeks 4, 8, and 12 were tested using the Roche Linear Array assay., Results: A total of 89 women were included in the analysis. The median age was 32 years (interquartile range [IQR], 28-36 years). The median CD4+ cell count was 350 cells/μL (IQR, 214-470 cells/μL), and 66% of women were receiving antiretroviral therapy. At baseline, the prevalence of hrHPV was 91% (95% confidence interval [CI], 83%-95%). HPV45 was the most common HPV type, present in (30%) women, followed by HPV16 (27%), HPV18 (27%), HPV51 (20%), and HPV58 (22%). Among women with valid results both at baseline and 12 weeks, 25% (17/67) cleared their initial hrHPV infection within 12 weeks of treatment, although 65% (11/17) had new hrHPV types detected., Conclusions: Cryotherapy led to clearance of 25% of hrHPV infections within 12 weeks of treatment. However, hrHPV infection remained persistent in most women, and new hrHPV types were detected often, explaining the high rate of persistence and recurrence of cervical disease in this population. Continued efforts to scale up HPV vaccination and cervical screening should remain a priority in high HIV burden settings such as Zambia.

Global AIDS programs such as the US President's Emergency Plan for AIDS Relief (PEPFAR) face a challenging health care management transition. HIV care must evolve from vertically-organized, externally-supported efforts to sustainable, locally controlled components that are integrated into the horizontal primary health care systems of host nations. We compared four southern African nations in AIDS care, financial, literacy, and health worker capacity parameters (2005 to 2009) to contrast in their capacities to absorb the huge HIV care and prevention endeavors that are now managed with international technical and fiscal support. Botswana has a relatively high national income, a small population, and an advanced HIV/AIDS care program; it is well poised to take on management of its HIV/AIDS programs. South Africa has had a slower start, given HIV denialism philosophies of the previous government leadership. Nonetheless, South Africa has the national income, health care management, and health worker capacity to succeed in fully local management. The sheer magnitude of the burden is daunting, however, and South Africa will need continuing fiscal assistance. In contrast, Zambia and Mozambique have comparatively lower per capita incomes, many fewer health care workers per capita, and lower national literacy rates. It is improbable that fully independent management of their HIV programs is feasible on the timetable being contemplated by donors, nor is locally sustainable financing conceivable at present. A tailored nation-by-nation approach is needed for the transition to full local capacitation; donor nation policymakers must ensure that global resources and technical support are not removed prematurely.

Objective: Determine whether enhanced labor ward-based services for prevention of mother-to-child transmission of HIV (PMTCT) would improve nevirapine (NVP) coverage., Design: Cluster-randomized trial at 12 public-sector delivery centers in Lusaka, Zambia., Methods: Following a baseline surveillance period, 12 labor wards were randomized, six to offer opt-in HIV testing to women of unknown serostatus (with NVP administration as indicated) and to assess NVP adherence among known HIV-infected women. The six control labor wards provided the standard of care. The NVP coverage endpoint was defined as the proportion of HIV-infected/exposed women/infant pairs with confirmed NVP ingestion. We used generalized estimating equations (GEE) to determine the odds of coverage associated with the intervention and ultimately used the parameters for the estimated GEE model to estimate relative risk., Results: Between October 2005 and January 2006, 7664 women gave birth at participating clinics. We collected anonymous-linked blood from 7592 (99%) umbilical cords; tested 7438 (97%) for HIV, 1618 (22%) were seropositive, and of these, 1279 (79%) were tested for NVP. At baseline (preintervention), the probability of HIV-infected/exposed women/infant pairs receiving NVP in treatment clinics (42%) was 0.89 times the probability of being covered in control clinics (53%) whereas during the intervention period the probability of treatment clinic coverage (52%) was 1.22 the probability control clinic coverage (43%), representing a multiplicative effect of 1.37 upon the RR at baseline (ratio of relative risks 1.37, bootstrapped 95% CI, 1.04-1.77)., Conclusion: Labor ward-based PMTCT programs are feasible and can have a significant, positive impact on NVP coverage.

Objective: To assess the uptake of and adherence to nevirapine to prevent mother-to-child HIV transmission among women of unknown HIV serostatus presenting in labor. We also assessed preliminary efficacy of the approach., Design: Women of unknown HIV serostatus presenting in labor were offered single-dose nevirapine in a prospective cohort study. Two additional contemporaneous comparison populations were also studied., Methods: We measured uptake by counting the number of women that accepted enrollment when offered. We measured adherence with cord blood nevirapine assay. We measured preliminary efficacy with HIV DNA polymerase chain reaction of infant blood spots at 4-6 weeks of life., Results: Of 1591 women approached in labor, 634 (40%) took up the intervention and received nevirapine, of whom 185 (29%) were HIV infected. Of 179 cord blood specimens from HIV-exposed infants that could be evaluated, 178 (99.4%) had nevirapine detected. This was higher than the 73 of 98 (74%) adherence rate observed in a comparison cohort in which women self-administered nevirapine before presenting to the labor ward (P < 0.001). Of 145 available infant specimens, 17 (11.7%) showed evidence of infection at 4-6 weeks, compared with 12 of 60 (20%) infants born immediately prior to study commencement whose HIV-infected mothers did not receive nevirapine (P < 0.05)., Conclusions: Nevirapine without HIV testing upon presentation in labor was accepted by two-fifths of women. Because therapy is directly observed, adherence is nearly perfect. Labor ward dosing to enhance nevirapine coverage should be considered as an adjunct to antenatal nevirapine administration for prevention of mother-to-child transmission of HIV.

Background: Nearly half of perinatal HIV infection is preventable with nevirapine (NVP), which has transformed the ability to confront this transmission route in resource-limited settings., Methods: A NVP-based perinatal HIV prevention program initiated in Lusaka, Zambia in November 2001., Results: The first 12 months cost US$221 000 and enabled 178 district health employees to be trained in voluntary counseling and testing: 17 263 pregnant women were counseled for HIV, 12 438 (72%) were tested, and 2924 (24%) were found to be infected with HIV. NVP has been taken by 1654 (57%) mothers and 1157 (40%) babies. It is estimated that at least 190 infants have been spared HIV infection (11 per 1000 counseled women or 65 per 1000 identified HIV-infected women)., Conclusions: Prevention of mother-to-child HIV transmission is feasible and cost effective in resource-limited settings. In Lusaka, thousands of women have received voluntary counseling and testing and NVP therapy under the present scheme. Patient attrition and non-adherence represented a major source of program inefficiency, which requires to be systematically addressed.