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Introduction Mother-to-child transmission is the major route of pediatric Human Immunodeficiency Virus (HIV) infection accounting for 90% of childhood HIV infection. Poor utilization of prevention of mother-to-child transmission (PMTCT) of HIV services has been shown in this situation. Hence, the study assessed the perception and utilization of PMTCT services among Women Living with HIV (WLHIV). Methods A cross-sectional research design was used with a purposive sampling technique to select 182 WLHIV within reproductive age attending President’s Emergency Plan for Acquired Immunodeficiency Syndrome (AIDS) Relief (PEPFAR)/AIDS Prevention Initiative in Nigeria (APIN) clinic in two secondary Health facilities in Ibadan, Oyo State. A validated structured questionnaire was used for data collection. Descriptive and inferential statistics were used for data analysis. Results The mean age of the women was 37.0±6.5 years. Majority (74.2%) of the respondents had good knowledge on PMTCT of HIV, positive perception (89%) towards PMTCT services while only 42.9% of the respondents have utilized PMTCT services during pregnancy. However, some of the challenges to use of PMTCT services identified by the respondents were stigma (16.5%), discrimination (15.4%), financial constraint (11.5%) and non-involvement of partner (8.2%). There was a significant association between level of knowledge and PMTCT services utilization (χ 2 =6.244, p=0.012). Conclusions There is need for improvement of knowledge and perception of HIV, MTCT and PMTCT among women through counseling and antenatal education, thereby increasing PMTCT services uptake. Partner involvement, good quality PMTCT services and lack of discrimination of people living with HIV in our society should be encouraged, hence promoting the utilization of PMTCT services.

Background: The pharmacological component of prevention of mother-to-child transmission (PMTCT) services involves the provision of antiretroviral agents (ARVs) to the mothers and/or their babies at any stage of pregnancy. This study assessed the knowledge, attitude and practice (KAP) of Pharmacists about PMTCT. Materials and Methods: A questionnaire-based cross-sectional study was conducted among consenting Pharmacists at Ahmadu Bello University Teaching Hospital (ABUTH) and University of Nigeria Teaching Hospital (UNTH). Completed questionnaires were collated and analyzed using SPSS Version-25 with appropriate descriptive and inferential statistics. P-values less than 0.05 were considered to be statistically significant. Results: A total of 77 Pharmacists participated in the study, with 54(70.13%) being from ABUTH. In ABUTH, 15(33.3%) Pharmacists identified as being females, against 16(69.6%) in UNTH. Majority (40,95.2%) of the Pharmacists in ABUTH had less than 10 years working experience as against 8(34.8%) in UNTH. Forty-eight (88.9%) respondents knew the correct meaning of PMTCT. The Pharmacists in ABUTH and UNTH had mean knowledge scores of 58.70±2.88% and 52.17±6.19%, respectively; t(75)=1.094, p=0.760. In ABUTH and UNTH, 16(69.6%) and 22(42.3%) Pharmacists, respectively, strongly agreed that PMTCT can prevent future infections in the infants. Their mean attitude scores were 69.65±1.22% (ABUTH) and 74.09±1.68% (UNTH); t(73)=-2.063, p=0.487. For practice, 4(5.33%) Pharmacists in both hospitals very often dispensed PMTCT drugs, while 37(70.83%) counseled PMTCT treatment-naïve patients. Conclusion: The Pharmacists assessed in both hospitals had a fair knowledge of PMTCT services. Their attitudes to PMTCT was very good, although only a few of them had experience in providing care for PMTCT patients.

Background Reports of pregnant women infected with avian influenza are rare. Studies showed that A/H5N1 virus can penetrate the placental barrier and infect the fetus. Of six documented cases, four died and two survivors had a spontaneous abortion. Objectives We report a clinical, outcome and epidemiological characteristics of a 36-week pregnant woman infected with A/H5N1 and her newborn in Soc Trang province of Vietnam in 2012. Methods Epidemiological and laboratory investigations were conducted. Clinical manifestations, progress, treatment and outcome of the case-patient and her newborn were collected. Human tracheal aspirate, throat swab and serum specimens were tested for influenza A/H5N1, A/H3N1, A/H1N1pdm09 and B by real-time RT-PCR and genome sequencing. Poultry throat and rectal swabs were tested by PCR and virus isolation. Results Case-patient hospitalized with high fever and cough, and died after onset 6 days. She continuously slaughtered sick poultry 5 days before illness onset. Clinical manifestation showed rapid progressive severe pneumonia. Her tracheal aspirate sample was positive influenza A/H5N1 virus. Her new-born was delivered by caesarean section with low birth weight and early onset pneumonia, however fully recovered after 16 days treatment. Neonate's throat swabs and paired serum samples tested negative for influenza A/H5N1. Clade 1.1 A/H5N1 virus was detected in poultry samples, was same clade and highly homogenous with the virus was detected in the mother. Conclusions This was the first documented a live birth from a pregnant woman infected with influenza A/H5N1 virus. Intensive studies are needed to better understand mother-to-child transmission of influenza A/H5N1 virus.

Background: This study's aims are to assess the current evidence presented in the literature regarding the potential risks of COVID-19 infection among pregnant women and consequent fetal transmission. Methods: a systematic literature review assessing papers published in the most comprehensive databases in the field of health intended to answer the question, "What are the effects of COVID-19 infection during pregnancy, and what is the neonatal prognosis?" Results: 49 papers published in 2020 were eligible, presenting low levels of evidence. A total of 755 pregnant women and 598 infants were assessed; more than half of pregnant women had C-sections (379/65%). Only 493 (82%) infants were tested for SARS-CoV-2, nine (2%) of whom tested positive. There is, however, no evidence of vertical transmission based on what has been assessed so far, considering there are knowledge gaps concerning the care provided during and after delivery, as well as a lack of suitable biological samples for testing SARS-CoV-2. Conclusions: We cannot rule out potential worsening of the clinical conditions of pregnant women infected with SARS-CoV-2, whether the infection is associated with comorbidities or not, due to the occurrence of respiratory disorders, cardiac rhythm disturbances, and acid-base imbalance, among others. We recommend relentless monitoring of all pregnant women in addition to testing them before delivery or the first contact with newborns. publishersversion published

Background: Great strides have been made in decreasing paediatric human immunodeficiency virus (HIV) infections, especially in sub-Saharan Africa. In South Africa, new paediatric HIV infections decreased by 84% between 2009 and 2015. This achievement is a result of a strong political will and the rapid evolution of the country’s prevention of mother-to-child transmission (PMTCT) guidelines. Objectives: In this paper we report on the implementation of a large PMTCT programme in Soweto, South Africa. Methods: We reviewed routinely collected PMTCT data from 13 healthcare facilities, for the period 2002–2015. Antiretroviral therapy (ART) coverage among pregnant women living with HIV (PWLHIV) and the mother-to-child transmission (MTCT) rate at early infant diagnosis were evaluated. Results: In total, 360 751 pregnant women attended the facilities during the review period, and the HIV prevalence remained high throughout at around 30%. The proportion of PWLHIV presenting with a known HIV status increased from 14.3% in 2009 when the indicator was first collected to 45% in 2015, p < 0.001. In 2006, less than 10% of the PWLHIV were initiated on ART, increasing to 88% by 2011. The MTCT rate decreased from 6.9% in 2007 to under 1% from 2013 to 2015, p < 0.001. Conclusion: The achievements in decreasing paediatric HIV infections have been hailed as one of the greatest public health achievements of our times. While there are inherent limitations with using routinely collected aggregate data, the Soweto data reflect progress made in the implementation of PMTCT programmes in South Africa. Progress with PMTCT has, however, not been accompanied by a decline in HIV prevalence among pregnant women.

Objective: To evaluate the association of type and timing of prophylactic maternal and infant antiretroviral regimen with time to first positive HIV-1 DNA PCR test, in nonbreastfed HIV-infected infants, from populations infected predominantly with HIV-1 non-B subtype virus. Design: Analysis of combined data on nonbreastfed HIV-infected infants from prospective cohorts in Botswana, Thailand, and the United Kingdom (N = 405). Methods: Parametric models appropriate for interval-censored outcomes estimated the time to first positive PCR according to maternal or infant antiretroviral regimen category and timing of maternal antiretroviral initiation, with adjustment for covariates. Results: Maternal antiretroviral regimens included: no antiretrovirals (n = 138), single-nucleoside analog reverse transcriptase inhibitor (n = 165), single-dose nevirapine with zidovudine (n = 66), and combination prophylaxis with 3 or more antiretrovirals [combination antiretroviral therapy (cART), n = 36]. Type of maternal/infant antiretroviral regimen and timing of maternal antiretroviral initiation were each significantly associated with time to first positive PCR (multivariate P < 0.0001). The probability of a positive test with no antiretrovirals compared with the other regimen/timing groups was significantly lower at 1 day after birth, but did not differ significantly after age 14 days. In a subgroup of 143 infants testing negative at birth, infant cART was significantly associated with longer time to first positive test (multivariate P = 0.04). Conclusion: Time to first positive HIV-1 DNA PCR in HIV-1-infected nonbreastfed infants (non-B HIV subtype) may differ according to maternal/infant antiretroviral regimen and may be longer with infant cART, which may have implications for scheduling infant HIV PCR-diagnostic testing and confirming final infant HIV status.

Background Mother -to -Child transmission of hepatitis B infection remains a major public health concern particularly in Africa. Adequate knowledge of physicians and midwives is crucial in averting most of the hepatitis B viral transmissions from mothers to their new-borns. However, there is a dearth of evidence on extent of knowledge of physicians and midwives in Ghana inspite of the increasing incidence of hepatitis B infection in the country. This study therefore assessed the knowledge level of physicians and midwives regarding Mother-to-Child transmission of hepatitis B in the Eastern region of Ghana. Methods A Cross sectional survey was conducted between August to November, 2015 using semi-structured self-administered questionnaire. Study participants were recruited from five health facilities and their level of awareness and knowledge about Mother-to-Child transmission of hepatitis B were assessed. The level of statistical significance was set at 0.05 alpha level. Results The findings showed that both physicians and midwives had good knowledge on Mother-to-Child transmission of hepatitis B infection. However, there were some knowledge gaps regarding effective hepatitis B prevention from mother to their newborns such as the use of hepatitis B vaccine and immunoglobulin. Additionally, 49.2 % (n = 62) of the participants had never attended any workshop on Mother-to-Child transmission of hepatitis B since completion of formal training. Conclusions Developing appropriate periodic training programmes on current issues of hepatitis B for physicians and midwives in Eastern region will further enhance their knowledge. It is recommended that, further study examine if the knowledge of the respondents is translated into practice.

Background: Mother-to-child transmission (MTCT) of HIV, has been a major global public health burden. Despite the use of antiretroviral prophylaxis by HIV-positive pregnant women and their infants, safe obstetric practice and safe infant feeding habits in the prevention of MTCT of HIV, the prevalence of HIV among HIV-exposed infants is still high in Cameroon. Objective: Our objectives were to determine the prevalence, assess the predictors and determine the effect of combination antiretroviral therapy (cART) on MTCT of HIV at the regional hospital in Bamenda, Cameroon. Methods: This was a retrospective study. Secondary data from 877 HIV-exposed infants aged ≤ 72 weeks were extracted from the records between January 2008 and December 2014. The predictors and effect of cART on MTCT of HIV were analysed using a multivariable logistic regression model and risk analysis, respectively. Results: Out of 877 HIV-exposed infants, 62 were positive for HIV, giving a prevalence of 7.1%. Maternal antiretroviral intervention and infant age group were statistically significant predictors of MTCT of HIV. HIV-positive mothers who were on cART were 2.49 times less likely to transmit HIV than those who were not on cART. Conclusion: In order to reduce the prevalence of HIV among HIV-exposed infants, maternal antiretroviral intervention should be targeted and the use of cART by HIV-positive pregnant women should be encouraged.

Background: During a 9 months period, September 2005 through June 2006, Nevada documented six cases of pediatric HIV acquired through mother to child transmission. Subsequently, a community based approach to the care of women and children living with or exposed to HIV was implemented. Subjects and Methods: A detailed review of mother infant pairs where HIV transmission occurred was performed to identify missed opportunities for prevention of mother to child HIV transmission. An intervention program was developed and implemented using the six step process. Data were collected prospectively over a 6 years period (2007–2012) and were evaluated for six core outcomes measures: (1) adequacy of prenatal care (2) HIV diagnoses of expectant mothers prior to delivery (3) appropriate use of antiretroviral (ARV) therapy before delivery (4) appropriate use of cesarean section for delivery (5) adequacy of zidovudine prophylaxis to newborn (6) HIV transmission rate. Results: Twenty six infants were born to HIV infected mothers from July 2005 to June 2006 with 6 documented infections. One hundred and five infants were born to HIV infected mothers from January 2007 to December 2012. Postimplementation, adequacy of prenatal care increased from 58% (15/26) to 85% (89/105); appropriate use of ARV therapy before delivery increased from 73% (19/26) to 86% (90/105); cesarean section as the method for delivery increased from 62% (16/26) to 74% (78/105); adequacy of zidovudine prophylaxis to newborn increased from 54% (14/26) to 87% (91/105). HIV transmission rate dropped from 23% (6/26) to 0%. Conclusion: Integrating public health and clinical services in the care of HIV infected pregnant women and exposed infants leads to better coordination of care and improved quality of care.

Obinna Ositadimma Oleribe,1 Ede Enenche,1 Deborah Udofia,1 Ekei Ekom,1 Princess Ifunanya Osita-Oleribe,1 Jin Un Kim,2 Simon David Taylor-Robinson2 1Excellence and Friends Management Care Centre (EFMC), Abuja, Nigeria; 2Hepatology Unit, Imperial College London, London, UK Background: Mother-to-child transmission (MTCT) of HIV is one of the commonest avenues through which infants are infected with HIV. To achieve an HIV-free generation, MTCT of HIV should be eliminated. Nigeria began prevention of mother-to-child transmission (PMTCT) services 13 years ago, but it still contributes to over one-third of global MTCT burden. We set out to explore and define the effectiveness of PMTCT in selected sites in North Central Nigeria.Methods: We conducted a retrospective secondary data analysis at eight service delivery points in two states. One thousand four hundred and fifty-four mother–infant pair data sets from 2012 to 2016 were extracted and analyzed. Maternal/infant antiretroviral (ARV) services, early infant diagnosis (EID), and final outcomes were reviewed to examine the predictors of MTCT of HIV in these centers.Results: We retrieved 1,454 mother–infant pair data sets. While 89.5% (1,302) of positive pregnant women (PPW) and 92.2% (1,340) of HIV-exposed infants (HEIs) received ARV prophylaxis/ARV treatment (ART), 88.4% (1,285) infants were breastfed with 32.5% still receiving breast milk at the time of dry blood spot (DBS) collection. EID PCR positivity rate was 3.5% (range, 0.0%–11.1%). Facility of delivery (X2=24.99, P

Background TTV has been detected in almost every human tissue type or body fluid reaching near 100% prevalence. Several studies report mother-to-child postnatal transmission of TTV in infancy but the risk of transplacental transmission of TTV is still unclear. Methods The blood and plasma collected postpartum from 100 mother-child pairs were analyzed using TTV-specific qPCR. Samples were collected from the peripheral vein of the mother and the umbilical cord. Results Eighty four percent of pregnant women were TTV positive (median titers: 8 × 104 copies/mL; range: 103 – 3 × 107). The TTV load in plasma was approximately 100 times lower than in whole blood. TTV was not detected in any of cord blood samples. Conclusions Our data demonstrate the lack of transplacental transmission of TTV (or effective prenatal inhibition of viral proliferation). The presence of the virus in infants may be associated with mother-to-child transmission through breast feeding or other routes of transmission.

Ukraine experiences one of the most severe HIV epidemics in Europe. This policy brief is a result of a team effort involving the State Institution Ukrainian Center for Socially Dangerous Disease Control of the MOH of Ukraine, and international partners. The study was part of the regional initiatives on HIV allocative efficiency analysisi and funded and technically supported by the World Bank and UNAIDS. We greatly acknowledge the contributions of all the team members, stakeholders and other partners. There are major opportunities, but also major risks in relation to HIV investment decisions in Ukraine in the coming five years. While decreasing funding would lead to a marked increase in deaths, new infections and future health care costs, a smart approach to increasing HIV investment, could avert around half of the new infections and deaths up to 2030 compared to business as usual. The keys to success are (1) scaling up ART; (2) reforming procurement to reduce unit costs for drugs and diagnostics; (3) sustaining prevention programs for key populations and further enhancing coverage with strong geographical prioritization; (4) establishing domestic financing and management of community systems for prevention and adherence support; and (5) strengthen integration with other health, social and drug-use treatment programs. Bold and immediate investment in the mentioned key programs and measures to improve efficiency are needed to avoid large increases in future health care cost and, most importantly, prevent over 150,000 new infections and save over 110,000 lives by 2030.

OBJECTIVES To describe the implementation and results of the linked response (LR) in Cambodia after 18 months of follow-up. METHODS The main objectives of the LR are to increase access to sexually transmitted infection/HIV prevention, testing, care, and treatment and to strengthen existing reproductive health services through increased linkages within and between public health facilities and community-based services. The LR was piloted in Cambodia in 2008, in 2 demonstration projects, covering 5 operational districts. Routine data were collected and analyzed before (2007), during (2008), and after (2009) the implementation of the LR. RESULTS Overall in the 5 operational districts, the proportion of pregnant women, tested for HIV increased from 6% (1261 of 21,376) in 2007 to 86% (18394 of 21,478) in 2009. Syphilis testing, introduced early 2009, reached similar (85%) coverage as HIV by the end of 2009. Between 2007 and 2009, reproductive indicators also increased: antenatal care coverage (at least 1 visit) from 80% to 100%, public health facility delivery rates from 26% to 46%, and contraceptive prevalence from 24% to 28%. Antiretroviral uptake was high among HIV-positive mothers and exposed infants, 84% and 95% respectively, and 3 of 36 (8%) infants tested so far for HIV were diagnosed positive. However, 6 maternal (HIV-positive women) and 7 child deaths (1 tested positive) occurred during the pregnancy or the 30-week postpartum follow-up period. CONCLUSIONS Sexually transmitted infection/HIV indicators and follow-up dramatically improved after the LR was implemented. Efforts should be pursued to further improve quality of health care services.

Currently, 40% of HIV-infected women enrolled in national prevention of mother-to-child transmission (PMTCT) program in India are loss to follow-up (LTF) before they can receive single dose Nevirapine. To date no study from India has examined the reasons for inadequate utilization of PMTCT services. This study sought to examine the socio-demographic factors associated with LTF of HIV-infected women enrolled during 2002-2008 in a large-scale private sector PMTCT program in Maharashtra, India. Data on HIV-infected women who were enrolled during pregnancy (N = 734) and who reported live birth (N = 770) were used to analyze factors associated with LTF before delivery and after delivery, respectively. Univariate and multivariate analyses were conducted to estimate the associations between being LTF and socio-demographic factors using generalized linear models. Eighty (10.9%) women were LTF before delivery and 151 (19.6%) women were LTF after delivery. Women with less than graduate level education (RR = 6.32), from a poor family (RR = 1.61), who were registered after 20 weeks of pregnancy (RR = 2.02) and whose partners were HIV non-infected or with unknown HIV status (RR = 2.69) were more likely to be LTF before delivery. Similarly, the significant factors for LTF after delivery were less than graduate level education (RR = 1.82), poor family (RR = 1.42), and registration after 20 weeks of pregnancy (RR = 1.75). This study highlights the need for innovative and effective counseling techniques for less educated women, economic empowerment of women, better strategies to increase uptake of partner's HIV testing, and early registration of women in the program for preventing LTF in PMTCT programs. This need for innovative counseling techniques is even greater for PMTCT programs in the public health sector as the women accessing care in the public sector are likely to be less educated and economically more deprived.

The HIV epidemic amongst men who have sex with men (MSM) in Bangkok is substantial. The population size of MSM in Bangkok is 120,000-250,000, with approximately one-third (33.5 percent) considered high-risk, characterized by their young age, multiple partnerships, frequent unprotected anal intercourse, and sexual activities around MSM hotspots. In metropolitan Bangkok, HIV prevalence among MSM reportedly increased from 21 percent to 28 percent between 2000 and 2012. The Thai Working Group of Estimation and Projection (2013) projected an estimate of 39,000 new HIV infections would occur in Thailand during 2012-2016, based on the AIDS Epidemic Model (AEM). MSM will account for 44 percent of these new HIV cases, and 25-30 percent of these infections will likely to occur in Bangkok. In 2011, the United Nations held a high-level meeting on HIV/AIDS where they adopted the ambitious epidemiological targets of the United Nations Political Declaration on HIV/AIDS (UNPD), to be met by 2015. Attaining these specific targets would lead to substantial progress towards ending AIDS. UNAIDS has also been prioritizing the “Getting to Zero” initiative (“Zero new HIV infections. Zero AIDS-related deaths. Zero discrimination.”). The Bangkok Metropolitan Administration (BMA) recently responded with the “Bangkok: Getting to Zero” initiative, which strategizes an increased focus on prevention amongst MSM in the city. The clinical trial, HPTN052, demonstrated a 96 percent reduction of HIV transmission among heterosexual discordant couples who received ART. “Treatment as prevention” has become an increasingly accepted strategy to prevent new infections. A cost-effectiveness analysis comparing current levels of investment in targeted HIV prevention interventions for MSM in Bangkok (including treatment), with scenarios of increased coverage, would provide evidence to shape efficient national and metropolitan strategies. A return-on-investment analysis would provide an economic rationale to finance this strategy in allocating sufficient resources to address the epidemic at the most appropriate scale. Demonstration by the study that a significant reduction in transmission (including potential elimination) are both feasible and cost effective, may galvanize global political support.

This report summarizes findings from an allocative efficiency and financial commitment analysis conducted for the Government of Zambia by the World Bank and the University of New South Wales. It uses Optima, a mathematical model of HIV transmission and disease progression. Optima is a population-based and flexible model, which provides a formal method of optimization and determines optimal allocations of HIV resources across numerous HIV programs, target populations, and funding levels. It also provides epidemic, investment scenario and financial commitment analysis.

The rate of mother-to-child transmission (MTCT) of HIV as well as the implications of the circulating multiple subtypes to MTCT in Nigeria are not known. This study was therefore undertaken to determine the differential rates of MTCT of HIV-1 subtypes detected among infected pregnant women before ARV intervention therapy became available in Nigeria. Twenty of the HIV-positive women who signed the informed consent form during pregnancy brought their babies for follow-up testing at age 18-24 months. Plasma samples from both mother and baby were tested for HIV antibody at the Department of Virology, UCH, Ibadan, Nigeria. All positive samples (plasma and peripheral blood mononuclear cells - PBMCs) were shipped to the Institute of Tropical Medicine, Antwerp, Belgium, where the subtype of the infecting virus was determined using the HMA technique. Overall, a mother-to-child HIV transmission rate of 45% was found in this cohort. Specifically, 36.4%, 66.7% and 100% of the women infected with HIV-1 CRF02 (IbNg), G and B, respectively, transmitted the virus to their babies. As far as it can be ascertained, this is the first report on the rate of MTCT of HIV in Nigeria. The findings reported in this paper will form a useful reference for assessment of currently available therapeutic intervention of MTCT in the country.

A low-income country, Ethiopia has made impressive progress in improving health outcomes. The Inter-agency Group for Child Mortality Estimation reported that Ethiopia has achieved Millennium Development Goal (MDG) 4, three years ahead of target, with under-5 mortality at 68 per 1,000 live births in 2012. Significant challenges remain, however, with the maternal mortality ratio at 420 out of 100,000 live births. The government has introduced a three-tier public health care delivery system to deliver essential health services and ensure referral linkages, with level three as specialized hospitals (one per 3.5 million 5 million population), level two as general hospitals (one per 1 million 1.5 million), level one as primary hospitals (one per 60,000 100,000) with satellite health centers (one per 15,000 25,000) and health posts (one per 3,000 5,000). One initiative contributing greatly toward universal health coverage (UHC) is the Health Extension Program (HEP) that provides free primary care services at health posts and communities. The country is at its early stage initiating insurance schemes to provide financial protection for its citizens: Social Health Insurance (SHI) for formal sector employees and Community-Based Health Insurance (CBHI) for rural residents and informal sector employees. Public facilities are expected to provide exempted services for free, and there is a fee-waiver system for the poor.

Objective: To test the a priori hypothesis that longer duration of ruptured membranes is associated with increased risk of vertical transmission of HIV. Design: The relationship between duration of ruptured membranes and vertical transmission of HIV was evaluated in an individual patient data meta-analysis. Methods: Eligible studies were prospective cohort studies including at least 100 mother-child pairs, from regions where HIV-infected women are counselled not to breastfeed. Analyses were restricted to vaginal deliveries and non-elective Cesarean sections; elective Cesarean section deliveries (those performed before onset of labour and before rupture of membranes) were excluded. Results: The primary analysis included 4721 deliveries with duration of ruptured membranes ≤ 24 h. After adjusting for other factors known to be associated with vertical transmission using logistic regression analysis to assess the strength of the relationship, the risk of vertical HIV transmission increased approximately 2% with an increase of 1 h in the duration of ruptured membranes [adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.04; for each 1 h increment]. There were no significant interactions of duration of ruptured membranes with study cohort or with any of the covariates, except maternal AIDS. Among women diagnosed with AIDS, the estimated probability of transmission increased from 8% to 31% with duration of ruptured membranes of 2 h and 24 h respectively (P < 0.01). Conclusions: These results support the importance of duration of ruptured membranes as a risk factor for vertical transmission of HIV and suggest that a diagnosis of AIDS in the mother at the time of delivery may potentiate the effect of duration of ruptured membranes. © 2001 Lippincott Williams & Wilkins.

Jamaica has made many notable achievements in the fight against HIV/AIDS, which include a robust treatment program and improved HIV prevention programs that increasingly focus on the key drivers of the HIV epidemic and which are based on evidence. These attainments have resulted in a sustained decline in the estimated incidence of HIV and in a reduction in AIDS mortality. The national response to HIV/AIDS in Jamaica is currently financed by the Government as well as by several external sources, including the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United States government. It is expected, however, that external financing will cease or be significantly reduced in the next two years. As a result, a substantial increase in domestic financing for the national HIV/AIDS response will be needed. However, public debt levels are high, and the country is feeling the repercussions of the global financial crisis, thus the availability of domestic resources is and will be very tight. Any shortfall in financing whether domestic, external or both will have serious implications for the delivery of HIV services. The Government of Jamaica requested this study so as to inform its future HIV/AIDS policy response. This study is one input in a series of actions that the Government will undertake to formulate a future sustainability plan and investment framework for the National HIV Program. This study was led and financed by the World Bank and conducted in collaboration with the Government of Jamaica and United Nations Programme on HIV/AIDS (UNAIDS). The study aimed to assess the sustainability of Jamaica's National HIV Program from a fiscal perspective. Specifically, the purpose of the study was to: 1) review current spending on HIV/AIDS and the sources of financing; 2) estimate the fiscal burden of the national HIV/AIDS response and assess the outlook for external financing of the HIV program; 3) project how the epidemic will unfold as well as what the costs would be under different potential scenarios; and 4) provide recommendations to inform policy decisions.

The study covered a wide range of topics, making data collection especially challenging. Key informants were sometimes new to their posts and were unable to provide details on specific programs, policies, or coverage rates. Few countries in Latin America and the Caribbean mainstream into their crisis and emergency plans protection of the nutritional status of mothers and children in the first 1,000 days of life. All countries should reinforce the promotion and protection of breastfeeding in emergencies, notably by providing an enabling space for mothers to safely breastfeed their children and by managing the provision of artificial milk formula. It is concerning that during emergencies most countries provide powdered artificial formula instead of ready-to-use artificial milk formula to infants that cannot breastfeed, greatly increasing the risks of illnesses and malnutrition as a result of inappropriate dilution and unsafe water. All countries need to reinforce their monitoring and evaluation systems, including surveillance of food and nutrition insecurity. While most countries have some form of monitoring system, few of those systems are computerized, which impairs timely and informed decision making. Systematic evaluations of emergency and crisis response are seldom performed. A number of countries would benefit from updating their nutrition policy and protocols based on the latest available evidence. Of particular importance are updates to the prevention and treatment of micronutrient deficiencies with micronutrient powders; treatment of acute malnutrition, notably with the use of ready-to-use supplements; and efficient treatment of diarrhea through the use of oral rehydration solution and zinc. Most countries will benefit from adapting the food and water rations given in emergencies to the specific nutritional needs of pregnant and lactating women and children

This section describes the priority nutrition interventions and cross-cutting approaches that are essential to promote and protect the nutritional status of mothers and children as well as a country's human capital in the short-, medium-, and long-terms. The main thrust of the guidance is that: (1) policies give special attention to the critical 'window of opportunity' represented by the first 1,000 days of life; (2) policies are aligned with the latest international recommendations in nutrition; (3) policies and interventions of key sectors are coordinated to provide synergy of action; and (4) resources allocated for disaster prevention and emergency management are invested in the most cost-effective way. Monitoring is a continuous process of collecting and analyzing information to better understand how well a program is operating against expected outputs and to allow remedial intervention to correct failures. Situation monitoring measures the change or lack of change, in a condition or a set of conditions and includes monitoring of the wider context. Performance monitoring, on the other hand, measures progress in achieving specific results in relation to an implementation plan. Evaluation is a systematic and objective assessment that attempts to determine the worth or significance of an intervention, strategy, or policy. It is used to appraise the effectiveness of an intervention to determine if it meets its goals, to estimate its results or impact, and to identify its costs vs. its benefits. Promote optimal breastfeeding practices. Provide all pregnant women with daily iron-folic acid supplements for at least six months. Provide deforming treatment to pregnant women, preschool-aged children, and school-aged children in areas where hookworms or soil-transmitted helminthes are prevalent. Establish strong links between agricultural, food security, social protection and nutrition policies that can be used to inform a robust communication program regarding maternal diet and critical infant and young child feeding practices. Support diversified agricultural production to increase availability of nutrient-dense foods, particularly those of animal sources.

The purpose of this study is to document the approaches of the World Bank and the Global Fund to monitoring and evaluation (M&E), and to systematically and objectively compare the principles and objectives of the M&E systems and how these systems are implemented and used in practice at the country level. The report also discusses the relationship of the M&E systems to the two different business models of the World Bank and the Global Fund. The first goal is to identify whether and how the conclusions that emerge from their M&E systems on the effectiveness of their respective global health activities can be compared. The second goal is to contribute to the ongoing process of identifying good practices for developing M&E policies for global health programs, setting up M&E frameworks, planning and programming evaluations, and using M&E results more effectively to manage programs and strengthen the health policy process in partner countries. The report is organized as follows. Section two summarizes the World Bank's stated policies and approach to monitoring and evaluation. Each element of standard M&E systems framework; system of indicators and performance measurement; data collection and analysis; feedback and use of monitoring findings; and evaluation is described for the World Bank's approach in this section. Section three summarizes the Global Fund's stated M&E approach and policies according to the same structure. Section four compares the application of the approach to M&E of the two agencies in Burkina Faso, Lesotho and Russia. Section five provides a summary of the comparison between the two approaches to M&E. Section six identifies conclusions and lessons learned.

The principal purpose of this Global Program Review (GPR) is to learn lessons from the experience of the Global Fund and its interaction with the Bank in three areas: (a) the design and operation of large global partnership programs like the Global Fund that are financing country-level investments, (b) the engagement of the World Bank with these partnership programs, and (c) the evaluation of these programs. The Review has an intensive focus on the Bank's engagement with the Global Fund at the country level because of the potential for competition or collaboration between Global Fund-supported activities and the Bank's lending operations at the country level. Therefore, it also focuses on the design and operation of the Global Fund-supported activities at the country level. This review was initiated before the high-level independent review panel on fiduciary controls and oversight mechanisms of the Global Fund was commissioned in February 2011, and it was drafted before their final report, turning the page from emergency to sustainability, was issued on September 19, 2011. While the two studies are complementary and overlap to some extent, they were conducted independently of each other, for different audiences, and for different purposes.

This article focuses on prevention of mother-to-child transmission (PMTCT) of HIV particularly in Malawi and discusses how the country is preparing to revise its policies for PMTCT of HIV and for antiretroviral therapy (ART) in response to WHOs 2010 guidelines. The authors propose offering all HIV-infected pregnant women lifelong ART which they see as a more feasible alternative to WHOs guidelines in addition to being more ethical. The article also describes the various benefits of their proposed plan and estimates the results and costs associated.

This toolkit is the first of its kind to provide information on promoting and protecting the nutritional status of mothers and children in crises and emergencies. Latin America and the Caribbean is one of the most vulnerable regions in the world to major crises and emergencies. This toolkit aims to improve the resilience of the most vulnerable in times of intensified nutritional needs, most notably pregnant and lactating mothers as well as children less than two years of age. Its principal objective is to offer countries, when faced with the transition from stable times into and out of crisis, clear guidance on how to safeguard the nutritional status of mothers and children during times of stability, crisis, and emergency. The principal objective of this toolkit is to offer clear guidance, in a single-source compilation, that will assist countries in safeguarding the nutritional status of mothers and children during times of stability, crisis, and emergency. It aims to inform changes in countries' policies and practices and to guide their attempts to deal with persistently high prevalence rates of malnutrition among their poorest, least educated, and indigenous populations. This toolkit has been crafted so that it can be readily used by non-nutrition specialists.

Low male participation in voluntary counselling and testing (VCT) services at antenatal clinics (ANCs) represents a lost HIV-prevention opportunity. A three-arm randomized controlled trial (RCT) was conducted that offered VCT at a neighbourhood health centre, bar or church to the male partners of pregnant women attending a maternity unit in Kinshasa, Democratic Republic of Congo (DRC). The primary outcome was the proportion of male participation at VCT; secondary outcomes were uptake of couple counselling and determinants of male and couple participation. From a total of 2706 women included in the study, 591 male partners (22%) attended one of the three venues. Male participation was significantly higher in bars (26%, P < 0.001), and higher but not statistically significant in church-based VCT (21%, P = 0.163) compared with health centre VCT (18%). Male participation in VCT associated with ANCs was higher in non-health service settings, particularly in bars. A combination of different strategies rather than single targeted interventions will be needed to increase VCT uptake in male partners of women seeking VCT at ANCs.

This study outlines the initial challenge presented by the HIV/AIDS epidemic, describes Djibouti's response, reviews the results achieved and the enabling factors in curbing the spread of the epidemic, and identifies remaining challenges. Between 2002 and 2008, HIV prevalence among young pregnant women aged 15-24 was reduced from 2.7 percent to 1.9 percent and among sentinel surveillance groups from 2.5 percent to 1.9 percent. HIV prevalence among tuberculosis patients was reduced from an estimated 22 percent to 12 percent. Condom use during last intercourse outside marriage increased from 27 percent to 55 percent and reached 95 percent among sex workers. Among the general population, awareness of HIV/AIDS increased to 95 percent and knowledge about transmission and prevention rose to 50 percent. Political commitment, engagement of community and religious leaders, rigorous communication, social marketing and the provision of an integrated package of medical and social services, and donor harmonization were among the key factors that contributed to the achievement of these results. Despite these impressive results in a relatively short period, Djibouti still has to address several challenges and consolidate program gains, but most importantly, funds are being mobilized from government resources to sustain the national AIDS control program.

This paper summarizes the key findings of an 'After Action Review' (AAR) that reflects a decade of experience in designing and implementing ten HIV/AIDS projects in the Caribbean, financed by the World Bank. The objective is to identify what worked (and what didn't) in the project approach, design and implementation, distilling useful lessons for other projects in small states.