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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.

Prevention of mother-to-child transmission (PMTCT) programs are considered as an entry point to continued care because they provide an opportunity to link an HIV-infected woman, her partner, and child(ren) (if infected) to long-term treatment and care. However, little is known about the factors associated with the utilization of continued care among women who have previously accessed PMTCT services. Better knowledge of the barriers to continued care in HIV-infected women could lead to effective strategies to increase the uptake of post-PMTCT care. This study was designed to examine the factors associated with the utilization of continued care among HIV-infected women enrolled in the PRAYAS PMTCT program in Maharashtra, India, between 2002 and 2011. All consenting women who had completed the receipt of PMTCT services or who were lost to follow-up at least six months prior to the time of data collection were interviewed. Univariate and multivariate analyses were conducted to estimate the associations between not utilizing continued care and hypothesized risk factors using generalized linear models. Of the 688 eligible HIV-positive women, 311 completed a structured interview. Since their exit from the PMTCT program, 59 (19%) had never utilized HIV-related care, 58 (19%) had intermittently utilized HIV-related care, and 194 (62%) had consistently utilized HIV-related care at regular intervals. After adjusting for potential confounders, women with poor HIV-related knowledge (relative risk [RR] = 1.83; 95% CI: 1.15-2.92), women whose partners had never utilized HIV-related care (RR = 4.82; 95% CI: 2.57-9.04), and women who could not afford to travel to the HIV-care facility (RR = 2.36; 95% CI: 1.23-4.53) were less likely to utilize HIV-related care after exiting the PMTCT program. This study highlights the need for enhanced techniques to impart HIV and antiretroviral therapy-related knowledge and underlines the need for improved partner involvement and financial support for travel to HIV facility to increase the uptake of post-PMTCT treatment and care.

Merkel cell-neurite complexes are somatosensory receptors that initiate the perception of gentle touch. The role of epidermal Merkel cells within these complexes is disputed. To ask whether Merkel cells are genetically programmed to be excitable cells that may participate in touch reception, we purified Merkel cells from touch domes and used DNA microarrays to compare gene expression in Merkel cells and other epidermal cells. We identified 362 Merkel-cell-enriched transcripts, including neuronal transcription factors, presynaptic molecules, and ion-channel subunits. Antibody staining of skin sections showed that Merkel cells are immunoreactive for presynaptic proteins, including piccolo, Rab3C, vesicular glutamate transporter 2, and cholecystokinin 26-33. These data indicate that Merkel cells are poised to release glutamate and neuropeptides. Finally, by using Ca 2+ imaging, we discovered that Merkel cells have L- and P/Q-type voltage-gated Ca 2+ channels, which have been shown to trigger vesicle release at synapses. These results demonstrate that Merkel cells are excitable cells and suggest that they release neurotransmitters to shape touch sensitivity.

Background In spite of effective strategies to eliminate mother-to-child-transmission of HIV, the implementation of such strategies remains a major challenge in developing countries. In India, programs for the prevention of mother-to-child transmission (PMTCT) have been scaled up widely since 2005. However, these programs reach only a small percentage of pregnant women, and their overall effectiveness is low. Evidence-based program planning and implementation could significantly improve their effectiveness. This study sought to systematically retrieve, thematically categorize and review published research on PMTCT of HIV in India, focusing on research related to the provision and/or utilization of the cascade of services provided in a PMTCT program, in order to direct further research to enhance program implementation and effectiveness. Methods A systematic search using MEDLINE, US National Library of Medicine Gateway system (PubMed) and ISI Web of Knowledge resulted in 1,944 abstracts, of which 167 met our inclusion criteria. Results A huge share of the empirical literature on PMTCT in India (N = 134) deals with epidemiological studies (N = 60). The 46 papers related to utilization/provision of the cascade of PMTCT services were mostly from the four high HIV prevalence states in southern India and from the public sector. Studies on experiences of implementing a PMTCT program (N = 20) show high rates of drop out of women in the cascade particularly prior to receiving ARV. Studies on individual components of the cascade (N = 26) show that HIV counseling and testing is acceptable and feasible. Literature on other components of the cascade - such as pregnant women’s access to ANC care, HIV infected women’s immunological assessment using CD4 testing, repeat HIV testing among pregnant women, early infant diagnosis and factors related to linking HIV infected women and children to postnatal care – is lacking. Conclusions While the scale of the Indian PMTCT program is large, comprehensive understanding of the context-driven factors affecting its efficiency is lacking. Systematic and more focused public health research output is needed on the issues related to reduction of drop outs of women in the cascade, role of PMTCT programs in improving maternal and child health indicators and role of private sector in delivering PMTCT services.

International audience; Ca(2+) signaling and neurotransmission modulate touch-evoked responses in Merkel cell-neurite complexes. To identify mechanisms governing these processes, we analyzed voltage-activated ion channels and Ca(2+) signaling in purified Merkel cells. Merkel cells in the intact skin were specifically labeled by antibodies against voltage-activated Ca(2+) channels (Ca(V)2.1) and voltage- and Ca(2+)-activated K(+) (BK(Ca)) channels. Voltage-clamp recordings revealed small Ca(2+) currents, which produced Ca(2+) transients that were amplified sevenfold by Ca(2+)-induced Ca(2+) release. Merkel cells' voltage-activated K(+) currents were carried predominantly by BK(Ca) channels with inactivating and non-inactivating components. Thus, Merkel cells, like hair cells, have functionally diverse BK(Ca) channels. Finally, blocking K(+) channels increased response magnitude and dramatically shortened Ca(2+) transients evoked by mechanical stimulation. Together, these results demonstrate that Ca(2+) signaling in Merkel cells is governed by the interplay of plasma membrane Ca(2+) channels, store release and K(+) channels, and they identify specific signaling mechanisms that may control touch sensitivity.