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In 2022, 54% of 1.5 million children (age 0–14) living with HIV had access to anti-retroviral medication (ART). Adherence to ART for pregnant or breastfeeding HIV + women is critical for maintaining their personal health and to prevent mother-to-child-transmission (MTCT). For HIV + infants, adherence is essential to establish early viremic control and is contingent on caregiver administration. We conducted a scoping review to systematically identify and categorize the influences on ART adherence for pregnant or breastfeeding HIV + women and their HIV + infants. We searched databases in June 2023 and employed the Social-Ecological Model (SEM) to organize facilitators and barriers to adherence referenced in published articles. All articles published before 2016 were excluded due to updated guidelines from WHO on MTCT and ART. Our analysis included 52 articles. 50/52 took place in Africa and used cross-sectional and mixed-methods design. Barriers to adherence for pregnant or breastfeeding HIV + women included maternal education, self-efficacy, social support, and social/economic context. Barriers to infant adherence included development, nutrition, age of treatment initiation, disclosure, and ART side effects. Additional facilitators and barriers to adherence are presented at family, extra-familial, and socio-cultural SEM levels. Stigma was the most salient barrier referenced across the entire continuum of HIV care and all SEM levels. This review revealed a dearth of literature focusing on HIV + infants who are dependent on their caregivers for ART adherence and lack of a standard adherence measure. We identified multi-leveled influences on adherence impacting both the mother and infant and are amenable to public health intervention. [ABSTRACT FROM AUTHOR]

Purpose of Review: In 2016, WHO sets a target to eliminate viral hepatitis as a public health threat by 2030, with significant emphasis placed on reducing MTCT of HBV, which is the leading cause of CHB worldwide. In this review, we discuss the most recent recommendations in the literature on the management of HBV in pregnancy, including treatment considerations during pregnancy and recommendations for infant management, to reduce the MTCT of HBV. Recent Findings: Recent research advancements have focused on further unraveling the safety and efficacy of treatment options during pregnancy, developing more accessible postnatal immunoprophylaxis regimens, and exploring theoretical models for HBV treatment during pregnancy aimed at preventing MTCT. Summary: Despite considerable public health efforts, HBV remains a significant global health concern. Effective collaboration among clinicians is essential for appropriate screening, assessment, treatment during and after pregnancy, and proper follow-up, in order to reduce the MTCT of HBV and optimize maternal health outcomes. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis-B virus (HBV) infection due to mother-to-child transmission (MTCT) during the perinatal period is an important global health concern. Chile is a low-prevalence country with an increasing migratory inflow from Latin- American countries, with intermediate to high endemic rates of HBV infection, and until 2021, there is no universal maternal screening. This study aimed to evaluate infant outcomes using a risk-based strategy of maternal screening to prevent MTCT of hepatitis B virus (HBV) in a low-prevalence country. Methods: This prospective study included infants born to HBsAg-positive women detected using a local risk-based strategy. The exposed infants received immunoprophylaxis (IP) and follow-up to evaluate their clinical outcomes and immune responses through post-serological vaccine testing (PSVT) after completing the three- dose schedule of the HBV vaccine. Results: A total of 99 HBsAg-positive mothers were detected. Seventy-six (82%) infants completed the follow-up and had PSVT between 9 and 12 months of age. 55.2% female, the median gestational age was 39 weeks (25–41) and the median birth weight was 3,130g (816–4,400 g). All patients received IP with recombinant HBV vaccine plus hepatitis-B virus immunoglobulin (HBIG) and three doses of the HBV vaccine. There were no cases of HBV infection, and 96% (72) responded to immunization with HBsAg antibodies (anti-HBsAg) >10 UI/ml, with a median level of 799 IU/ml. Conclusions: A high-risk strategy can be implemented in countries with non-universal screening for VHB. Timely IP plus high-uptake VHB vaccination in infants born to HBsAg-positive mothers was associated with a high immunogenic response and absence of MTCT. Significance: What's it's already known on this subject?: There is robust evidence that immunoprophylaxis is recommended in all infants born to a HBsAg positive mother like one of different strategies to control VHBtransmission. What this study adds?: In countries with non-universal screening of VHB a risk based strategy could be considered to prevent MTCT. Timely immunoprophylaxis plus high uptake VHB vaccination in infants born to HBsAg positive mothers is associated with a high immunogenic response and no MTCT. PVST should be considered in populations with lower immunogenic response such as infants born with <2,000 g of weight. PVST should be performed 1 or 2 months after the priming vaccine doses, helping to avoid unnecessary revaccination due to expected declining seroprotecting levels through time. [ABSTRACT FROM AUTHOR]

Pregnant women and the general public are both directly impacted by cirrhosis which is a chronic liver disease. It is also widely known that women who have a history of injectable drug use and cirrhosis are more prone to experience unfavorable consequences that have a negative impact on the health of both the mother and the unborn child. Higher maternal Hepatitis-C Virus (HCV) in pregnancy viral load, length of labor, use of amniocentesis or fetal scalp monitoring and protracted membrane rupture are all the risk of perinatal transmission of HCV in newborns. Globally, a large number of childbearing-age women become affected by HCV every year and vertical transmission of HCV is still a serious public health concern. Pregnancy-related immune alterations have a significant impact on the course of HCV infection throughout the third trimester and provide favorable circumstances for the spread of the virus. The exacerbation of hepatic damage during pregnancy and the postpartum period is mostly responsible for HCV-specific cell-mediated immune responses. An extensive literature search done via electronic search engine including Cochrane library databases, PubMed, Google Scholar, Science Direct and HCV in pregnancy articles were included. [ABSTRACT FROM AUTHOR]

Pregnant mothers with chronic hepatitis B infection (CHB) need peri‐partum antiviral prophylaxis (PAP) to reduce the risk of mother‐to‐child‐transmission. Currently, PAP is recommended in those with high viral load (VL) that is, HBV DNA >200,000 IU/mL. Quantitative hepatitis B surface antigen (qHBsAg) >10,000 IU/mL, a cut‐off derived primarily from hepatitis B e‐antigen (HBeAg) positive antenatal cohorts in Chinese populations, is advocated as a surrogate marker of VL for guiding PAP. We investigated the utility of qHBsAg to predict high‐VL in a multi‐ethnic urban cohort with CHB. A consecutive cohort of women with CHB was identified from Barts Health NHS Trust databases in the United Kingdom. We included women with paired HBV DNA and qHBsAg during pregnancy. Women already on antiviral at conception were excluded. A total of 769 pregnancies in 678 CHB pregnant mothers (median age 31 years‐old, 8.6% HBeAg+) were included. At median gestational age of 15.3 weeks, HBV DNA was 336 (IQR 44–2998) IU/mL, with 65 (8.5%) being high‐VL. Serum qHBsAg was most useful in Black/Black‐British/Caribbean/African (AUROC 0.946) with 100% sensitivity and 80.6% specificity to predict high‐VL; but it performed less well for other ethnicities: Asian (AUROC 0.877), White (AUROC 0.797) and mixed ethnicities (AUROC 0.742). In conclusion, for settings where healthcare resources are not limited, HBV DNA remains the optimal marker to identify highly viraemic pregnancies for guiding PAP. For resource‐limited settings where the prevailing cost is treatment, serum qHBsAg can be used in Black/Black British/Caribbean/African sub‐cohorts, but not for other ethnicities. [ABSTRACT FROM AUTHOR]

Background: HIV-positive and pregnancy diagnosis is a traumatic, shocking, and distressing experience for women. Adoption of routine HIV counselling and testing in the antenatal programme aimed to increase the uptake and the early diagnosis of HIV among pregnant women to prevent maternal HIV transmission to unborn babies and neonates. Objectives: The study aimed to explore the psychological reaction of women coincidentally discovering their HIV-positive status and pregnancy while seeking medical care in primary healthcare facilities in the Tshwane district. Method: Descriptive phenomenology involving a semi-structured in-depth interview was used to collect data. The sample was purposively selected. Twenty-eight women participated in the research project. Face-to-face in-depth audio recorded interviews were used to gain a full understanding of the experiences and feelings of the participants. Results: Reason for the uptake of pregnancy and HIV testing, reactions upon discovering HIV and pregnancy-positive status, emotions arising from the pregnancy and HIV-positive diagnosis, understanding HIV infection in pregnancy, and transitions to acceptance and coping with the HIV-positive diagnosis were themes that emerged from this study. Conclusion: It is crucial that responsible healthcare workers consider this psychological imbalance during their offering of antenatal and postnatal care services so that the pregnant women living with HIV can accept and cope with the situation. Contribution: This study accounts to support other studies that offer intense counselling for women coincidentally discovering their positive HIV status and pregnancy. It is important to remedy the acceptance of the situation and to promote HIV prevention and family planning for women of childbearing age.

Despite the availability for nearly twenty years of an effective vaccine, hepatitis B remains one of the most frequent viral diseases throughout the world. Mother-to-child transmission is one of the primary routes of transmission in children. To assess the vaccine response in children born to HBV infected mothers. HBsAg-positive consenting mothers registered in the antenatal care (ANC) service database of Centre Hospitalier Dominicain St-Martin de Porres, Yaounde were enrolled with their children. Socio-demographic characteristics were collected using a tested questionnaire. The 5 markers of hepatitis B were tested and the quantification of anti-HBsAg antibodies was done by indirect ELISA method. The data collected was analyzed using Microsoft excel and Epi-info softwares. Out of 5,996 women registered, 143 were identified as HBsAg positive (2.38% prevalence) and none was HBeAg positive. Of these 143 HBsAg positive women, 50 were enrolled in the study. Of the 50 positive mothers, 78 children were included with a mean age ± standard deviation of 2.33±2.86 years. No child was infected with HBV, but all have been exposed to the virus (HBeAb-positive). Overall 64 (82.05%) received at birth both anti-HBs immunoglobulin (HBIG) and a dose of vaccine, while 14 (17.95%) received only the birth dose of vaccine. 72 (92.31%) children received all three recommended doses of vaccine. Vaccine responders were 62.82% (above 10 IU/ml), while 37.18% of children were non-responders; representing a higher risk group if not boosted. The coverage of the anti-HBV vaccine in children in this study was 92.31%. The protection level of 62.82% is below the 95% recommended rate by WHO. The factors sustaining this suboptimal protection should be investigated. [ABSTRACT FROM AUTHOR]

Background: With the advancement of antiretroviral therapy scale-up, it is possible for women living with HIV to breastfeed safely. However, this practice has not been adopted in Malaysia. Instead, infants are provided with subsidized human milk substitutes for their first 2 years of life. Research Aim: This study describes the infant feeding experiences of women living with HIV in Malaysia. Methods: From August to October 2021, a nationwide, community-based qualitative study was conducted among women living with HIV and who received care from the Malaysian Ministry of Health. Using purposive sampling, participants who met the inclusion criteria were recruited. Interview and focus group transcripts were coded based on a secondary thematic analysis. Results: Six in-depth interviews and five focus group discussions were conducted among 32 participants. Study participants were mostly Malay secondary school graduates in their 30s and 40s. Due to the fear of vertical transmission, which was explained by healthcare providers to the participants, none of the women breastfed their infants. The three primary themes that emerged from analyzing the women's infant feeding experiences were (1) a human milk substitute was the only option and was encouraged; (2) feeding infants with a human milk substitute made the women feel incomplete as mothers; and (3) the women encountered difficulties in obtaining the subsidized human milk substitute. Conclusion: Women living with HIV in Malaysia have been advised to provide human milk substitutes to their infants in fear of HIV transmission. [ABSTRACT FROM AUTHOR]

Introduction: Hepatitis B surface Antigen (HBsAGg) prevalence among pregnant women in India is between 0.9-3.1%. The most important factor in determining the prevalence is transmission from asymptomatic chronic Hepatitis B Virus (HBV) mother to newborn. This study was done to observe antiviral treatment and fetomaternal outcome in asymptomatic HBV mothers. Aim: To study fetomaternal outcomes in asymptomatic chronic hepatitis B pregnant women. Materials and Methods: This prospective cohort study enrolled 125 HBsAg seropositive singleton pregnancy over a period of 18 months from October 2020 to March 2022 at Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India. Chronic Hepatitis B (CHB) was diagnosed when HBsAg, HBeAg or HBV DNA was present and IgM antiHBc was absent. Tenofovir was started in consultation with the Gastroenterologist in women with HBeAg positivity or with high HBV DNA titre ≥200,000 IU/mL or Alanine Transaminase (ALT)> two times the Upper Normal Limit (UNL). All women were followed with Liver Function Test (LFT) till delivery and six weeks postpartum and their fetomaternal outcome were noted. The p-value 2 times the ULN can replace the need of HBV DNA titres for initiation of antiviral therapy in India.

Abstract Background Although mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is prevalent in West Africa, epidemiological data on HBV infection in women remain scarce. We studied i) hepatitis B surface antigen (HBsAg) prevalence and its correlates, ii) HBV screening history and serological status awareness, iii) MTCT risk and treatment needs in Senegalese women. Methods A cross-sectional population-based serosurvey for HBsAg positivity was conducted in 2018–2019 in the rural area of Niakhar (Fatick region, Senegal). Participants were offered home-based HBV screening and answered face-to-face questionnaires. HBsAg-positive participants underwent clinical and biological assessments. Data were weighted and calibrated to be representative of the area’s population. Logistic regression models helped identify factors associated with HBsAg-positivity in adult women (> 15 years old). Results HBsAg prevalence in adult women was 9.2% [95% confidence interval: 7.0–11.4]. Factors associated with HBsAg-positivity were being 15–49 years old (ref: ≥ 50), living in a household with > 2 other HBsAg-positive members, and knowing someone with liver disease. Only 1.6% of women had already been tested for HBV; no one who tested HBsAg positive was already aware of their serological status. In women 15–49 years old, 5% risked MTCT and none were eligible for long-term antiviral treatment. Conclusions Adult women have a high HBsAg prevalence but a low MTCT risk. Low rates of HBV screening and serological status awareness argue for the adoption of systematic screening during pregnancy using free and rapid diagnostic tests. Additionally, screening household members of HBsAg-positive women may greatly improve the cascade of care in rural Senegal. Trial registration ClinicalTrials.gov identifier (NCT number): NCT03215732.

Introduction: Hepatitis B surface Antigen (HBsAGg) prevalence among pregnant women in India is between 0.9-3.1%. The most important factor in determining the prevalence is transmission from asymptomatic chronic Hepatitis B Virus (HBV) mother to newborn. This study was done to observe antiviral treatment and fetomaternal outcome in asymptomatic HBV mothers. Aim: To study fetomaternal outcomes in asymptomatic chronic hepatitis B pregnant women. Materials and Methods: This prospective cohort study enrolled 125 HBsAg seropositive singleton pregnancy over a period of 18 months from October 2020 to March 2022 at Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India. Chronic Hepatitis B (CHB) was diagnosed when HBsAg, HBeAg or HBV DNA was present and IgM anti-HBc was absent. Tenofovir was started in consultation with the Gastroenterologist in women with HBeAg positivity or with high HBV DNA titre =200,000 IU/mL or Alanine Transaminase (ALT)> two times the Upper Normal Limit (UNL). All women were followed with Liver Function Test (LFT) till delivery and six weeks postpartum and their fetomaternal outcome were noted. The p-value < 0 .05 was taken as significant. Descriptive statistics was analysed with Statistical Package for the Social Sciences (SPSS) version 17.0 software. Results: Tenofovir was started in 26 (20.8%) women. LFT flare was seen in 15.15% (15/99) women who were not on treatment and 0% in women on treatment. In women without treatment, log HBV DNA level was significantly increased while it was reduced in the women who received tenofovir and the reduction was significant (p-value <0.05). HBeAg was positive in 61.5% women on treatment and 0% in untreated women. No significant association was found in maternal outcomes i.e., Gestational Diabetes Mellitus (GDM), Antepartum Haemorrhage (APH), Preeclampsia, Premature Rupture Of Membrane (PROM), Preterm labour, Postpartum Haemorrhage (PPH) and High Dependency Unit (HDU) stay, in treated and untreated women. Foetal outcomes such as birth weight, APGAR score, Neonatal Intensive Care Unit (NICU) admission, prematurity, Foetal Growth Restriction (FGR) and neonatal jaundice also showed no significant association between antiviral treated and untreated women. Conclusion: There was no significant association of antiviral treatment with maternal and foetal outcome. Tenofovir is safe and reduces the LFT flare in CHB mothers. HBV DNA levels were reduced in treated women which may have reduced the incidence of Mother To Child Transmission (MTCT), which was not studied in the present study. HBeAg seropositivity and ALT >2 times the ULN can replace the need of HBV DNA titres for initiation of antiviral therapy in India. [ABSTRACT FROM AUTHOR]

Background: Although mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is prevalent in West Africa, epidemiological data on HBV infection in women remain scarce. We studied i) hepatitis B surface antigen (HBsAg) prevalence and its correlates, ii) HBV screening history and serological status awareness, iii) MTCT risk and treatment needs in Senegalese women. Methods: A cross-sectional population-based serosurvey for HBsAg positivity was conducted in 2018–2019 in the rural area of Niakhar (Fatick region, Senegal). Participants were offered home-based HBV screening and answered face-to-face questionnaires. HBsAg-positive participants underwent clinical and biological assessments. Data were weighted and calibrated to be representative of the area's population. Logistic regression models helped identify factors associated with HBsAg-positivity in adult women (> 15 years old). Results: HBsAg prevalence in adult women was 9.2% [95% confidence interval: 7.0–11.4]. Factors associated with HBsAg-positivity were being 15–49 years old (ref: ≥ 50), living in a household with > 2 other HBsAg-positive members, and knowing someone with liver disease. Only 1.6% of women had already been tested for HBV; no one who tested HBsAg positive was already aware of their serological status. In women 15–49 years old, 5% risked MTCT and none were eligible for long-term antiviral treatment. Conclusions: Adult women have a high HBsAg prevalence but a low MTCT risk. Low rates of HBV screening and serological status awareness argue for the adoption of systematic screening during pregnancy using free and rapid diagnostic tests. Additionally, screening household members of HBsAg-positive women may greatly improve the cascade of care in rural Senegal. Trial registration: ClinicalTrials.gov identifier (NCT number): NCT03215732. [ABSTRACT FROM AUTHOR]

HIV remains a threat to global public health, disproportionately affecting countries across Sub-Saharan Africa. Although treatment and access to care have improved, prevention remains critical to ending new HIV infections by 2030. A variety of prevention strategies exist, yet their effectiveness is difficult to measure and variable due to the nature of the interventions and vulnerability of the intervention during implementation. This systematic review of 51 studies synthesizes data on the implementation and evaluation of evidence-based HIV prevention interventions across Sub-Saharan Africa. Studies were included if they occurred between January 1, 2008, and December 31, 2019, inclusive in Sub-Saharan Africa, were written in English, implemented an HIV prevention intervention in the field, and had reportable results. Using a modified social-ecological model for HIV prevention, we divided studies into three categories: interventions targeting health systems (n = 16), communities (n = 8), and individuals (n = 27). Across all categories, the data emphasized preventing mother-to-child transmission (PMTCT), medical interventions, and psychosocial interventions. The most successful programs bundled several interventions that were integrated into the health system. There is a notable lack of interventions targeting key populations and there are significant rates of loss to follow up (LTFU) across many studies. This review provides insight into the prioritization of evidence-based HIV prevention interventions across Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Courtney Andrews,1 Tina Kempin Reuter,1 Valeria Londono,2 Lea Claye,3 Maung Aung,4 Pauline Jolly3 1Institute for Human Rights, University of Alabama at Birmingham, Birmingham, Alabama, USA, Birmingham, AL, USA; 2Minority Health Research Training, University of Alabama at Birmingham, Birmingham, AL, USA; 3Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA; 4Epidemiology and Research Unit, Western Regional Health Authority, Ministry of Health, Montego Bay, JamaicaCorrespondence: Courtney Andrews, Institute for Human Rights, University of Alabama at Birmingham, HHB 551, 1720 2 nd Avenue South, Birmingham, AL, 35294-1152, USA, Tel +1 205 975 6492, Email cjandrews@uab.eduPurpose: To identify factors associated with reproductive decision-making for women living with HIV in Western Jamaica, to assess their confidence in anti-retroviral therapy to reduce the chances of mother to child transmission of HIV, and to better understand the experience of stigmatization surrounding becoming pregnant after HIV diagnosis.Participants and Methods: Two focus groups were conducted among women living with HIV in the four parishes of Western Jamaica in 2011. A trained moderator conducted the focus groups along with two student notetakers. Qualitative coding and content analysis were used to identify common themes and exemplary quotations characterizing those themes.Results: Participants agree that adherence to antiretroviral therapy as prescribed by a physician facilitates better health and longevity; however, they were conflicted on the efficacy of the therapy to prevent mother to child transmission of the virus. Participants report that becoming pregnant after HIV diagnosis continues to be highly stigmatized. Among participants, fear of MTCT and concern that their children will be mistreated are the primary drivers of reproductive decision-making.Conclusion: Despite advances in HIV treatment and assisted technologies to prevent MTCT, participants show skepticism that ARV medication is effective at preventing MTCT. Stigma and discriminatory behavior by community members and health-care professionals continue to shape reproductive decision-making for the women who participated in this study. More informed counseling that includes education on recent advancements in HIV treatment and its efficacy at preventing MTCT should be more widely available to pregnant women. To reduce stigma and discriminatory behavior, this education should extend to the larger community.Keywords: HIV, reproduction, mother to child transmission, stigma

Background: Prevention of Mother to Child Transmission (PMTCT) is an important public health intervention that has significantly reduced the risk of mother-to-child transmission of Human Immunodeficiency Virus (HIV) from 40% to close to 5%. Midwives need to have good knowledge of this important preventive strategy to be able to contribute to global efforts aimed at the elimination childhood HIV infections and all other forms of HIV infection. Methods: This research employed an analytical cross-sectional study design and recruited 179 Midwives through purposive sampling. A self-administered questionnaire was completed by participants to test their knowledge regarding PMTCT for HIV. Analysis of data was done through STATA using ANOVA, binary logistic regression analysis with a level of significance set at

Context: Sexually transmitted infections (STIs) are a problem of increasing concern among men and women. They can affect fertility, increase maternal and neonatal morbidity, and can become a burden on both physical and emotional health. Owing to lack of awareness and partly due to the social stigma attached, couples do not come forward for screening. Antenatal testing for STIs is an effective strategy recommended to detect STIs in this subset of the population. Aims: To estimate the seroprevalence of four STIs (hepatitis B, hepatitis C virus, HIV, and syphilis) in pregnant women, to evaluate its correlation with sociodemographic characteristics and sexual behavior, and to check awareness regarding STIs. Settings and Design: It was an observational study on 500 pregnant women attending an antenatal clinic at a tertiary care hospital in rural Haryana, India. Methods and Material: Pregnant women were screened for four STIs – hepatitis B, hepatitis C virus, HIV, and syphilis. Statistical Analysis Used: The sample size was calculated considering the mean reported seroprevalence of infections in pregnant women in previous studies. The power of the study was kept 80% and the alpha error was 0.05. Results: Seroprevalence for STIs in pregnancy was 5.2% – hepatitis C virus (2.6%), hepatitis B (2.4%), and syphilis (0.4%). Conclusions: Viral STIs are more prevalent among pregnant women. Antenatal screening is an effective strategy for the detection of STIs in pregnant women.

A meta-analysis (MA) of natural vs. cesarean births in HBV infected mothers was performed to assess which delivery methods could minimize the mother-to-child transmission (MTCT) of Hepatitis B virus (HBV). Electrical databases PubMed, Embase and Cochrane Library were searched for the English papers about the HBV MTCT up to 19 August 2019. STATA 11.0 software was used for all analysis. Odds ratio (OR) and 95% confidence interval (CI) were used to present the effect size for MTCT at birth and MTCT more than 6 months. Heterogeneity was evaluated using the chi-squared Q and I2 test to determine the use of random effects model or fixed effects model. A total of 19 articles involving 11,144 HBV-positive pregnant women (5251 underwent natural delivery and 5893 received a cesarean section) were included in the study. The pooled OR for MTCT at birth was 0.42, 95% CI: 0.23–0.76 based on random effect model (I2 = 69.9%, p =.019). Meanwhile, in fixed effect model (I2 = 0.0%, p =.470), the pooled OR for MTCT more than 6 months was 0.62, 95% CI: 0.48–0.81. The results indicated that HBV infection in cesarean births significantly lower than that of vaginal delivery. Subgroup analysis of MTCT more than 6 months was clearly, and the results indicated that cesarean section significantly reduced the risk of MTCT (OR = 0.62, 95% CI: 0.48–0.81, p <.001). Cesarean section can reduce the risk of HBV MTCT and should be employed as a preventive measure. Due to the limitations of this study, further multi-center, large-sample randomized controlled trials must be performed to confirm these findings. [ABSTRACT FROM AUTHOR]

Context: Sexually transmitted infections (STIs) are a problem of increasing concern among men and women. They can affect fertility, increase maternal and neonatal morbidity, and can become a burden on both physical and emotional health. Owing to lack of awareness and partly due to the social stigma attached, couples do not come forward for screening. Antenatal testing for STIs is an effective strategy recommended to detect STIs in this subset of the population. Aims: To estimate the seroprevalence of four STIs (hepatitis B, hepatitis C virus, HIV, and syphilis) in pregnant women, to evaluate its correlation with sociodemographic characteristics and sexual behavior, and to check awareness regarding STIs. Settings and Design: It was an observational study on 500 pregnant women attending an antenatal clinic at a tertiary care hospital in rural Haryana, India. Methods and Material: Pregnant women were screened for four STIs - hepatitis B, hepatitis C virus, HIV, and syphilis. Statistical Analysis Used: The sample size was calculated considering the mean reported seroprevalence of infections in pregnant women in previous studies. The power of the study was kept 80% and the alpha error was 0.05. Results: Seroprevalence for STIs in pregnancy was 5.2% - hepatitis C virus (2.6%), hepatitis B (2.4%), and syphilis (0.4%). Conclusions: Viral STIs are more prevalent among pregnant women. Antenatal screening is an effective strategy for the detection of STIs in pregnant women. [ABSTRACT FROM AUTHOR]

While there have been considerable advances in the reduction of mother to child transmission of HIV (MTCT) in sub-Saharan Africa with the advance of anti-retroviral therapies (ART), there remain challenges in the late postpartum period.  Structural issues including food insecurity and stigma make better maternal ART adherence and exclusive breastfeeding unreachable for some women. There are no other scientifically researched feeding options as there have been few studies on different types of mixed feeding practices and risk of HIV infection. Additional studies are warranted to assess detailed feeding practices in HIV exposed infants in relation to clinical outcomes.

ABSTRACT Background: Mother-to-child transmission of Chagas disease (CD) has become a relevant problem in both endemic and non-endemic areas. Methods: Description of the CUIDA Chagas Project - Communities United for Innovation, Development and Attention for Chagas disease’. Results: Through innovative and strategic research, this project will provide improved diagnostic and treatment options as well as replicable implementation models that are adaptable to different contexts. Conclusions: By integrating test, treat and care actions for CD into primary health care practices, the burden of CD on people and health systems may be significantly reduced.

Hepatitis B (HBV) infection is a major public health concern. Perinatal transmission of HBV from mother to child represents the main mode of transmission. Despite the existence of effective immunoprophylaxis, the preventive strategy is inefficient in neonates born to mothers with HBV viral loads above 2 × 105 IU/mL. To prevent mother-to-child transmission, it is important to identify highly viremic pregnant women and initiate antiviral therapy to decrease their viral load. We developed a simple innovative molecular approach avoiding the use of automatic devices to screen highly viremic pregnant women. This method includes rapid DNA extraction coupled with an isothermal recombinase polymerase amplification (RPA) combined with direct visual detection on a lateral flow assay (LFA). We applied our RPA-LFA approach to HBV DNA-positive plasma samples with various loads and genotypes. We designed a triage test by adapting the analytical sensitivity to the recommended therapeutic decision threshold of 2 × 105 IU/mL. The sensitivity and specificity were 98.6% (95% CI: 92.7–99.9%) and 88.2% (95% CI: 73.4–95.3%), respectively. This assay performed excellently, with an area under the ROC curve value of 0.99 (95% CI: 0.99–1.00, p < 0.001). This simple method will open new perspectives in the development of point-of-care testing to prevent HBV perinatal transmission. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: Iran is facing a rapid change in the epidemiological pattern of HIV. We examine trends in disease incidence and factors associated with the development of HIV over the last two decades in Iran. Methods: We retrospectively collected data from patients who attended the Behavior Diseases Consultation Center of Mashhad University of Medical Sciences in Iran. Individuals were contributed if they were HIV-positive. We examined baseline factors including demographic, behavioral and clinical characteristics for all participants. Changes in population characteristics were assessed using chi-square test or the Fisher’s exact test. Results: From 1989 to 2014, 584 individuals were eligible for present analysis according to the inclusion criteria. Most patients were men (87%) with most being 36–52 years old, unemployed (58%), married (39.3%), less educated (47.7%) and had a history of imprisonment (83%). The most common modes of HIV transmission were injection drug use (IDU) (51.4%) and IDU along with the sexual relationship (26.5%). These transmission modes varied significantly according to gender (p-value

Background:  HIV-positive and pregnancy diagnosis is a traumatic, shocking, and distressing experience for women. Adoption of routine HIV counselling and testing in the antenatal programme aimed to increase the uptake and the early diagnosis of HIV among pregnant women to prevent maternal HIV transmission to unborn babies and neonates., Objectives:  The study aimed to explore the psychological reaction of women coincidentally discovering their HIV-positive status and pregnancy while seeking medical care in primary healthcare facilities in the Tshwane district., Method:  Descriptive phenomenology involving a semi-structured in-depth interview was used to collect data. The sample was purposively selected. Twenty-eight women participated in the research project. Face-to-face in-depth audio recorded interviews were used to gain a full understanding of the experiences and feelings of the participants., Results:  Reason for the uptake of pregnancy and HIV testing, reactions upon discovering HIV and pregnancy-positive status, emotions arising from the pregnancy and HIV-positive diagnosis, understanding HIV infection in pregnancy, and transitions to acceptance and coping with the HIV-positive diagnosis were themes that emerged from this study., Conclusion:  It is crucial that responsible healthcare workers consider this psychological imbalance during their offering of antenatal and postnatal care services so that the pregnant women living with HIV can accept and cope with the situation.Contribution: This study accounts to support other studies that offer intense counselling for women coincidentally discovering their positive HIV status and pregnancy. It is important to remedy the acceptance of the situation and to promote HIV prevention and family planning for women of childbearing age.

Background: Birth-dose (Hep-BD) followed by three additional doses (Hep-B3) of hepatitis B virus (HBV) vaccine are key to eliminating HBV by 2030. Unfortunately, Hep-BD and Hep-B3 coverage in our country is poor., Aim: To studied the parent's knowledge and awareness about HBV infection, its prevention, consequences and vaccination., Methods: Parents of 6 months to 8 years old children were interviewed to assess their knowledge & awareness about hepatitis B, its transmission, prevention, illness caused by this, and vaccination. Eighteen close-ended questions were administered, and responses were recorded as 'yes', 'no', or 'not sure'. HBV knowledge score was calculated based on the sum of correct answers. Each correct response scored one point and incorrect, missing or 'not sure' responses received no points. Categorical data are presented as number (%) and numerical data are expressed as median. Data were compared using Chi 2 tests and level of significance was kept as P < 0.05., Results: Parents (58.3% mothers) of 384 children (89.9% age < 5 years; 82% age-appropriately vaccinated) were included. Three hundred and twenty-two (83.9%) children were Hep-B3 vaccinated. 94.3%, 87.5%, and 29.2% parents knew about polio, tetanus, and hepatitis B vaccine. Overall, 41.2%, 15.8%, and 23% parents knew about hepatitis B transmission, consequences of infection, and prevention respectively. Only 7.6% parents knew about three-dose schedule of hepatitis B vaccination. Only 23% parents believed that vaccine could prevent HBV, 15.7% knew that HBV affects liver. Parents of Hep-B3 vaccinated children were significantly more aware about HBV than the parents of unvaccinated children ( P < 0.05 for 17/18 questions)., Conclusion: The knowledge and awareness among the parents about hepatitis B is poor. The Increasing knowledge/awareness about HBV among parents may improve Hep-B3 vaccination coverage., Competing Interests: Conflict-of-interest statement: Dr. Amit has nothing to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) and human cytomegalovirus (HCMV) may occur during pregnancy, labor, or breastfeeding. These viruses from amniotic fluid, cervicovaginal secretions, and breast milk may simultaneously interact with oropharyngeal and tonsil epithelia; however, the molecular mechanism of HIV-1 and HCMV cotransmission through the oral mucosa and its role in MTCT are poorly understood. To study the molecular mechanism of HIV-1 and HCMV MTCT via oral epithelium, we established polarized infant tonsil epithelial cells and polarized-oriented ex vivo tonsil tissue explants. Using these models, we showed that cell-free HIV-1 and its proteins gp120 and tat induce the disruption of tonsil epithelial tight junctions and increase paracellular permeability, which facilitates HCMV spread within the tonsil mucosa. Inhibition of HIV-1 gp120-induced upregulation of mitogen-activated protein kinase (MAPK) and NF-k B signaling in tonsil epithelial cells, reduces HCMV infection, indicating that HIV-1-activated MAPK and NF-k B signaling may play a critical role in HCMV infection of tonsil epithelium. HCMV infection of tonsil epithelial cells also leads to the disruption of tight junctions and increases paracellular permeability, facilitating HIV-1 paracellular spread into tonsil mucosa. HCMV-promoted paracellular spread of HIV-1 increases its accessibility to tonsil CD4 T lymphocytes, macrophages, and dendritic cells. HIV-1-enhanced HCMV paracellular spread and infection of epithelial cells subsequently leads to the spread of HCMV to tonsil macrophages and dendritic cells. Our findings revealed that HIV-1- and HCMV-induced disruption of infant tonsil epithelial tight junctions promotes MTCT of these viruses through tonsil mucosal epithelium, and therapeutic intervention for both HIV-1 and HCMV infection may substantially reduce their MTCT. IMPORTANCE Most HIV-1 and HCMV MTCT occurs in infancy, and the cotransmission of these viruses may occur via infant oropharyngeal and tonsil epithelia, which are the first biological barriers for viral pathogens. We have shown that HIV-1 and HCMV disrupt epithelial junctions, reducing the barrier functions of epithelia and thus allowing paracellular penetration of both viruses via mucosal epithelia. Subsequently, HCMV infects epithelial cells, macrophages, and dendritic cells, and HIV-1 infects CD41 lymphocytes, macrophages, and dendritic cells. Infection of these cells in HCMV- and HIV-1-coinfected tonsil tissues is much higher than that by HCMV or HIV-1 infection alone, promoting their MTCT at its initial stages via infant oropharyngeal and tonsil epithelia. [ABSTRACT FROM AUTHOR]

Summary: Hepatitis B virus (HBV) infection caused by mother‐to‐child transmission (MTCT) continues to pose challenges to global health. This study aimed to assess the efficacy and safety of tenofovir disoproxil fumarate (TDF) for preventing HBV MTCT. PubMed and the Cochrane Central Register of Controlled Trials were searched through August 2020. Randomised controlled trials (RCTs) were selected that evaluated the efficacy and safety of TDF for preventing MTCT of HBV compared with the standard of care, placebo or other HBV therapies. The primary outcomes were HBV MTCT rate and maternal HBV DNA level. Secondary outcomes were infant and maternal safety outcomes. The review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Guidelines, and prospectively registered on PROSPERO (CRD42020186275). Of 240 citations, three RCTs that involved 651 participants were included. The pooled result showed that TDF can reduce the risk of HBV MTCT after 6 months postpartum by 80% (risk ratio [RR] 0.2, 95% confidence interval [CI 0.06–0.7], n = 584) with low heterogeneity (I2 = 0%). TDF demonstrated HBV DNA suppression at delivery, though there was heterogeneity among individual studies (RR 0.13, 95% CI [0.08–0.20] and (RR 0.36, 95% CI [0.27–0.49]). Maternal and infant safety outcomes were comparable among treated and untreated mothers and infants born to them. The quality of evidence varied from high to very low. There is evidence that TDF effectively interrupted MTCT of HBV and suppressed HBV DNA level. Available studies on safety are very limited and heterogeneous, emphasising the need for additional RCTs with complete safety indicators. [ABSTRACT FROM AUTHOR]

The pandemic spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has affected 188 countries and territories. Altered physiological status during pregnancy makes a mother vulnerable to severe SARS-CoV-2 infection. The virus may be transmitted from mother to baby during antenatal period or postnatal period. Although the primary mode of transmission of the virus is by respiratory droplets, there is emerging evidence of in utero transmission from mother to foetus. In this rare case report, we describe one such episode of probable vertical transmission. To the best of our knowledge, this is the second systematically investigated Indian case, indicating in utero transmission of SARS-CoV-2 from mother to foetus. [ABSTRACT FROM AUTHOR]

Background: According to the 2019 UNAIDS reports, globally 38 million people were living with HIV (36.2 million adult and 1.8 million Children). About 25.4 million were accessing antiretroviral therapy. Only 81% knew their HIV status. About 85% pregnant women living with HIV had access to antiretroviral medicines. Objective: The purpose of this study was to assess the determinants of mother to child transmission of HIV in Addis Ababa, Ethiopia. Method: The study was conducted in three hospitals of Addis Ababa, Ethiopia. Mothers and HIV exposed infants were taken as study population. A total of 216 HIV exposed infants and mothers were selected by systematic random sampling method. Data was collected from February 2018 to April 2018. A hospital based cross-sectional study design was used for this study. Multivariate analysis was used to determine the association between dependant and independent variables. Results: According to multivariate analysis, mothers who did not disclose their HIV status for their sexual partner (AOR: 1.4, CI: 1.33–3.865, p: 0.000), HIV discordant couple (AOR: 4.021, CI: 2.380, 55.622, p: 000), maternal CD4 count/mm3 less than 350 (AOR: 8.435, CI: 2.130, 48.299, p: 000) and unknown HIV status before pregnancy (AOR = 4.562, CI: 3.168, 42.303, p = 0.000) were significantly associated with increased risk of mother to child HIV transmission. Conclusion: This study shows that mothers who didn’t disclose their HIV status, HIV discordant couple, Maternal CD4 count less than 350/mm3 and unknown HIV status before pregnancy were associated with increased risk of mother to child HIV transmission.

Pregnant women in Vietnam have a high prevalence of hepatitis B virus (HBV) and low prevalence of human immunodeficiency virus (HIV) and syphilis. This study aims to assess the feasibility and benefit of universal testing for HIV, HBV and syphilis in antenatal care (ANC) services. A pilot project was conducted in the Thai Nguyen province of Vietnam between 2012 and 2014. HIV, HBV and syphilis testing were offered to pregnant women. Interventions to eliminate mother-to child-transmission (MTCT) of the three pathogens were provided to infected mothers and their infants. Descriptive analysis was conducted, and the number of infections averted from integrating hepatitis B tests into ANC was estimated. Testing coverage for HIV, HBV and syphilis for the cohort of pregnant women during the pilot project was 98%. Prevalence of HIV, HBV and syphilis infections in this cohort was 0.14%, 7.8%, and 0.03%, respectively. No infant was infected with HIV or syphilis, while HBV infection was diagnosed in 27 infants (13.9%). An estimated 23 mother to child HBV infections were prevented by integrated interventions. The triple prevention of mother-to-child transmission of HIV, HBV and syphilis is feasible. Investment in the expansion of the integrated approach is required to achieve the goal of eliminating MTCT. [ABSTRACT FROM AUTHOR]

Hepatitis B (HBV) infection is a major public health concern. Perinatal transmission of HBV from mother to child represents the main mode of transmission. Despite the existence of effective immunoprophylaxis, the preventive strategy is inefficient in neonates born to mothers with HBV viral loads above 2 × 105 IU/mL. To prevent mother-to-child transmission, it is important to identify highly viremic pregnant women and initiate antiviral therapy to decrease their viral load. We developed a simple innovative molecular approach avoiding the use of automatic devices to screen highly viremic pregnant women. This method includes rapid DNA extraction coupled with an isothermal recombinase polymerase amplification (RPA) combined with direct visual detection on a lateral flow assay (LFA). We applied our RPA-LFA approach to HBV DNA-positive plasma samples with various loads and genotypes. We designed a triage test by adapting the analytical sensitivity to the recommended therapeutic decision threshold of 2 × 105 IU/mL. The sensitivity and specificity were 98.6% (95% CI: 92.7–99.9%) and 88.2% (95% CI: 73.4–95.3%), respectively. This assay performed excellently, with an area under the ROC curve value of 0.99 (95% CI: 0.99–1.00, p < 0.001). This simple method will open new perspectives in the development of point-of-care testing to prevent HBV perinatal transmission.

Background: The World Health Organisation (WHO) has established criteria to diagnose vertical transmission in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to determine the incidence of vertical transmission of SARS-CoV-2 using WHO criteria in a tertiary care centre in eastern India., Methods: A hospital-based prospective observational study was conducted from June 2021 to February 2022 on women admitted for delivery with a positive nasopharyngeal (NP) swab and a SARS-CoV-2 real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test. Following the delivery, the amniotic fluid (AF) and swab from the placenta were tested for SARS-CoV-2 by the Truenat test. The umbilical cord and maternal blood were analyzed to detect immunoglobulin M (IgM) and immunoglobulin G (IgG). The nasopharyngeal swabs of the newborns were tested for SARS-CoV-2 by RT-PCR., Results: Forty-eight SARS-CoV-2-positive asymptomatic women were included in the study. Twenty-eight (58.3%) were delivered via cesarean section. Preterm delivery occurred in 13 (27.1%) cases. In only one case, vertical transmission was confirmed as the neonate had a positive nasopharyngeal SARS-CoV-2 RT-PCR test and the cord blood was IgM positive (suggesting an immune response in the neonate). The placenta was positive in three cases, and amniotic fluid was positive in two. However, vertical transmission was deemed unlikely in these cases as there was no evidence of immune response or viral persistence according to the WHO criteria. There was one stillbirth, and it tested negative for SARS-CoV-2., Conclusion: This study strengthens the evidence of vertical transmission in COVID-19-positive asymptomatic mothers. The data suggest a low transmission rate., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Singh et al.)

A major global public health challenge is the continuance of new pediatric HIV infections primarily because of mother to child transmission of HIV occurring mainly in sub-Saharan African countries. The purpose of this study was to examine antiretroviral therapy (ART) refill adherence and its determinants among pregnant women living with HIV in Nigeria. A retrospective review of pharmacy refill records was undertaken to examine adherence data on 275 pregnant women undergoing ART in 4 high-volume HIV treatment sites in Nigeria. A pharmacy refill adherence measure was used to assess medication refill behavior of pregnant women living with HIV who had received an ART refill during a period of 3 months. Medication-based ART refill adherence was categorized as % adherence (100% adherence) or % nonadherence (<100% adherence) to the ART refill scheduled dates. Refill appointments were scheduled on a 28-day cycle. Multivariable logistic regression analysis was performed. Of the 275 women, 59.3% (95% CI, 53.1%–65.5%) were adherent to their ART refill schedule. Women who initiated ART during the third trimester of their current pregnancy had the lowest adherence rate of 30.8% (95% CI, 7.7%–53.8%) compared with women who commenced ART before conception or during the first or second trimester. The availability of a treatment support person was significantly associated with ART refill adherence. The odds of medication-based refill adherence were 2.9 times higher for participants who had a treatment support person (odds ratio = 2.9; 95% CI, 1.6–5.2; p = 0.001). Results indicate that having a treatment support person could contribute to improving ART adherence in pregnant women living in Nigeria. • Nearly 40% of women did not achieve 100% adherence to ART refill scheduled visits. • A treatment support person is critical to ART refill adherence during pregnancy. • Initiating ART before conception is vital to ART refill adherence during pregnancy. [ABSTRACT FROM AUTHOR]

Background: The HIV perinatal transmission in India even after interventions is still high. The anti-retroviral therapy failure rate and the risk of HIV vertical transmission to infants from women with failed treatment during pregnancy also largely remains unevaluated.Methods: This is a prospective, observational and follow-up study of 18 months to determine the association of ART failure in pregnant women and the subsequent risk of HIV transmission to their infants. A total of 81 mothers were evaluated for ART success/failure by analysing their viral loads.Results: Analyses revealed that a high percentage (19.75%) of women on ART had high viral loads, while the overall HIV transmission rate to the infants was 8.64%. The rate of transmission from women with high viral load was significantly high compared to women with low viral load (37.5% vs. 1.54%; p = 0.0015). CD4 level was not associated with HIV transmission. However, CD4 levels in women, who had successful or failed ART, were significantly different (p = 0.0031). Factors such as mother's age, baby's sex and weight as well as delivery mode were not associated with HIV transmission, however, breastfeeding and viral loads were found to be independently associated with HIV transmission to the neonates.Conclusions: This study highlights that a significant proportion of women on ART had impaired viral load control. The rate of HIV transmission to infants was also significantly high among these women. This warrants viral load monitoring of HIV infected women to reduce the overall transmission to the infants. [ABSTRACT FROM AUTHOR]

Nigeria has the highest burden of mother-to-child transmission of human immunodeficiency virus (HIV) worldwide. Pregnant women living with HIV in Nigeria face challenges adhering to antiretroviral therapy (ART). We explored the perspectives of pregnant women living with HIV, family members, friends and health professionals to understand adherence to ART. Pregnant women, family members, friends and health professionals recruited from four HIV treatment sites in Nigeria participated in semi-structured interviews and focus groups. Thematic analysis was conducted and themes and sub-themes were mapped against the Theory of Planned Behaviour comprising behavioural, normative and control beliefs. Overall, 74 participants took part in the study. Common behavioural beliefs comprised maintaining the mother's and unborn child's health and success of having HIV-negative children from previous pregnancies. Common normative beliefs involved partner and family support for medication taking and medication refill visits. Common control beliefs comprised fear of discrimination and stigmatisation. Results showed that adherence to ART in pregnancy is intricate. Hence, before interventions are developed to change adherence behaviours in pregnant women tailored strategies should be devised that address the salient beliefs that influence adherence during pregnancy. [ABSTRACT FROM AUTHOR]

Background Maternal syphilis causes poor birth outcomes, including congenital syphilis. Testing and treatment of partners prevents reinfection, but strategies to improve partner attendance are failing. The aim of this study was to determine the effectiveness of three partner notification strategies.Methods: Pregnant women with a positive point-of-care treponemal test at three antenatal clinics (ANCs) in Kampala, Uganda, were randomised 1:1:1 to receive either notification slips (NS; standard of care), NS and a text messages (SMS) or NS and telephone calls. The primary outcome was the proportion of partners who attended the ANC and were treated for syphilis.Results: Between 2015 and 2016, 17130 pregnant women were screened; 601 (3.5%) had a positive treponemal result, and 442 were enrolled in the study. Only 81 of 442 partners (18.3%; 23/152 (15.1%), 31/144 (21.5%) and 27/146 (18.5%) in the NS only, NS + SMS and NS + telephone call groups respectively) attended an ANC for follow-up; there were no significant differences between the groups. Twelve per cent of women attended the ANC with their male partner, and this proportion increased over time. Partner non-treatment was independently associated with adverse birth outcomes (odds ratio 2.75; 95% confidence interval 2.36-3.21; P < 0.001).Conclusions: Only 18.3% of partners of pregnant women who tested positive for syphilis received treatment. Female partners of non-attendant men had worse birth outcomes. Encouraging men to accompany women to the ANC and testing both may address the urgent need to treat partners of pregnant women in sub-Saharan Africa to reduce poor fetal outcomes. [ABSTRACT FROM AUTHOR]

Background Hepatitis B virus (HBV) infection is a severe health problem, especially in developing countries. Almost 45% of the population lives in highly endemic areas, where the most common form of transmission is mother to child transmission (MTCT). Administration of antiviral therapy has been established. Nevertheless, its efficacy still remains controversial. Methods We conducted the current study to fully evaluate the effectiveness of lamivudine in preventing the MTCT of HBV based on randomized controlled trials (RCTs). Four English electronic databases and four Chinese electronic databases were searched from the inception of each database to 26 September 2017. Studies were included if they (1) were human RCT studies, (2) indicated exposure to lamivudine, (3) explicitly indicated control to placebo or no treatment, (4) indicated the participants were pregnant women infected with HBVand (5) compared the outcome of interest as the MTCT. Extracted data were tabulated and analyzed using Review Manager. Results Eleven RCTs were included and analyzed. Compared with controls (placebo or no treatment), lamivudine significantly reduced the probability of MTCT, as indicated by newborn HBsAg seropositivity (RR=0.44, 95% CI 0.26 to 0.74, I2=41%), HBeAg seropositivity (RR=0.66, 95% CI 0.36 to 1.19, I2=0%) and HBV DNA seropositivity (RR=0.29, 95% CI 0.18 to 0.4'6, I2=0%) within 24 h after birth. Similar results were noted pertaining to infant HBsAg seropositivity and HBV DNA seropositivity within 6–7 and 12 mo. Conclusions Lamivudine can significantly reduce the MTCT of HBsAg and HBV DNA of neonates during the third trimester of pregnancy without severe adverse events. [ABSTRACT FROM AUTHOR]

HIV/AIDS continue to be serious communicable disease whose impact on public health in Namibia is massive. It is estimated that the prevalence rate of HIV in Namibia is 17.2%, ranking the country as the fifth highest in sub-Saharan Africa (SSA). Some improvement in reducing the number of cases of HIV/AIDS has been made in the country, but the sporadic shortage of medicines continues to slow down government efforts to foster the emergence of an HIV-free generation of Namibians. Develop and demonstrate a mathematical supply-chain model, which can establish parameters to prevent stock-outs of NVP suspension. The study adopted retrospective approach to acquire data from 2012-2016. Gamma supply chain model was developed as the optimal model for NVP syrup and forecasted consumption for 2017-2018 was determined. It is a recommendation of this study that new guidelines for implementation of optimal supply-chain models at the regional medical store, health centers and clinics be implemented for Nevirapine syrup. [ABSTRACT FROM AUTHOR]

Abstract Objective The purpose of this study was to identify factors associated with family planning needs among people living with human immunodeficiency virus (HIV) in Ethiopia. Results Three hundred twenty-one participants provided information on family planning methods and associated factors. Forty-six-point four percent of respondents reported using at least one form of family planning method; injectables (50.3%) and condoms (70.2%) were the most commonly used type of family planning method before and after HIV diagnosis, respectively. Age, the desire to have children, and the desire to have more than two children were significantly associated with the use of family planning methods.