Download or read book Delivery of Antiretroviral Pre exposure Prophylaxis for HIV Prevention in Pregnant and Postpartum Women written by Jillian Pintye and published by . This book was released on 2017 with total page 94 pages. Available in PDF, EPUB and Kindle. Book excerpt: Women in sub-Saharan Africa have substantial risk of acquiring HIV acquisition during and soon after pregnancy. Additionally, acute HIV infection among pregnant and breastfeeding women poses a double burden in that acute maternal HIV accounts for nearly one-third of all mother-to-child transmissions of HIV (MTCT). To reach global targets for elimination of MTCT and HIV prevention for mothers, it is critical to integrate effective primary HIV prevention strategies into maternal and child health (MCH) services. Tenofovir disoproxil fumarate (TDF)-based pre-exposure prophylaxis (PrEP) prevents HIV infection in adherent women. The World Health Organization (WHO) recommends PrEP for all individuals, including pregnant and breastfeeding women, at substantial HIV risk (defined as HIV residence in regions where HIV incidence is >3%). Programmatic delivery of PrEP for pregnant women is currently being considered in high-prevalence regions, though implementation approaches that efficiently optimize the benefit of PrEP during pregnancy have not been defined. Additionally, although WHO guidelines support PrEP use in pregnancy, national committees have differed in their conclusions. For example, PrEP use during pregnancy is supported by Kenyan antiretroviral guidelines but the lack of complete safety data led PrEP to be contraindicated for pregnant women in the current South African PrEP guidelines. As countries expand programmatic delivery of PrEP to pregnant women, it is important to understand motivations and beliefs for using PrEP during pregnancy to address concerns unique to this population. The studies within this dissertation address the implementation science gaps described above for the delivery of PrEP for HIV prevention to pregnant and postpartum in sub-Saharan Africa. To inform efficient PrEP delivery models, we present an empiric risk score for identifying pregnant and postpartum Kenyan women at highest risk for HIV acquisition who would mostly benefit from PrEP while reducing unnecessary exposure among low-risk women. Using data that could be easily collected in standard MCH clinic settings without additional laboratory diagnostics, our risk score identified 56% of pregnant women who acquired HIV among just 16% of women. Using register data from 62 antenatal MCH facilities throughout Kenya, we further estimated the absolute number and proportion of HIV-uninfected pregnant women in Kenya who could be offered PrEP under different public health approaches, including offering PrEP universally or based on either regional HIV prevalence and/or individual-level HIV risk factors. We found that offering PrEP only to pregnant women in the region with highest HIV prevalence (Nyanza) would reduce PrEP use among low-risk women by 74%, but exclude 63% of women with high risk for HIV based on individual-level characteristics nationally. To complement service delivery data, we also assessed experiences of using PrEP during pregnancy among HIV-uninfected Kenyan women in HIV-serodiscordant couples who became pregnant while using PrEP. The personal experiences of women with direct exposure to PrEP during pregnancy offers valuable insights for informing development of effective PrEP messaging strategies and programs. Finally, we evaluate whether adverse perinatal outcomes were more frequent in a cohort of Kenyan and Ugandan HIV-infected women who used TDF-containing antiretroviral therapy (ART) during pregnancy compared to HIV-infected women who used ART during pregnancy that did not contain TDF. Our findings support the growing evidence that prolonged prenatal TDF use is not associated with adverse perinatal outcomes and contribute to the few prospective studies evaluating the safety of TDF use during pregnancy from African cohorts. The studies within this dissertation aim to address these implementation science gaps and inform optimal and effective delivery of PrEP for HIV prevention to pregnant and postpartum in sub-Saharan Africa.

Download or read book Oral Pre exposure Prophylaxis Delivery Among HIV negative Pregnant and Postpartum Women in Antenatal Clinics of Cape Town South Africa written by Nehaa Khadka and published by . This book was released on 2023 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: HIV acquisition risks remain high for pregnant and breastfeeding populations in South Africa. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF-FTC) can be used daily during periods of sexual activity to prevent HIV infections for cisgender women. In 2021, oral PrEP became the standard of care for HIV prevention during pregnancy and breastfeeding periods. The objective of this dissertation was to evaluate trends in oral PrEP initiation, continuation, and adherence among adolescent girls and young women, women experiencing intimate partner violence, and by sexual behaviors throughout gestational periods and postpartum. We used data from the PrEP in Pregnancy and Postpartum (PrEP-PP) study, a prospective cohort in Cape Town of 1200 participants without HIV. The PrEP-PP study provided HIV prevention counselling and offered PrEP to pregnant and breastfeeding women.The first study evaluated the oral PrEP cascade framework among adolescent girls and young women (AGYW) in the PrEP-PP study. Approximately 83% of AGYW initiated PrEP at their first antenatal care (ANC) visit, 34% continued PrEP at 6 months, and 11% stopped and restarted. AGYW with a higher HIV risk had an increased adjusted likelihood of continuing PrEP through 6 months (adjusted odds ratio[aOR]:1.91 [95% CI, 1.15-3.16]). About 7% of AGYW had high adherence to PrEP at 6 months. The second study examined the relationship between recent and past-year intimate partner violence (IPV) experienced by pregnant and postpartum women and oral PrEP continuation and adherence. Women who experienced past-year IPV were less likely to discontinue PrEP(adjusted hazards ratio: 0.80 (95% CI: 0.61, 1.06) and had higher adherence(quantifiable tenofovir-diphosphate[TFV-DP] in dried blood spots; aOR=1.82 (95% CI: 1.02, 3.25) at 6-month follow-up visits. The third study evaluated prevention-effective adherence by gestational trimesters of pregnancy and postpartum. Prevention-effective adherence(initiation/quantifiable TFV-DP or reported use during follow-up among those engaging in condomless sex) was 65% overall, with the highest adherence in trimester 1(81%) and lowest at early postpartum(49%). There was a positive association between engaging in condomless sex and PrEP use(quantifiable TFV-DP or self-reported use; adjusted risk ratio:1.88; 95% CI: 1.67, 2.12). In conclusion, AGYW during pregnancy and postpartum had high oral uptake, but retention in PrEP by 6 months was low. Those with higher HIV risks are more likely to continue PrEP. Pregnant/postpartum women who experienced past-year IPV were more likely to stay in the study and had greater adherence. The findings suggest that pregnant and postpartum women align their PrEP use with their potential HIV risks. Implementing violence screening and oral PrEP counselling (with conversations about changing HIV risks) at ANC may improve HIV prevention for women during pregnancy and postpartum in South Africa and beyond.

Download or read book HIV Testing During Pregnancy at Delivery and Postpartum written by Rodney L. Wright and published by . This book was released on 2020 with total page 11 pages. Available in PDF, EPUB and Kindle. Book excerpt: Timely diagnosis of HIV and rapid initiation of antiretroviral therapy are crucial to reducing the risk of perinatal HIV transmission and maintaining the health of pregnant patients and their infants. This guideline was developed by the New York State (NYS) Department of Health (DOH) AIDS Institute (AI) to provide evidence-based recommendations regarding HIV testing during pregnancy and at delivery and to promote universal HIV screening for all pregnant patients to achieve the following: Ensure universal HIV screening early in pregnancy, during the third trimester, and during labor for individuals who do not have a documented negative HIV status. Encourage third-trimester testing for syphilis and HIV testing. Encourage HIV testing for pregnant and postpartum patients who exhibit symptoms of acute HIV. Increase uptake of pre-exposure prophylaxis among pregnant patients who do not test positive for HIV but who are at high risk of HIV acquisition during pregnancy and postpartum.

Download or read book Obstetric Care written by Martin Olsen and published by Cambridge University Press. This book was released on 2017-10-04 with total page 540 pages. Available in PDF, EPUB and Kindle. Book excerpt: Gain a critical understanding of obstetrics, and a thorough knowledge base of modern management techniques, with this accessible textbook. While acting as a stand-alone text on obstetric care, this volume also forms part of a three-volume set - all authored by leading authorities - on the entirety of obstetric and gynecologic practice. Obstetric Care's topics are based on academic objectives of experts in the field. This textbook offers tailored support for new residents and experienced physicians alike. Obstetric Care is invaluable for wide-ranging yet concise reference material, and provides evidence based care recommendations for specific patient conditions. The chapters in this textbook are based on the objectives of the Committee for Resident Education in Obstetrics and Gynecology; the book offers outstanding modern management techniques across the obstetrics specialty, making it a go-to for reference and comprehensive study.

Download or read book Disease Control Priorities Third Edition Volume 6 written by King K. Holmes and published by World Bank Publications. This book was released on 2017-11-06 with total page 1027 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

Download or read book Creating a Circle of Care written by and published by . This book was released on 1998 with total page 104 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV written by World Health Organization and published by World Health Organization. This book was released on 2017-02-20 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt: he starting point for this guideline is the point at which a woman has learnt that she is living with HIV and it therefore covers key issues for providing comprehensive sexual and reproductive health and rights-related services and support for women living with HIV. As women living with HIV face unique challenges and human rights violations related to their sexuality and reproduction within their families and communities as well as from the health-care institutions where they seek care particular emphasis is placed on the creation of an enabling environment to support more effective health interventions and better health outcomes. This guideline is meant to help countries to more effectively and efficiently plan develop and monitor programmes and services that promote gender equality and human rights and hence are more acceptable and appropriate for women living with HIV taking into account the national and local epidemiological context. It discusses implementation issues that health interventions and service delivery must address to achieve gender equality and support human rights.

Download or read book Counselling for Maternal and Newborn Health Care written by World Health Organization and published by World Health Organization. This book was released on 2010 with total page 240 pages. Available in PDF, EPUB and Kindle. Book excerpt: The main aim of this practical Handbookis to strengthen counselling and communication skills of skilled attendants (SAs) and other health providers, helping them to effectively discuss with women, families and communities the key issues surrounding pregnancy, childbirth, postpartum, postnatal and post-abortion care. Counselling for Maternal and Newborn Health Careis divided into three main sections. Part 1 is an introduction which describes the aims and objectives and the general layout of the Handbook. Part 2 describes the counselling process and outlines the six key steps to effective counselling. It explores the counselling context and factors that influence this context including the socio-economic, gender, and cultural environment. A series of guiding principles is introduced and specific counselling skills are outlined. Part 3 focuses on different maternal and newborn health topics, including general care in the home during pregnancy; birth and emergency planning; danger signs in pregnancy; post-abortion care; support during labor; postnatal care of the mother and newborn; family planning counselling; breastfeeding; women with HIV/AIDS; death and bereavement; women and violence; linking with the community. Each Session contains specific aims and objectives, clearly outlining the skills that will be developed and corresponding learning outcomes. Practical activities have been designed to encourage reflection, provoke discussions, build skills and ensure the local relevance of information. There is a review at the end of each session to ensure the SAs have understood the key points before they progress to subsequent sessions.

Download or read book Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection written by World Health Organization and published by . This book was released on 2016 with total page 429 pages. Available in PDF, EPUB and Kindle. Book excerpt: These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.

Download or read book Pregnancy Childbirth Postpartum and Newborn Care written by World Health Organization and published by . This book was released on 2015 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Intended to provide evidence-based recommendations to guide health care professionals in the management of women during pregnancy, childbirth and postpartum, and newborns, and the post abortion, including management of endemic deseases like malaria, HIV/AIDS, TB and anaemia. This edition has been updated to include recommendations from recently approved WHO guidelines relevant to maternal and perinatal health. These include pre-eclampsia & eclampsia; postpartum haemorrhage; postnatal care for the mother and baby; newborn resuscitation; prevention of mother-to- child transmission of HIV; HIV and infant feeding; malaria in pregnancy, interventions to improve preterm birth outcomes, tobacco use and second-hand exposure in pregnancy, post-partum depression, post-partum family planning and post abortion care.

Download or read book Infections in Pregnancy written by Adel Elkady and published by Cambridge University Press. This book was released on 2019-10-24 with total page 215 pages. Available in PDF, EPUB and Kindle. Book excerpt: Provides effective diagnosis and management of infectious diseases in pregnant women in a single comprehensive available resource for busy clinicians.

Download or read book A Guide to the Clinical Care of Women with HIV written by Jean R. Anderson and published by DIANE Publishing Inc.. This book was released on 2005 with total page 636 pages. Available in PDF, EPUB and Kindle. Book excerpt: NOTE: NO FURTHER DISCOUNT FOR THIS PRODUCT ITEM -OVERSRTOCK SALE-- Significantly reduced price. Edited by Jean R. Anderson. This guide addresses the health care needs unique to women with HIV. It targets clinicians who provide primary care to women as well as those seeking an understanding of how to take care of women with HIV/AIDS. This guide includes tables, figures, color plates, resources, references, and indices. This 2005 edition includes new chapters on international issues and nutrition. Edge indexed."

Download or read book Screening for HIV in Pregnant Women Systematic Review to Update the U S Preventive Services Task Force Recommendation written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-04-17 with total page 106 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of this report is to update a previous evidence review commissioned by the U.S. Preventive Services Task Force (USPSTF) on screening for asymptomatic HIV infection in pregnant women, including adolescents. In 2005, based on the earlier review, the USPSTF recommended that clinicians screen all pregnant women for HIV (grade A recommendation). Although the USPSTF found no studies that directly evaluated prenatal HIV screening versus no screening on risk of mother-to-child transmission or other clinical outcomes, it found good evidence that prenatal testing is accurate and acceptable to women and that treatment with recommended interventions (combination antiretrovirals, elective Cesarean delivery in women with viral loads greater than 1,000 copies/mL near the time of delivery, and avoidance of breastfeeding) is associated with major reductions in risk of mother-to-child transmission (from 14% to 25% in untreated women to 1% to 2% with treatment). The USPSTF concluded that benefits of treatments in reducing perinatal transmission substantially outweighed short-term harms, though evidence on long-term maternal or infant harms associated with screening and subsequent interventions was limited. The current report will be used by the USPSTF to update its 2005 recommendation on prenatal HIV screening. This update focuses on newer evidence on the accuracy and acceptability of rapid versus standard testing, the effectiveness of newer antiretroviral regimens for reducing mother-to-child transmission, long-term maternal outcomes following use of antiretroviral regimens during pregnancy, and maternal and infant harms associated with use of antiretroviral medications. Because perinatal practices and interventions related to prevention of HIV infection are substantially impacted by the availability of resources, the report will emphasize evidence applicable to typical practice in the United States. A major goal of prenatal screening for HIV is to reduce the risk of mother-to-child transmission through subsequent interventions. Other important goals are to improve long-term clinical outcomes in HIV-infected women, facilitate early identification of infected newborns, help women to make more informed future reproductive choices, and reduce risk of horizontal transmission through effects on risky behaviors. Using the methods developed by the USPSTF, the USPSTF and the Agency for Healthcare Research and Quality (AHRQ) determined the scope and key questions for this review. Investigators created an analytic framework with the key questions and patient populations, interventions, and outcomes reviewed. The target population for HIV screening was pregnant women without signs or symptoms of HIV infection. Key Questions include: Key Question 1. What are the benefits of HIV screening versus no screening in asymptomatic pregnant women on maternal or child morbidity, mortality, or quality of life or rates of mother-to-child transmission? Key Question 2a. What is the yield (number of new diagnoses) of repeat HIV screening in asymptomatic pregnant women? Key Question 2b. What are the adverse effects (including false-positive results and anxiety) of rapid versus standard HIV testing in asymptomatic pregnant women? Key Question 3a. What is the effectiveness of newer antiretroviral regimens for reducing mother-to- child transmission? Key Question 3b. What are the effects of antiretroviral regimens in pregnant, HIV-positive women on long-term maternal morbidity, mortality, or quality of life? Key Question 3c. What are the harms (including longer-term harms) to the mother or child associated with antiretroviral therapy during pregnancy?

Download or read book HIV 1 Risk and Prevention Strategies for Women During Pregnancy and Postpartum written by Kerry A. Thomson and published by . This book was released on 2017 with total page 92 pages. Available in PDF, EPUB and Kindle. Book excerpt: HIV-1 is the leading cause of death worldwide among women of reproductive age, and this group is a priority to reach with effective HIV-1 prevention. There is great potential to provide HIV-1 interventions to women during the periconception, pregnancy, and postpartum periods by leveraging existing healthcare settings that serve women and couples at high risk of HIV-1 acquisition. These opportunities include integration of HIV-1 prevention strategies within antenatal and postnatal care programs in settings with high HIV-1 prevalence and inclusion of safer conception programs within clinical HIV-1 care for HIV-1 affected individuals and couples desiring children. Specifically, antiretrovirals, as PrEP used by HIV-1 uninfected people and ART used by HIV-1 infected people, are highly effective and important for women and couples, especially those planning and experiencing pregnancy. The aims within this dissertation address questions regarding HIV-1 risk and implementation of antiretrovirals for HIV-1 prevention among women and their partners during reproductive stages, including: quantifying the risk of female HIV-1 acquisition in different reproductive stages, making the case for PrEP as a highly efficacious HIV-1 strategy for women, and describing fertility intentions and willingness to use safer conception strategies during pregnancy attempts among HIV-1 infected individuals. Previous studies have shown that pregnancy and postpartum are periods with heightened HIV-1 acquisition risk for women, but it is not clear whether this is primarily driven by biological or behavioral factors. We have addressed this gap by using robust data from two longitudinal studies to estimate the per coital act probability of female HIV-1 acquisition during the early pregnancy, late pregnancy, and postpartum stages, relative to time periods to unrelated to pregnancy. We found that the risk of HIV-1 transmission per coital act steadily increased pregnancy and was highest during postpartum, even after accounting for sexual behavior, PrEP, and HIV-1 viral load, suggesting that biological changes during these periods increase HIV-1 risk. Conflicting results and conclusions from the initial randomized clinical trials that assessed efficacy of PrEP for HIV-1 prevention among women has spurred debate about whether PrEP is a strategy that women will use effectively. This debate has delayed the initiation of programs to deliver PrEP to women, and specifically has been a barrier to the integration of PrEP into antenatal and postnatal care where it has the potential to reach women who most need enhanced HIV-1 prevention. We have objectively assessed and synthesized existing evidence of PrEP efficacy among women and made a conclusive case that PrEP is an effective HIV-1 prevention strategy for women. Couples affected by HIV-1 with fertility desires experience heightened vulnerability to HIV-1 acquisition when they forgo condom use during pregnancy attempts. “Safer conception” is a risk reduction approach where HIV-1 serodiscordant couples use one or more strategies to reduce the risk of HIV-1 transmission and optimize fertility during pregnancy attempts. We have contributed to the growing demand for information on safer conception with a cross-sectional study to describe fertility intentions and preferences for safer conception strategies, including PrEP and ART, among HIV-1 infected individuals in Seattle, WA. The collective results from this dissertation provide evidence for the urgent need to enhance HIV-1 prevention during pregnancy and the postpartum period, and advance global and local delivery mechanisms for PrEP and ART during periods of heightened risk when they can have substantial HIV-1 prevention impact.

Download or read book WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience written by World Health Organization and published by . This book was released on 2016 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Within the continuum of reproductive health care, antenatal care provides a platform for important health-care functions, including health promotion, screening and diagnosis, and disease prevention. It has been established that, by implementing timely and appropriate evidence-based practices, antenatal care can save lives. Endorsed by the United Nations Secretary-General, this is a comprehensive WHO guideline on routine antenatal care for pregnant women and adolescent girls. It aims to complement existing WHO guidelines on the management of specific pregnancy-related complications. The guidance captures the complex nature of the antenatal care issues surrounding healthcare practices and delivery, and prioritizes person-centered health and well-being --- not only the prevention of death and morbidity --- in accordance with a human rights-based approach.

Download or read book WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV related disease in adults and children written by and published by . This book was released on 2007 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Evaluation and Management of Early HIV Infection written by and published by . This book was released on 1994 with total page 214 pages. Available in PDF, EPUB and Kindle. Book excerpt: