Antenatal Care - Treatment
Gaps in Research
- 1.
- Interventions are needed to increase community knowledge of PMTCT-Plus programs and to reduce stigma and discrimination directed toward HIV-positive mothers.
- 2.
- Interventions are needed to inform both providers and women injection drug users of the benefits of harm reduction early in pregnancy and to provide women who use drugs with proven effective interventions for safe motherhood and prevention of vertical transmission.
- 3.
- Pregnant women living with HIV need timely CD4 count testing, with results, to access HAART.
- 4.
- Prospective surveillance systems of pregnant women on ARVs who give birth in developing countries are needed to inform the assessment of rare birth defects.
- 5.
- Additional efforts are needed so that pregnant women who qualify to receive HAART, both for their own health and to prevent transmission to partners and infants.
- 6.
- Nutritional supplements in addition to ARVs may be needed to avert adverse outcomes for mothers and babies.
- 7.
- Further research is needed to assess the long-term health impacts and possible drug resistance for pregnant women living with HIV who initiate ART solely for the prevention of vertical transmission and then stop.
- 8.
- Interventions are needed to address gender inequality related to uptake and adherence of ART and ARV prophylaxis.
1. Interventions are needed to increase community knowledge of PMTCT-Plus programs and to reduce stigma and discrimination directed toward HIV-positive mothers. [See also Reducing Stigma and Discrimination] Studies found that single dose nevirapine for HIV-positive mothers to prevent vertical transmission which is currently contraindicated by WHO is still widely used. Studies found that providers do not expect pregnant women living with HIV to be sexually active and do not have adequate training or counseling skills. Providers and community members blamed women for being HIV-positive and for becoming pregnant. A study also found that pregnant women believed that HAART is only required after clinical signs of HIV are manifested.
Gap noted, for example, in Uganda (Duff et al., 2010); South Africa (Sprague, 2009; Sprague et al., 2011), Botswana (Kebaabetswe, 2007) and Zimbabwe (Feldman and Maposhere, 2003).
2. Interventions are needed to inform both providers and women injection drug users of the benefits of harm reduction early in pregnancy and to provide women who use drugs with proven effective interventions for safe motherhood and prevention of vertical transmission. [See also Women Who Use Drugs and Female Partners of Men Who Use Drugs] A study of PMTCT programs found that women who use drugs were the least likely to receive treatment and only to be tested for HIV during labor. No linkages were found between PMTCT programs and harm reduction programs. Women who use drugs fear accessing health services for fear of losing custody of their children. Another study found that continuous methadone treatment for female drug users during pregnancy is associated with earlier antenatal care and improved neonatal outcomes. However, a study found that medical providers caring for pregnant women did not understand opioid agonist treatment or the safety of opioid agonist treatment during pregnancy. Another study found that fewer pregnant HIV-positive drug users had access to proven effective interventions for safe motherhood and prevention of vertical transmission compared to other pregnant women.
Gap noted, for example, in Ukraine (Finnerty et al., 2010; Thorne et al., 2010; Thorne et al., 2009); Australia (Burns et al., 2006); and for FWID in numerous countries (Pinkham and Malinowska-Sempruch, 2008; HRW, 2005 cited in Pinkham and Malinowska-Sempruch, 2008).
3. Pregnant women living with HIV need timely CD4 count testing, with results, to access HAART. A study found that of 14,815 HIV-positive pregnant women, only 17.1% had their CD4 cells counted and of those only 66.5% had their CD4 counts available; of these, only 581 were initiated on HAART.
Gap noted, for example in Zambia (Mandala et al., 2009) Zimbabwe (Muchedzi et al., 2010) and globally in resource-limited settings (Wilfert et al., 2011).
4. Prospective surveillance systems of pregnant women on ARVs who give birth in developing countries are needed to inform the assessment of rare birth defects. Randomized controlled trials would be unethical but meta-analysis shows the need for more data to assess birth defects for pregnant women who give birth while on ARVs.
Gap noted generally in Côte d’Ivoire, South Africa, Thailand and other countries (Ford et al., 2011).
5. Additional efforts are needed so that pregnant women who qualify to receive HAART, both for their own health and to prevent transmission to partners and infants. A study found that pregnant women who were eligible for HAART did not access HAART.
Gap noted, for example, in South Africa (Stinson et al., 2010); Uganda (Ahoua et al., 2010) and Brazil (Fernandes et al., 2010).
6. Nutritional supplements in addition to ARVs may be needed to avert adverse outcomes for mothers and babies. A study found high rates of anemia as well as adverse infant outcomes due to maternal malnutrition. Globally, women in developing countries suffer high rates of anemia in pregnancy (Hardee et al., 2012).
Gap noted globally (Mirochnick et al., 2010); in Uganda (Cohan et al., 2012) and Tanzania (Mehta et al., 2010)
7. Further research is needed to assess the long-term health impacts and possible drug resistance for pregnant women living with HIV who initiate ART solely for the prevention of vertical transmission and then stop. A study showed that changes in CD4 counts and viral levels over a period of one year were similar between women who continued ART and stopped ART after delivery, however increased immune activation among women stopping ART requires further study. The ongoing NIH-funded PROMISE study is designed to answer this question with results anticipated in 2015.
Gap noted, for example, in the United States (Watts et al., 2009); and South Africa (Parboosing et al., 2011).
8. Interventions are needed to address gender inequality related to uptake and adherence of ART and ARV prophylaxis. [See Treatment]
Gap noted for Uganda (Duff et al., 2010).