Antenatal Care - Treatment
Gaps in Research
- 1.
- Interventions are needed to increase knowledge of PMTCT-Plus programs among women and the community and to reduce stigma and discrimination directed toward HIV-positive mothers.
- 2.
- Interventions are needed to inform women IDUs of harm reduction early in pregnancy.
- 3.
- Well functioning laboratory systems are needed to measure viral load via PCR to assess effectiveness of treatment.
- 4.
- Interventions are needed to address gender inequity 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. 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.
Gap noted, for example, in South Africa (Sprague, 2009), Botswana (Kebaabetswe, 2007) and Zimbabwe (Feldman and Masophere, 2003).
Sprague, C. 2009. “Cuo Bono? A Capabilities Approach to Understanding HIV Prevention and Treatment for Pregnant Women and Children in South Africa.” Submitted for the Degree of Doctor of Philosophy. University of Witwatersrand. South Africa.
2. Interventions are needed to inform women injection drug users of harm reduction early in pregnancy. A study of PMTCT programs found that women IDUs 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 IDUs fear accessing health services for fear of losing custody of their children. Another study found that continuous methadone treatment for female IDUs during pregnancy is associated with earlier antenatal care and improved neonatal outcomes.
Gap noted, for example, in Ukraine (Thorne et al., 2009); Australia (Burns et al., 2006); and for female IDUs in numerous countries (Pinkham and Malinowska-Sempruch, 2008; HRW, 2005 cited in Pinkham and Malinowska-Sempruch, 2008).
Thorne, C., I. Semenko, T. Pilipenko, R. Malyuta and the Ukraine European Collaborative Study Group. 2009. “Progress in Prevention of Mother-to-child Transmission of HIV Infection in Ukraine: Results from a Birth Cohort Study.” BMC Infectious Diseases 9 (40); doi: 10.1186/1471-2334-9-40
3. Well functioning laboratory systems are needed to measure viral load via PCR to assess effectiveness of treatment. A study noted “In Africa, access to viral load assessment is extremely limited, and patients must wait until immunologic or clinical deterioration is manifested before being switched to new drugs, which reduces future treatment options and increases the risk of transmission.”
Gap noted generally in Africa.
Ford, N., E. Mills and A. Calmy. 2009b. “Rationing Antiretroviral Therapy in Africa – Treating Too Few, Too Late.” New England Journal of Medicine 360 (18): 1808-1810.