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Option B+ for prevention of vertical HIV transmission has no influence on adverse birth outcomes in a cross-sectional cohort in Western Uganda.
BMC Pregnancy and Childbirth. 2017 Mar 7; 17(82):1-12.Background While most Sub-Saharan African countries are now implementing the WHO-recommended Option B+ protocol for prevention of vertical HIV transmission, there is a lack of knowledge regarding the influence of Option B+ exposure on adverse birth outcomes (ABOs). Against this background, we assessed ABOs among delivering women in Western Uganda. Methods A cross-sectional, observational study was performed within a cohort of 412 mother-newborn-pairs in Virika Hospital, Fort Portal in 2013. The occurrence of stillbirth, pre-term delivery, and small size for gestational age (SGA) was analyzed, looking for influencing factors related to HIV-status, antiretroviral drug exposure and duration, and other sociodemographic and clinical parameters. Results Among 302 HIV-negative and 110 HIV-positive women, ABOs occurred in 40.5%, with stillbirth in 6.3%, pre-term delivery in 28.6%, and SGA in 12.2% of deliveries. For Option B+ intake (n = 59), no significant association was found with stillbirth (OR 0.48, p = 0.55), pre-term delivery (OR 0.97, p = 0.92) and SGA (OR 1.5, p = 0.3) compared to seronegative women. Women enrolled on antiretroviral therapy (ART) before conception (n = 38) had no different risk for ABOs than women on Option B+ or HIV-negative women. Identified risk factors for stillbirth included lack of formal education, poor socio-economic status, long travel distance, hypertension and anemia. Pre-term delivery risk was increased with poor socio-economic status, primiparity, Malaria and anemia. The occurrence of SGA was influenced by older age and Malaria. Conclusion In our study, women on Option B+ showed no difference in ABOs compared to HIV-negative women and to women on ART. We identified several non-HIV/ART-related influencing factors, suggesting an urgent need for improving early risk assessment mechanisms in antenatal care through better screening and triage systems. Our results are encouraging with regard to continued universal scale-up of Option B+ and ART programs.
Monitoring equity in access to AIDS treatment programmes: a review of concepts, models, methods and indicators.
Geneva, Switzerland, WHO, 2010.  p.The World Health Organization (WHO) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through REACH Trust Malawi and Training and Research Support Centre (TARSC) developed this review. It provides a practical resource for programme managers, health planning departments, evaluation experts and civil society organizations working on health systems and HIV / AIDS programmes at sub-national, national and regional levels in East and Southern Africa. Many of the orientations and tools in this document were developed through a wide consultation process, starting in 2003. We draw on the broader analysis of health equity advanced by EQUINET, as well as evidence from five background studies on equity and health systems impacts of ART programming in East and Southern Africa which were supported by EQUINET, TARSC and DFID (available at www. equinetafrica.org). (Excerpt)
2005 Oct 1; 366:1151-1152.Aid organisations are fighting an uphill battle to help victims of Zimbabwe’s disastrous Operation Restore Order which, according to UN envoy Anna Tibaijuka, left an estimated 700 000 people without a home or livelihood and caused chaos and suffering “on an unprecedented scale”. The clampdown on slum dwellers and street traders—ostensibly to tackle crime—added to the humanitarian nightmares in the southern African nation where more than one-third of the population will soon be dependent on food aid; where HIV/AIDS rates of some 25% are expected to rise; and where life expectancy has plummeted to 33 years. Although the UN launched urgent appeals for drought-stricken neighbouring countries like Malawi and Mozambique, its efforts to aid victims of Operation Restore Order have been frustrated by the Zimbabwean government. (excerpt)
Geneva, Switzerland, WHO, 2004 May 11.  p.This is a critical moment in the history of HIV/AIDS. There is more money, more political will and more attention being paid to this killer disease than ever before. And yet, more people than ever are dying of AIDS and becoming infected with HIV. By using HIV treatment programs to strengthen existing prevention programs and improve health systems, the international community has a unique opportunity to change the course of history, says The World Health Report 2004 - Changing History. WHO, UNAIDS and partners are implementing a comprehensive HIV/AIDS strategy which links prevention, treatment, care and support for people living with the virus. Until now, treatment has been the most neglected element in most developing countries. Yet among all possible HIV- related interventions, the report says it is treatment that can most effectively boost prevention efforts and in turn drive the strengthening of health systems and enable poor countries to protect people from a wide range of health threats. "At long last, global investment in health - and particularly in the fight against HIV/AIDS - is on the rise. It brings a welcome and long overdue improvement in the prospects for controlling the worst global epidemic in several centuries. The challenge now is to coordinate all our efforts and to ensure that this money benefits the people who need it most," said LEE Jong-wook, Director- General of the World Health Organization (WHO). (excerpt)