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Application opportunities of geographic information systems analysis to support achievement of the UNAIDS 90-90-90 targets in South Africa.
South African Medical Journal. 2017 Nov 27; 107(12):1065-1071.In an effort to achieve control of the HIV epidemic, 90-90-90 targets have been proposed whereby 90% of the HIV-infected population should know their status, 90% of those diagnosed should be receiving antiretroviral therapy, and 90% of those on treatment should be virologically suppressed. In this article we present approaches for using relatively simple geographic information systems (GIS) analyses of routinely available data to support HIV programme management towards achieving the 90-90-90 targets, with a focus on South Africa (SA) and other high-prevalence settings in low- and middle-income countries. We present programme-level GIS applications to map aggregated health data and individual-level applications to track distinct patients. We illustrate these applications using data from City of Johannesburg Region D, demonstrating that GIS has great potential to guide HIV programme operations and assist in achieving the 90-90-90 targets in SA.
Uptake and performance of prevention of mother-to-child transmission and early infant diagnosis in pregnant HIV infected women and their exposed infants at seven health centres in Addis Ababa, Ethiopia.
Tropical Medicine and International Health. 2017 Jun; 22(6):765-775.Objective To assess the uptake of WHO-recommended PMTCT procedures in Ethiopia's health services. Methods Prospective observational study of HIV-positive pregnant mothers and their newborns attending PMTCT services at seven health centers in Addis Ababa. Women were recruited during antenatal care and followed-up with their newborns at delivery, day 6 and week 6 postpartum. Retention to PMCTC procedures, self-reported ART adherence, and HIV infant outcome were assessed. Turnaround times of HIV early infant diagnosis (EID) procedures were extracted from health registers. Results Of 494 women enrolled 4.9% did not complete PMTCT procedures due to active denial or loss to follow-up. HIV was first diagnosed in 223 (45.1%) and ART initiated in 321 (65.0%) women during pregnancy. ART was initiated in a median of 1.3 weeks (IQR 0-4.3) after HIV diagnosis. Poor self-reported treatment adherence was higher post-partum than during pregnancy (12.5% versus 7.0%, p=0.002), and significantly associated with divorced/separated marital status (RR 2.2, 95% CI 1.3-3.8), low family income (RR 2.1, 95% CI 1.1-4.1), low CD4-count (RR 1.7, 95% CI 1.0-3.0), and ART initiation during delivery (RR 2.5, 95% CI 1.1-5.6). Of 435 infants born alive 98.6% received nevirapine prophylaxis. The mother-to-child HIV transmission rate was 0.7% after a median of 6.7 weeks (IQR 6.4-10.4), but EID results were received for only 46.6% within 3 months of birth. Conclusion High retention in PMTCT services, triple maternal ART and high infant nevirapine prophylaxis coverage were associated with low mother-to-child HIV transmission. Declining post-partum ART adherence and challenges of EID linkage require attention.
Validation of 2006 WHO prediction scores for true HIV infection in children less than 18 months with a positive serological HIV test.
PloS One. 2009; 4(4):e5312.INTRODUCTION: All infants born to HIV-positive mothers have maternal HIV antibodies, sometimes persistent for 18 months. When Polymerase Chain Reaction (PCR) is not available, August 2006 World Health Organization (WHO) recommendations suggest that clinical criteria may be used for starting antiretroviral treatment (ART) in HIV seropositive children <18 months. Predictors are at least two out of sepsis, severe pneumonia and thrush, or any stage 4 defining clinical finding according to the WHO staging system. METHODS AND RESULTS: From January 2005 to October 2006, we conducted a prospective study on 236 hospitalized children <18 months old with a positive HIV serological test at the national reference hospital in Kigali. The following data were collected: PCR, clinical signs and CD4 cell count. Current proposed clinical criteria were present in 148 of 236 children (62.7%) and in 95 of 124 infected children, resulting in 76.6% sensitivity and 52.7% specificity. For 87 children (59.0%), clinical diagnosis was made based on severe unexplained malnutrition (stage 4 clinical WHO classification), of whom only 44 (50.5%) were PCR positive. Low CD4 count had a sensitivity of 55.6% and a specificity of 78.5%. CONCLUSION: As PCR is not yet widely available, clinical diagnosis is often necessary, but these criteria have poor specificity and therefore have limited use for HIV diagnosis. Unexplained malnutrition is not clearly enough defined in WHO recommendations. Extra pulmonary tuberculosis (TB), almost impossible to prove in young children, may often be the cause of malnutrition, especially in HIV-affected families more often exposed to TB. Food supplementation and TB treatment should be initiated before starting ART in children who are staged based only on severe malnutrition.
Geneva, Switzerland, UNAIDS, 1997 Nov. 7 p. (UNAIDS Best Practice Collection; UNAIDS Technical Update)Since 1985, HIV testing has been essential in securing the safety of blood supplies, monitoring the progress of the epidemic and diagnosing individuals infected with the virus. Various assays are now available, allowing testing strategies to be tailored to the epidemiological conditions and budgets of national health systems. New techniques -- including simple tests giving instant results -- hold great promise, but also raise some serious issues for governments and for individuals. HIV infection is most frequently diagnosed by detecting antibodies which the body produces as it tries to resist the virus. These antibodies usually begin to be produced within 3 to 8 weeks after the time of infection. The period following infection but before the antibodies become detectable is known as the .window period.. Antibodies are much easier to detect than the virus itself. It is sometimes possible to detect HIV antigen during the window period if, by coincidence, an individual is tested during the short peak of high levels of circulating virus particles. After this peak, the level of p24 antigen steeply declines to the point where it is no longer detectable. It fluctuates or rises steeply again, usually years later, when the clinical situation of the patient starts to deteriorate with the onset of AIDS. (excerpt)