Sexual and reproductive health

Prevention of mother-to-child transmission of HIV (PMTCT) and family planning (FP)

Empowering women living with HIV

Poster

Women of childbearing age account for more than half of the world's HIV cases.

Unintended pregnancies are high among HIV-positive women.

Every day over 1700 infants become infected with HIV; (90% of these new infections are acquired through mother-to-child transmission).

For the same cost, a contraceptive strategy prevents 28.6% more HIV-positive births than nevirapine.


New national-level core indicator for monitoring and evaluating family planning aspect of PMTCT programmes

Preventing unintended pregnancies among women living with HIV is a critical step towards reducing mother-to-child transmission, and is a core component of the international standards for a comprehensive approach to prevention of mother-to-child transmission of HIV (PMTCT). All women, irrespective of HIV status, need services that can help them make informed reproductive decisions and provide them with contraceptive options, if and when they are desired. By enabling women living with HIV to prevent or delay pregnancies, access to these services could avert HIV infection in infants.

A new indicator has been developed to evaluate the family planning component of PMTCT programmes. The indicator measures the proportion of HIV-infected women of reproductive age attending HIV care and treatment services with unmet need for family planning (wanting to delay or stop childbearing, but not currently using a method of contraception).

The new indicator is included among the recommended list of indicators to monitor national PMTCT programmes. It provides information on whether women living with HIV have the opportunity to control their fertility if and when they want to, thereby preventing unintended pregnancies.


Postpartum family planning in Mwanza, Tanzania: effects of HIV status and of family planning advice

Investigators seek to examine the effects of HIV status and family planning (FP) counselling during PMTCT sessions on postpartum (after giving birth) contraceptive use. The aim of the study is to develop strategies for delivering improved family planning (FP) services to both HIV+ and HIV- women and to clarify the effects of both HIV status and family planning counselling during PMTCT on postpartum contraceptive use by HIV+ women. The specific research objectives are:

  • to assess the acceptability of FP among HIV- and HIV+ women before their pregnancy for those yet to give birth and 9-15 months for postpartum women;
  • to measure the proportion of PMTCT clients who use/used FP and the extent of unmet need, by HIV status, before voluntary counselling and testing (VCT) and 15 months after;
  • to compare the proportions of women using FP and the extent of unmet need, in the group who were counselled on family planning during VCT and the group not counselled, before VCT and 15 months after;
  • to measure the proportion of HIV+ VCT clients in non-PMTCT clinics who actually go to a PMTCT clinic for delivery, and to explore the determinants of PMTCT use.

This project is the second phase of a panel study in two study sites – Mwanza and Magu. The first wave involved a survey of antenatal clinic attendees in 15 clinics. The second wave, will follow-up on these women during the postpartum period, 15 months after the end of the first survey.

The quantitative survey included approximately 3764 women out of the expected 6000 from the baseline study. In addition, in-depth interviews are being conducted with 30 women selected from those surveyed. The study population is based on participants of an ongoing clinic-based sample. Participants of the follow-up survey were selected based on the following criteria: (a) pregnant for at least three months at the time of the baseline survey; (b) received VCT after baseline; and (c) still living in the catchment area.

Participants of the in-depth interview will be selected to represent various situations based on HIV status, contraceptive use, and other characteristics found to be important from baseline results. Recruitment and analysis will be conducted simultaneously so that recruitment can be adjusted after information saturation has been met. Study findings have the potential to influence programmes in Tanzania and in the region. The study began in January 2009 and results are expected by the end of 2009.


Prevention of mother-to-child transmission of HIV: Updates on the Kesho Bora Project

HIV-infected women in Africa are in most cases unable to offer their infants acceptable alternatives to breast milk. Combination antiretroviral therapy continued through the breastfeeding period can potentially reduce the risk of transmission to very low levels, thus allowing mothers with HIV infection to breastfeed safely. This intervention reduces stigma that is associated with replacement feeding and provides optimal nutrition and immunological benefit for the infant.

Evidence shows new drug combination dramatically reduces mother-to child transmission of HIV during breastfeeding

Kesho Bora - image of poster

According to a new study led by the World Health Organization (WHO), if HIV-positive pregnant women are given a combination of antiretroviral (ARV) drugs from late in pregnancy until six months into breastfeeding, rather than a short course of drugs that ends at delivery, their babies are over 40% less likely to become infected with HIV.


Antenatal care in Southern Africa and linkages with HIV/AIDS services and violence against women programme

Falling within HRP’s scope of research on antenatal care and concerted efforts to promote the translation of research to practice, HRP is implementing an intervention to assist three Southern African countries (Malawi, Mozambique and South Africa) in their efforts to improve maternal and newborn health (MDGs 4 & 5) and strengthen their health systems through the integration of related vertical services with antenatal care packages based on the WHO Antenatal Care Model.

The intervention aims to determine whether the implementation of an adapted version of the basic WHO Antenatal Care Model that integrates antenatal care services with other health care programmes in antenatal clinics in each of the three target countries will improve: (a) health outcomes for women and infants; and (b) the capacity of these clinics to detect, treat, and prevent major health-related conditions (e.g. violence against women, and diseases such as HIV/AIDS, malaria, and anaemia). It is expected that the first stage will be initiated in Mozambique in the second half of 2009.


Refusal for HIV testing among pregnant women attending antenatal care clinics in Cambodia

A cross-sectional study was recently conducted in 21 health centres in three Cambodian provinces which implemented PMTCT services between January and December 2006 (Svay Rieng, Kampong Thom, and Battambang Provinces). PMTCT services have continued until now.

The three provinces were selected because of different rates of HIV testing uptake and also different geographical locations: Svay Rieng which is close to the Viet Nam border, has the highest uptake of HIV testing among pregnant women (97%), Kampong Thom which is in the middle of the country, has a medium rate (74%), and Battambang, which is close to the Thai border, has the lowest rate (55%).

The objective of the study is to identify factors associated with refusal to have HIV testing among pregnant women attending antenatal care clinics with PMTCT services. Study results will contribute to the development of strategies for increasing the uptake of HIV testing. Data collection was conducted in February and March 2009 and data analysis is ongoing.

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