A systematic review and document analysis on the prevention of mother-to-child programmes to prevent vertical transmission of human immuno-deficiency virus
- Authors: Sobetwa, Nwabisa Nokuzola
- Date: 2017
- Subjects: AIDS (Disease) in pregnancy , Maternal health services , HIV infections -- Children -- Transmission -- Prevention
- Language: English
- Type: Thesis , Masters , MSoc
- Identifier: http://hdl.handle.net/10353/7957 , vital:31282
- Description: Background: The National Strategic Plan 2012-2016 is advocating for zero new infections due to vertical transmission. This goal has not yet been achieved. This study evaluated whether the prevention of mother-to-child vertical transmission (PMTCT) of Human Immuno-deficiency Virus (HIV) programmes in South Africa are based on evidence. Aim: The aim of this study was to conduct a systematic review of the available literature comparing PMTCT antiretroviral regimens published between the years 2000 to 2015 and to do a document analysis of the current implemented PMTCT programme to evaluate if it is based on best evidence. Rational: The rational of the systematic review and the document analysis were to assess whether the latest PMTCT policy was based on evidence and to critically analyse published articles that addressed aspects related to efficacy and efficiency of PMTCT programmes to reduce transmission of HIV from mothers to their infants. Methods: Overall 25 randomised controlled trials and primary studies that assessed efficacy of ARV regimens to prevent mother-to-child transmission of the HIV during pregnancy, labour and the postnatal periods were systematically reviewed. In 1997 the first trial began and the last one ended in 2012. Twelve guidelines referring to PMTCT were sampled and they were published by WHO and Department of Health South Africa from 2001 to 2015. The document analysis was only based on National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults April, 2015. Findings: The systematic review illustrated that significantly fewer infants tested HIV-positive when exposed to a longer ARV regime although there was no significant difference once the infants reached six months of age. Different ARVs have a similar Preamble effect on maternal deaths; however, a double or triple combination of ARVs is superior to monotherapy to decrease infant deaths. Common maternal adverse reactions to ARVs include anaemia, bronchopneumonia, and maculopapular rash. Infant adverse events included septicaemia, pneumonia, gastroenteritis, fever and maculopapular rash. The document analysis has shown that the PMTCT policy is mainly based on evidence from randomised controlled trials and systematic reviews. Occasionally some statements are still based on lower categories of evidence such as non-experimental descriptive studies. Conclusion: The systematic review showed that double and triple ARV therapy is superior to monotherapy and that the longer the mother and her infant are exposed to ARV therapy the better the results are to prevent MTCT. Adverse events are always posing a challenge and as with any other medication, caregivers must be aware of potential adverse reactions. The National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults April 2015 is based on evidence, but the policy itself does not include any reference to evidence.
- Full Text:
- Date Issued: 2017
- Authors: Sobetwa, Nwabisa Nokuzola
- Date: 2017
- Subjects: AIDS (Disease) in pregnancy , Maternal health services , HIV infections -- Children -- Transmission -- Prevention
- Language: English
- Type: Thesis , Masters , MSoc
- Identifier: http://hdl.handle.net/10353/7957 , vital:31282
- Description: Background: The National Strategic Plan 2012-2016 is advocating for zero new infections due to vertical transmission. This goal has not yet been achieved. This study evaluated whether the prevention of mother-to-child vertical transmission (PMTCT) of Human Immuno-deficiency Virus (HIV) programmes in South Africa are based on evidence. Aim: The aim of this study was to conduct a systematic review of the available literature comparing PMTCT antiretroviral regimens published between the years 2000 to 2015 and to do a document analysis of the current implemented PMTCT programme to evaluate if it is based on best evidence. Rational: The rational of the systematic review and the document analysis were to assess whether the latest PMTCT policy was based on evidence and to critically analyse published articles that addressed aspects related to efficacy and efficiency of PMTCT programmes to reduce transmission of HIV from mothers to their infants. Methods: Overall 25 randomised controlled trials and primary studies that assessed efficacy of ARV regimens to prevent mother-to-child transmission of the HIV during pregnancy, labour and the postnatal periods were systematically reviewed. In 1997 the first trial began and the last one ended in 2012. Twelve guidelines referring to PMTCT were sampled and they were published by WHO and Department of Health South Africa from 2001 to 2015. The document analysis was only based on National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults April, 2015. Findings: The systematic review illustrated that significantly fewer infants tested HIV-positive when exposed to a longer ARV regime although there was no significant difference once the infants reached six months of age. Different ARVs have a similar Preamble effect on maternal deaths; however, a double or triple combination of ARVs is superior to monotherapy to decrease infant deaths. Common maternal adverse reactions to ARVs include anaemia, bronchopneumonia, and maculopapular rash. Infant adverse events included septicaemia, pneumonia, gastroenteritis, fever and maculopapular rash. The document analysis has shown that the PMTCT policy is mainly based on evidence from randomised controlled trials and systematic reviews. Occasionally some statements are still based on lower categories of evidence such as non-experimental descriptive studies. Conclusion: The systematic review showed that double and triple ARV therapy is superior to monotherapy and that the longer the mother and her infant are exposed to ARV therapy the better the results are to prevent MTCT. Adverse events are always posing a challenge and as with any other medication, caregivers must be aware of potential adverse reactions. The National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults April 2015 is based on evidence, but the policy itself does not include any reference to evidence.
- Full Text:
- Date Issued: 2017
Adherence to pre-selected infant feeding practices among mothers on the prevention of mother-to-child transmission (PMTCT) of HIV/AIDS programme in the Amathole region, Eastern Cape
- Authors: Yako, Elizabeth Matseliso
- Date: 2011
- Subjects: Child care -- South Africa -- Eastern Cape , Child health services -- South Africa -- Eastern Cape , Mother and infant -- South Africa -- Eastern Cape , Parenteral feeding of children -- South Africa -- Eastern Cape , Motherhood -- South Africa -- Eastern Cape , HIV infections -- Children -- Transmission -- Prevention , Maternal health services -- South Africa -- Eastern Cape , AIDS (Disease) in pregnancy -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Nursing Science)
- Identifier: vital:11891 , http://hdl.handle.net/10353/d1001091 , Child care -- South Africa -- Eastern Cape , Child health services -- South Africa -- Eastern Cape , Mother and infant -- South Africa -- Eastern Cape , Parenteral feeding of children -- South Africa -- Eastern Cape , Motherhood -- South Africa -- Eastern Cape , HIV infections -- Children -- Transmission -- Prevention , Maternal health services -- South Africa -- Eastern Cape , AIDS (Disease) in pregnancy -- South Africa -- Eastern Cape
- Description: Infant feeding in the context of HIV/AIDS poses a challenge among mothers. The implementation of UNICEF guidelines on infant feeding, which state that “when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended” (WHO, 2003:12) are not easy to meet. In more developed countries, where these criteria are met, almost all HIV-infected mothers have ceased to breast feed. Consequently, infants of mothers in these countries are less likely to be infected with HIV postnatally. In South Africa, more specifically in the Eastern Cape, infant feeding is a challenge as a number of UNICEF criteria cannot be met. The Eastern Cape is one of the poorest Provinces in South Africa, with a number of rural communities. Earlier studies have shown that, if mothers select either exclusive breast feeding or exclusive formula feeding, this reduces mother-to-child transmission of HIV. A limited number of studies on adherence to the method of infant feeding selected before delivery were found in the literature, hence the need for the current study. The purpose of the study was to explore adherence to exclusive breast feeding and exclusive formula feeding among mothers with HIV infection and to determine the problems that mothers may be facing in implementing their pre-selected methods.
- Full Text:
- Date Issued: 2011
- Authors: Yako, Elizabeth Matseliso
- Date: 2011
- Subjects: Child care -- South Africa -- Eastern Cape , Child health services -- South Africa -- Eastern Cape , Mother and infant -- South Africa -- Eastern Cape , Parenteral feeding of children -- South Africa -- Eastern Cape , Motherhood -- South Africa -- Eastern Cape , HIV infections -- Children -- Transmission -- Prevention , Maternal health services -- South Africa -- Eastern Cape , AIDS (Disease) in pregnancy -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Nursing Science)
- Identifier: vital:11891 , http://hdl.handle.net/10353/d1001091 , Child care -- South Africa -- Eastern Cape , Child health services -- South Africa -- Eastern Cape , Mother and infant -- South Africa -- Eastern Cape , Parenteral feeding of children -- South Africa -- Eastern Cape , Motherhood -- South Africa -- Eastern Cape , HIV infections -- Children -- Transmission -- Prevention , Maternal health services -- South Africa -- Eastern Cape , AIDS (Disease) in pregnancy -- South Africa -- Eastern Cape
- Description: Infant feeding in the context of HIV/AIDS poses a challenge among mothers. The implementation of UNICEF guidelines on infant feeding, which state that “when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended” (WHO, 2003:12) are not easy to meet. In more developed countries, where these criteria are met, almost all HIV-infected mothers have ceased to breast feed. Consequently, infants of mothers in these countries are less likely to be infected with HIV postnatally. In South Africa, more specifically in the Eastern Cape, infant feeding is a challenge as a number of UNICEF criteria cannot be met. The Eastern Cape is one of the poorest Provinces in South Africa, with a number of rural communities. Earlier studies have shown that, if mothers select either exclusive breast feeding or exclusive formula feeding, this reduces mother-to-child transmission of HIV. A limited number of studies on adherence to the method of infant feeding selected before delivery were found in the literature, hence the need for the current study. The purpose of the study was to explore adherence to exclusive breast feeding and exclusive formula feeding among mothers with HIV infection and to determine the problems that mothers may be facing in implementing their pre-selected methods.
- Full Text:
- Date Issued: 2011
Postnatal women's experiences of the prevention of mother-to-child transmittion of HIV programme
- Authors: Links, Nomvuyiseko
- Date: 2007
- Subjects: AIDS (Disease) in pregnancy -- South Africa , HIV infections -- Children -- Transmission -- Prevention , Children -- Diseases -- Prevention , HIV infections -- Transmission , Maternal health services
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10042 , http://hdl.handle.net/10948/545 , http://hdl.handle.net/10948/d1011704 , AIDS (Disease) in pregnancy -- South Africa , HIV infections -- Children -- Transmission -- Prevention , Children -- Diseases -- Prevention , HIV infections -- Transmission , Maternal health services
- Description: This research study endeavoured to explore and describe the experiences of women who participated in the Prevention of Mother-To-Child Transmission (PMTCT) of HIV Programme. Data relating to evaluation of the PMTCT Programme in the piloted sites compiled by other researchers in the Department of Health focus on the process, progress and extent of service implementation. There appears to be a dearth of information available from women participants in the PMTCT Programme. The objectives of the study were to: · Explore and describe postnatal women’s experiences of the PMTCT Programme offered in the East London Hospital Complex. · Propose recommendations into the existing guidelines for midwives who implement the PMTCT Programme in the health services to ensure optimal implementation of this programme. The research population included postnatal women who participated in the PMTCT of HIV Programme at the East London Hospital Complex (Frere site). Permission to conduct the research was obtained from the Eastern Cape Department of Health Ethics Committee, Chief Executive Officer of the hospital complex and the Advanced Degrees Committee and Human Ethics Committee at the Nelson Mandela Metropolitan University. The research study was qualitative, exploratory, descriptive and contextual in design. Data collection was carried out by face-to-face semi-structured interviews with postnatal women at the East London Hospital Complex (Frere site). The tape-recorded interviews were transcribed verbatim with the aid of field notes. Data analysis was done according to Tesch’s method of data analysis (in De Vos et al, 2000:343). Themes were identified from the transcriptions and finalised after consensus discussions with an independent coder who was experienced in qualitative research. Literature control, guided by the themes identified in the interviews, was carried out to compare and verify the findings of the study. Three major themes with sub-themes were identified during data analysis. The major themes were identified as follows: · The participants expressed feelings of being devastated by the results that confirmed their HIV positive status. · The participants expressed a thirst for knowledge on how to live with the diagnosis and on how to continue with the PMTCT Programme. · The physical environment where counselling and testing were done, as well as the practical arrangements, were not conducive to the full implementation of the PMTCT Programme at the antenatal clinic. Conclusions were drawn and recommendations were made in the form of additional guidelines for midwives implementing the PMTCT Programme in the antenatal clinic health services. Guidelines for further midwifery-related research were formulated.
- Full Text:
- Date Issued: 2007
- Authors: Links, Nomvuyiseko
- Date: 2007
- Subjects: AIDS (Disease) in pregnancy -- South Africa , HIV infections -- Children -- Transmission -- Prevention , Children -- Diseases -- Prevention , HIV infections -- Transmission , Maternal health services
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10042 , http://hdl.handle.net/10948/545 , http://hdl.handle.net/10948/d1011704 , AIDS (Disease) in pregnancy -- South Africa , HIV infections -- Children -- Transmission -- Prevention , Children -- Diseases -- Prevention , HIV infections -- Transmission , Maternal health services
- Description: This research study endeavoured to explore and describe the experiences of women who participated in the Prevention of Mother-To-Child Transmission (PMTCT) of HIV Programme. Data relating to evaluation of the PMTCT Programme in the piloted sites compiled by other researchers in the Department of Health focus on the process, progress and extent of service implementation. There appears to be a dearth of information available from women participants in the PMTCT Programme. The objectives of the study were to: · Explore and describe postnatal women’s experiences of the PMTCT Programme offered in the East London Hospital Complex. · Propose recommendations into the existing guidelines for midwives who implement the PMTCT Programme in the health services to ensure optimal implementation of this programme. The research population included postnatal women who participated in the PMTCT of HIV Programme at the East London Hospital Complex (Frere site). Permission to conduct the research was obtained from the Eastern Cape Department of Health Ethics Committee, Chief Executive Officer of the hospital complex and the Advanced Degrees Committee and Human Ethics Committee at the Nelson Mandela Metropolitan University. The research study was qualitative, exploratory, descriptive and contextual in design. Data collection was carried out by face-to-face semi-structured interviews with postnatal women at the East London Hospital Complex (Frere site). The tape-recorded interviews were transcribed verbatim with the aid of field notes. Data analysis was done according to Tesch’s method of data analysis (in De Vos et al, 2000:343). Themes were identified from the transcriptions and finalised after consensus discussions with an independent coder who was experienced in qualitative research. Literature control, guided by the themes identified in the interviews, was carried out to compare and verify the findings of the study. Three major themes with sub-themes were identified during data analysis. The major themes were identified as follows: · The participants expressed feelings of being devastated by the results that confirmed their HIV positive status. · The participants expressed a thirst for knowledge on how to live with the diagnosis and on how to continue with the PMTCT Programme. · The physical environment where counselling and testing were done, as well as the practical arrangements, were not conducive to the full implementation of the PMTCT Programme at the antenatal clinic. Conclusions were drawn and recommendations were made in the form of additional guidelines for midwives implementing the PMTCT Programme in the antenatal clinic health services. Guidelines for further midwifery-related research were formulated.
- Full Text:
- Date Issued: 2007
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