Empowering Women to Fight HIV: An Interview with South African Dr. Sengeziwe Sibeko

via AllAfrica.com, interview with Dr. Sengeziwe Sibeko

What makes a young African doctor decide to devote her career to helping women fight HIV? Dr. Sengeziwe Sibeko is a 37-year-old medical researcher with a degree in obstetrics and gynecology from the University of KwaZulu Natal (UKZN) in South Africa, an MSc in epidemiology from Columbia University in the United States, and is about to take up a fellowship to study for her PhD at Oxford University in the United Kingdom. AllAfrica's Julie Frederikse interviewed Dr. Sibeko at the community women's reproductive health clinic run by the Centre for the Aids Program of Research in South Africa (Caprisa) in Durban.

When I did my internship back in 1998, I went to the rural northern part of KwaZulu Natal (the South African province where she lives and works) and I was really looking forward to saving lives - yet that was not what was happening at the time. People were dying. You came in each morning to see people die rather than to be able to save lives. But when I went on to do my community service (a two-year requirement for all South African medical students), I really enjoyed obstetrics and gynecology, so when I had the opportunity to specialise I knew that was what I wanted to do.

But over the five years of my specialisation, that changed too. It was no longer just about babies being born - women were coming in because they were sick and babies were dying. I found it to be a depressing situation, and this was further compounded by staff shortages due to people leaving the health system.

Given the depressing effects of Aids that you witnessed, how did you develop your passion around protecting African women from HIV?

My actual turning point came when I went overseas. I got a fellowship in 2006 (from the Fogarty International Clinical Research Scholars and Fellows). That meant that for the first time - I remember this so clearly - I was removed from the everyday numbing situation that I had been in back in South Africa.

So it was only when the National Institutes of Health (NIH) in Washington DC brought all the global health experts together, and their presentations showed me that this is how Asia is doing with the HIV and Aids situation, this is how the United States is doing, and this is you in sub-Saharan Africa - I almost collapsed! I never realised that this is the situation in the region where I'm from. It made me decide that I'm going to go home and be part of the solution.

So what did you do next?

I thought, we can't be waiting for women to come to the clinic, to be sick and to die - there's got to be a way to prevent women getting HIV in the first place. I wanted to do something major, and I saw that it must be through the public health route. So I went into Caprisa and met Dr. Quarraisha Abdool Karim. The time that I joined coincided with a conference on the potential of microbicides to fight HIV. So I thought, wow, I'm in the right place, this could save women's lives. I became the overall gynecologist of the study, so I like to think of it as my baby.

When I joined the field there hadn't been any success stories with microbicides. There were lots of negative trials and the field was almost dying. I remember talking to Dr. Henry Gabelnick (head of Caprisa's research partner, the U.S. reproductive health group, CONRAD) who is the greatest proponent of microbicides, and I told him, if you give up on this concept you give up on women. Because I see this as a woman-empowering strategy. It gives women the opportunity to be in control when they can't negotiate other safe sex practices.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

What it really takes to prevent mother-to-child HIV transmission

via PLoS Medicine, by Andrea L. Ciaranello, Freddy Perez, Jo Keatinge, Ji-Eun Park, Barbara Engelsmann, Matthews Maruva, Rochelle P. Walensky

Background

The World Health Organization (WHO) has called for the “virtual elimination” of pediatric HIV: a mother-to-child HIV transmission (MTCT) risk of less than 5%. We investigated uptake of prevention of MTCT (PMTCT) services, infant feeding recommendations, and specific drug regimens necessary to achieve this goal in Zimbabwe.

Methods and Findings

We used a computer model to simulate a cohort of HIV-infected, pregnant/breastfeeding women (mean age, 24 y; mean CD4, 451/µl; breastfeeding duration, 12 mo). Three PMTCT regimens were evaluated: (1) single-dose nevirapine (sdNVP), (2) WHO 2010 guidelines' “Option A” (zidovudine in pregnancy, infant nevirapine throughout breastfeeding for women without advanced disease, lifelong combination antiretroviral therapy for women with advanced disease), and (3) WHO “Option B” (pregnancy/breastfeeding-limited combination antiretroviral drug regimens without advanced disease; lifelong antiretroviral therapy with advanced disease). We examined four levels of PMTCT uptake (proportion of pregnant women accessing and adhering to PMTCT services): reported rates in 2008 and 2009 (36% and 56%, respectively) and target goals in 2008 and 2009 (80% and 95%, respectively). The primary model outcome was MTCT risk at weaning.

The 2008 sdNVP-based National PMTCT Program led to a projected 12-mo MTCT risk of 20.3%. Improved uptake in 2009 reduced projected risk to 18.0%. If sdNVP were replaced by more effective regimens, with 2009 (56%) uptake, estimated MTCT risk would be 14.4% (Option A) or 13.4% (Option B). Even with 95% uptake of Option A or B, projected transmission risks (6.1%–7.7%) would exceed the WHO goal of less than 5%. Only if the lowest published transmission risks were used for each drug regimen, or breastfeeding duration were shortened, would MTCT risks at 95% uptake fall below 5%.

Conclusions

Implementation of the WHO PMTCT guidelines must be accompanied by efforts to improve access to PMTCT services, retain women in care, and support medication adherence throughout pregnancy and breastfeeding, to approach the “virtual elimination” of pediatric HIV in Zimbabwe.

Read the rest of the study here.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

PMTCT Requires Greater Male Participation in Ethiopia

via PlusNews Global

Ethiopia's new plan to eliminate mother-to-child HIV transmission by 2015 cannot be attained unless men are more meaningfully involved in reproductive health, experts say.

"Among the pregnant women who come to our hospital, less than 10 percent of them come with their partners," said Etalem Gebrehiwot, head nurse at the prevention of mother-to-child transmission (PMTCT) wing of Gandhi Memorial Hospital. "Those who find out that they are living with the virus usually face a problem while taking medicines, given that most prefer to take it without the knowledge of their partners."

Studies show that low male partner involvement is one of the challenges to the success of the country's PMTCT programme.

According to experts, men's involvement in PMTCT can have a positive impact on PMTCT by encouraging their partners to visit antenatal clinics and have skilled health workers attend the birth of their children. In a 2010 Kenyan study, male partner involvement in PMTCT reduced the risks of vertical transmission and infant mortality by more than 40 percent compared to no involvement.

"The biggest challenge we are currently facing is to convince mothers to get tested in order to determine that they are eligible for PMTCT services... the major reason for their resistance is lack of consent from their husbands or partners, who are more influential in family matters including this," said Aster Shewa, who supervises Zewditu Hospital antiretroviral service centre in Addis Ababa.

"Besides, after they know their status, most HIV-positive mothers refrain from disclosing it, which usually impacts the way they use PMTCT services and their effectiveness," she added.

Many men do not see the advantages of an HIV test; one father, whose wife gave birth to a daughter in November 2011, told IRIN/PlusNews: "We are married - what is there to test about?"

"At the moment, hospitals with PMTCT services are increasing, and we have to work hard in convincing pregnant women, along with their partners, to use health facilities with the service in order to reach zero new infections," said Aster.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

PMTCT with combination of nevirapine and cotrimoxazole

via Aidsmap, by Carole Leach-Lemens

"Policy makers can now make informed decision regarding the WHO 2010 prevention of mother-to-child (PMTCT) guidelines and the combined use of nevirapine and cotrimoxazole prophylaxis for extended periods of time. Such use is critical in these settings where frequent monitoring is challenging, and where the difficulties of travelling long distances and the high costs of transportation make regular clinic visits difficult."

Use of nevirapine with cotrimoxazole prophylaxis in HIV-exposed uninfected infants (HIV-EU) until six months of age in Zimbabwe and Uganda was safe with no immediate or long-term adverse effects, researchers on behalf of the HIV Prevention Trials Network (HPTN) 046 protocol trial report in the advance online edition of AIDS.

The findings from this secondary data analysis have important policy implications for HIV-exposed but uninfected infants in resource-poor settings.

The HPTN 046 protocol, a prospective randomised placebo controlled trial, looked at the safety and efficacy of nevirapine prophylaxis against HIV transmission in breast milk with infants followed for 18 months.

Policy makers can now make informed decision regarding the WHO 2010 prevention of mother-to-child (PMTCT) guidelines and the combined use of nevirapine and cotrimoxazole prophylaxis for extended periods of time. Such use is critical in these settings where frequent monitoring is challenging, and where the difficulties of travelling long distances and the high costs of transportation make regular clinic visits difficult.
The guidelines are based on evidence of the effectiveness of the extended use of daily nevirapine in reducing breast milk transmission of HIV. Daily use of nevirapine prophylaxis in HIV-exposed but uninfected infants for PMTCT from birth until one year of age, or until the stopping of breastfeeding (whichever comes first), is recommended.

Read the rest.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]