HIV This Week

Braitstein P, Boulle A, Nash D, Brinkhof MW, Dabis F, Laurent C, Schechter M, Tuboi SH, Sprinz E, Miotti P, Hosseinipour M, May M, Egger M, Bangsberg DR, Low N; the Antiretroviral Therapy in Lower Income Countries (ART-LINC) Study Group. Gender and the Use of Antiretroviral Treatment in Resource-Constrained Settings: Findings from a Multicenter Collaboration. J Womens Health (Larchmt) 2008;17(1):47-55.

Braitstein and colleagues aimed to compare the gender distribution of HIV-infected adults receiving highly active antiretroviral treatment (HAART) in resource-constrained settings with estimates of the gender distribution of HIV infection; and to describe the clinical characteristics of women and men receiving HAART. The Antiretroviral Therapy in Lower-Income Countries, ART-LINC Collaboration is a network of clinics providing HAART in Africa, Latin America, and Asia. The authors compared UNAIDS data on the gender distribution of HIV infection with the proportions of women and men receiving HAART in the ART-LINC Collaboration. Twenty-nine centers in 13 countries participated. Among 33,164 individuals, 19,989 (60.3%) were women. Proportions of women receiving HAART in ART-LINC centers were similar to, or higher than, UNAIDS estimates of the proportions of HIV-infected women in all but two centers. There were fewer women receiving HAART than expected from UNAIDS data in one center in Uganda and one center in India. Taking into account heterogeneity across cohorts, women were younger than men, less likely to have advanced HIV infection, and more likely to be anaemic at HAART initiation. The authors conclude that, women in resource-constrained settings are not necessarily disadvantaged in their access to HAART. More attention needs to be paid to ensuring that HIV-infected men are seeking care and starting HAART.

Editors’ note: It is only through the collection of sex-disaggregated data that assessments can be made of the comparative participation of women and men in the benefits of antiretroviral scale-up. This 13 country study found a similar preponderance of women on antiretroviral treatment as has been reported in Southern Africa. One explanation is that women are accessing health services more frequently than men, particularly sexual and reproductive heath services where HIV testing may be more likely to be offered.

Ginsburg AS, Hoblitzelle CW, Sripipatana TL, Wilfert CM. Provision of care following prevention of mother-to-child HIV transmission services in resource-limited settings. AIDS 2007;21:2529-32.

The objective of the study was to evaluate the provision of care for mother and child after institution of prevention of mother-to-child transmission (PMTCT) of HIV services. As part of an effort to improve services, Ginsburg and colleagues undertook a review of the multicountry PMTCT program. Review of key indicators from the PMTCT database and reporting practices from January 2005 to June 2006 throughout 18 resource-limited countries. 1 066 606 pregnant women were counselled and tested, and 102 336 tested HIV-positive. Antiretroviral prophylaxis was dispensed to 81 384 mothers and 52 342 HIV-exposed infants. From available reporting, 1388 pregnant women were dispensed antiretroviral drugs for treatment and 9060 children received cotrimoxazole prophylaxis at 6 weeks. In conclusion, PMTCT services are integrated into maternal-child health services but adult and paediatric care and treatment programmes often function independently, without coordination or linkages. Integrating care into maternal-child health services and linking mother’s HIV status to child are necessary for HIV-infected mothers and HIV-exposed children to receive appropriate follow-up and treatment.

Editors’ note: HIV-infected mothers and their HIV-exposed infants can be lost to follow up if antenatal services offering prevention of mother-to-child transmission programmes are not linked to HIV care and treatment services. Monitoring the percentage of HIV-exposed infants on cotrimoxasole at 6 weeks of age when diagnostic HIV DNA polymerase chain reaction (PCR) testing may be offered, at first immunization visit, and at the time of weaning from breastfeeding around 6 months of age would provide an indication of infant follow-up. Likewise, it is important to monitor the numbers of women in need of treatment that are started on antiretroviral treatment in pregnancy or who have higher CD4 counts and are referred for follow-up post pregnancy and are counselled about contraceptive choices. To prevent unplanned pregnancy, counselling about contraceptive choices post-partum should be standard for all women, regardless of serostatus.