Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

64 Abstracts WePeB5936-WePeB5939

XIV International AIDS Conference

(22%) than in the L&D (0.5%, p< 0.05 for all 2-way comparisons). In multivariate analysis, uptake of any strategy was higher among women who reported a
prior stillbirth or infant death (AOR 1.6; 95%CI:1.1 - 2.5.) No predictors of nonadherence were identified. Population coverage was: MASS 43%; TARGETED
46%; L&D 52% (p>0.05 for all 2-way comparisons.)
Conclusions: In ANC, a MASS NVP strategy where women do not learn their
HIV status resulted in higher uptake than a TARGETED strategy; however, this
was offset by lower adherence. Offering NVP upon presentation in labor results
in near perfect adherence, but poorer uptake. To achieve maximum population
coverage, a combination of strategies must be considered.
Presenting author: Stringer Jeffrey, 9965 Makanta Close, PO Box: 34681,
Fairview, Lusaka, Zambia, Tel.: [phone], Fax: [phone], E-mail:
stringer@ uab.edu
WePeB5936I Human immune deficiency virus and pregnancy in
Uruguay
A. Visconti', D. Colella2, M. Cuitiho3, J. Quian3, J.G. Alonso4. 1 Mother-Child
Center HIV-AIDS, Ministry of Public Health, Car/os Maria Morales 944 ap 903,
Montevideo, Uruguay; 2Mother-Child Center HIVA/DS, Ministry of Public
Health., Montevideo, Uruguay; 3Mother-Child Center HIVAIDS, Ministry of
Public Health., Montevideo, Uruguay; Department of Obstetrics and
Gynecology "C" Prof. J C Cuadro, M.D, School of Medicine, University of
Uruguay, Montevideo, Uruguay
Background: Vertical transmission of Human Immune Deficiency virus (HIV) with
no interventions is 25%. In Uruguay, in 1998, 2 every thousand pregnant women
were HIV positive. Therefore, out of a total of 54.000 births in the country for that
same year, we estimate 108 HIV positive pregnancies.
The objective of the present study is to analyse behavioural characteristics, tolerance to pregnancy and perinatal results in HIV positive pregnant women.
Methods: Retrospective, observational and descriptive study.
131 pregnancies in HIV positive patients were controlled and treated in the
Mother-Child Center HIV-AIDS, in the national reference center Pereira Rossell
Hospital between January 1st. 1998 and June 31st. 2001. This sample corresponds to 125 patients, since 6 patients were pregnant more than once during
the mentioned period.
Results: Maternal age ranges from 16 to 40 years. HIV was diagnosed prior to
pregnancy in 66.4% of cases. 15.2% were intravenous drug users, 9 out of 10 patients declare they do not use condoms. 18.3% of them were primigravidas and
97.7% controlled their pregnancies. Most frequent pathologies during pregnancy
were: threatened preterm labor, lower genital infection and hepatitis C. 87.8% received anti-retroviral treatment. 99% of patients received AZT, and in 33% of them
it was associated with 3TC. 39.7% showed viral charge lower than 10.000 copies
of RNA/ml and 38.2% higher than 500CD4/mm3.
20% of cases ended in Caesarean in 1998, 24.4 in 1999, 73.7 in 2000, and 75.0%
in 2001. 88.6% received AZT IN previous to birth. 87.8 of newborns were term, 9
out of 10 were vigorous and 95.9 received AZT per os. Off all the children, 6.7%
in 1998, 8.1% in 1999 and 5.4% in 2000 were infected. There were no infected in
2001.
Conclusions: The importance of precocious diagnosis and treatment stands out
in terms of diminishing vertical transmission. A higher incidence of pathologies
was found during pregnancy, compared to general population.
Presenting author: Ana Visconti, Carlos Maria Morales 944 ap 903, Montevideo,
Uruguay, Tel.: [phone], E-mail: [email protected]
WePeB5937 Integrating HIV mother-to-child transmission
prevention into reproductive health services: the
Jamaican experience
Y. Gebre1, J.P. Figueroa1, L.R. Norman2, D. Ashley', D. Dale', T. Hylton-Kong'
' MINISTRY OF HEALTH, 2-4 KING STREET OCEANA BUILDING, MINISTRY
OF HEALTH, KINGSTON, JAMAICA, WI, Jamaica; 2University of the West
Indies, Kingston, Jamaica
Background: HIV mother-to-child transmission (MTCT) accounts for 10% of the
total reported AIDS cases in the Caribbean. In Jamaica, Paediatric AIDS cases
represent 8% of the total. The main objective of this study is to examine the feasibility and cost effectiveness of introducing HIV-MTCT into the existing reproductive health services.
Methods: The pilot program was introduced in 16 randomly selected health centres in four parishes. An estimated 6000 first time antenatal clinic attendants under 34 weeks of gestation were expected to participate and benefit from the program. The program components included (1) modification of obstetrical practice;
(2) provision of voluntary confidential HIV counseling and testing; (3) provision
of short course antiretroviral therapy for infants and HIV positive mothers; (4) replacement feeding for infants born to HIV positive mothers; (5) follow up of infants
and HIV positive mothers; and (6) training of health care workers in HIV-MTCT

management.
Results: From August 2000 to April 2001 a total of 5183 pregnant women were
enrolled and tested for HIV antibodies. The mean age at enrollment was 26 years
(standard deviation = 5.1 years). 62% of the women attended their first antenatal
clinic visit between 16 and 28 weeks of their pregnancy. The antenatal HIV antibody seroprevalence rate ranged from 0.5% in the rural area to 3.14% in the urban resort areas. The overall seroprevalence in this sample population was 1.6%.

The age-specific seroprevalence rate was highest in the age groups 25 -29 years
(1.36%) and 20-24 years (1%). Most HIV negative women were not given their
test results. Only 78% of HIV positive mothers received short course antiretroviral
therapy at the onset of labour.
Conclusion: The integration of HIV-MTCT prevention into existing reproductive
health services is an essential HIV intervention strategy However, it requires welltrained and dedicated staff.
Presenting author: Yitades Gebre, 2-4 KING STREET, OCEANA BUILDING,
MINISTRY OF HEALTH, KINGSTON, JAMAICA, WI, Jamaica, Tel.: [phone], Fax: [phone], E-mail: [email protected]
WePeB5938 Needs assessment of HIV positive mothers
U.L. Likhitwonnawut, U. Likhitwonnawut. CARE Thailand/Raks Thai Foundation,
Chiang Mai, Thailand
Objective: To identify problems and needs of the participants of the government's
mother-to-child HIV transmission (MTCT) program in northern Thailand.
Methodology: In-depth interviews with 50 HIV positive mothers who participated
in the MTCT program using a structured open-ended questionnaire during home
and hospital visits, and during their visits to self-help groups. The interview included the following: awareness of HIV risk, history of HIV testing, awareness
of the MTCT program, compliance of regimen, problems & concerns and future
plans. It also focused on roles of husbands and families in care and support, factors affecting disclosure of HIV status, and post delivery services. Case studies
were conducted to provide more in-depth data revealing patterns for specific issues such as safe sex practice, informed choice, abortion, and sterilization. Group
discussions were conducted to supplement the interviews.
Results: Awareness of the MTCT program and risk awarenesswas were low. Few
parrticipants had prior knowledge of the program. 40% had not considered themselves at risk. The compliance reported by participants was high. Family planning
and safe sex practice was low; 2/3 of pregnancies were unplanned. 2/3 considered abortion and a few participants attempted abortion. Only 1/3 informed their
husbands of their participation in the program. 22% did not inform their husbands
of their HIV status. Post delivery service was not available. Care and support also
narrowly focused on medical/nursing care. Very few mothers had realistic plans
for the well-being of their children. The majority of husbands also showed unconcerned attitude towards their family's situation including the HIV status of their
wives.
Conclusion: Narrowly focused programs can hinder the effectiveness and impact of the interventions. Comprehensive care and support that addresses socioeconomic needs of affected families is essential for the sustainability of the MTCT
program.
Presenting author: Udom Likhitwonnawut, 113/9 M.4, Chiang Mai-Lampang
Rd., Thasala, A. Muang, Chiang Mai 50000, Thailand, Tel.: [phone], 66
53 308 169, Fax: [phone], E-mail: [email protected]
WePeB5939 Qualitative DNA PCR for HIV diagnosis in infants
R. Viswanath', M. Jacob', N.M. Samuel1, S. Ahamed', P.L. Joshi2
' Tn.dr.mgrmedicaluniversity, 69,annasalai, tn. dr.mgr medicaluniversity,deptof
expt.mediine, guindy chennai, tamilnadu, India; 2NACO, New De/hi, India
Background: Qualitative DNA PCR is used to monitor HIV-1 status in infants.
Earlier detection of HIV-1 in infants will help in deciding breast feeding a child. In
India risk of vertical transmission of HIV-1 is 48%(NACO).To reduce this risk of
transmission National AIDS Control Organisation has conducted Fesibility study
of Administering short term AZT intervention amoung HIV infected mothers to
prevent mother to child transmission of HIV at 11 centers.Samples for DNA PCR
is sent to our laboratory from 5 centers.
Objective: Importance of Qualitative DNA PCR for infant diagnosis.
Method: Whole blood Samples for DNA PCR are sent from 5 medical institutions
in south India to our PCR referral laboratorySamples are collected and sent to us
at two intervals one at 48hrs after birth and another at 2 months of age.DNA is
extracted from whole blood using standard procedure.Nested PCR is performed
on these samples using HIV-1 gag primers.
Results: The results of 5 MTCT centers are out of 225 babies delivered 30 were
found to be positive at 48 hrs. of this 30 positive babies, only 10 turned up for
follow up at 2nd month and diagnosed positive. All the 10 positives were positive
at birth.
Positive 30(13.3%) - Day Zero 12(13.4%) - 2nd Month
Negative 195(86.7%)- Day Zero 78(86.6%) - 2nd Month
Total 225 90
Out of 195 negatives in day zero only 90 turned up for follow up. Among the 90
negatives 2* were turned positive in 2nd month. Of the total 225 babies 60% of
babies did not turned up for follow up.
Conclusion: *Qualitative DNA PCR is essential for diagnosis of HIV-1 in infants.
*As this technique require expensive equipments central facility can be estab
lished where others can utilize it. * adherence to the procedure of the technique.
Presenting author: ragupathy Viswanath, 69,annasalai,tn.dr.mgr medical university,dept.of expt.mediine, guindy, chennai, tamilnadu, India, Tel.: [phone],
Fax: [phone], E-mail: [email protected]