Prevention of mother-to-child transmission of HIV in developing countries: recommendations for practice

被引:37
作者
Dabis, F
Newell, ML
Fransen, L
Saba, J
Lepage, P
Leroy, V
Cartoux, M
Meda, N
Whynes, DK
Peckham, C
Nduati, R
Msellati, P
De Vincenzi, I
Van de Perre, P
机构
[1] Univ Bordeaux 2, U330, INSERM, F-33076 Bordeaux, France
[2] Inst Child Hlth, Dept Epidemiol & Publ Hlth, London, England
[3] Commiss European Communities, B-1049 Brussels, Belgium
[4] UNAIDS, Dept Policy Strategy & Res, Geneva, Switzerland
[5] Ctr Hosp InterUniv Ambroise Pare & Tivoli La Louv, Mons, Belgium
[6] OCCGE, Ctr Muraz, Bobo Dioulasso, Burkina Faso
[7] Univ Nottingham, Dept Econ, Nottingham NG7 2RD, England
[8] Univ Nairobi, Nairobi, Kenya
[9] ORSTOM, Programme SIDA, Abidjan, Cote Ivoire
关键词
D O I
10.1093/heapol/15.1.34
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objectives: Different approaches to prevent mother-to-child transmission of HIV are being evaluated in developing countries. The first trials using a short regimen of zidovudine have been successful in Thailand, Cote d'lvoire and Burkina Faso. International and local strategies are now being considered. The Ghent International Working Group on Mother-to-Child Transmission of HIV developed public health policy options to integrate these interventions into basic and maternal and child health (MCH) services. Methods: The following tasks were undertaken: a critical review of randomized trials; an international pooled analysis of late postnatal transmission of HIV through breastfeeding; a review of the cost-effectiveness and cost-benefit of antiretroviral prophylaxis; a feasibility assessment of preventive strategies, including a postal survey on HIV voluntary counselling and testing (VCT) of pregnant women; the identification of requirements and research priorities for prenatal, obstetric and paediatric care. These projects provided the background for a three-day workshop in Ghent, Belgium, in November 1997. Conclusions were further refined, based on 1998 research findings. Results: A summary of relevant evidence and ten public health recommendations are reported. VCT for pregnant women, a short regimen of zidovudine together with alternatives to breastfeeding currently represent the best option to reduce vertical transmission in most developing countries. The primary goal of the integrated package supporting these interventions is to alleviate overall maternal and infant morbidity and mortality. Conclusion: Prevention of mother-to-child transmission of HIV should now be considered for integration into basic health and MCH services of selected countries, with the involvement of governments and donor agencies.
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页码:34 / 42
页数:9
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