Introduction: Prevention of mother-to-child transmission of HIV (PMTCT ) remains a challenge for developing countries. Research indicates that health-system related barriers have a negative impact on PMTCT programs. This study explores barriers and facilitators in the implementation of PMTCT program in Suva, Fiji.
Methods: The study utilised a qualitative approach. Data were collected via individual,in-depth, interviews held in a single hospital in May 2013. A total of seventeen healthcare providers were interviewed. The selection of respondents was based on their involvement with provision PMTCT services. The data were analysed using thematic analysis. results: Preliminary results indicate facilitators for the PMTCT program include improvements in the availability of resources. The supply of anti-retroviral medications is currently adequate for both mothers and babies, with the exception of protease inhibitor for babies. The availability of HIV testing kits has improved in recent years due to improvements in forecasting demand for materials.Resource barriers include: shortages of personal protective equipment; lack of hospital laboratory facility to perform confirmatory HIV tests; and delays in receiving tests results due to shortage of reagents in the reference laboratory. Workforce barriers include: shortages of healthcare workers in the antenatal clinic to cater for pregnant women; limited access to PMTCT training for nurses and midwives; and tensions between the hospital PMTCT staff (who perceive a lack of PMTCT knowledge in counsellors) and external providers of patient counseling services (who identified a lack of referrals to their service by PMTCT staff ). Conclusion: The results indicate that hospital has made significant progress in provision of PMTCT services since the program commenced in 2005. Resource and workforce barriers, though improving, remain a concern. Cultural tensions between public and private providers require a more detailed examination, and will be considered once the full results are analysed. Disclosure of Interest Statement: One-year study scholarship has been provided by the Human Resources for Health Knowledge Hub, University of New South Wales, No other grant was received in the development of this study.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.