Toward secure breastfeeding under HAART?: the Mitra plus Study

Mitra Plus is a prospective study, conducted in Tanzania, in which women were administered HAART during the third trimester of pregnancy and continued on it for 6 months after they gave birth. The mothers breastfed their babies for an average period of six months.Four hundred and forty-one newborns (441) were followed for 18 months, through virological tests (PCR) or serological tests (after one year). The cumulative rate of infection in newborns was 4.1% at 6 weeks (corresponding to pre- or peri-natal infection), 5% at 6 months (an additional risk of 0.9%) and 6.1% (+ 2%) at 18 months (as compared to the risk of unprotected breastfeeding, estimated to be between 5 and 20%). The authors concluded that the rate of transmission was low in children whose mothers received HAART late in their pregnancy and for 6 months while they were breastfeeding.  They recommend this approach for women in developing countries who have opted to breastfeed their infants. However it should be noted that this risk increases again if mothers continue to breastfeed once they have stopped taking ARVs which demonstrates the importance of continuing ARV therapy throughout the entire course of the breastfeeding period. Other studies are underway to further understand the side effects, mortality, indications and procedures of this promising alternative to replacement feeding. 

Clinical and anthropometric follow up for small children co-infected with HIV and TB

Researchers presented an original retrospective study which looked at the clinical and anthropometric evolution of forty six (46) children under 3 years old, co-infected by HIV and TB, treated at the TRAC and Kigali (Rwanda) University centers. The study describes the children’s nutritional status at the time of enrolment and their evolution while on TB treatment and ARVs Before treatment severe malnutrition (Weight/Age < -3DS) was present in 67% of the cases; chronic malnutrition (Height/Age < -2 DS) was found in 80% of cases; also, the Weight/Height marker did not reveal severe malnutrition except in 20% of cases. After 9 months of medical treatment and nutritional support, mortality of the children was high-- 41%-- and was mostly due to the severity of their nutritional status.Among the survivors, weight gain (W/A > - 2DS) was observed in almost 90% of cases; on the other hand moderate to severe growth retardation (< -2DS) remained present in 2/3 cases. The authors conclude that early diagnosis and treatment as well as using Weight/Age and Height/Age markers to diagnose and initiate nutritional treatment is critical for children who present with chronic malnutrition. The weight / size indicator, however, is insufficient to identify children suffering from chronic malnutrition.  

Contraception and PMTCT

Linking family planning services and HIV services was the subject of several presentations during the conference. The prevention of undesired pregnancies is considered as one of the pillars of PMTCT. Various studies have shown the cost effectiveness of this approach.  For the same cost, using these services in preventing undesired pregnancies in women living with HIV  more infections in children can be prevented than if they had recourse to nevirapine (this  decreases the number of babies born with HIV by +30%). Meanwhile, there is still a lot to do in this often neglected area-- specifically in promoting access to double protection where condoms (to prevent transmission of HIV and STDs to one’s partner, reinfection by other strains of the virus) are used in conjunction with an additional contraception method (such as hormonal contraceptives, like implants or IUDs). Advocacy is essential so that family planning services adapted to the needs of women living with HIV are integrated with PMTCT services and provided throughout the first postpartum month.  

Orphans and Vulnerable Children (OVCs) in Africa

In 2007, it was estimated that 12 million children in sub-Saharan Africa had lost one or two parents because of AIDS. However, the most recent UNICEF report on children and HIV, presented during this 15^th ICASA, indicates that AIDS is not the only cause of this increase in the number of orphans. In Burundi and Rwanda for example, it is probably due more to armed conflict than to the epidemic. This means that solutions should not centre exclusively on AIDS. If AIDS is obviously not the only cause of the large number of orphans, nonetheless, the HIV epidemic has accentuated their vulnerability.While national efforts towards OVCs have improved, community members and families are the first to take care of orphans; a challenge for organisations that are willing to assist these families: resolve difficulties in assessing the ability of the host family to take care of the child. The notion of vulnerability is complex and must be understood in terms of the country and local context. 

Recommendations that emerged from the different sessions on this issue are: it is essential to reinforce community capacities, analyze and treat the extreme vulnerability of girls, improve social protection of all vulnerable children and establish programs adapted to OVCs needs by including them in the programs.