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close this bookNew Data on the Prevention of Mother-to-Child Transmission of HIV and Their Policy Implications (UNAIDS, 2001, 24 p.)
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Open this folder and view contentsIntroduction
Open this folder and view contentsConclusions and recommendations on the use of antiretrovirals
Open this folder and view contentsConclusions and recommendations regarding infant feeding
View the documentIdentified needs for research
View the documentReferences
View the documentAbbreviations
View the documentParticipants

Identified needs for research

Highest priority issues are marked with an asterisk (*)

Type, duration and efficacy of antiretroviral prophylactic regimens


Continue evaluation of long term efficacy and safety of antiretroviral regimens.


Evaluate the short term and long term efficacy and safety of combination antiretrovirals during the peripartum period (e.g. ZDV + NVP).


Evaluate the efficacy and safety of antiretroviral drugs not yet assessed for PMTCT,e.g. non-nucleoside reverse transcriptase inhibitors such as Efavirenz, and nucleoside reverse transcriptase inhibitors such as Stavudine (d4T), Didanosine (ddI).

Resistance to antiretroviral prophylactic regimensg

*

Evaluate the development, timing, and evolution of genotypic and phenotypic drug resistance induced by antiretroviral prophylaxis regimens, including the relationship of resistance to viral subtype/subtype recombinants, and specific drugs and drug classes

*

Assess the clinical significance of the occurrence of viral mutations in relationship to:

· The course of HIV disease in mothers and infants exposed to peripartum antiretroviral MTCT-prevention interventions;

· The treatment of HIV disease in mothers and infants exposed to peripartum antiretroviral MTCT-prevention interventions;

· Risk of transmission in current and subsequent pregnancies;


· Risk of sexual transmission following use of antiretrovirals for MTCT-prevention.

*

Encourage surveillance for emergence of viral resistance in populations where antiretrovirals have been introduced for PMTCT and/or treatment. This should be undertaken as part of an overall strategy for resistance surveillance, based for example on the WHO global strategy for antimicrobial resistance containment.

g Resistance should be evaluated in the context of clinical trials or sub-studies within implementation projects.

Risks and benefits of different patterns of infant feeding

*

Evaluate further the influence of infant feeding patterns (exclusive breastfeeding, exclusive formula feeding, mixed feeding and duration/timing of breastfeeding cessation) on MTCT, overall infant morbidity and mortality, and birth spacing.


Evaluate the influence of breastfeeding on nutritional status, disease progression and mortality of HIV infected women. Identify an appropriate package of nutritional support and care for HIV infected women.


Better quantify the rate of MTCT through breastfeeding among mothers who become infected with HIV after delivery.


Conduct research on HIV in breastmilk to better understand the relationship between postnatal HIV transmission and HIV viral load, the presence of resistant virus in breastmilk, and other breastmilk components that influence transmission risk.


Study the feasibility and practicality of improving the quality and safety of replacement feeding in different settings.

Reduction of MTCT during breastfeeding

*

Evaluate the efficacy of infant and/or mother ARV treatment (including full combination therapy for treatment of the mother) and immune based interventions (i.e. infant HIV vaccines and passive immune therapy) on the prevention of MTCT through breastfeeding.

*

Evaluate how best to ensure that the transition period between exclusive breastfeeding and no breastfeeding carries a minimum HIV, nutritional and psychological risk for the infant and mother.


Assess the feasibility and safety of heat treating expressed breastmilk in the home to inactivate the virus.


Evaluate further the role of mastitis and other breast pathology in HIV transmission through breastmilk and develop strategies to minimize such problems.

Standardization of the methodology for HIV and infant feeding research

*

Ensure the comparability between studies on MTCT in populations where breastfeeding occurs through:

· Use of existing definition of breastfeeding patterns and when necessary, development of new definitions;

· Developing guidance on how to collect, analyze and interpret disaggregated data on infant feeding and timing of post natal infection in a standardized way.

Research Linked to Implementation, Monitoring and Evaluation


Study approaches to enhancing community preparedness and communication strategies.

*

Study barriers to different steps of VCT in pregnant women in different settings.


Study barrier to antiretroviral adherence for MTCT prophylaxis.


Study the acceptability and performance of rapid same day antenatal VCT.


Study the acceptability and effectiveness of VCT and ARV prophylaxis starting in labour or soon after delivery in mothers who have not benefited from antenatal testing.


Develop alternative methods to PCR for early diagnosis of HIV infection in infants suitable for use in developing countries.

*

Study the effects of infant feeding recommendations for HIV-infected mothers on general population behaviours related to breastfeeding.

*

Determine ways to promote partner, family and community involvement to increase acceptance and support for infant feeding options and choices.


Evaluate existing and develop improved techniques for infant feeding counseling.