In Uganda, there is an urgent need for quality, voluntary family planning (FP) services to help people living with HIV (PLHIV) achieve their fertility intentions and to reduce HIV incidence. The AIDS Support Organization (TASO), one of the leading local nongovernmental organizations (NGOs) in Uganda providing HIV counseling, prevention, care, treatment, and support services to PLHIV, provides services in 11 centers and 15 minicenters. TASO clinicians and administrators struggle to meet the FP needs of PLHIV who arrive at their clinics with unplanned pregnancies and/or incomplete abortions. Although TASO/M has provided limited FP services to ART clients on an ad hoc basis since 2004, it lacked a comprehensive FP program. The ACQUIRE Project-in collaboration with TASO/M and the Ugandan Ministry of Health (MOH) implemented an FP-ART integration pilot from March 2006 to April 2007 with the launching of FP services in September 2006. This report details the results of a retrospective evaluation conducted by ACQUIRE in November 2007, using a case study methodology to assess its FP-ART integration pilot, including its effect on the program processes and FP method mix and uptake at TASO/M. 

Authors: Schenk KD, Ndhlovu L, Tembo S, Nsune A, and Nkhata C

Source: AIDS Care

Date: September 2008

This study explores how communities in Zambia characterize vulnerable children in the context of HIV; demonstrates how estimates of vulnerability vary depending on definitions; and discusses the implications of these estimates for program delivery. Baseline research conducted in 2005 included cross-sectional community-based household surveys at six locations using multi-stage random sampling (totalling 1,503 households, reporting on 5,009 children) and participatory qualitative research (focus group and in-depth interviews) with adults and youth at four locations. Between 14 and 27% of children in the sample had experienced a parental death (2-5% maternal orphans, 7-13% paternal orphans, 4-10% double orphans). In addition, other characteristics that communities associated with children's vulnerability were prevalent: 26-34% had been taken into another household, 15-27% were living in female-headed households, and 11-28% were living in a household with someone who is chronically ill. Overall, 58-73% of children had one or more community-defined characteristics of vulnerability. This study highlights the need to carefully consider the meaning of "vulnerability" when targeting programmes to support children affected by HIV and AIDS. Local community input is vital to inform context-specific criteria for distributing programme resources. If used, eligibility criteria should be context-specific yet flexible to evolving community realities. In settings such as rural Zambia where levels of HIV-related vulnerability are high, it may be more efficient to target at the level of communities rather than assess individual households.  

Authors: Boulle A, Bock P, Osler M, Cohen K, Channing L

Source: Bulletin of the World Health Organization

Date: September 2008

The objective of this study is to describe province-wide outcomes and temporal trends of the Western Cape Province antiretroviral treatment (ART) programme 5 years since inception, and to demonstrate the utility of the WHO monitoring system for ART. The treatment programme started in 2001 through innovator sites. Rapid scaling-up of ART provision began early in 2004, located predominantly in primary-care facilities. Data on patients starting ART were prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated. Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at 6-monthly durations on ART. By the end of March 2006, 16 234 patients were in care. The cohort analysis included 12,587 adults and 1709 children. Women accounted for 70% of adults enrolled. After 4 and 3 years on ART respectively, 72.0% of adults (95% confidence interval, CI: 68.0-75.6) and 81.5% (95% CI: 75.7-86.1) of children remained in care. The percentage of adults starting ART with CD4 counts less than 50 cells/microl fell from 51.3% in 2001 to 21.5% in 2005, while mortality at 6 months fell from 12.7% to 6.6%, offset in part by an increase in loss to follow-up (reaching 4.7% at 6 months in 2005). Over 85% of adults tested had viral loads below 400 copies/ml at 6-monthly durations until 4 years on ART. The location of care in primary-care sites in this programme was associated with good retention in care, while the scaling-up of ART provision was associated with reduced early mortality.

Declining HIV prevalence among young pregnant women in Lusaka, Zambia

Author: Stringer EM, Chintu NT, Levy JW, Sinkala M, Chi BH

Source: Bulletin of the World Health Organization

Date: September 2008

HIV prevention has been ongoing in Lusaka for many years. Recent reports suggest a possible decline in HIV seroincidence in Zambia and some neighbouring countries. This study aimed to examine trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006. The authors analysed HIV seroprevalence trends from two Lusaka sources: (i) antenatal data from a city-wide programme to prevent mother-to-child HIV transmission, and (ii) delivery data from two anonymous unlinked cord-blood surveillances performed in 2003 and again in 2005-2006, where specimens from greater than 97% of public-sector births in each period were obtained and analysed. Between July 2002 and December 2006, the Lusaka district tested 243,302 antenatal women for HIV; 54 853 (22.5%) were HIV infected. Over this period, the HIV seroprevalence among antenatal attendees who were tested declined steadily from 24.5% in the third quarter of 2002 to 21.4% in the last quarter of 2006 (P less than 0.001). The cord-blood surveillances were conducted between June and August 2003 and again between October 2005 and January 2006. Overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005-2006 (P = 0.001). Among women less than or= 17 years of age, seroprevalence declined from 12.1% to 7.7% (P = 0.015). HIV seroprevalence appears to be declining among antenatal and parturient women in Lusaka. The decline is most dramatic among women less than or= 17 years of age, suggesting a reduction in sero-incidence in this important age group.

Pregnancy, pregnancy desires, and contraceptive use among HIV- infected women : Findings from a survey of women enrolled in PMTCT in Rwanda

Authors: Bangendanye L

Corporate Author: Family Health International (FHI), Rwanda

URL: http://db.jhuccp.org/mmc/media/TRRWA9.pdf

Provides an overview of a study in Rwanda surveying HIV positive women's pregnancy desires, wanted versus unwanted pregnancies, and contraceptive usage. Recommendations are made to make family planning education and commodities accessible at all HIV service points, to provide targeted services to young women, and to generally strengthen FP services.

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