RESUMO
Objective To assess adoption of World Health Organization (WHO) guidance into national policies for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) and to monitor implementation of guidelines at facility level in rural Malawi, South Africa and the United Republic of Tanzania. Methods : We summarized national PMTCT policies and WHO guidance for 15 indicators across the cascades of maternal and infant care over 20132016. Two survey rounds were conducted (20132015 and 20152016) in 46 health facilities serving five health and demographic surveillance system populations. We administered structured questionnaires to facility managers to describe service delivery. We report the proportions of facilities implementing each indicator and the frequency and durations of stock-outs of supplies, by site and survey round.Findings In all countries, national policies influencing the maternal and infant PMTCT cascade of care aligned with WHO guidelines by 2016; most inter-country policy variations concerned linkage to routine HIV care. The proportion of facilities delivering post-test counselling, same-day antiretroviral therapy (ART) initiation, antenatal care and ART provision in the same building, and Option B+ increased or remained at 100% in all sites. Progress in implementing policies on infant diagnosis and treatment varied across sites. Stock-outs of HIV test kits or antiretroviral drugs in the past year declined overall, but were reported by at least one facility per site in both rounds. Conclusion Progress has been made in implementing PMTCT policy in these settings. However, persistent gaps across the infant cascade of care and supply-chain challenges, risk undermining infant HIV elimination goals
Assuntos
Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/legislação & jurisprudência , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Malaui , Gestantes , África do Sul , TanzâniaRESUMO
In this article, the following topics about pediatric HIV infection and AIDS are summarized: a description of pathogenic and clinical aspects of HIV infection in children, the clues for its suspicion, the preventive strategies to avoid the vertical transmission of HIV, the study to certify or to rule out the HIV infection in infants and children, the main recommendations of antiretroviral treatment and how to prevent and treat manifestations of HIV infection. Besides, the evolution in Chile of the pediatric HIV infection is described with details, since the first child detected with AIDS in 1987, infected by transfusion and the first infants (twin) diagnosed in 1989, infected by vertical twins transmission, to 2014, with the progress obtained, snags, hopes and challenges addressed.
En este artículo se describe en forma resumida la patogénesis y aspectos clínicos de la infección por VIH en niños, las claves para su sospecha, las medidas preventivas para evitar su transmisión vertical, el estudio necesario para certificar o descartar la infección en lactantes y niños mayores, y las principales recomendaciones para la terapia anti-retroviral y cómo tratar y prevenir las manifestaciones de la infección por VIH. Se relata a continuación, en forma detallada, la evolución que ha experimentado en Chile la infección por VIH en pediatría, desde el primer caso pesquisado en el año 1987, producto de una transfusión sanguínea, y los primeros lactantes (mellizos) detectados en 1989, que fueran infectados en forma vertical, hasta el año 2014, con el progreso obtenido, las trabas, esperanzas y desafíos enfrentados.