Assessing missed opportunities for the prevention of mother-to-child HIV transmission in an Eastern Cape local service area.

BACKGROUND: Prevention of new HIV infections is a critical imperative for South Africa; the prevention of mother-to-child transmission (PMTCT) is one of the most efficacious HIV prevention interventions. OBJECTIVE: Assessment of a PMTCT programme to determine missed opportunities. SETTING: The Kouga local service area (LSA), bordering Nelson Mandela Bay Municipality (Port Elizabeth) in the Eastern Cape. METHODS: An assessment was conducted in 2007 before implementing technical support for strengthening the PMTCT programme, including: interviews with 20 PMTCT managers, 4 maternity staff and 27 other health workers on service provision, management, infrastructure, human resources and the health information system; 296 antenatal clinic users on their service perceptions; 70 HIV-positive women on HIV knowledge, infant feeding, coping, support and service perceptions; 8 representatives from community organisations and 101 traditional health practitioners (THPs). Observations were conducted during site visits to health facilities, and the District Health Information System (DHIS) data were reviewed. RESULTS: Staff had high levels of awareness of HIV policies and most had received some relevant training. Nevirapine uptake varied by clinic, with an average of 56%. There were many missed opportunities for PMTCT, with 67% of pregnant women tested for HIV and only 43% of antenatal care attendees tested during a previous pregnancy. Only 6% of HIV-positive women reported support group participation. CONCLUSIONS: Reducing missed opportunities for PMTCT requires strengthening of the formal health sector, intersectoral liaison, and greater community support. Priority areas that require strengthening in the formal health sector include HIV counselling and testing; family planning and nutrition counselling; infant follow-up; human resources; and monitoring and evaluation.

The human glucocerebrosidase gene has two functional ATG initiator codons.

Gaucher disease is due to a deficiency in the activity of the enzyme glucocerebrosidase. Glucocerebrosidase is a lysosomal enzyme that presumably requires a signal peptide for transport across the membrane of the rough endoplasmic reticulum and glycosylation for transport into lysosomes. Human glucocerebrosidase cDNA contains two potential ATG start codons in its long open reading frame. The signal peptides that are initiated from each ATG are quite different in their hydrophobicity. We demonstrate that either ATG can function independently to produce active glucocerebrosidase enzyme in cultured fibroblasts. The glucocerebrosidase activity produced from translation products initiated at either ATG is found predominantly in the lysosomes.

Transfection of a factor-dependent cell line with the murine interleukin-3 (IL-3) cDNA results in autonomous growth and tumorigenesis.

The factor dependent murine myeloid line 32D c15 was transfected by electroporation with a murine interleukin-3 (IL-3) cDNA expression plasmid bearing the murine metallothionein-I promoter element. Factor-independent cell growth was readily obtained, and was shown to be accompanied by the production of biologically active IL-3. Three cell lines, growing autonomously and secreting IL-3 activity into their supernatants were established. S-1 nuclease analysis was employed to demonstrate that the introduced plasmid and not the endogenous IL-3 gene was the source of the IL-3 in one of these lines. The transfected IL-3 secreting cell lines, but not the parental factor-dependent 32D c15 cells, were uniformly able to induce tumors in syngeneic mice. These results indicate that the conversion to a malignant phenotype of a "partially transformed" cell line may be achieved by one additional dominant genetic event, such as the acquisition of autocrine growth factor secretion.