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Journal of Acquired Immune Deficiency... Jul 2014Human papillomavirus (HPV) vaccines to prevent cervical cancer have become available in recent years and presented a new challenge to health systems, since they prevent... (Review)
Review
BACKGROUND
Human papillomavirus (HPV) vaccines to prevent cervical cancer have become available in recent years and presented a new challenge to health systems, since they prevent a sexually transmitted virus and are most effective if they are delivered to young adolescent girls, a group not widely served by other health programs. Demonstration and pilot HPV vaccination programs undertaken in the past 7-8 years in low-resource settings have produced lessons that may be more broadly applied to other adolescent health interventions, particularly to those that attempt to reduce human immunodeficiency virus (HIV) infection.
METHODS
A systematic literature review was undertaken to identify formal and informal evaluations of HPV vaccine use in low- and middle-income countries. Special attention was devoted to the detailed evaluations carried out on large demonstration projects in India, Peru, Uganda, and Vietnam.
RESULTS
These lessons fall into 2 main categories: service delivery operations and community outreach and mobilization. Operational issues included venue and timing of vaccinations, definition of target population, micro-planning and coordination, integration with other services, and training. Community issues included consent, messages and channels, endorsement and support, and timing of mobilization efforts.
DISCUSSION
Careful planning, good coordination across sectors and levels, and sensitive attention to the expressed needs for information and preferences for communication channels among youth, parents, and communities more broadly were among the key lessons that are relevant for HIV interventions, but many of the smaller details were also important.
CONCLUSIONS
Applying or adapting these lessons to adolescent HIV services could accelerate effective program design and enhance success.
Topics: AIDS Vaccines; Adolescent; Female; HIV Infections; Humans; Immunization Programs; Papillomavirus Vaccines; Socioeconomic Factors
PubMed: 24918597
DOI: 10.1097/QAI.0000000000000175 -
Bulletin of the World Health... Jan 2013To determine whether integrating antiretroviral therapy (ART) into antenatal care (ANC) and maternal and child health (MCH) clinics could improve programmatic and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether integrating antiretroviral therapy (ART) into antenatal care (ANC) and maternal and child health (MCH) clinics could improve programmatic and patient outcomes.
METHODS
The authors systematically searched PubMed, Embase, African Index Medicus and LiLACS for randomized controlled trials, prospective cohort studies, or retrospective cohort studies comparing outcomes in ANC or MCH clinics that had and had not integrated ART. The outcomes of interest were ART coverage, ART enrolment, ART retention, mortality and transmission of human immunodeficiency virus (HIV).
FINDINGS
Four studies met the inclusion criteria. All were conducted in ANC clinics. Increased enrolment of pregnant women in ART was observed in ANC clinics that had integrated ART (relative risk, RR: 2.09; 95% confidence interval, CI; 1.78-2.46; I(2): 15%). Increased ART coverage was also noted in such clinics (RR: 1.37; 95% CI: 1.05-1.79; I(2): 83%). Sensitivity analyses revealed a trend for the national prevalence of HIV infection to explain the heterogeneity in the size of the effect of ART integration on ART coverage (P = 0.13). Retention in ART was similar in ANC clinics with and without ART integration.
CONCLUSION
Although few data were available, ART integration in ANC clinics appears to lead to higher rates of ART enrolment and ART coverage. Rates of retention in ART remain similar to those observed in referral-based models.
Topics: Female; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Maternal-Child Health Centers; Pregnancy; Pregnancy Complications, Infectious; Prenatal Care
PubMed: 23397350
DOI: 10.2471/BLT.12.107003 -
The Journal of Infectious Diseases Mar 2012The World Health Organization and the United Nations Children's Fund promote integration of maternal and child health (MCH) and immunization services as a strategy to... (Review)
Review
BACKGROUND
The World Health Organization and the United Nations Children's Fund promote integration of maternal and child health (MCH) and immunization services as a strategy to strengthen immunization programs. We updated our previous review of integrated programs and reviewed reports of integration of MCH services with immunization programs at the service delivery level.
METHODS
Published and unpublished reports of interventions integrating MCH and immunization service delivery were reviewed by searching journal databases and Web sites and by contacting organizations.
RESULTS
Among 27 integrated activities, interventions included hearing screening, human immunodeficiency virus services, vitamin A supplementation, deworming tablet administration, malaria treatment, bednet distribution, family planning, growth monitoring, and health education. When reported, linked intervention coverage increased, though not to the level of the corresponding immunization coverage in all cases. Logistical difficulties, time-intensive interventions ill suited for campaign delivery, concern for harming existing services, inadequate overlap of target age groups, and low immunization coverage were identified as challenges.
CONCLUSIONS
Results of this review reinforce our 2005 review findings, including importance of intervention compatibility and focus on immunization program strength. Ensuring proper planning and awareness of compatibility of service delivery requirements were found to be important. The review revealed gaps in information about costs, comparison to vertical delivery, and impact on all integrated interventions that future studies should aim to address.
Topics: Child Health Services; Child, Preschool; Delivery of Health Care, Integrated; Female; Humans; Immunization Programs; Maternal Health Services; Pregnancy
PubMed: 22315388
DOI: 10.1093/infdis/jir778 -
Obstetrics and Gynecology Jul 2010To evaluate efficacy of lamivudine in reducing in utero transmission of hepatitis B virus (HBV). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate efficacy of lamivudine in reducing in utero transmission of hepatitis B virus (HBV).
DATA SOURCES
A database was constructed from Medline, EMBASE, Cochrane Library, National Science Digital Library, China Biological Medicine Database, and through contact with experts in the field from January 1990 to October 2009.
METHODS OF STUDY SELECTION
We used the Jadad score and Cochrane Collaboration's tool for assessing risk of bias.
TABULATION, INTEGRATION, AND RESULTS
We abstracted data regarding HBV intrauterine infection, mother-to-child transmission, maternal HBV DNA level, treatment methods, and adverse effects. All newborns followed joint immune prophylaxis schedule of hepatitis B vaccine and hepatitis B immunoglobulin after delivery. The Mantel-Haenszel random-effects model was employed for all analyses using odds ratio (OR) and 95% confidence interval. Compared with the no-treatment group or placebo group, newborns in the lamivudine group had a 10.7–23.7% lower incidence of intrauterine infection, indicated by newborn hepatitis B surface antigen (0.38,0.15–0.94, six randomized controlled trials [RCTs], P5.04) and HBV DNA (0.22, 0.12–0.40, four RCTs, P,.001) seropositivity, and a 12.7–33.2% lower mother-to child transmission rate at 9–12 months, indicated by infant hepatitis B surface antigen (0.31, 0.15–0.63, five RCTs, P,.01) and HBV DNA (0.20, 0.10–0.39, two RCTs,P,.001) seropositivity [corrected].No significant higher adverse effects or complications in pregnancy were observed.
CONCLUSION
Lamivudine in HBV carrier-mothers with high degree of infectiousness in late pregnancy effectively prevented HBV intrauterine infection and mother-to-child transmission.
Topics: Carrier State; DNA, Viral; Female; Hepatitis B; Hepatitis B Surface Antigens; Hepatitis B virus; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Lamivudine; Models, Theoretical; Pregnancy; Pregnancy Complications, Infectious; Randomized Controlled Trials as Topic; Reverse Transcriptase Inhibitors
PubMed: 20567182
DOI: 10.1097/AOG.0b013e3181e45951 -
Cancer Research Jun 2004Cancers of the anogenital tract as well as some head and neck cancers are caused by persistent infections with high-risk type human papillomaviruses (HPVs). Two viral... (Review)
Review
Cancers of the anogenital tract as well as some head and neck cancers are caused by persistent infections with high-risk type human papillomaviruses (HPVs). Two viral oncogenes, E6 and E7, induce severe chromosomal instability associated with centrosome aberrations, anaphase bridges, chromosome lagging, and breaking. This occurs early in preneoplastic lesions, when the viral genome still persists in an episomal state. In most invasive cancers and also in a few high-grade dysplastic lesions, however, integration of high-risk HPV genomes into the host genome is observed. Integration seems to be a direct consequence of chromosomal instability and an important molecular event in the progression of preneoplastic lesions. Disruption or deregulation of defined critical cellular gene functions by insertional mutagenesis by integrated HPV genome fragments has been hypothesized as one major promoting factor in the pathogenesis of HPV-associated cancers. This hypothesis was based on the detection of HPV integration events in the area of tumor-relevant genes in few cases. Here, we reviewed >190 reported integration loci with respect to changes in the viral structure and the targeted genomic locus. This analysis confirms that HPV integration sites are randomly distributed over the whole genome with a clear predilection for genomic fragile sites. No evidence for targeted disruption or functional alteration of critical cellular genes by the integrated viral sequences could be found.
Topics: Cell Transformation, Viral; DNA, Viral; Epithelial Cells; Female; Gene Expression Regulation, Viral; Genital Neoplasms, Female; Humans; In Situ Hybridization, Fluorescence; Papillomaviridae; Uterine Cervical Neoplasms; Vaginal Neoplasms; Virus Integration; Vulvar Neoplasms; Uterine Cervical Dysplasia
PubMed: 15172997
DOI: 10.1158/0008-5472.CAN-04-0009 -
Obstetrics and Gynecology Dec 2003Genital herpes simplex virus (HSV) infection is one of the most common viral sexually transmitted diseases in the United States. Perinatal transmission of the virus to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Genital herpes simplex virus (HSV) infection is one of the most common viral sexually transmitted diseases in the United States. Perinatal transmission of the virus to the fetus or neonate is a major concern in affected pregnancies. Our objective was to systematically review published data to estimate the effect of prophylactic acyclovir provided to pregnant women near term on the rate of recurrent genital herpes at delivery; the number of cesarean deliveries performed for clinical HSV recurrences or prodromal symptoms; and the prevalence of HSV virologic detection at delivery.
DATA SOURCES
Our search included MEDLINE (1966-March 2003), LILACS, EMBASE, conference proceedings, abstracts from scientific forums and bibliographies of published articles with the following medical headings: acyclovir, pregnancy, Herpes viridae, and Herpesviridae.
METHODS OF STUDY SELECTION
Prospectively designed criteria included randomized, clinical trials detailing the use of acyclovir in pregnancy for women with HSV published in either abstract or article form. Five trials with a total enrollment of 799 patients were included in the analysis.
TABULATION, INTEGRATION, AND RESULTS
The studies were reviewed independently by three of the authors. With RevMan software, a fixed-effects model was used to calculate a summary odds ratio (OR) comparing the effect of treatment with placebo. Acyclovir prophylaxis beginning at 36 weeks' gestation was effective in reducing clinical HSV recurrences at the time of delivery (OR 0.25; 95% confidence interval [95% CI] 0.15, 0.40), cesarean deliveries for clinical recurrence genital herpes (OR 0.30; 95% CI 0.13, 0.67), total HSV detection at delivery (OR 0.11; 95% CI 0.04, 0.31), and asymptomatic HSV shedding at delivery (OR 0.09; 95% CI 0.02, 0.39).
CONCLUSION
The results of this meta-analysis indicate that prophylactic acyclovir beginning at 36 weeks' gestation reduces the risk of clinical HSV recurrence at delivery, cesarean delivery for recurrent genital herpes, and the risk of HSV viral shedding at delivery.
Topics: Acyclovir; Antiviral Agents; Female; Herpes Simplex; Humans; Obstetric Labor Complications; Pregnancy; Prospective Studies; Randomized Controlled Trials as Topic; Recurrence
PubMed: 14662233
DOI: 10.1016/j.obstetgynecol.2003.08.015