art - rapid advice- pregnant women and pmtct - 19dec09

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RAPID ADVICE

Use o antiretroviral drugs or treating pregnant womenand preventing HIV inection in inants

NOVEMBER 2009


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WHO Library cataloguing-in-publication data

Rapid advice: use o antiretroviral drugs or treating pregnant women and preventing HIV inection in inants

1. Antiretroviral agents - pharmacology. 2.HIV inections - therapy. 3. HIV inections - prevention and control. 4. Disease transmission, Vertical - prevention and control.

5. Pregnant women. 6. Guidelines. 7. Developing countries. I. World Health Organization.

ISBN

World Health Organization 2009

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Printed in Switzerland


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RAPID ADVICE

Use o antiretroviral drugs or treating pregnant womenand preventing HIV inection in inants

NOVEMBER 2009


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Contents

1. Overview 4

1.1 Background 4

1.2 Why a revision? 4

1.3 Guiding principles 4

2. Recommendations at a glance 5

3. The revision process 6

3.1. Retrieving, summarizing and presenting the evidence 6

3.2 Consensus, external review and updating 6

3.3 Publication and timing 7

4. Adaptation, implementation and evaluation 8

5. Companion documents 9

6. Declarations o interest 10

7. Collaboration with external partners 11

8. Key recommendations 12

8.1 ART or HIV-inected pregnant women who need treatment or their own health 12

8.2 ARV prophylaxis or all HIV-inected pregnant women

who do not need treatment or their own health. 13

9. Annex 1 16


6/254 RAPID ADVICE: USE OF ANTIRETROVIRAL DRUGS FOR TREATING PREGNANT WOMEN AND PREVENTING HIV INFECTION IN INFANTS

1. Overview

1.1 Background

The World Health Organization (WHO) worked on the revision

o the Use o antiretroviral drugs or treating pregnant women and

preventing HIV inection in inants: recommendations or a public

health approach, 2006, through a series o coordinated eorts

to review and synthesize emerging evidence. The key areas o

review are:

a. when to start and what antiretroviral therapy (ART) to give to

pregnant women living with HIV who are eligible or ART; and

b. when to start and what antiretroviral (ARV) prophylaxis to

give to pregnant women who do not need ART or their own

health, but need ARVs to reduce the risk o mother-to-child

transmission (MTCT) o HIV.

This evidence was assembled ollowing systematic reviews,

GRADE prole analysis, consultations with key implementers,

cost review, and peer review.

Various individuals were involved in the development o these

recommendations: the Core Writing Group consisting o WHO

sta and external experts, the ull Guideline Review Committee,

and the Peer Review Group. The members are listed in Annex 1.

The aim was to identiy evidence-based recommendations that

would be likely to deliver high quality care. The evidence and

its quality, risks and benets, acceptability, easibility, cost and

nancial implications, were considered by the Guideline Review

Committee and the Peer Review Group, who agreed on a series o

updated recommendations.

1.2 Why a revision?

The availability o a signicant amount o new evidence on ARV

prophylaxis to prevent MTCT, as well as new inormation onoptimal timing or ART initiation (treatment eligibility) warrants

development o revised 2009 guidelines. Particularly important is

the evidence indicating the benets o starting ARV prophylaxis

or PMTCT earlier during pregnancy, and new data indicating

that extended ARV prophylaxis to mothers or inants is eective

in substantially decreasing the risk o HIV transmission through

breasteeding. Revision o the guidelines provides an important

opportunity to simpliy and standardize current recommenda-

tions, and to provide updated normative guidance or more

eective PMTCT interventions in both resource-limited settings

and globally. Once implemented, these recommendations canreduce MTCT risk to less than 5% in breasteeding populations

(rom a background risk o 35%) and in non-breasteeding popu-

lations (rom a background risk o 25%), and will help promoteimproved maternal and child health and survival. More eective

interventions in resource-limited settings make it possible or low

and middle income countries to target the virtual elimination o

MTCT and paediatric HIV/AIDS, as has already been achieved in

many countries.

It provides guidance to policy-makers and programme managers

responsible or national PMTCT programmes, and is a resource

document or health care workers involved in the prevention,

care and treatment o pregnant women and their inants. The

guidance also provides a normative ramework to internationaland bilateral unding and implementation and support agencies.

This Rapid advice ocuses on two key areas:

1. When to start and what ART to give to pregnant women living

with HIV who are eligible or ART; and

2. When to start and what ARV prophylaxis to give to pregnant

women who do not need ART or their own health, but need

ARVs to reduce the risk o MTCT.

1.3 Guiding principlesThe WHO guidelines on the use o ARV drugs or treating

pregnant women and preventing HIV inection in inants were

revised in accordance with the ollowing guiding principles:

1. Women (including pregnant women) in need o ARV drugs

or their own health should receive lie-long ART.

2. A CD4 cell count available antenatally is critically important

or decision-making with regard to maternal ART eligibility.

3. Recommended interventions should be aimed at maximizing

the eectiveness o reducing vertical HIV transmission,

minimizing the side eects or both mothers and inants, and

preserving uture HIV care and treatment options.

4. Eective postpartum ARV-based interventions will allow

saer breasteeding practices.

5. Simple uniying principles or dierent country settings are

needed.


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2. Recommendations at a glance

The PMTCT recommendations reer to two key approaches:

1. Lielong ART or HIV-positive women in need o treatment.

2. Prophylaxis, or the short-term provision o ARVs, to prevent

HIV transmission rom mother to child.

This provides the basis or:

1. Earlier ART or a larger group o HIV-positive pregnant

women to benet both the health o the mother and prevent

HIV transmission to her child during pregnancy.

2. Longer provision o antiretroviral ARV prophylaxis or

HIV-positive pregnant women with relatively strong immune

systems who do not need ART or their own health. This

would reduce the risk o HIV transmission rom mother to

child.

3. Provision o ARVs to the mother or child to reduce the risk

o HIV transmission during the breasteeding period. For the

rst time, there is enough evidence or WHO to recommend

ARVs while breasteeding.



3. The revision process

3.1. Retrieving, summarizing and presenting the

evidenceWHO convened an expert consultation in November 2008 to

review new evidence accumulated since the 2006 guidelines.

This consultation helped WHO to compile the evidence and make

a decision whether there was enough new evidence to warrant

the revision o the 2006 guidelines.

Following this initial meeting, WHO drated the scope o work

and developed PICO* questions to the key areas o review.

GRADE proles were prepared or our PICO questions:

a. when to start ART in pregnant women; and what to give topregnant women eligible or ART,

b. when to start ARV prophylaxis in pregnant women, and what

to give pregnant women or ARV prophylaxis,

c. what to give newborn inants in the immediate postpartum,

and

d. what to give breasteeding-exposed inant beyond the

immediate postpartum period.

Based on the PICO questions, systematic review o peer-reviewed

literature and abstracts was perormed through a collaborative

eort between UCSF, CDC and WHO. The HIV/ AIDS Cochrane

Collaborative Review Group search strategy was used or each o

the our key questions.

An inormal two day meeting with key stakeholders, co-hosted

by PEPFAR, was held in Washington in September 2009. This

meeting helped assess the easibility o potential new recommen-

dations and the challenges that countries may ace in revising

their national guidelines.

A second easibility assessment was done through a rapid

assessment in the orm o a structured questionnaire.

Additional considerations on the easibility o relevant PMTCT

interventions were provided through a presentation on: the

health-systems considerations o PMTCT programmes presented

during the Guidelines Review meeting.

Cost inormation and implications were prepared by WHO or key

ART regimens and ARV prophylaxis regimens taking into account

* PICO is an acronym that describes the elements o a well-ormed clinicalquestion. The structure includes: P or the patient or population; I or theintervention o interest; C or comparison; and O or outcome

the dierent pricing in low-income, lower-middle income and

upper-middle income countries. Pricing inormation was based onthe Global Price Reporting Mechanism (GPRM, http://apps.who.

int/hiv/amds/price/hdd/). Cost implications o the proposed

recommendations were presented and discussed during the

Guidelines review meeting.

GRADE evidence proles will be included in the ull guideline.

3.2 Consensus, external review and updating

The Guidelines review meeting on the use o antiretroviral drugs

or treating pregnant women and preventing HIV inection in

inants was held in Geneva rom 1921 October, 2009. The

meeting reviewed evidence around the our key areas in dierent

sessions. Each o the sessions included presentations on the

related GRADE evidence, current and proposed recommenda-

tions, cost implications, and the risk-benet analysis o the key

questions. Discussions were held both in plenary and in group

work sessions.

The proposed recommendations were reviewed and the nal

recommendation(s) were ormulated, taking into consideration

the quality o evidence, the balance between benets and harms,

the balance between values and preerences, cost, easibility,

and other actors. I outcomes o GRADE analysis were inconclu-

sive, other actors as listed above were taken into consideration

in making a recommendation. For consensus reaching, the group

took into account the actors listed above and went through

the risk-benet tables to make decisions on recommendations.

In ew cases where there was no initial consensus, there was

urther discussion and decisions were reached by voting. The

key recommendations were summarized in recommendation

tables according to the our main questions, and included a

summary o key actors that were considered in making the

recommendations.

The summary recommendations were sent or peer review

to six independent peer reviewers and the six WHO regional

oces. They also received the risk-benet tables that include the

strength o the evidence and the strength o the recommendation

and were asked to provide eedback on whether they agreed with

the recommendations or not, and i not why; and whether there

are any key points that are not addressed that are important to be

included. Feedback was received in writing rom all o the review-

ers. Representing dierent countries and perspectives, there was

overall strong support or the proposed recommendations.


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Comments received rom peer review were shared with the core

writing group by teleconerence. The drat recommendations andrecommendation tables were reviewed again, and nalized.

Based on all o the above mentioned steps the nal summary

recommendations were nalized and submitted to the WHO

Guideline Review Committee or approval in early November

2009.

The current guidelines are to be reviewed in 2012, unless

signicant new evidence emerges beore and warrants a review

process earlier.

3.3 Publication and timing

This Rapid advice: use o antiretroviral drugs or treating pregnant

women and preventing HIV inection in inants will be published

online in English and French.

Two guideline writers have been contracted to assist in develop-

ing the revised 2009 guidelines. It is anticipated that the ull

guidelines will be available in February 2010 or nal clearance.

Publication and dissemination is estimated to start in March

or April 2010. The guidelines target national-level policy and

decision-makers, programme managers and managers respon-

sible or designing and implementing PMTCT programmes,

including ART or women.



4. Adaptation, implementation and evaluation

WHO is working closely with UN and other implementing part-

ners, as part o the IATT (InterAgency Task Team), the PEPFARPMTCT/Peds technical working group, and WHO regional

oces to plan or rapid dissemination and implementation o

the new guidelines. Much experience has been obtained rom

the dissemination o the previous guidelines, and active support

or guideline revision at country level is needed. Key steps in the

dissemination include:

1. Translation into at least three other languages (French,

Spanish and Russian). This will be in both hard copies and

web documents.

2. Rapid development o an adaptation guide, in conjunctionwith implementing partners. This adaptation guide will

include a process eedback document that will provide WHO

with important inormation on the quality, useulness and

impact o the guidelines.

3. Briengs, support and joint planning or dissemination with

IATT partners, PEPFAR, Global Fund, etc.

4. Regional workshops to disseminate the guidelines and

support country adaptation. (Nearly all WHO regions have

included this in their workplans or 2010, and PEPFAR has

provided specic support or joint regional workshops.)

5. Rapid country adaptation WHO will work directly with

2-3 high burden countries to support the rapid adaptation

and implementation o the new guidelines, in order to learn

rst-hand how to accelerate the process.


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5. Companion documents

Simple tools to accompany the guideline are being developed in

collaboration with key implementing partners. These tools aredesigned to:

assist countries in the revision o the national PMTCT

guidelines and

support the choice o regimen taking into account the

resources and limitations within the country.

The frst o these important tools is this rapid advice document.



6. Declarations o interest

Forms were collected rom every member o each group. All

individuals attending the Guidelines review meeting completedthe required declaration o confict o interest orm. Altogether

ve individuals declared some confict o interest: L Kuhn,

S Luchters, R Shapiro, and L Guay each declared receiving re-

search support in the past and present. None o the participants

received unding rom pharmaceutical companies. The support

is mainly as research grants rom universities and government

unding. The WHO Secretariat elt that the declarations did

not represent signicant conficts (standard publicly unded

research support) and would not unduly aect the individuals

judgment or the outcome o the meeting. The declaration rom

E Nyankesha was not seen as a confict o interest. A Mushavirom the Peer review group declared some confict but the WHO

Secretariat did not eel that the magnitude o the disclosure

warrants any urther clearance.


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7. Collaboration with external partners

There are no external collaborators specic to this Rapid advice.

However, several partners have been engaged in the develop-ment o the guideline. All collaborations will be detailed in the

ull guideline.

Funding to support this work comes rom PEPFAR and UNAIDS.



8. Key recommendations

8.1 ART or HIV-inected pregnant women who

need treatment or their own health

RECOMMENDATION 1

In pregnant women with confrmed HIV serostatus, initiation

o ART or her own health is recommended or all HIV-inected

pregnant women with CD4 cell count


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RECOMMENDATION 4

Inants born to HIV-inected women receiving ART or their ownhealth should receive

a. or breasteeding inants: daily NVP rom birth until 6 weeks

o age

(strong recommendation, moderate quality evidence)

b. or non-breasteeding inants: daily AZT or NVP rom birth

until 6 weeks o age

(Conditional recommendation, low quality evidence)

Remarks: The recommendation places a high value on preventing

perinatal transmission o HIV and providing additional protectionto the newborn inant in addition to the protection received rom

the mothers ART regimen. Among breasteeding inants, there is

evidence that daily NVP or 6 weeks is efcacious in reducing HIV

transmission or death. Among non-breasteeding inants, there is no

evidence assessing the efcacy o daily NVP or any duration beyond

a single dose at birth. However, there is high quality o evidence that

6 weeks o daily inant AZT prophylaxis in conjunction with maternal

antepartum AZT prophylaxis or more than 4 weeks signifcantly

prevents MTCT. There is additional evidence that AZT or 6 weeks

to the inant provides signifcant protection when mothers have

received less than 4 weeks o antepartum prophylaxis. For motherson ART, inant prophylaxis or the frst 6 weeks o lie provides added

early postpartum protection, especially or mothers who start ART

late, have less than optimal adherence or have not achieved ull viral

suppression.

8.2 ARV prophylaxis or all HIV-inected

pregnant women who do not need treatmentor their own health.

RECOMMENDATION 5

All HIV-inected pregnant women who are not in need o ART or

their own health require an eective ARV prophylaxis strategy

to prevent HIV transmission to the inant. ARV prophylaxis

should be started rom as early as 14 weeks gestation (second

trimester) or as soon as possible when women present late in

pregnancy, in labour or at delivery.

(Strong recommendation, low quality of evidence)

Remarks: Despite the lack o direct evidence showing that starting

prophylaxis earlier (than 28 weeks) is associated with lower rates o

intrauterine transmission, the panel placed a high value on reducing

the potential lost to ollow-up and delayed start o prophylaxis by

waiting until the third trimester, and recognized that there is some

risk o intrauterine transmission throughout pregnancy. Available

observational studies show the benefts o the early start o prophy-

laxis. This will minimize delays between HIV testing in pregnancy and

ARV prophylaxis initiation. Given the median time o 1st antenatal

visit in most settings, most women would not start ARV prophylaxis

at 14 weeks, but the goal is or a majority o women to start during

the 2nd trimester, rather than the middle o the 3rd trimester.



RECOMMENDATION 6

For all HIV-inected pregnant women who are not in need o ARTor their own health, ARV prophylaxis option A consists o:

antepartum daily AZT;

sd-NVP at onset o labour ;

AZT + 3TC during labour and delivery;

AZT + 3TC or 7 days postpartum.


sd-NVP and AZT+3TC intra- and post-partum can be omitted i

mother receives more than 4 weeks o AZT during pregnancy

In breasteeding inants, maternal ARV prophylaxis should be

coupled with daily administration o NVP to the inant rom birth

until one week ater all exposure to breast milk has ended.

(Strong recommendation, moderate quality of evidence)

In non-breasteeding inants, maternal ARV prophylaxis should

be coupled with daily administration o AZT or NVP rom birth

until 6 weeks o age.

(Conditional recommendation, low quality of evidence)

Remarks: The maternal component o this ARV prophylaxis strategy

is the same as the one recommended in the 2006 guidelines,

although the revised recommendation is to start earlier during

pregnancy (see Recommendation 5).

For breasteeding inants, the panel placed a high value on an

intervention that would allow saer breasteeding practices in settings

where breasteeding is the norm. Although data are only available

or the provision o NVP to inants up to 6 months o age, the panel

elt there is a need to provide ARV prophylaxis throughout the

breasteeding period to minimize the risk o transmission. The panel

also elt that these ARV guidelines should not recommend a target

duration or breasteeding; WHO will provide separate guidelines on

HIV and inant eeding, in the context o ARVs.

As in Recommendation 4, or non-breasteeding inants, there is

no evidence assessing the efcacy o daily NVP or any duration

beyond a single dose. However, there is high quality o evidence that

6 weeks o daily inant AZT prophylaxis in conjunction with maternal

antepartum AZT prophylaxis or more than 4 weeks signifcantly

prevents HIV MTCT. There is additional evidence that AZT or 6

weeks to the inant provides signifcant protection when mothers

have received less than 4 weeks o antepartum prophylaxis. This

conditional recommendation was primarily based on programmatic

considerations that would acilitate its implementation in the feld:

countries should have the option o using NVP or AZT prophylaxis

in inants; 6 weeks is also the frst immunization visit and the target

date or early diagnosis testing or HIV-exposed children in mostsettings, implying that most children will have an opportunit y to be

seen and re-evaluated at that age.

RECOMMENDATION 7

For all HIV-inected pregnant women who are not eligible orART, ARV prophylaxis option B consists o triple ARV drugs

provided to pregnant women starting rom as early as 14 weeks

o gestation until one week ater all exposure to breast milk has

ended. The recommended regimens include:

AZT + 3TC + LPV/r*

AZT + 3TC + ABC

AZT + 3TC + EFV

TDF + XTC + EFV

(Strong recommendation, moderate quality of evidence)

In breasteeding inants, the maternal triple ARV prophylaxis

should be coupled with the daily administration o NVP to the

inant rom birth until 6 weeks o age.


In non-breasteeding inants, the maternal triple ARV prophy-

laxis should be coupled with the daily administration o AZT or

NVP to the inant rom birth until 6 weeks o age.

(Conditional recommendation, very low quality of evidence)

Remarks: The provision o maternal triple ARV prophylaxis during

pregnancy in women who are not eligible or ART results in very low

intrauterine and peripartum transmission rates. A high value is alsoplaced on the simplicity o the intervention as it contains only one

maternal and one inant regimen and may be available as a single

daily fxed-dose combination.

For breasteeding inants, available data suggest that maternal

triple ARV prophylaxis started in pregnancy and continued during

breasteeding is efcacious in reducing HIV transmission and inant

death. The panel placed a high value on providing an intervention

that would allow saer breasteeding practices or as long as the child

is exposed to breast milk.

For non-breasteeding inants, the conditional recommendationwas primarily based on programmatic issues that would acilitate

its implementation in the feld: 6 weeks is the frst immunization

visit and the target date or early diagnosis testing or HIV-exposed

children in most settings, implying that most children will have an

opportunity to be seen and re-evaluated at that age.

* LPV-r: lopinavir/ritonovir; ABC: abacavir


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Table 2 summarizes the two recommended ARV prophylaxis

options or HIV-inected pregnant women who are not eligibleor ART:

Option A: Maternal AZT

Option B: Maternal triple ARV prophylaxis

There is a strong benet o providing eective and sustained

prophylaxis to women not eligible or ART during pregnancy,labour and delivery, as well as throughout breasteeding in

settings where breasteeding is the preerred practice. Both

recommended options A and B provide signicant reduction

o the MTCT risk. There are advantages and disadvantages o

both options, in terms o easibility, acceptability and saety or

mothers and inants, as well as cost. The choice or a preerred

option should be made at a country level, ater considering these

advantages and disadvantages.

TABLE 2. ARV-prophylaxis options recommended or HIV-inected pregnant women who do not need treatment or their own health

Option A: Maternal AZT Option B: Maternal triple ARV prophylaxis

MOTHER MOTHER

Antepartum AZT (rom as early as 14 weeks gestation)

sd-NVP at onset o labour*

AZT + 3TC during labour and delivery*

AZT + 3TC or 7 days postpartum*

* sd-NVP and AZT+3TC can be omitted i mother receives >4 weeks o

AZT antepartum

Triple ARV rom 14 weeks until one week ater all exposure to

breast milk has ended

AZT + 3TC + LPV/r

AZT + 3TC + ABC

AZT + 3TC + EFV

TDF + XTC + EFV

INFANT INFANT

Breastfeeding infant

Daily NVP rom birth until one week ater all exposure to breast

milk has ended

Non-breastfeeding infant

AZT or NVP or 6 weeks

Breastfeeding infant

Daily NVP rom birth to 6 weeks

Non-breastfeeding infant

AZT or NVP or 6 weeks



9. Annex 1

WORLD HEALTH ORGANIZATION

Guidelines committee review meeting on the

use o antiretroviral drugs or treating pregnant

women and preventing HIV inection in inants

- 2009 version

Chteau de Penthes, Geneva, Switzerland, 1921 October 2009

LIST OF PARTICIPANTS

Content (PMTCT) experts

Elaine Abrams

The International Center or AIDS Care and Treatment Programs

Mailman School o Public Health

722 West 168th Street

New York, NY 10032, USA

[email protected]

Franois Dabis

Unit INSERM 330

Institut de Sant Publique, Epidmiologie et Dveloppement

(ISPED)Universit Victor Segalen Bordeaux 2,

33076 Bordeaux Cedex, France

[email protected]

Laura A. Guay

Elizabeth Glaser Pediatric AIDS Foundation

1140 Connecticut Ave. NW, Suite 200

Washington, DC 20036, USA

[email protected]

Louise KuhnGertrude H. Sergievsky Center

College o Physicians and Surgeons

Columbia University, New York, USA

[email protected]

Marc Lallemant

Programs or HIV Prevention and Treatment (PHPT)

29/7-8 Samlan Road, Soi 1 - Prasing, Muang, Chiang Mai 50200,

Thailand

[email protected]

James McIntyre

Perinatal HIV Research UnitUniversity o the Witwatersrand

Chris Hani Baragwanath Hospital

PO Bertsham, Johannesburg 2013

South Arica

[email protected]

Lynne M. Moenson

National Institutes o Health

6100 Executive Boulevard, Room 4B11

Rockville, MD 20852, USA

[email protected]

Roger Shapiro

Harvard Medical School

110 Francis Street, Suite GB

Boston, MA 02215, USA

rshapirosph.harvard.du

Jerey S. A . Stringer

University o Alabama at Birmingham

Center or Inectious Disease Research in Zambia (CIDRZ),

Lusaka, [email protected]


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Country representatives/Programme experts

Marcelo Arajo de Freitas

Care and Treatment Division

STD and Aids Department

Ministry o Health, Brazil

SAF Sul Trecho 02, Bloco F, Torre 1,

Edicio Premium, Trreo, Sala 12

CEP: 70070-600 - Braslia DF

Brazil

[email protected]

Kevin M. De Cock

Centers or Disease Control and Prevention (CDC)

KEMRI, Mbagathi Road

O Mbaganthi Way, Nairobi

Kenya

[email protected]

Nonhlanhla Rosemary Dlamini

Deparment o Health

Private Bag X 828 Pretoria 0001

Hallmark Building, Room 1513

235 Proes street, Pretoria 0002

South Arica

[email protected]

Svitlana Komar

Centre Clinic or Treatment o HIV-inected Children

Chornovola str., 28/1, Kiev, 01135

Ukraine

[email protected]

Dorothy Mbori-Ngacha

University o Nairobi (Kenya)

Dept. o Pediatrics & Child Health

P.O. Box 19676, Nairobi

Kenya

[email protected]

[email protected]

Elevanie Munyana

Clinical Prevention Department

PMTCT at TRAC Plus Ministry o Health

P.O. Box 84, Kigali

Rwanda

[email protected]

Sarah Shalongo

Paediatric ARVMinistry o Health and Social Services

Harvey Street, Windhoek

Namibia

Florence Soroses

Global Fund

Ministry o Health and Social Services

Harvey Street, Windhoek

Namibia

[email protected]

Nipunporn Voramongkol

Maternal and Child Health Group

Department o Health

Ministry o Public Health

Tivanon Rd., Muang District

Nonthaburi 11000

Thailand

[email protected]



Methodologists

Health system:

Pierre Barker

Department o Paediatrics

University o North Carolina

Chapel Hill, NC 27516, USA

[email protected]

GRADE expert:

Nancy Santesso

Department o Clinical Epidemiology and Biostatistics,

McMaster University

1200 Main Street West

Hamilton, ON L8N 3Z5

Canada

[email protected]

Implementing partners

Omotayo Bolu

PMTCT Team,

Global AIDS Program, CDC

1600 Cliton Road

Atlanta, GA 30333

USA

[email protected]

Margaret Brewinski

USAID Oce o HIV/AIDS

1300 Pennsylvania Ave, NW

Washington, D.C. 20523-3600

USA

[email protected]

Ren Ekpini

PMTCT - Pediatric care and treatment Health Section,

Program Division

UNICEF

3 United Nations Plaza

New York, NY 10017

USA

[email protected]

Civil societies/PLHIV

Jane Mwirumubi

ICW East Arica Tagore Crescent

Plot 15, Kamwokya, Kampala

Uganda

[email protected]

Portia Ngcaba

Portia Nomzuzu Ngcaba7.16 Goodhope Road

Vuyo Gardens , Amalinda

East London 5247

South Arica

[email protected]


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Grade reviewers

Jaco Homsy

Institute or Global Health

University o Caliornia, San Francisco

50 Beale St

San Francisco, CA 94105

USA

[email protected]

Jennier S. Read

National Institutes o Health (NIH)

Executive Building, Room 4B11C

6100 Executive Boulevard MSC 7510

Bethesda, MD 20892-7510

USA

[email protected]

George Rutherord

Institute or Global Health

University o Caliornia, San Francisco

50 Beale St, San Francisco, CA 94105

USA

[email protected]

Amy Sturt

Stanord University

300 Pasteur Drive, S-101

Stanord, CA 94305

USA

[email protected]

WHO Secretariat

20 Avenue Appia

CH-1211 Geneva 27

Switzerland

Boniace Dongmo Nguimack

Strategic Inormation, HIV/AIDS Department

[email protected]

Siobhan Crowley

Antiretroviral Treatment and HIV Care, HIV/AIDS Department

[email protected]

Isseu Diop-Toure

AFRO - Regional Oce or Arica

Bote postale 6, Brazzaville

Republic o Congo

[email protected]

Ying-Ru Lo

Prevention in the Health Sector

HIV/AIDS Department

[email protected]

Eleonora Marini

[email protected]

Franoise Renaud-Thry

Systems Strengthening and HIV

HIV/AIDS Department

[email protected]

Nigel Rollins

Newborn and Child Health and Development

Department o Child and Adolescent Health and Development

[email protected]

Charles Sagoe-Moses

AFRO

P.O. Box No. 6

Brazzaville, Republic o Congo

[email protected]



Nathan Shaer

Prevention in the Health Sector, PMTCTHIV/AIDS Department

HIV/AIDS, TB and Malaria Cluster

[email protected]

Tin Tin Sint

Prevention in the Health Sector, PMTCT, HIV/AIDS Department

HIV/AIDS, TB and Malaria Cluster

[email protected]

Isabelle de Vincenzi

Control o Sexually Transmitted and Reproductive TractInections

Department o Reproductive Health and Research

[email protected]

Marco Vitoria

Antiretroviral Treatment and HIV Care, HIV/AIDS Department

[email protected]

Rapporteurs (guideline writers)

Renaud Becquet

INSERM, Unit 897

Research Centre in Epidemiology and Biostatistics

Universit Victor Segalen Bordeaux 2

146, rue Lo Saignat

33076 BORDEAUX Cedex

France

[email protected]

Stanley Luchters

International Centre or Reproductive Health

Department o Obstetrics and Gynaecology

Ghent University

De Pintelaan 185 P3, 9000 Ghent

Belgium

[email protected]


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Core writing group

James McIntyre (Expert)

Franois Dabis (Expert)

Lynne M. Moenson (Expert)

Ying-Ru Lo (WHO)

Nathan Shaer (WHO)

Tin Tin Sint (WHO)

Marco Vitoria (WHO)

Siobhan Crowley (WHO)

Isabelle de Vincenzi (WHO)

Stanley Luchters (Writer)

Renaud Becquet (Writer)

External peer reviewers

Sostena Romana

Global PMTCT Initiative

Clinton Foundation HIV/AIDS Initiative

Boston, USA

[email protected]

Angela Mushavi

PMTCT and Pediatric Treatment

CDC - Namibia and Namibia MOH

[email protected]

Suna Balkan

Mdecins Sans Frontires

Medical Department MSF Paris

8, rue Saint-Sabin

75011 Paris, France

[email protected]

Mary Glenn Fowler

Makere University

Johns Hopkins University Research Collaboration

Kampala, Uganda

[email protected]

Marc Bulterys

CDC China

Beijing, China

[email protected]

Landry Tsague

UNICEF - Rwanda

[email protected]


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art - rapid advice- pregnant women and pmtct - 19dec09

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