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8/7/2019 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
All rights reserved. Publications o the World Health Organization can be obtained rom WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.:
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distribution should be addressed to WHO Press, at the above address (ax: +41 22 791 4806; email: [email protected]).
The designations employed and the presentation o the material in th is publication do not imply the expression o any opini on whatsoever on the part o the World Health
Organization concerning the legal status o any countr y, territory, city or area or o its authorities, or concerning the delimitation o its rontiers or boun daries. Dotted lines on maps
represent approximate border lines or which th ere may not yet be ull a greement.
The mention o specifc companies or o certain manuacturers products does not imply that they are endorsed or recommended by the World Health Organization in preerence to
others o a similar nature that are not mentioned. Errors and omissions excepted, the names o proprietary products are distinguished by ini tial capital letters.
All reasonable precautions have been taken by the World Health Organ ization to veriy the inormation contai ned in this publication. However, the published material is being
distributed without warranty o any kind, either expressed or implied. The responsibility or the interpretation and use o the material lies with the reader. In no event shall the World
Health Organization be liable or damages arising rom its use.
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
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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.
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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.
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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.
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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.
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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.
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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.
(Strong recommendation, low quality of evidence)
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.
(Strong recommendation, low quality of evidence)
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
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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
Franois Dabis
Unit INSERM 330
Institut de Sant Publique, Epidmiologie et Dveloppement
(ISPED)Universit Victor Segalen Bordeaux 2,
33076 Bordeaux Cedex, France
Laura A. Guay
Elizabeth Glaser Pediatric AIDS Foundation
1140 Connecticut Ave. NW, Suite 200
Washington, DC 20036, USA
Louise KuhnGertrude H. Sergievsky Center
College o Physicians and Surgeons
Columbia University, New York, USA
Marc Lallemant
Programs or HIV Prevention and Treatment (PHPT)
29/7-8 Samlan Road, Soi 1 - Prasing, Muang, Chiang Mai 50200,
Thailand
James McIntyre
Perinatal HIV Research UnitUniversity o the Witwatersrand
Chris Hani Baragwanath Hospital
PO Bertsham, Johannesburg 2013
South Arica
Lynne M. Moenson
National Institutes o Health
6100 Executive Boulevard, Room 4B11
Rockville, MD 20852, USA
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
Kevin M. De Cock
Centers or Disease Control and Prevention (CDC)
KEMRI, Mbagathi Road
O Mbaganthi Way, Nairobi
Kenya
Nonhlanhla Rosemary Dlamini
Deparment o Health
Private Bag X 828 Pretoria 0001
Hallmark Building, Room 1513
235 Proes street, Pretoria 0002
South Arica
Svitlana Komar
Centre Clinic or Treatment o HIV-inected Children
Chornovola str., 28/1, Kiev, 01135
Ukraine
Dorothy Mbori-Ngacha
University o Nairobi (Kenya)
Dept. o Pediatrics & Child Health
P.O. Box 19676, Nairobi
Kenya
Elevanie Munyana
Clinical Prevention Department
PMTCT at TRAC Plus Ministry o Health
P.O. Box 84, Kigali
Rwanda
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
Nipunporn Voramongkol
Maternal and Child Health Group
Department o Health
Ministry o Public Health
Tivanon Rd., Muang District
Nonthaburi 11000
Thailand
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Methodologists
Health system:
Pierre Barker
Department o Paediatrics
University o North Carolina
Chapel Hill, NC 27516, USA
GRADE expert:
Nancy Santesso
Department o Clinical Epidemiology and Biostatistics,
McMaster University
1200 Main Street West
Hamilton, ON L8N 3Z5
Canada
Implementing partners
Omotayo Bolu
PMTCT Team,
Global AIDS Program, CDC
1600 Cliton Road
Atlanta, GA 30333
USA
Margaret Brewinski
USAID Oce o HIV/AIDS
1300 Pennsylvania Ave, NW
Washington, D.C. 20523-3600
USA
Ren Ekpini
PMTCT - Pediatric care and treatment Health Section,
Program Division
UNICEF
3 United Nations Plaza
New York, NY 10017
USA
Civil societies/PLHIV
Jane Mwirumubi
ICW East Arica Tagore Crescent
Plot 15, Kamwokya, Kampala
Uganda
Portia Ngcaba
Portia Nomzuzu Ngcaba7.16 Goodhope Road
Vuyo Gardens , Amalinda
East London 5247
South Arica
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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
Jennier S. Read
National Institutes o Health (NIH)
Executive Building, Room 4B11C
6100 Executive Boulevard MSC 7510
Bethesda, MD 20892-7510
USA
George Rutherord
Institute or Global Health
University o Caliornia, San Francisco
50 Beale St, San Francisco, CA 94105
USA
Amy Sturt
Stanord University
300 Pasteur Drive, S-101
Stanord, CA 94305
USA
WHO Secretariat
20 Avenue Appia
CH-1211 Geneva 27
Switzerland
Boniace Dongmo Nguimack
Strategic Inormation, HIV/AIDS Department
Siobhan Crowley
Antiretroviral Treatment and HIV Care, HIV/AIDS Department
Isseu Diop-Toure
AFRO - Regional Oce or Arica
Bote postale 6, Brazzaville
Republic o Congo
Ying-Ru Lo
Prevention in the Health Sector
HIV/AIDS Department
Eleonora Marini
Franoise Renaud-Thry
Systems Strengthening and HIV
HIV/AIDS Department
Nigel Rollins
Newborn and Child Health and Development
Department o Child and Adolescent Health and Development
Charles Sagoe-Moses
AFRO
P.O. Box No. 6
Brazzaville, Republic o Congo
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Nathan Shaer
Prevention in the Health Sector, PMTCTHIV/AIDS Department
HIV/AIDS, TB and Malaria Cluster
Tin Tin Sint
Prevention in the Health Sector, PMTCT, HIV/AIDS Department
HIV/AIDS, TB and Malaria Cluster
Isabelle de Vincenzi
Control o Sexually Transmitted and Reproductive TractInections
Department o Reproductive Health and Research
Marco Vitoria
Antiretroviral Treatment and HIV Care, HIV/AIDS Department
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
Stanley Luchters
International Centre or Reproductive Health
Department o Obstetrics and Gynaecology
Ghent University
De Pintelaan 185 P3, 9000 Ghent
Belgium
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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
Angela Mushavi
PMTCT and Pediatric Treatment
CDC - Namibia and Namibia MOH
Suna Balkan
Mdecins Sans Frontires
Medical Department MSF Paris
8, rue Saint-Sabin
75011 Paris, France
Mary Glenn Fowler
Makere University
Johns Hopkins University Research Collaboration
Kampala, Uganda
Marc Bulterys
CDC China
Beijing, China
Landry Tsague
UNICEF - Rwanda
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