Elimination of mother-to-child transmission of HIV and Syphilis (EMTCT): Process, progress, and program integration.

Melanie Taylor and colleagues discuss progress towards eliminating vertical transmission of HIV and syphilis.

Gonorrhoea and gonococcal antimicrobial resistance surveillance networks in the WHO European Region, including the independent countries of the former Soviet Union.

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae has emerged for essentially all antimicrobials following their introduction into clinical practice. During the latest decade, susceptibility to the last remaining options for antimicrobial monotherapy, the extended-spectrum cephalosporins (ESC), has markedly decreased internationally and treatment failures with these ESCs have been verified. In response to this developing situation, WHO and the European Centre for Disease Prevention and Control (ECDC) have published global and region-specific response plans, respectively. One main component of these action/response plans is to enhance the surveillance of AMR and treatment failures. This paper describes the perspectives from the diverse WHO European Region (53 countries), including the independent countries of the former Soviet Union, regarding gonococcal AMR surveillance networks. The WHO European Region has a high prevalence of resistance to all previously recommended antimicrobials, and most of the first strictly verified treatment failures with cefixime and ceftriaxone were also reported from Europe. In the European Union/European Economic Area (EU/EEA), the European gonococcal antimicrobial surveillance programme (Euro-GASP) funded by the ECDC is running. In 2011, the Euro-GASP included 21/31 (68%) EU/EEA countries, and the programme is further strengthened annually. However, in the non-EU/EEA countries, internationally reported and quality assured gonococcal AMR data are lacking in 87% of the countries and, worryingly, appropriate support for establishment of a GASP is still lacking. Accordingly, national and international support, including political and financial commitment, for gonococcal AMR surveillance in the non-EU/EEA countries of the WHO European Region is essential.

Experience of antiretroviral treatment in Georgia.

INTRODUCTION: HIV infection is the major public health, social and economic problem in Georgia. Although the HIV epidemic is in its nascent phase in the country, the potential risk for development of a wide spread HIV epidemic is very high. The aim of this study is to evaluate the effectiveness of ARV treatment principles in Georgia, including treatment and monitoring methods. MATERIALS AND METHODS: The study included 985 people living with HIV/AIDS in Georgia registered at Infectious Disease, AIDS and Clinical Immunology Research Center since 2004. To ensure universal access to ARV therapy all HIV/AIDS individuals included in the study were investigated by special algorithm, all identified patients requiring ARV therapy were offered treatment and monitored during therapy on treatment effectiveness and side effects. HIV-1 RNA in plasma was measured by quantitative Polymerase Chain Reaction. For determination of percentages and absolute count of T-lymphocyte subpopulations single-platform immunophenotyping technique using the Becton-Dickinson FACSCalibur flow cytometer was applied. For resistance testing TRUGENE HIV-1 Genotyping Kit with the OpenGene DNA Sequencing System (Siemens) was used. Reasons of treatment failure and mortality rate among ARV treated patients were analyzed. RESULTS AND CONCLUSIONS: Treatment was offered to 398 HIV/AIDS patients. 397 patients started treatment, 1 patient refused. Out of 397 HIV/AIDS patients treated 21 patients discontinued, 54 patients died and 322 patients are currently on ARV treatment. Out of the treated patients 281 adults and 11 children are receiving first-line treatment, 27 adults and 2 children are on second-line treatment and 1 adult is receiving salvage regimen. Treatment failure was defined in 52 cases. Among them immunological failure was observed in 7 cases, clinical failure in 1 case and virologic failure in 44 cases. Prevalence of drug resistance among virologic failure cases accounted for 73% and inadequate adherence for 27% cases. Out of drug resistance cases 3% has three-class drug resistance, 84%--two-class drug resistance and 13% found to be resistant to one class. In ARV naive patients the prevalence of drug resistance to any class was 4.33%. The majority of death cases among ARV treated patients was due to non-AIDS related or incurable conditions, while deaths due to AIDS related conditions were mainly associated with delayed referral of patients in already advanced stage of disease. It's worth to mention that the highest number of death cases was due to liver failure in HIV/HCV and/or HBV co-infected patients.

Mission to assess readiness for validation of the elimination of mother to child transmission of HIV: Latvia, 23–27 May 2016

The WHO Regional Office for Europe, in partnership with UNAIDS and also UNICEF, UNFPA and other partners including ECDC and civil society, leads the process for the elimination of MTCT of HIV and CS in the WHO European Region and provides secretariat support. This is the report of a technical support mission to Latvia in response to the request of the MOH of Latvia to assess country readiness for validation of the elimination of mother to child transmission of HIV. The major goal and objectives of the mission included the review of the progress achieved in Latvia on the elimination of mother to child transmission of HIV, the assessment of the country readiness for elimination validation and, based on the mission findings, preparing recommendations to accelerate progress towards achieving elimination and elimination validation as appropriate.