This week PLOS Medicine publishes the following new articles:
Prevention of maternal and child mortality has featured prominently in the Millennium Development Goals and follow-up targets, but to date there has been little focus on how better preparation for pregnancy, by ensuring that a woman enters pregnancy in the best state possible, could improve outcomes for mothers and babies. Sohni Dean and colleagues identify the most important research areas for improving pre-conception care for women in low- and middle-income countries. Identified research areas include cost-effective integration of preconception care into wider health-related programs, increasing health promotion and healthcare provision through community health workers, strategies for reducing women’s exposure to tobacco smoke, prevention of pregnancies in adolescents, and promoting birth spacing. An accompanying Perspective from Joel Ray and colleagues welcomes research priorities for this neglected area, considers which personnel are best placed to deliver the interventions, and indicates that improving female education and literacy are important components to reduce maternal and child mortality.
Amanda Mocroft and colleagues conclude that late diagnosis of HIV infection and entry into care remains a substantial problem across Europe. Analyzing data from 84,000 individuals with HIV infections from 35 European countries from 2000 to 2011, the study found that nearly 54% of the participants diagnosed with HIV present late to a clinic. Diagnosis of HIV infection and receiving care as soon as possible is important for patients because individuals who receive earlier anti-retroviral drugs and counseling have better health outcomes and are also less likely to pass on the virus. While late presentation has decreased over time across Europe, it remains a significant issue; earlier HIV testing strategies within the health care system and in community based programs are essential.
Bertran Auvert and colleagues report that the roll-out of voluntary male circumcision services into the community of Orange Farm, South Africa is linked to reductions in HIV infection levels. Furthermore, substantial uptake of voluntary male circumcision in one community is not linked to changes in sexual behavior that might affect HIV infection rates. The authors conclude that the current roll-out of adult voluntary medical male circumcision in sub-Saharan Africa, endorsed by UNAIDS and WHO, and supported by international agencies such as PEPFAR, the Global Fund, and by donors like the Bill and Melinda gates Foundation, should be accelerated.