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  1. Article ; Online: The path to find an HIV vaccine.

    Gray, Glenda E / Corey, Lawrence

    Journal of the International AIDS Society

    2021  Volume 24, Issue 5, Page(s) e25749

    Language English
    Publishing date 2021-05-18
    Publishing country Switzerland
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2467110-1
    ISSN 1758-2652 ; 1758-2652
    ISSN (online) 1758-2652
    ISSN 1758-2652
    DOI 10.1002/jia2.25749
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  2. Article ; Online: Health system response to preventing mother-to-child transmission of HIV policy changes in Zambia: a health system dynamics analysis of primary health care facilities.

    Mwanza, Jonathan / Kawonga, Mary / Kumwenda, Andrew / Gray, Glenda E / Mutale, Wilbroad / Doherty, Tanya

    Global health action

    2023  Volume 15, Issue 1, Page(s) 2126269

    Abstract: Background: Zambia is focusing on attaining HIV epidemic control by 2021, including eliminating Mother to Child Transmission (eMTCT) of HIV. However, there is little evidence to understand frontline healthcare workers' experience with the policy changes ...

    Abstract Background: Zambia is focusing on attaining HIV epidemic control by 2021, including eliminating Mother to Child Transmission (eMTCT) of HIV. However, there is little evidence to understand frontline healthcare workers' experience with the policy changes and the readiness of different health system elements to contribute to this goal.
    Objective: To understand frontline healthcare workers' experience of preventing mother-to-child transmission (PMTCT) of human immunodeficiency (HIV) policy changes and to explore the health system readiness to respond to rapid changes in PMTCT policy by using the health system dynamic framework.
    Method: We conducted a qualitative study in which 35 frontline healthcare workers were selected and interviewed using a snowball sampling technique. All transcripts were analysed through thematic content analysis and deductive coding. Themes were derived and presented according to the health system dynamics framework.
    Results: Among the ten elements of the health system dynamics framework, service delivery, context, and resources (i.e. infrastructure and supplies, knowledge and information, human resource, and finance) were critical in implementing the continuously evolving PMTCT policies. Furthermore, due to the fragmented primary health care platform in Zambia, non-governmental organisations (NGOs) were instrumental in ensuring that the PMTCT programme met the demand and requirements of the general population. Frontline healthcare workers who participated in the study described inequity in access to ART services due to the service delivery model employed in the selected study sites.
    Conclusion: The study highlights challenges when policies are implemented without consideration for the readiness, context, and capacity in which the policy is implemented. We offer lessons that can inform implementation of universal health coverage of antiretroviral therapy (ART), a strategy many countries have adopted, despite weak health systems.
    MeSH term(s) Female ; HIV Infections/drug therapy ; HIV Infections/prevention & control ; Humans ; Infectious Disease Transmission, Vertical/prevention & control ; Policy ; Pregnancy ; Pregnancy Complications, Infectious ; Primary Health Care ; Systems Analysis ; Zambia/epidemiology
    Language English
    Publishing date 2023-03-21
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2540569-X
    ISSN 1654-9880 ; 1654-9880
    ISSN (online) 1654-9880
    ISSN 1654-9880
    DOI 10.1080/16549716.2022.2126269
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  3. Article ; Online: Laboratory services in the context of prevention of mother-to-child transmission of HIV testing requirements in Copperbelt Province, Zambia: a qualitative inquiry.

    Mwanza, Jonathan / Doherty, Tanya / Lubeya, Mwansa Ketty / Gray, Glenda E / Mutale, Wilbroad / Kawonga, Mary

    BMC health services research

    2023  Volume 23, Issue 1, Page(s) 753

    Abstract: Introduction: Reliable and timely laboratory results are crucial for monitoring the Prevention of the Mother-to-Child Transmission (PMTCT) cascade, particularly to enable early HIV diagnosis and early intervention. We sought to explore whether and how ... ...

    Abstract Introduction: Reliable and timely laboratory results are crucial for monitoring the Prevention of the Mother-to-Child Transmission (PMTCT) cascade, particularly to enable early HIV diagnosis and early intervention. We sought to explore whether and how laboratory services have been prepared to absorb new testing requirements following PMTCT Test-and-Treat policy changes in three districts of Zambia.
    Method: We employed in-depth interviews and thematic data analysis, informed by the health system dynamic framework. Twenty-Six health workers were purposively selected and a document review of laboratory services in the context of PMTCT was undertaken. All face-to-face interviews were conducted in three local government areas in the Copperbelt Province (one urban and two rural) between February 2019 and July 2020. We extracted notes and markings from the transcripts for coding. Different codes were sorted into potential themes and the data extracted were put within the identified themes. Trustworthiness was confirmed by keeping records of all data field notes, transcripts, and reflexive journals.
    Results: The findings revealed that the health system inputs (infrastructure and supplies, human resources, knowledge, and information and finance) and service delivery were unequal between the rural and urban sites, and this affected the ability of health facilities to apply the new testing requirements, especially, in the rural-based health facilities. The major barriers identified include gaps in the capacity of the existing laboratory system to perform crucial PMTCT clinical and surveillance functions in a coordinated manner and insufficient skilled human resources to absorb the increased testing demands. The centralized laboratory system for HIV testing of mothers and exposed neonates meant facilities had to send specimens to other facilities and districts which resulted in high turnaround time and hence delayed HIV diagnosis.
    Conclusion: New guidelines implemented without sufficient capacitation of health system laboratory capacity severely limited the effectiveness of PMTCT program implementation. This study documented the areas relating to health system inputs and laboratory service delivery where greater support to enable the absorption of the new testing requirements is needed.
    MeSH term(s) Infant, Newborn ; Humans ; Female ; HIV Infections/diagnosis ; HIV Infections/prevention & control ; HIV Infections/epidemiology ; Zambia/epidemiology ; Infectious Disease Transmission, Vertical/prevention & control ; Government Programs ; HIV Testing
    Language English
    Publishing date 2023-07-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-023-09747-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Pandemic Vaccine Trials in Low- and Middle-Income Countries and Global Health Security.

    Yamey, Gavin / Gordon, Richard / Gray, Glenda E

    JAMA network open

    2021  Volume 4, Issue 11, Page(s) e2134455

    MeSH term(s) Developing Countries ; Global Health ; Humans ; Influenza Vaccines ; Influenza, Human/epidemiology ; Influenza, Human/prevention & control ; Pandemics/prevention & control
    Chemical Substances Influenza Vaccines
    Language English
    Publishing date 2021-11-01
    Publishing country United States
    Document type Journal Article ; Comment
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2021.34455
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  5. Article ; Online: Audio Interview: Vaccination and Variants in the U.S. and South Africa.

    Rubin, Eric J / Baden, Lindsey R / Gray, Glenda E / Morrissey, Stephen

    The New England journal of medicine

    2021  Volume 384, Issue 19, Page(s) e85

    MeSH term(s) Antibodies, Neutralizing/blood ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines/immunology ; COVID-19 Vaccines/supply & distribution ; Clinical Trials as Topic ; Drug Industry ; Female ; HIV Infections/therapy ; Health Personnel ; Health Services Accessibility ; Humans ; Immunogenicity, Vaccine ; In Vitro Techniques ; Patient Acuity ; Pregnancy ; Pregnancy Complications, Infectious/therapy ; Prisoners/psychology ; SARS-CoV-2 ; South Africa/epidemiology ; Tuberculosis/therapy ; United States ; Vaccination Refusal
    Chemical Substances Antibodies, Neutralizing ; COVID-19 Vaccines
    Language English
    Publishing date 2021-05-12
    Publishing country United States
    Document type Editorial
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMe2108162
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  6. Article ; Online: Preventing acquisition of HIV is the only path to an AIDS-free generation.

    Corey, Lawrence / Gray, Glenda E

    Proceedings of the National Academy of Sciences of the United States of America

    2017  Volume 114, Issue 15, Page(s) 3798–3800

    MeSH term(s) Acquired Immunodeficiency Syndrome ; HIV Infections ; Infectious Disease Transmission, Vertical
    Language English
    Publishing date 2017-03-30
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 209104-5
    ISSN 1091-6490 ; 0027-8424
    ISSN (online) 1091-6490
    ISSN 0027-8424
    DOI 10.1073/pnas.1703236114
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  7. Article ; Online: Hope for HIV control in southern Africa: The continued quest for a vaccine.

    Bekker, Linda-Gail / Gray, Glenda E

    PLoS medicine

    2017  Volume 14, Issue 2, Page(s) e1002241

    Abstract: In a Perspective, Linda-Gail Bekker and Glenda Gray discuss HIV vaccine development. ...

    Abstract In a Perspective, Linda-Gail Bekker and Glenda Gray discuss HIV vaccine development.
    MeSH term(s) AIDS Vaccines/immunology ; AIDS Vaccines/isolation & purification ; Africa, Southern ; HIV Infections/prevention & control ; HIV-1/immunology ; Humans
    Chemical Substances AIDS Vaccines
    Language English
    Publishing date 2017-02-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2185925-5
    ISSN 1549-1676 ; 1549-1277
    ISSN (online) 1549-1676
    ISSN 1549-1277
    DOI 10.1371/journal.pmed.1002241
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    Zs.A 6042: Show issues Location:
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  8. Article ; Online: Evolution of prevention of mother to child transmission of HIV policy in Zambia: Application of the policy triangle to understand the roles of actors, process and power.

    Mwanza, Jonathan / Kawonga, Mary / Gray, Glenda E / Doherty, Tanya / Mutale, Wilbroad

    Global public health

    2021  Volume 17, Issue 11, Page(s) 2764–2778

    Abstract: The Prevention of Mother-to-child Transmission (PMTCT) of HIV program in Zambia has undergone several policy iterations over the past 10 years. This qualitative study aimed to contribute towards addressing this knowledge gap by analysing the evolution ... ...

    Abstract The Prevention of Mother-to-child Transmission (PMTCT) of HIV program in Zambia has undergone several policy iterations over the past 10 years. This qualitative study aimed to contribute towards addressing this knowledge gap by analysing the evolution and actors' influence during the policy process using the Walt and Gilson policy triangle as our evaluation framework. Document review and key informant interviews with policy makers were undertaken to identify the contextual factors that had shaped the PMTCT policy evolution in Zambia. Overall, the study revealed that over the past decade, at least five PMTCT policy changes have occurred, averaging three years per policy with extensive overlap between policies. This resulted in more than two policies being implemented at a given time. Pressure from the international community and scientific evidence were the main drivers of policy change in Zambia, with local actors being mainly reactive. Among international agencies, UNICEF and WHO were the key actors who had driven the policy changes as they had the power and resources. The rapid changes, negatively impacted the health system, disrupted service delivery, which was unprepared to effectively and efficiently shift from one policy to another.
    MeSH term(s) Female ; Humans ; Infectious Disease Transmission, Vertical/prevention & control ; Zambia ; Health Policy ; HIV Infections/prevention & control ; Policy Making
    Language English
    Publishing date 2021-11-28
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2234129-8
    ISSN 1744-1706 ; 1744-1706
    ISSN (online) 1744-1706
    ISSN 1744-1706
    DOI 10.1080/17441692.2021.2007975
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Meeting report: South African Medical Research Council Standard of Care in Clinical Research in Low- And Middle-Income Settings Summit, November 2017.

    Miner, Maurine D / Bekker, Linda-Gail / Kredo, Tamara / Bhagwandin, Niresh / Corey, Lawrence / Gray, Glenda E

    Trials

    2021  Volume 22, Issue 1, Page(s) 778

    Abstract: A cornerstone of HIV prevention clinical trials is providing a combination prevention package to all trial participants. The elements included in that standard of care (SoC) package evolve as new prevention modalities are developed. Pre-exposure ... ...

    Abstract A cornerstone of HIV prevention clinical trials is providing a combination prevention package to all trial participants. The elements included in that standard of care (SoC) package evolve as new prevention modalities are developed. Pre-exposure prophylaxis (PrEP) was recommended by the World Health Organization for persons at high risk of acquiring HIV, but not all countries immediately adopted those recommendations. The South African Medical Research Council (SAMRC) convened a summit to discuss issues relating to SoC and PrEP in HIV prevention clinical trials taking place in lower- to middle-income countries (LMIC). Policymakers, regulators, ethicists, experts in law, researchers, representatives of advocacy groups, and the HIV Vaccine Trials Network (HVTN) presented a framework within which SoC principles could be articulated. A group of subject matter experts presented on the regulatory, ethical, scientific, and historic framework of SoC in clinical trials, focusing on PrEP in South Africa. Summit participants discussed how and when to include new HIV treatment and prevention practices into existing clinical guidelines and trial protocols, as well as the opportunities for and challenges to scaling up interventions. The summit addressed challenges to PrEP provision, such as inconsistent efficacy amongst different populations and various biological, virological, and immunological explanations for this heterogeneity. Advocates and community members propagated the urgent need for accessible interventions that could avert HIV infection. The meeting recommended supporting access to PrEP in HIV prevention trials by (1) developing PrEP access plans for HIV vaccine trials, (2) creating a PrEP fund that would supply PrEP to sites conducting HIV prevention trials via a central procurement mechanism, and (3) supporting the safety monitoring of PrEP. This report summarizes the presentations and discussions from the summit in order to highlight the importance of SoC in HIV prevention clinical trials.
    MeSH term(s) Biomedical Research ; HIV Infections/prevention & control ; Humans ; Pre-Exposure Prophylaxis ; South Africa ; Standard of Care
    Language English
    Publishing date 2021-11-06
    Publishing country England
    Document type Congress ; Letter
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1745-6215
    ISSN (online) 1745-6215
    ISSN 1468-6694 ; 1745-6215
    DOI 10.1186/s13063-021-05754-z
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  10. Article ; Online: Adolescent HIV--cause for concern in Southern Africa.

    Gray, Glenda E

    PLoS medicine

    2010  Volume 7, Issue 2, Page(s) e1000227

    MeSH term(s) Adolescent ; Africa, Southern/epidemiology ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; HIV Infections/etiology ; HIV Infections/mortality ; Humans ; Male ; Sexual Behavior
    Language English
    Publishing date 2010-02-02
    Publishing country United States
    Document type Comment ; Journal Article
    ZDB-ID 2185925-5
    ISSN 1549-1676 ; 1549-1277
    ISSN (online) 1549-1676
    ISSN 1549-1277
    DOI 10.1371/journal.pmed.1000227
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