18-24-month HIV-free survival as measurement of the effectiveness of prevention of mother-to-child transmission in the context of lifelong antiretroviral therapy: Results of a community-based survey

Abstract

Introduction Population-based HIV-free survival at 18-24 months of age among HIV-exposed infants in high prevalence settings in the era of treatment for all is largely unknown. We conducted a community-based survey to determine outcomes of HIV-exposed infants at 18-24 months in Lesotho. Methods Between November 2015 and December 2016, we conducted a survey among households with a child born 18-24 months prior to data collection. Catchment areas from 25 health facilities in Butha-Buthe, Maseru, Mohale's Hoek and Thaba-Tseka districts were randomly selected using probability proportional to size sampling. Consecutive households were visited and eligible consenting caregivers and children were enrolled. Rapid HIV antibody testing was performed on mothers of unknown HIV status (never tested or tested HIV-negative >3 months prior) and their children, and to children born to known HIV-positive mothers. Information on demographics, health-seeking behavior, HIV, and mortality were captured for mothers and children, including those who died. The difference in survival between subgroups was determined using the log-rank test. Results Of the 1,852 mothers/caregivers enrolled, 570 mothers were HIV-positive. The mother-tochild HIV transmission rate was 5.7% [95% CI: 4.0-8.0]. The mortality rate was 2.6% [95% CI: 1.6-4.2] among HIV-exposed children compared to 1.4% (95%

HIV Drug Resistance in Children and Adolescents: Always a Challenge?

“…ART eligibility was expanded from initial guidance for immunologically suppressed patients with CD4 counts <200 cells/mm 3 , to PLHIV with a CD4 count ≤500 cells/mm 3 plus other high-risk groups in 2013, and subsequently to all PLHIV regardless of CD4 count in 2015 [ 11 , 12 ]. Prevention of mother-to-child HIV transmission (PMTCT) achieved a dramatic reduction of perinatal HIV transmission and infant morbidity and mortality globally, with new HIV infections among children having declined by 52%, from ~310,000 in 2010 to 150,000 in 2019 [ 1 , 13 – 15 ]. The PMTCT paradigm has also contributed to viewing “treatment as prevention” and the introduction of the concept of “undetectable=untransmittable” (U=U) and pre-exposure prophylaxis (PrEP) with ARVs among uninfected people at risk for acquiring HIV [ 12 , 16 , 17 ].…”