A retrospective study of Human Immunodeficiency Virus transmission, mortality and loss to follow-up among infants in the first 18 months of life in a prevention of mother-to-child transmission programme in an urban hospital in KwaZulu-Natal, South Africa

Abstract

BackgroundFollow up of Human Immunodeficiency Virus (HIV)-exposed infants is an important component of Prevention of Mother-to-Child Transmission (PMTCT) programmes in order to ascertain infant outcomes post delivery. We determined HIV transmission, mortality and loss to follow-up (LTFU) of HIV-exposed infants attending a postnatal clinic in an urban hospital in Durban, South Africa.MethodsWe conducted a retrospective cohort study of infants born to women in the PMTCT programme at McCord Hospital, where mothers paid a fee for service. Data were abstracted from patient records for live-born infants delivered between 1 May 2008 and 31 May 2009. The infants’ LTFU status and age was based on the date of the last visit. HIV transmission was calculated as a proportion of infants followed and tested at six weeks. Mortality rates were analyzed using Kaplan-Meier (K-M), with censoring on 15 January 2010, LTFU or death.ResultsOf 260 infants, 155 (59.6%) remained in care at McCord beyond 28 weeks: one died at < 28 days, three died between one to six months; 34 were LTFU within seven days, 60 were LTFU by six months. K-M mortality rate: 1.7% at six months (95% confidence interval (CI): 0.6% to 4.3%). Of 220 (83%) infants tested for HIV at six weeks, six (2.7%, 95% CI: 1.1% to 5.8%) were HIV-infected. In Cox regression analysis, late antenatal attendance (≥ 28 weeks gestation) relative to attending in the first trimester was a predictor for infant LTFU (adjusted hazards ratio = 2.3; 95% CI: 1.0 to 5.1; p = 0.044).ConclusionThis urban PMTCT programme achieved low transmission rates at six weeks, but LTFU in the first six months limited our ability to examine HIV transmission up to 18 months and determinants of mortality. The LTFU of infants born to women who attended antenatal care at 28 weeks gestation or later emphasizes the need to identify late antenatal attendees for follow up care to educate and support them regarding the importance of follow up care for themselves and their infants.

Health literacy predicts pediatric dosing accuracy for liquid zidovudine

“…With infrastructure to support timely diagnosis and antiretroviral (ARV) medications for pregnant HIV-infected mothers and infants, mother-to-child HIV transmission rates may be reduced from greater than 25% to less than 5%. [2, 3] In 2010 however, an estimated 390,000 new pediatric infections occurred, with 98% of these occurring in low and middle income countries (LMIC). [1] In 2011, The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently framed an initiative to reduce new pediatric HIV infections globally by 90%, provide ARV medications for all HIV-infected children, and reduce AIDS-related infant deaths by >50% by 2015.…”

Fragmentation of maternal, child and HIV services: A missed opportunity to provide comprehensive care

“…25 However, loss to follow up for HIV care in the postnatal period remains a challenge leading to high mortality among HIV-infected infants 4,5,26 despite high immunisation coverage over the same time period. Thus, by integrating postnatal HIV care with well-child services, health policymakers and practitioners can help actively reduce the burden of paediatric HIV disease.…”

“…2 However, it has been difficult to ensure that HIV-positive mothers are retained in care and continue taking ART, and that their babies receive early infant diagnosis and initiate ART 3 where appropriate in the postnatal period. 4 As ongoing HIV care devolves to PHC facilities, clinics must be prepared to adopt innovative strategies to deliver a high standard of care and to retain mothers and babies in care. 5 …”

Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings

“…Infant dropout along the care and treatment cascade was associated with younger mothers, poor healthcare worker training and knowledge, poor caregiver understanding of early infant diagnosis (EID), absence of social support, poor physical access to health facilities, stock-outs of infant DBS cards and delayed availability of HIV test results (Hassan et al 2012). Late antenatal care presentation (≥28 weeks gestation) due to high transport costs, lack of knowledge or poor maternal health is also a strong predictor of loss to follow-up (Chetty et al 2012). …”

“…Delayed return of results has been linked with the lack of telephone lines, fax lines, internet and computers at facility level, necessitating the use of paper-based and physical transport systems for return of results (Hassan et al 2012; Chetty et al 2012). …”