Antiretroviral Regimens in Pregnancy and Breast-Feeding in Botswana

Shapiro, Roger; Ogwu, Anthony; Kitch, Douglas; Lockman, Shahin; Moffat, Claire; Makhema, Joseph; Moyo, S.; Thior, Ibou; McIntosh, Kenneth; Widenfelt, Erik van; Leidner, Jean; Powis, Kathleen M.; Asmelash, Aida; Tumbare, Esther; Zwerski, Sheryl; Sharma, Usha; Handelsman, Edward; Mburu, K.; Jayeoba, O.; Moko, E.; Souda, Sajini; Lubega, E.; Akhtar, M J; Wester, Carolyn; Tuomola, R.; Snowden, Wendy; Martinez-Tristani, Marisol; Mazhani, Loeto; Essex, Max; Act, Abstr

doi:10.1056/nejmoa0907736

Cited by 452 publications

(351 citation statements)

References 38 publications

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“…The use of combined antiretroviral therapy (ART) and elective caesarean section has reduced MTCT rates to less than 2% in non-breastfeeding populations. Among breastfeeding populations, studies have demonstrated that timely antiretroviral therapy (ART) can reduce MTCT of HIV to 5% or less [2][3][4]. In view of these studies and more in 2010, UNAIDS set a target for member states to have virtual elimination of MTCT, defined as reducing MTCT to less than 5% and 90% reduction of new HIV infections among young children by 2015 [5].…”

Section: Introductionmentioning

confidence: 99%

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

Kweyamba

Buregyeya

Kusiima

et al. 2018

Advances in Public Health

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Background. Mother-to-Child Transmission of HIV accounts for more than 90% of all pediatric HIV infections. However, Prevention of Mother-to-Child Transmission (PMTCT) of HIV through provision of lifelong ART to HIV positive mothers faces various challenges which affect its success. One of such challenges is the loss to follow-up (LTFU) of mothers. Methodology. We conducted a cross-sectional study utilizing both quantitative and qualitative data collection methods. We were able to trace 279 HIV positive, pregnant, and lactating mothers among mothers who were initiated on lifelong ART for PMTCT in public health facilities in Ntungamo district, Western Uganda. The proportion of those who were lost to follow-up was determined, and Log binomial regression with stepwise backward elimination method was employed to identify factors associated with LTFU. Focus group discussions (FDGs) of women on lifelong ART and key informant interviews (KIIs) of peer educators were also performed. Results. Out of the 279 mothers that were successfully traced and interviewed, 103 (37%) were identified as lost to follow-up. The prevalence of LTFU was higher among those whose transport costs were above $2.75, adj (adjusted) PR (Prevalence Ratio) 1.6 (95% CI; 1.02-2.55); those who waited beyond one hour before being attended to, adj PR 1.74 (95% CI; 1.02-2.96); and those who assumed that their infant was already infected, adj PR 1.76 (95% CI; 1.15-2.70). On interviews, LTFU in these mothers was attributed to fear of swallowing antiretroviral drugs, HIV related stigma and discrimination, inadequate facilitation of the peer educators, long patient waiting time, and transportation to the health facilities. Conclusion. More than one-third of mothers initiated on lifelong ART for PMTCT in Ntungamo district were lost to follow-up over a period of 25 months. Recommendations. Provision of regular and adequate pre-ART and ART adherence counseling and provision of routine health education would reduce LTFU.

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Section: Introductionmentioning

confidence: 99%

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

Kweyamba

Buregyeya

Kusiima

et al. 2018

Advances in Public Health

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“…Without intervention, 30–45% of the women transmit HIV to their children [2]. With effective antiretroviral therapy (ART) mother-to-child transmission can be reduced to less than 5% [3]. In the last years, huge progress has been made in the global efforts to eliminate HIV mother-to-child transmission [4].…”

Section: Introductionmentioning

confidence: 99%

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

Haas

Oosterhout

Tenthani

et al. 2017

Journal of the International AIDS Society

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Introduction: In Malawi, HIV-infected pregnant and breastfeeding women are offered lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage (Option B+). Their HIV-exposed children are enrolled in the national prevention of mother-to-child transmission (PMTCT) programme, but many are lost to follow-up. We estimated the cumulative incidence of vertical HIV transmission, taking loss to follow-up into account. Methods: We abstracted data from HIV-exposed children enrolled into care between September 2011 and June 2014 from patient records at 21 health facilities in central and southern Malawi. We used competing risk models to estimate the probability of loss to follow-up, death, ART initiation and discharge, and used pooled logistic regression and inverse probability of censoring weighting to estimate the vertical HIV transmission risk. Results: A total of 11,285 children were included; 9285 (82%) were born to women who initiated ART during pregnancy. At age 30 months, an estimated 57.9% (95% CI 56.6–59.2) of children were lost to follow-up, 0.8% (0.6–1.0) had died, 2.6% (2.3–3.0) initiated ART, 36.5% (35.2–37.9) were discharged HIV-negative and 2.2% (1.5–2.8) continued follow-up. We estimated that 5.3% (95% CI 4.7–5.9) of the children who enrolled were HIV-infected by the age of 30 months, but only about half of these children (2.6%; 95% CI 2.3–2.9) were diagnosed. Conclusions: Confirmed mother-to-child transmission rates were low, but due to poor retention only about half of HIV-infected children were diagnosed. Tracing of children lost to follow-up and HIV testing in outpatient clinics should be scaled up to ensure that all HIV-positive children have access to early ART.

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“…The efficacy of maternal use of cART in pregnancy for PMTCT is indisputable [1][2][3][4]. However, to maximize health outcomes among HEU children we need to understand the long-term implications of in-utero cART exposure and mitigate any identified adverse consequences to the greatest extent possible.…”

Section: Discussionmentioning

confidence: 99%

“…The Mma Bana Study enrolled 730 HIV-1 infected pregnant women between July 2006 and May 2008 and has been described in detail previously [1,15]. A total of 560 women with CD4 + cell counts ≥ 200 cells/µl were randomized to receive either abacavir/ZDV/lamivudine co-formulated as Trizivir (GlaxoSmithKline) (TZV) twice daily or lopinavir/ritonavir with ZDV/lamivudine co-formulated as Kaletra (Abbott)/Combivir (GlaxoSmithKline) (KAL/ CBV) twice daily.…”

Section: Study Population and Monitoringmentioning

confidence: 99%

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In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana

2016

Aids

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Objective-To assess associations between in-utero triple antiretrovirals (cART) versus zidovudine (ZDV) monotherapy exposure and growth among HIV-uninfected children of HIVinfected women in Botswana. Design-Secondary retrospective data analysis from two randomized intervention trials of mother-to-child HIV transmission prevention. HHS Public Access Methods-TheMashi and Mma Bana studies enrolled HIV-infected pregnant women, following their children through 24 months of age. This analysis includes singleton, full-term, HIV-exposed uninfected children. Mothers received cART or ZDV at least 2 weeks predelivery, and breastfed up to 6 months. Weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) zscores were derived. Mean z-scores were compared by exposure group at 24 months (t-test, linear regression).Results-Of 819 children, 303 were ZDV-and 516 cART-exposed in utero. Maternal median enrolment CD4 + was higher among ZDV versus cART-treated mothers (393 versus 324 cells/µl; P < 0.0001). Median duration of antepartum antiretroviral use was shorter among ZDV-treated women (5.7 versus 12.0 weeks; P < 0.0001). Median months breastfed were similar (5.9 and 6.0; P = 0.43). At 24 months, mean LAZ and WAZ were significantly lower among cART-exposed children (LAZ −1.01 versus −0.74; P = 0.003) (WAZ −0.53 versus −0.30; P = 0.002) in unadjusted analyses. Adjusting for maternal CD4 + , viral load, enrolment site and maternal anthropometric measures, cART-exposed children had significantly lower LAZ and WAZ at 24 months (P = 0.0004 for both).Conclusion-At 24 months, in-utero cART-exposed children had significantly lower LAZ and WAZ. Poor growth impacts childhood and adult mortality. These findings raise concerns for potential lasting health impacts among HIV-exposed uninfected children with in-utero cART exposure.

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Antiretroviral Regimens in Pregnancy and Breast-Feeding in Botswana

Cited by 452 publications

References 38 publications

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

Loss to Follow-Up among HIV Positive Pregnant and Lactating Mothers on Lifelong Antiretroviral Therapy for PMTCT in Rural Uganda

HIV transmission and retention in care among HIV‐exposed children enrolled in Malawi's prevention of mother‐to‐child transmission programme

In-utero triple antiretroviral exposure associated with decreased growth among HIV-exposed uninfected infants in Botswana

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