Brief Report

Kim, Maria H.; Ahmed, Saeed; Hosseinipour, Mina C.; Yu, Xiaoying; Nguyen, Chi; Chimbwandira, Frank; Paul, Mary E.; Kazembe, Peter N.; Abrams, Elaine J.

doi:10.1097/qai.0000000000000692

Cited by 20 publications

(8 citation statements)

References 20 publications

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“…This could be because of PMTCT strategy, government policies, system strengthening and other interventions that might have contributed to the reduction of the MTCT of HIV. This finding is supported by a study conducted in Zambia and Malawi [ 21 , 22 ]. This shows that the strategy is good foot step for elimination plan of vertical HIV transmission below 2% in Ethiopia [ 23 ].…”

Section: Discussionsupporting

confidence: 77%

Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study

2017

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BackgroundIn 2014, there were 170,000 new HIV-infected children globally. The rate of HIV transmission from mother to child in Ethiopia was 18%. Though there are a number of HIV-related studies conducted in Ethiopia, there is a scarcity of evidence on the rate of mother to child transmission. So, the aim of this study was to determine the rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities in East and West Gojjam Zones, Northwest Ethiopia.MethodsRetrospective cohort study design was conducted. A total of 305 exposed infant- and mother pairs were included in this study. Data were collected from seven selected health facilities in East and West Gojjam Zone, Northwest Ethiopia. The study included a four-year duration PMTCT data, registered from July/2011 to July/2015. Data was collected using a prepared checklist. Data was entered using EpiData and analyzed using SPSS software. Descriptive, bivariate and multiple variable logistic regression analysis were conducted. A p-value less than 0.05 were used to declare statistical significant association.ResultThree hundred five infants and their mothers were included in this study. The mean age of mothers was 27.4 with a standard deviation of 4.3 years. The majority, 96.4% of infants were on exclusive breastfeeding before six months. The rate of HIV transmission at the end of 24 months were 5.9% (95% CI: 3.9%–7.9%). The number of positive children was reduced from 14 (10.29%) to 4(2.37%) due to the program shift from option A to option B+. Factors which were associated with transmission of HIV from mother to child were; children who were born from older mothers (AOR = 5.4, 95% CI = 1.15, 25.70), and infants whose mother couldn’t get PMTCT intervention (AOR = 15.95, 95% CI = 3.35, 75), and mothers who became pregnant after they knew they were HIV positive (AOR = 0.22, 95%CI = 0.049,096).ConclusionsThere is significant progress on the reduction of the rate of HIV transmission from mother to child in Ethiopia. Age of the mother, status of the mother at an entry to PMTCT program and presence of PMTCT interventions were significant factors associated with HIV transmission. Hence, the above factors should be given due emphasis on controlling HIV transmission from mother to child.

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Section: Discussionsupporting

confidence: 77%

Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study

2017

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“…Successes associated with Option B+ have included earlier ART initiation in pregnancy, earlier clinical stage of women initiating treatment, increased duration of time that women receive ART before delivery, and decrease in the proportion of young infants (up to 12 weeks of age) becoming infected [2, 4–6]. However, women who initiate ART for pregnancy or breastfeeding are consistently shown to have lower ART adherence and retention rates, particularly in the postpartum period, than women who initiate therapy for clinical stage or CD4+ count [5, 7–9].…”

Section: Introductionmentioning

confidence: 99%

Correlates of HIV detection among breastfeeding postpartum Kenyan women eligible under Option B+

et al. 2019

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Background The Option B+ strategy streamlines delivery of HIV antiretroviral therapy (ART) to pregnant women, but concerns remain about ART treatment adherence and long term outcomes. Methods We conducted a retrospective analysis of a cohort of HIV-positive, postpartum breastfeeding women receiving ART via Option B+ in Nairobi, Kenya. The primary outcome was virologic failure in plasma (HIV RNA >1000 copies/mL), and detection in breast milk (>150 copies/mL) and endocervical secretions (>100 copies/mL) at 2 postpartum timepoints. Correlates of virologic failure were assessed using univariate tests and multivariate logistic regression. Results Of 42 women at 6–14 weeks postpartum, 21.4% of women had HIV RNA detected in plasma; 14.3% in breast milk, and 23.7% in endocervical secretions. At 18–24 weeks postpartum, the percentages were 21.1%, 7.1%, and 14.3%, respectively. Younger maternal age, intent to breastfeed for longer, and later ART start in pregnancy were significantly associated with plasma virologic failure (p < 0.05 for each). Odds of plasma virologic failure at 6–14 weeks postpartum were 1.25 times higher (95% CI 1.04, 1.51) for each increase in week of gestation at ART initiation. Only 3 women had resistance mutations to their regimen. Conclusions Despite months of ART, nearly one-quarter of the women in our cohort did not achieve plasma virologic suppression in the postpartum period. After adjusting for time on ART, earlier ART initiation in pregnancy was significantly associated with plasma suppression. Our findings suggest that postpartum HIV RNA monitoring in Option B+ programs will be needed to achieve elimination of MTCT.

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“…27 Similarly, low retention in the postpartum period could result from pregnancy loss and poor birth outcomes, including infant death. 38 …”

Section: Discussionmentioning

confidence: 99%

Mother Infant Retention for Health (MIR4Health): Study Design, Adaptations, and Challenges With PMTCT Implementation Science Research

Fayorsey

Chege

Wang

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Effective retention of HIV-infected mothers and their infants is fraught with multiple challenges, resulting in loss across the continuum of prevention of mother-to-child HIV transmission (PMTCT) care and missed opportunities to offer life-saving HIV prevention and treatment.Methods:The Mother Infant Retention for Health study is an individual-randomized study evaluating the effectiveness of active patient follow-up compared with standard of care on the combined outcome of attrition of HIV-infected women and their infants at 6 months postpartum. Lay counselors administered the active patient follow-up package of interventions, including individualized health education, use of flip charts during clinic visits, and at home, phone and short message service appointment reminders, active phone and physical tracking of patients immediately after missed clinic visits, and individualized retention and adherence support.Results:Use of study visits to indicate participant progression along the PMTCT cascade highlights the nature of loss among women and infants in PMTCT care because of issues such as pregnancy complications, infant deaths, and transfer out. Delay in implementation of Option B+, unanticipated slow enrollment, a health-care worker strike, rapid HIV test kit shortages, and changes in national PMTCT guidelines necessitated several modifications to the protocol design and implementation to ensure successful completion of the study.Conclusions:Flexibility when operationalizing an implementation science study is critical in the context of the shifting landscape in a noncontrolled “real-world” setting.Trial Registration:Clinicaltrials.gov NCT01962220.

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Brief Report

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 20 publications

References 20 publications

Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study

Rate of HIV transmission and associated factors among HIV-exposed infants in selected health facilities of East and West Gojjam Zones, Northwest Ethiopia; retrospective cohort study

Correlates of HIV detection among breastfeeding postpartum Kenyan women eligible under Option B+

Mother Infant Retention for Health (MIR4Health): Study Design, Adaptations, and Challenges With PMTCT Implementation Science Research

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