Elimination of mother-to-child transmission of HIV in Oman: a success story from the Middle East

Abstract

Background: In January 2016, the National AIDS Programme (NAP) in Oman introduced a package of interventions, including capacity building for service providers, to improve the quality of HIV services. Aims: To report the impact of these interventions on the rate of vertical HIV transmission in the period from January 2016 to December 2019. We also describe the virological and obstetric outcomes for HIV-infected pregnant women. Methods: This was a medical record review of 94 HIV-positive pregnant women (median age 32 years; interquartile range 25-34 years) reported to NAP in 2016–2019. Results: There were 110 pregnancies in 94 women. The majority (75.3%, 61/81) of women were diagnosed with HIV infection from routine antenatal screening, with 60% (66/110) of pregnancies occurring in women who knew their HIV status at conception. Caesarean section was the most common (50%) mode of delivery. The preterm labour and low birth weight rates were 21.2% and 15.9%, respectively. The antiretroviral coverage during pregnancy was 95.5%, with most (87.8%) women reporting excellent or good adherence. The majority (81.6%) of women achieved HIV viral load of < 400 copies/ml at or near delivery. Almost all infants (99%) were given prophylactic antiretrovirals. The rate of mother-to-child transmission of HIV was 1%. Conclusion: The obstetric and virological outcomes for HIV-infected pregnant women delivered in 2016–2019 were favourable, with a low rate of mother-to-child transmission of HIV. Oman is now in the process of finalizing application of World Health Organization validation of elimination of mother-to-child transmission of HIV.

Mother-to-child transmission of human immunodeficiency virus, hepatitis B virus and hepatitis C virus among pregnant women with single, dual or triplex infections of human immunodeficiency virus, hepatitis B virus and hepatitis C virus in Nigeria: A systematic review and meta-analysis

“…The pooled MTCT rate of 2.74% for HIV was lower than 3.6% reported in Swaziland, 38 3.5% in Romania, 39 3·1% in Israel, 40 but higher than 1% reported in Oman 41 and 0% reported in Brazil. 42 Although the pooled MTCT rate of 2.74% is reported in this study, this is not a reflection of good PMTCT program in Nigeria because Nigeria still accounts for the highest number of new pediatric HIV infections in the world.…”

“…The principal findings in this systematic review were that the rate of MTCT of HIV was 2.74% and HBV was 55.49% among mother-infant pairs with mono-infection of HIV and HBV respectively. We identified no completed studies examining The pooled MTCT rate of 2.74% for HIV was lower than 3.6% reported in Swaziland, 38 3.5% in Romania, 39 3•1% in Israel, 40 but higher than 1% reported in Oman 41 and 0% reported in Brazil. 42 Although the pooled MTCT rate of 2.74% is reported in this study, this is not a reflection of good PMTCT program in Nigeria because Nigeria still accounts for the highest number of new pediatric HIV infections in the world.…”

Recent Increase in HIV cases in Oman

“…15 In September 2022, the World Health Organization (WHO) certified that Oman had eliminated mother-to-child transmission of HIV and syphilis, becoming the first country in the WHO Eastern Mediterranean Region and only the sixteenth country in the world to achieve this. 16,17 This accomplishment is a testimony of Oman's potential to end the AIDS epidemic by 2030 realising the goal of the Global Health Sector Strategies on HIV, viral hepatitis and sexually transmitted infections (GHSS) for the period 2022-2030. 18 To achieve this ambitious goal, the NAP in Oman must focus on two key GHSS targets, the reduction of the percentage of people starting ART with a CD4 count of < 200 cells/mm 3 to <10% and the use of combination HIV prevention by 95% of people at risk of HIV by 2025.…”