High Baseline CD4 Count and Exclusive Breastfeeding Are Associated with Lower Rates of Mother to Child HIV Transmission in Northwestern Uganda: A Two-Year Retrospective Cohort Study

Abstract

Background. Under Option B plus, the transmission of Human Immunodeficiency Virus (HIV) along the Early Infant Diagnosis (EID) of HIV cascade remains unknown. We described HIV transmission along the EID cascade and determined associated factors at Arua Regional Referral Hospital, Northwestern Uganda. Methods. Data on 295 mother-baby pairs in EID care (January 2014 and April 2015) was extracted, cleaned, and analysed in STATA. Univariate, bivariate, and multivariate analyses were performed. Independently associated factors were stated in adjusted odds ratio (AOR), 95% confidence interval (CI), and p-values. Results. 233 (89.0%) mothers were above 30 years, 251 (85.1%) were in World Health Organization (WHO) clinical stages I/II at enrolment, 170 (57.6%) attended antenatal care (ANC) visits during recent pregnancy, and 204 (69.1%) delivered in a health facility. Meanwhile, 257 (87.1%) HIV Exposed Infants (HEIs) received Nevirapine prophylaxis from birth up to 6 weeks and 245 (83.0%) were exclusively breastfed during the first 6 months. Of 295 mother-baby pairs, 25 (8.5%) HEIs turned HIV-positive along the EID cascade. Baseline maternal CD4 count of more than 500 cells/ul compared to less than 500 cells/ul (adjusted odds ratio (AOR) = 0.29; 95% Confidence Interval (CI): 0.10–0.85; p = 0.024) and exclusive breastfeeding (EBF) in the first 6 months of delivery in contrast to not EBF in the first 6 months (AOR = 0.17; 95% CI: 0.52–0.55; p = 0.003) reduced HIV transmission. Meanwhile, ANC visits, place of delivery, time of Nevirapine initiation, and maternal antiretroviral therapy use were not significantly associated with infant HIV transmission. Conclusion. HIV transmission was high. High baseline CD4 count and exclusive breastfeeding reduced HIV transmission.

<p>Joint and Separate Analysis for Longitudinal and Survival Data on Mother-to-Child Transmission of HIV Among Infected Mothers on Option B+ at Health Centers in North Shewa Zone, Ethiopia, 2017</p>

“…The findings of this study were similar with other studies. [28][29][30] In our study findings delivered at home were the main determinant factors for vertical transmission of HIV to their infants. During the follow-up, 73 (35.96%) infants were delivered at home; among those mothers, 16 (21.9%) infants were HIV positive that delivered at health institutions.…”

Ordinal Regression Modeling of Mother to Infant HIV Transmission in Nyeri County, Kenya

“…Infant CD4 count and viral load were the only consistent factors in the estimation and prediction of mother to infant HIV infections as they had confidence intervals close to zero. This was as with the case for Fondoh et al [3], Izudi et al [13] and Obsa et al [8] who used a multivariate logistic approach to modeling of the mother to infant HIV infections.…”

“…Mugwenza et al (2018) used the Binary Logistic Regression to determine the predictors of HIV transmission [9]. Izudi et al (2018) used the Multivariable logistic regression to determine the factors that were independently associated with mother to child transmission of HIV [13] while Obsa et al (2018) used the Binary logistic regression [8].…”

“…Infant feeding is crucial for child growth and development as it enables newly born infants to acquire nutrients and develop immune systems that can fight and prevent new disease infections. The immune system at this early stages of life is usually not fully developed and thus the risk of new infections like HIV-1 transmission hence calling for proper feeding programs for infants [13]. The type of infant feeding substantially affects the risk of HIV transmission but prolonged breastfeeding still remains the main cause of acquiring HIV and other infections for newly born infants [5].…”

“…Infants born of HIV positive mothers are more prone to HIV than those born of HIV negative mothers. It is assumed that there is a negative association between breast milk HIV shedding and use of combined oral contraceptives and thus the need for further studies on the same [13]. Further proposals are on the use of replacement feeding methods by lactating mothers so as to reduce the potential risk of HIV transmission [7,9,11].…”