Identifying Gaps in Prevention of Mother to Child Transmission of HIV

Bonawitz, Rachael; Sambambi, Kennedy; Vickery, Michelle; Hamomba, Leoda; Hammond, Emily E.; Duncan, Julie; Musokotwane, Kebby; Thea, Donald M.; Herlihy, Julie M.

doi:10.1097/inf.0000000000001155

Cited by 5 publications

(9 citation statements)

References 21 publications

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“…Approximately half of the studies did not clearly present this information. Where data were available, high rates of over 90% were commonly reported with two exceptions, Malawi at ~77% 28 and Zambia at 76% 33 …”

Section: Resultsmentioning

confidence: 99%

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The impact of Option B+ on mother‐to‐child transmission of HIV in Africa: A systematic review

Maingi

Stark

Iron‐Segev

2022

Tropical Med Int Health

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In 2015, the WHO released new guidelines to reduce mother-to-child transmission (MTCT) of HIV. The recommendations, known as Option B+, included initiation of lifelong highly active antiretroviral therapy regardless of CD4 count for all HIV-positive pregnant and breastfeeding mothers. For infants, exclusive breastfeeding for 6 months and antiviral therapy were sanctioned. Targets of <5% transmission in breastfeeding populations and <2% in non-breastfeeding populations were set. This review evaluated the impact of Option B+ on MTCT in African countries. Methods: Using the PRISMA guidelines, a systematic search of PubMed and Google Scholar databases was conducted to identify relevant studies published between 2015 and 2021. All studies meeting inclusion criteria were evaluated. Results: Of the 687 references screened, 22 studies from 11 countries (Cameroon,

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Section: Resultsmentioning

confidence: 99%

“…Results from this review indicate that when reported, exclusive breastfeeding was widespread. To maximise the benefits of following the Option B+ protocols, adhering to lifelong ART treatment and EBF for the first 6 months must be routine components of care 33 …”

Section: Discussionmentioning

confidence: 99%

The impact of Option B+ on mother‐to‐child transmission of HIV in Africa: A systematic review

Maingi

Stark

Iron‐Segev

2022

Tropical Med Int Health

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“…One of the highest risk settings is a new diagnosis or acquisition of HIV during pregnancy, where initiation of antiretroviral medications during pregnancy is associated with high risk of vertical virus transmission (94). Thus, strategies that can synergize with maternal antiretroviral medication are needed to eliminate the pediatric HIV epidemic.…”

Section: Maternal Immunization To Protect Infants From Neonatal Pamentioning

confidence: 99%

The Impact of IgG Transplacental Transfer on Early Life Immunity

et al. 2018

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Pediatric vaccines have significantly reduced infectious disease-related infant mortality, but as protective immunity often require several infant vaccine doses; maternally-acquired antibodies are critical to protect infants during the first months of life. Consequently, immunization of pregnant women is an important strategy not only to protect mothers from infection, but also to provide immunity to young infants. Nevertheless, maternal immunization can also negatively impact early life immunity. In fact, maternal antibodies can interfere with the development of infant immune responses, though it is unclear if such interference is clinically significant. Moreover, the transplacental transfer of maternal immunoglobulin therapeutics can be harmful to the fetus. Thus, the risk/benefit of maternal immunization for both the mother and the fetus should be carefully weighed. In addition, it is critical to fully understand the mechanisms by which IgG is transferred across the placenta in order to develop optimal maternal and infant immunization strategies.

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“…Despite the limitations of this small study, the results confirm prior research regarding poor retention and health outcomes for HIV-exposed infants, both pre-and post-Option B+. 11,[20][21][22][23] All study infants had a mean time to EID testing that exceeded the recommended six weeks, and receipt of NVP prophylaxis was below intended targets. While multiple challenges and barriers impact the maternal component of PMTCT adherence, HIV-exposed infants are particularly vulnerable: infants depend on their mothers' and other caregivers' adherence to appropriate feeding modalities, administration of NVP prophylaxis, and scheduled EID testing.…”

Section: Conclusion and Global Health Implicationsmentioning

confidence: 99%

Impact of a Maternal Prevention of Mother-to-child Transmission of HIV (PMTCT) Intervention on HIV-exposed Infants in Uganda

et al. 2020

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Background: Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions. We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing. Methods: At two sites in Uganda, the Wise Infant Study (WIN) prospectively followed an infant cohort. Infants were born to women enrolled in an RCT testing the effect of real-time reminders delivered via EDM on maternal adherence to antiretroviral therapy. We assessed intrapartum and discharge receipt of NVP prophylaxis using pharmacy and infant HIV DNA testing laboratory data. Results: Of 121 women eligible for WIN, 97 (80%) consented and enrolled; 46 had been randomized to control and 51 to intervention. There were no differences in receipt of a six-week NVP supply (control 87%, intervention 82%, p = 0.53). Receipt of any NVP prophylaxis did not vary by delivery location (p = 0.35), and although 12% of infants were delivered at non-study health facilities, they were not less likely to receive NVP at discharge (p = 0.37). Among infants with a completed HIV test, there was no difference in mean time to first test (control 52 days (SD 18), intervention 51 days (SD 15), p = 0.86). Only one infant, in the control group, tested positive for HIV. Conclusion and Global Health Implications: We found no significant differences in adherence to infant PMTCT practices between intervention and control infants with relatively high rates of NVP receipt albeit with suboptimal adherence to six-week EID testing. Further work is needed to ensure improved access, uptake, and follow-up of HIV-exposed infants in the Option B+ era. Key words: • Prevention of maternal to child transmission of HIV • HIV • Nevirapine • Antiretroviral therapy prophylaxis • Early infant diagnosis • HIV-exposed infants Copyright © 2020 Murillo et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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Identifying Gaps in Prevention of Mother to Child Transmission of HIV

Cited by 5 publications

References 21 publications

The impact of Option B+ on mother‐to‐child transmission of HIV in Africa: A systematic review

The impact of Option B+ on mother‐to‐child transmission of HIV in Africa: A systematic review

The Impact of IgG Transplacental Transfer on Early Life Immunity

Impact of a Maternal Prevention of Mother-to-child Transmission of HIV (PMTCT) Intervention on HIV-exposed Infants in Uganda

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