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

Abstract

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.

Analysis of Related Factors of Mother-to-Child Transmission of AIDS and Evaluation of Measures to Prevent Mother-to-Child Transmission

“…There are also researchers who evaluated the effectiveness of the city government-led all-round multilevel cooperation platform model in blocking mother-to-child transmission of AIDS. The method was to select 339 136 newly diagnosed pregnant women from health care institutions at all levels and divide them into two groups: the first group is composed of unresearched subjects, and the second group is the control group; the two groups are AIDS regular health education and AIDS testing; adopt the government-led all-round multilevel cooperation platform work model to intervene in the observation group and compare the proportion of pregnant women tested for HIV antibody, HIV antibody positive rate, and pregnancy failure rate [ 10 ]. There are also researchers aiming at blocking mother-to-child transmission with combined drug therapy, and they selected 150 cases of human immunodeficiency virus- (HIV-) positive pregnant women in 2014 and divided them into experimental groups based on positive antibodies and intervention during pregnancy (detected before 14 weeks of gestation); 75 cases were compared with the control group (found after 14 weeks of gestation) to compare the levels of serum inflammatory markers (TNF- α , hs-CRP, and Ang-II), viral load, and infant HIV infection between the two groups and found to have obvious representational meaning [ 11 ].…”