Incidence, prevalence and associated factors of mother-to-child transmission of HIV, among children exposed to maternal HIV, in Belgaum district, Karnataka, India

Abstract

Background India lacks data on the incidence of Paediatric HIV. In 2010, the Indian Council of Medical Research commissioned a task force study to estimate the paediatric HIV burden in Belgaum district, Karnataka, India. We estimated the HIV incidence, prevalence and associated risk factors of mother to child transmission of HIV among children exposed to maternal HIV by age 24 months. Methods We included Belgaum resident pregnant women who tested HIV positive between January 1st, 2011 and May 31st, 2013 and who provided consent. Their babies were tested for HIV at three time intervals using DNA PCR dry blood spot (DBS) method at 6–10 weeks and 6–9 months, and using Antibody tests at 18–24 months of age. We estimated cumulative incidence using survival analysis that considered censoring of cases and prevalence rates of HIV by age 24 months. Using competing-risk survival regression model, we examined the correlates of transmission of HIV among babies exposed to maternal HIV. Results Among 487 children of HIV positive mothers recruited in the study, the cumulative incidence rate by 24 months of age was 4.8 per 1000 person months [95% CI: 3.5–6.6]. The HIV prevalence rate among babies exposed to maternal HIV until 24 months was 7.8% [95% CI: 5.7–10.7]. Mother’s age above 30 years, and breastfeeding duration of more than six months were factors that significantly increased the HIV transmission; adjusted hazard ratio (AHR) 6.98 [95% CI: 1.73–28.16] and 5.28 [95% CI, 1.75–15.90], respectively. The risk of MTCT was significantly reduced if both mother and baby had received Nevirapine at delivery [AHR 0.25; 95%CI: 0.10–0.61] and if either mother or baby had been given Nevirapine at delivery [AHR 0.12; 95%CI: 0.03–0.49]. Conclusion The study findings suggest that mother’s age above 30 years and breastfeeding beyond 26 weeks is associated with higher rates of HIV transmission from mother to child. It confirms the benefits of providing anti-retrovirals (Nevirapine) in reducing mother to child transmission of HIV. Effective strategies to promote safe infant feeding practices, including avoidance of mixed feeding beyond 26 weeks among HIV infected mothers, is critical to reduce incidence of paediatric HIV in India.

HIV in pregnancy: a 9 year study of the seroprevalence, sociodemographic factors and pregnancy outcomes of seropositive women at a tertiary care hospital in Mumbai, Maharashtra, India

“…In a study done by Shiradkar et al, 10.29% of seropositive women had an abortion and caesarean section rates declined from 50% to 31% from 2002 to 2011. 6 In a study done by Kwatra Stillbirth rate in our study was 3.23%, compared to 6.9% reported by Radhika et al, and 2% by Potty et al 8,16 There were 96.77% live births in our study as compared to 93.91% in the study done by Kwatra et al, and 93.12% reported by Shiradkar et al 6,7 We reported 100% ART coverage of antenatally registered HIV-positive pregnant women at our institute, 2013 onwards, which surpasses the target of >95% set by the WHO.…”

“…Potty et al, also found that majority of the seropositive women were uneducated housewives. 16 The general trend observed is that most seropositive women are from a low socioeconomic class with a lack of knowledge about HIV, thus widespread education to the masses in a language they understand and using such a method that they will accept and comply to the information given is the need of the hour, such as group counseling with husbands, in-laws and other family members.…”

Experience of pregnancy and maternity by adolescents/young people born infected with HIV

“…Together, these findings demonstrate a relevant peculiarity of the experience of motherhood in the presence of HIV, which can emotionally burden women (13) . Evidence of factors that interfere with VT supports the importance of early identification of HIV-infected pregnant women and their active search for permanent clinical and laboratory evaluation and implementation of prophylactic and support measures (19) . Many pregnant women still fail to perform anti-HIV testing during prenatal care or do not undergo VT prophylaxis, often due to lack of information.…”

Effectiveness of Maternal Transmission Risk Stratification in Identification of Infants for HIV Birth Testing: Lessons From Zimbabwe

“…In contrast to some other studies, our study did not find an association between either reported maternal ART adherence or VL .1000 copies/mL in the third trimester and neonatal HIV infection. [18][19][20] The limited availability of maternal VL results in this study limits our ability to interpret this finding. However, a study by Garcia et al 21 concluded that although these risk factors can predict transmission, they cannot predict timing of transmission.…”