Preventing HIV-1 Transmission in Breastfed Infants in Low Resource Settings: Early HIV Infection and Late Postnatal Transmission in a Routine Prevention of Mother-to-Child Transmission Program in Yaounde, Cameroon

Nlend, Anne Esther Njom; Ekobo, Chantal Same; Ekani, Bernadette Bagfegue; Ngoue, Jeannette Epee; Ndiang, Suzie Tetang; Toussi, Fabrice Tchinde; Wamba, Guillaume; Ekoe, Tetanye

doi:10.1093/tropej/fmt038

Cited by 5 publications

(2 citation statements)

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“…Transmission rates are similar to findings from other studies [45–47]. These data, however, need to be interpreted with caution because EID results were available for only less than half of the eligible children.…”

Section: Discussionsupporting

confidence: 85%

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

et al. 2018

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BackgroundUniversal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland.MethodsLifelong ART was offered to a cohort of HIV+ pregnant women aged ≥16 years at the first antenatal care (ANC1) visit in 9 public sector facilities, between 01/2013 and 06/2014. The study enrolment period was divided into 3 phases (early: 01–06/2013, mid: 07–12/2013 and late: 01–06/2014) to account for temporal trends. Kaplan-Meier estimates and Cox proportional-hazards regression models were applied for ART initiation and attrition analyses.ResultsOf 665 HIV+ pregnant women, 496 (74.6%) initiated ART. ART initiation increased in later study enrolment phases (mid: aHR: 1.41; later: aHR: 2.36), and decreased at CD4 ≥ 500 (aHR: 0.69). 52.9% were retained in care at 24 months. Attrition was associated with ANC1 in the third trimester (aHR: 2.37), attending a secondary care facility (aHR: 1.98) and ART initiation during later enrolment phases (mid aHR: 1.48; late aHR: 1.67). Of 373 women eligible, 67.3% received a first VL. 223/251 (88.8%) were virologically suppressed (< 1000 copies/mL). Of 670 infants, 53.6% received an EID test, 320/359 had a test result recorded and of whom 7 (2.2%) were HIV+.ConclusionsPMTCTB+ was found to be feasible in this setting, with high rates of maternal viral suppression and low transmission to the infant. High treatment attrition, poor follow-up of mother-baby pairs and under-utilisation of VL and EID testing are important programmatic challenges.

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Section: Discussionsupporting

confidence: 85%

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

et al. 2018

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“…Regarding geographical location, all the ten regions of Cameroon were represented; one in the Adamoua [ 30 ]; 19 in the Centre [ 13 , 14 , 24 , 25 , 27 , 29 , 30 , 32 – 35 , 40 , 42 – 49 ]; two in the East [ 10 , 30 ]; one in the Far North [ 30 ]; three in the Littoral [ 28 , 30 , 35 ]; one in the North [ 30 ]; four in the North-West [ 11 , 30 , 35 , 38 ]; one in the South [ 30 ]; four in the South-West [ 28 , 30 , 31 , 35 ]; and two in the West [ 26 , 30 ]. Concerning the types of studied population, most of the studies were conducted in the urban area [ 9 – 11 , 13 , 14 , 24 , 25 , 27 , 29 , 31 – 34 , 37 , 42 – 47 , 49 ]; while only three of the studies were conducted in the rural area [ 26 , 28 , 38 ]. The characteristics of those studies are reported in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

The mother-to-child transmission of HIV-1 and profile of viral reservoirs in pediatric population: A systematic review with meta-analysis of the Cameroonian studies

et al. 2023

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Background The mother-to-child transmission of HIV-1 (MTCT) remains on the major route of HIV-transmission among pediatric populations in Africa. Though a prevention of MTCT (PMTCT) high-priority country, data on the MTCT burdens in Cameroon remains fragmented. Objective We sought to assess the pooled MTCT rate, its risk-factors, and to characterize viral reservoirs of infected-children in Cameroon. Methods All relevant observational cohort and cross-sectional studies conducted in Cameroon were searched from PubMed, African Journals Online, Google scholar, ScienceDirect and academic medical education databases. Heterogeneity and publication bias were respectively assessed by the I2 statistic and the Egger/funnel plot test. Meta-analysis was performed using the random effects model. MTCT rate >5% was considered as “high”. This review was registered in the Prospero database, CRD42021224497. Results We included a total of 29 studies and analyzed 46 684 children born from HIV-positive mothers. The overall rate of MTCT was 7.00% (95% CI = 6.07–8.51). According to regions, the highest burden was in Adamaoua-region (17.51% [95% CI:14.21–21.07]) with only one study found. PMTCT option-B+ resulted in about 25% reduction of MTCT (8.97% [95% CI: 8.71–9.24] without option-B+ versus 2.88% [95% CI: 5.03–9.34] with option-B+). Regarding risk-factors, MTCT was significantly associated with the absence of PMTCT-interventions both in children (OR:5.40 [95% CI: 2.58–11.27]) and mothers (OR: 3.59 [95% CI: 2.15–5.99]). Regarding viral reservoirs, a pro-viral DNA mean of 3.34±1.05 log10/mL was observed among 5/57 children and archived HIV drug resistance mutations were identified in pro-viral DNA marker among 21/79 infected-children. Conclusion In spite of the dropdown in MTCT following option-B+ implementation, MTCT remains high in Cameroon, with substantial disparities across regions. Thus, in this era of option-B+, achieving MTCT elimination requires interventions in northern-Cameroon. The variation in pro-viral load in infected-children underlines the relevance of characterizing viral reservoirs for possible infection control in tropical settings.

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Efficacité à 12 mois de l’option B+ pour prévenir la transmission mère-enfant (PTME) du VIH à Yaoundé, Cameroun

Nlend

Marcelle

Ndombo³

et al. 2019

Revue d'Épidémiologie et de Santé Publique

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Preventing HIV-1 Transmission in Breastfed Infants in Low Resource Settings: Early HIV Infection and Late Postnatal Transmission in a Routine Prevention of Mother-to-Child Transmission Program in Yaounde, Cameroon

Abstract: Both promotion of EBF and access to antiretroviral therapy contribute to lower HIV transmission in breastfed infants in low resource settings.

Cited by 5 publications

References 15 publications

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

Challenges and successes in the implementation of option B+ to prevent mother-to-child transmission of HIV in southern Swaziland

The mother-to-child transmission of HIV-1 and profile of viral reservoirs in pediatric population: A systematic review with meta-analysis of the Cameroonian studies

Efficacité à 12 mois de l’option B+ pour prévenir la transmission mère-enfant (PTME) du VIH à Yaoundé, Cameroun

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