Preventing Mother-to-Child Transmission of Hiv in Resource-Limited Settings

Maheswaran, Hendramoorthy; Bland, Ruth

doi:10.2217/17460794.4.2.165

Cited by 8 publications

(7 citation statements)

References 110 publications

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“…It has been shown that successful retention at all steps throughout the PMTCT cascade is paramount to effectively reduce vertical transmission [25, 33–37]. The CHW-DT intervention in Tsholotsho failed to increase the share of such patients in the cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Modern PMTCT medication has proven to be highly efficacious and could lead to virtual elimination of paediatric HIV if universally implemented [15, 24, 32, 33]. This, however, would require high coverage and retention levels with timely service uptake at all recommended steps [25, 33–37]. While some SSA countries, such as Botswana, Namibia or South Africa, demonstrate that universal PMTCT coverage is feasible in low-resource settings, most SSA countries show major gaps [7, 10, 14, 16, 24, 35].…”

Section: Introductionmentioning

confidence: 99%

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Tracing defaulters in HIV prevention of mother‐to‐child transmission programmes through community health workers: results from a rural setting in Zimbabwe

Vogt

Ferreyra

Bernasconi

et al. 2015

Journal of the International AIDS Society

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IntroductionHigh retention in care is paramount to reduce vertical human immunodeficiency virus (HIV) infections in prevention of mother-to-child transmission (PMTCT) programmes but remains low in many sub-Saharan African countries. We aimed to assess the effects of community health worker–based defaulter tracing (CHW-DT) on retention in care and mother-to-child HIV transmission, an innovative approach that has not been evaluated to date.MethodsWe analyzed patient records of 1878 HIV-positive pregnant women and their newborns in a rural PMTCT programme in the Tsholotsho district of Zimbabwe between 2010 and 2013 in a retrospective cohort study. Using binomial regression, we compared vertical HIV transmission rates at six weeks post-partum, and retention rates during the perinatal PMTCT period (at delivery, nevirapine [NVP] initiation at three days post-partum, cotrimoxazole (CTX) initiation at six weeks post-partum, and HIV testing at six weeks post-partum) before and after the introduction of CHW-DT in the project.ResultsMedian maternal age was 27 years (inter-quartile range [IQR] 23 to 32) and median CD4 count was 394 cells/µL3 (IQR 257 to 563). The covariate-adjusted rate ratio (aRR) for perinatal HIV transmission was 0.72 (95% confidence intervals [95% CI] 0.27 to 1.96, p=0.504), comparing patient outcomes after and before the intervention. Among fully retained patients, 11 (1.9%) newborns tested HIV positive. ARRs for retention in care were 1.01 (95% CI 0.96 to 1.06, p=0.730) at delivery; 1.35 (95% CI 1.28 to 1.42, p<0.001) at NVP initiation; 1.78 (95% CI 1.58 to 2.01, p<0.001) at CTX initiation; and 2.54 (95% CI 2.20 to 2.93, p<0.001) at infant HIV testing. Cumulative retention after and before the intervention was 496 (85.7%) and 1083 (87.3%) until delivery; 480 (82.9%) and 1005 (81.0%) until NVP initiation; 303 (52.3%) and 517 (41.7%) until CTX initiation; 272 (47.0%) and 427 (34.4%) until infant HIV testing; and 172 (29.7%) and 405 (32.6%) until HIV test result collection.ConclusionsThe CHW-DT intervention did not reduce perinatal HIV transmission significantly. Retention improved moderately during the post-natal period, but cumulative retention decreased rapidly even after the intervention. We showed that transmission in resource-limited settings can be as low as in resource-rich countries if patients are fully retained in care. This requires structural changes to the regular PMTCT services, in which community health workers can, at best, play a complementary role.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tracing defaulters in HIV prevention of mother‐to‐child transmission programmes through community health workers: results from a rural setting in Zimbabwe

Vogt

Ferreyra

Bernasconi

et al. 2015

Journal of the International AIDS Society

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“…These factors are known to increase the risk of vertical transmission. Mode of delivery, nutritional deficiencies, use of addictive drugs like tobacco, cocaine, heroin and opiates, breastfeeding and failure to initiate nevirapine/zidovudine (NVP/ZDV) prophylaxis in the exposed infants also affect transmission rate of HIV from mother to infant 7,8 .…”

Section: Chama Et Al In University Of Maiduguri Teachingmentioning

confidence: 99%

Vertical transmission rate of human immunodeficiency virus amid formula-fed infants in a resource-constrained tertiary hospital in Jos, Nigeria

Igbudu

Inyang

Longmut

et al. 2015

Sri Lanka J Child Health

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Background: Human Immunodeficiency Virus (HIV) can be transmitted from infected mother to her baby. Objective: To assess transmission rate of HIV from seropositive mothers on highly active anti-retroviral therapy (HAART) to their formula-fed babies. Method: A cross-sectional study of 65 paired mothers on HAART and their formula-fed babies was carried out. Polymerase chain reaction-deoxyribonucleic acid (PCR-DNA) of the babies was done at six weeks of age. Epi info was used to analyse data. Results: Mean age of mothers was 30.26 ± 0.5 years. About 73.8% of the paired mothers were diagnosed with HIV before their current pregnancies and 69.2% initiated HAART before their current pregnancies. Duration of HAART use was between three months and two years. Modes of deliveries were caesarean section (15.4%) and vaginal route (84.6%). Only one (1.5%) of the babies was positive to PCR-DNA test at six weeks of age. There was no statistically significant association between the baby's PCR-DNA at six weeks of age and the mode of delivery (OR-0.0047, CI-95%, Fisher Exact=0.8461) as well as between the time of initiation of HAART by the paired mothers and the paired baby's PCR-DNA results (RR-0.9778, CI-95%, Fisher Exact=0.6923). Conclusions: Overall mother to child transmission (MTCT) rate in this study was 1.5%. Use of HAART for more than three months, irrespective of delivery route, is capable of significantly reducing MTCT of HIV even in resource-constrained settings.

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“…The 2001 National HIV Sentinel Surveillance Survey estimated that an antenatal nationwide HIV sero-prevalence of 29.5% acquire HIV from their mothers annually in Zimbabwe [5]. The authors in [6] reported that MTCT before, during and after delivery may result in the acquisition of HIV for 30–35% of infants of HIV-infected mothers.…”

Section: Introductionmentioning

confidence: 99%

Estimating HIV Prevalence in Zimbabwe Using Population-Based Survey Data

Chinomona

Mwambi

2015

PLoS ONE

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Estimates of HIV prevalence computed using data obtained from sampling a subgroup of the national population may lack the representativeness of all the relevant domains of the population. These estimates are often computed on the assumption that HIV prevalence is uniform across all domains of the population. Use of appropriate statistical methods together with population-based survey data can enhance better estimation of national and subgroup level HIV prevalence and can provide improved explanations of the variation in HIV prevalence across different domains of the population. In this study we computed design-consistent estimates of HIV prevalence, and their respective 95% confidence intervals at both the national and subgroup levels. In addition, we provided a multivariable survey logistic regression model from a generalized linear modelling perspective for explaining the variation in HIV prevalence using demographic, socio-economic, socio-cultural and behavioural factors. Essentially, this study borrows from the proximate determinants conceptual framework which provides guiding principles upon which socio-economic and socio-cultural variables affect HIV prevalence through biological behavioural factors. We utilize the 2010–11 Zimbabwe Demographic and Health Survey (2010–11 ZDHS) data (which are population based) to estimate HIV prevalence in different categories of the population and for constructing the logistic regression model. It was established that HIV prevalence varies greatly with age, gender, marital status, place of residence, literacy level, belief on whether condom use can reduce the risk of contracting HIV and level of recent sexual activity whereas there was no marked variation in HIV prevalence with social status (measured using a wealth index), method of contraceptive and an individual’s level of education.

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Preventing Mother-to-Child Transmission of Hiv in Resource-Limited Settings

Cited by 8 publications

References 110 publications

Tracing defaulters in HIV prevention of mother‐to‐child transmission programmes through community health workers: results from a rural setting in Zimbabwe

Tracing defaulters in HIV prevention of mother‐to‐child transmission programmes through community health workers: results from a rural setting in Zimbabwe

Vertical transmission rate of human immunodeficiency virus amid formula-fed infants in a resource-constrained tertiary hospital in Jos, Nigeria

Estimating HIV Prevalence in Zimbabwe Using Population-Based Survey Data

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