Prevention of mother-to-child transmission of HIV: a cross-sectional study in Malawi

Lettow, Monique van; Landes, Megan; Oosterhout, Joep J. van; Schouten, Erik J; Phiri, Happy; Nkhoma, Ernest; Kalua, Thokozani; Gupta, S. C.; Wadonda, Nellie; Jahn, Andreas; Tippett-Barr, Beth A

doi:10.2471/blt.17.203265

Cited by 31 publications

(34 citation statements)

References 20 publications

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“…Overall, infant outcomes were reassuring with regards to maternal‐to‐child transmission (MTCT) of HIV. MTCT occurred in only 2% of women enrolled in this cohort, comparable to MTCT among participants managed on this same regimen in other studies , and lower than the overall MTCT rate of >4% in Malawi . Most MTCT events in our cohort occurred in mother‐infant pairs where the mother had an unsuppressed viral load.…”

Section: Discussionsupporting

confidence: 58%

Safety and efficacy of Option B+ ART in Malawi: few severe maternal toxicity events or infant HIV infections among pregnant women initiating tenofovir/lamivudine/efavirenz

Harrington

DiPrete

Jumbe

et al. 2019

Tropical Med Int Health

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Objectives Malawi's Option B+ universal antiretroviral therapy (ART) program for pregnant and breastfeeding women does not include routine laboratory monitoring. We report safety outcomes of pregnant women who initiated ART through Option B+. Methods We analysed 12‐month data from an observational cohort study on Option B+ among women newly initiating tenofovir/lamivudine/efavirenz (TDF/3TC/EFV) at a government antenatal clinic in Lilongwe, Malawi. Proportions of women engaged in care, incidence of DAIDS grade ≥ 2 laboratory toxicity, grade ≥ 3 adverse events (AEs), viral suppression (<1000 copies/mL), birth outcomes and infant HIV infections are reported. Results At ART initiation, participants (n = 299) had a median age of 26 years (IQR 22–30), median CD4 count of 352 cells/μl (IQR 231–520) and 94% were in WHO Stage 1. We noted 76 incident DAIDS Grade ≥ 2 laboratory results among 58 women, most commonly elevated liver function tests (n = 30 events) and low haemoglobin (n = 27). No women had elevated creatinine. Clinical AEs (n = 45) were predominantly infectious diseases and Grade 3. Five participants (2%) discontinued TDF/3TC/EFV due to virologic failure (3) or toxicity (2). Twelve months after ART initiation, most women were engaged in care (89%) and had HIV RNA < 1000 copies/ml (90%). 8% of pregnancies resulted in preterm birth, 9% were low birthweight (<2500 g), and 2% resulted in infant HIV infection at 6 weeks post‐delivery. Conclusion Most women remained on ART and were virally suppressed 12 months after starting Option B+. Few infants contracted HIV perinatally. While some women experienced adverse laboratory events, clinical symptom monitoring is likely reasonable.

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Section: Discussionsupporting

confidence: 58%

Safety and efficacy of Option B+ ART in Malawi: few severe maternal toxicity events or infant HIV infections among pregnant women initiating tenofovir/lamivudine/efavirenz

Harrington

DiPrete

Jumbe

et al. 2019

Tropical Med Int Health

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“…This may be because all sites involved in our study had a PMTCT program. Studies have demonstrated that PMTCT programs increase HIV test rates during ante-natal care in pregnant women, promote uptake of antiretroviral drugs during pregnancy and promote HIV testing among HIV exposed infants [31][32][33][34]. We found that the percentage of contributions by age group to total children tested were closely aligned to the proportions contributed to total HIV positive found.…”

Section: Plos Onementioning

confidence: 57%

Increasing pediatric HIV testing positivity rates through focused testing in high-yield points of service in health facilities—Nigeria, 2016-2017

et al. 2020

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Background In 2017, UNAIDS estimated that 140,000 children aged 0-14 years are living with HIV in Nigeria, but only 35% have been diagnosed and are receiving antiretroviral therapy. Children are tested primarily in outpatient clinics, which show low HIV-positive rates. To demonstrate efficient facility-based HIV testing among children aged 0-14 years, we evaluated pediatric HIV-positivity rates in points of service in select health facilities in Nigeria. Methods We conducted a retrospective analysis of HIV testing and case identification among children aged 0-14 years at all points of service at nine purposively sampled hospitals (November 2016-March 2017). Points of service included family index testing, pediatric outpatient department (POPD), tuberculosis (TB) clinics, immunization clinics, and pediatric inpatient ward. Eligibility for testing at POPD was done using a screening tool while all children with unknown status were eligible for HIV test at other points of service. The main outcome was HIV positivity rates stratified by the testing point of service and by age group. Predictors of an HIV-positive result were assessed using logistic regression. All analyses were done using Stata 15 statistical software. Results Of 2,180 children seen at all facility points of service with unknown HIV status, 1,822 (83.6%) were tested for HIV, of whom 43 (2.4%) tested HIV positive. The numbers of children tested by age group were <1 years = 230 (12.6%); 1-4 years = 752 (41.3%); 5-9 years = 520 (28.5%); and 10-14 years = 320 (17.6%). The number of children tested by point of

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“…The National Evaluation of Malawi's PMTCT Programme (NEMAPP) study launched in 2014 to evaluate the effectiveness of Option B+ by enrolling HIV‐infected women and their infants at four to twenty‐six weeks postpartum and following them for 24 months. Within this nationally representative cohort, uptake of PMTCT services was very high: 97.8% of women knew their HIV status at enrolment and 96.3% of these were on ART . Here, we describe VL suppression rates, factors associated with VL suppression and MTCT ratios stratified by low‐detectable, undetectable and unsuppressed VL, at four to twenty‐six weeks postpartum among a sample of women enrolled in the NEMAPP study.…”

Section: Introductionmentioning

confidence: 97%

Low detectable postpartum viral load is associated with HIV transmission in Malawi's prevention of mother‐to‐child transmission programme

et al. 2019

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Introduction In 2011, Malawi implemented “Option B+,” a test‐and‐treat strategy for the prevention of maternal to child transmission of HIV (PMTCT); however limited data on viral load (VL) suppression exist. We describe VL suppression in HIV‐infected women at four to twenty‐six weeks postpartum, factors associated with VL suppression and the impact of VL suppression levels on MTCT. Methods HIV‐positive mothers at four to twenty‐six weeks postpartum were enrolled in a nested cross‐sectional study within the “National Evaluation of Malawi's PMTCT Programme” cohort study between October 2014 and May 2016. HIV‐exposed infants received HIV‐1 DNA testing and venous samples determined maternal VL, classified as unsuppressed (>1000 copies/mL), low‐detectable (40 to 1000 copies/mL) or undetectable (<40 copies/mL). Socio‐demographic and PMTCT indicators were collected. Suboptimal adherence was defined as self‐reported ≥2 days missed ART in the month prior to visit. Results Of the 1274 women, 1191 (93.5%) knew their HIV status and 1154/1191 (96.9%) were on ART. VL was available for 1124/1154 (97.4%) of women on ART: 988/1124 (87.9%) had VL suppression of whom 86 (8.7%) had low‐detectable and 902 (91.3%) undetectable VL. Suboptimal adherence was associated with unsuppressed VL (vs. suppressed VL; aOR 3.1, 95% CI 2.0 to 4.9; p < 0.001). Women with low‐detectable VL were more likely to be adolescent (vs. undetectable VL; aOR 3.0, 95% CI 1.4 to 6.6), on ART <6 months (aOR 4.4, 95% CI 2.3 to 8.6), report suboptimal adherence (aOR 2.1, 95% CI 1.1 to 3.8; p = 0.02), and less likely to have primary or secondary education (vs. none; aOR 0.3, 95% CI 0.2 to 0.7 or aOR 0.3, 95% 0.1 to 0.6). MTCT ratios among women on ART who had undetectable VL, low‐detectable VL and unsuppressed VL were 0.9% (8/902; 95% CI 0.3 to 1.5), 7.0% (6/86; 95% CI 1.5 to 12.5) and 14.0% (19/136; 95% CI 8.1 to 20.0). Unsuppressed VL and low‐detectable VL (vs. undetectable VL) increased the risk of MTCT 17‐fold (aOR 17.4, 95% CI 7.4 to 41.1; p = 0.002) and ninefold (aOR 8.5, 95% CI 2.9 to 25.2; p < 0.001). Conclusions Unsuppressed and low‐detectable VL was strongly predictive of MTCT among women on ART and associated with suboptimal adherence. This urges further consideration of optimal VL monitoring and target levels to reach elimination of paediatric infection.

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Prevention of mother-to-child transmission of HIV: a cross-sectional study in Malawi

Cited by 31 publications

References 20 publications

Safety and efficacy of Option B+ ART in Malawi: few severe maternal toxicity events or infant HIV infections among pregnant women initiating tenofovir/lamivudine/efavirenz

Safety and efficacy of Option B+ ART in Malawi: few severe maternal toxicity events or infant HIV infections among pregnant women initiating tenofovir/lamivudine/efavirenz

Increasing pediatric HIV testing positivity rates through focused testing in high-yield points of service in health facilities—Nigeria, 2016-2017

Low detectable postpartum viral load is associated with HIV transmission in Malawi's prevention of mother‐to‐child transmission programme

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