Progress towards Elimination of HIV Mother-to-Child Transmission in the Dominican Republic from 1999 to 2011

Abstract

In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999–2008 and 12/302 (4.0%) in 2009–2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003–2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.

Depression and Response to Antiretroviral Therapy in the Dominican Republic

“…However, such optimal immune response may be less likely in populations like ours where most patients initiated ART after profound immunosuppression. Because women have been offered HIV prenatal testing since 1999 in the DR even if asymptomatic [3] they were more likely to be diagnosed with HIV before severe immunosuppression than men, as reflected by their CD4 counts at ART initiation and CD4 count increases. However, this protective effect of female sex (and earlier ART initiation) declines among women with CSDS, suggesting that in persons who do not begin ART with severe immunosuppression, and may have a greater likelihood of optimal ART immune response [38] depression may impair their response to ART.…”

“…In the DR, rapid uptake of antiretroviral therapy (ART) has resulted in 78%-80% ART coverage for HIV-infected persons with CD4 + T-lymphocyte (CD4) counts less than 350 cells/ml (i.e., meeting criteria for ART for their own health). As in other low and middle-income countries advances associated with ART scale-up in the DR and the psychosocial challenges faced there have increased interest in improvement of other neglected healthcare services, including mental health [2][3][4][5][6][7][8][9].…”

The impact of expedited third trimester viral load testing on the proportion of vaginal deliveries in HIVpositive pregnant women in the Dominican Republic

“…Currently, approximately 72,000 individuals are living with HIV in the DR, yielding a prevalence of 0.9% in adults [2]. Although much progress has been made, mother-to-child (i.e., vertical) transmission of HIV remains significant, with approximately 1,300 children below the age of 15 living with HIV in the DR [2,3].…”

Short Communication: HIV-1 Subtype B in the Dominican Republic: Evolution and Molecular Epidemiology

“…In 1999, ART treatment was introduced in the DR to prevent MTCT and has been free of charge to all patients who qualify since 2003. 27,28 The scaled-up antiretroviral therapy, improved adherence to ART, and better health care provision post-1990 might have slowed the rate of HIV evolution.…”