Trends and predictors of mother-to-child transmission of HIV in an era of protocol changes: Findings from two large health facilities in North East Nigeria

Abstract

BackgroundResearch studies have demonstrated a reduction in the risk of mother-to-child transmission of HIV (MTCT) to less than 2%, or 5% in non-breastfeeding and breastfeeding populations, respectively, with antiretroviral interventions. However, the risk of MTCT in routine health-facility settings, where service delivery is usually sub-optimal needs monitoring.MethodWe conducted a retrospective review of data from 2008–2014, in two health facilities in Adamawa State, Nigeria. Descriptive statistics were used to estimate overall MTCT rate and MTCT rate by year, and period of prevention of mother-to-child transmission of HIV (PMTCT) protocol implementation. We conducted simple and multiple logistic-regression analyses, to identify predictors of MTCT.ResultsData from 1,651 mother-to-infant pairs, with HIV deoxyribonucleic acid (DNA) polymerase-chain reaction (PCR) test results from 2008 (n = 49), 2009 (n = 246), 2010 (n = 280), 2011 (n = 335), 2012 (n = 290), 2013 (n = 225) and 2014 (n = 226) were analysed. The overall MTCT rate among HIV exposed infants (HEIs) was 9.7% (95% CI 8.3% - 11.1%) at a median age of 8 weeks (IQR = 6–20). The MTCT rate decreased from 14.3% (4.4%-24.2%) in 2008 to 4.9% (2.1%-7.7%) in 2014 (p = 0.016). The MTCT rate was the lowest (5.4% [3.7% - 7.0%]) when all pregnant women living with HIV received triple antiretroviral therapy, as treatment or prophylaxis (ARVT/P). Using the pooled data, we found that infant age, breastfeeding option, antiretroviral regimen and year were predictors of MTCT. The adjusted odds of MTCT were significantly higher, when neither mother nor HEI received ARVT/P (Adjusted odds ratio (AOR) 26.4 [14.0–49.8], and lower amongst infants born in 2012, compared with those born in 2008 (AOR 0.2 [0.0–1.0]).ConclusionThe MTCT rate declined significantly between 2008 and 2014 in these two routine health-facility settings in Nigeria. Our study suggests that ARVT/P yields the lowest MTCT. Thus, efforts to scale up lifelong ARVT/P (Option B+) in Nigeria should be accelerated.

Mother-to-child transmission of human immunodeficiency virus, hepatitis B virus and hepatitis C virus among pregnant women with single, dual or triplex infections of human immunodeficiency virus, hepatitis B virus and hepatitis C virus in Nigeria: A systematic review and meta-analysis

“…Three studies involving 433 participants reported on the MTCT rate of HBV in mother–infant pair with HBV mono-infection confirmed using PCR technique. 35 – 37 The MTCT rate for HBV were reported to be 42.86% by Onakewhor et al, 35 51.6% by Eke et al, 36 and 72.0% by Olaleye et al 37 among newborns at birth. The results of our meta-analysis revealed that the overall MTCT rates for HBV mono-infections as seen in the three included studies that reported on HBV mono-infections was 55.49% (95% CI: 35.93%–75.04%; 433 participants; three studies, I 2 = 100%; p-value < 0.001) ( Figure 4 ).…”

The impact of Option B+ on mother‐to‐child transmission of HIV in Africa: A systematic review

“…Data published in a retrospective review did not specifically identify the protocols used in Nigeria as being Option B+. Regardless, a marked decrease in MTCT from 2008 (14.3%) to 2014 (4.9%) was reported 54 . More recent data from the north central zone reported an MTCT rate of 11.4% in infants at age 20 months or older.…”

“…Regardless, a marked decrease in MTCT from 2008 (14.3%) to 2014 (4.9%) was reported. 54 More recent data from the north central zone reported an MTCT rate of 11.4% in infants at age 20 months or older. Only 54.5% of mothers received ART medication prior to pregnancy.…”

Thirty-five years (1986–2021) of HIV/AIDS in Nigeria: bibliometric and scoping analysis

“…The current discussions are on mapping current epidemiology, administration of antiretroviral therapy and the prevention of mother-to-child-transmission of HIV. For instance, there have been varying current discussions on trends, predictors, spatial patterns, knowledge and the reduction of mother-to-child transmission of HIV in Nigeria [46][47][48][49][50]. Often, the first response to an epidemic is to characterize the disease followed by diagnosis and possible means of amelioration/cure.…”