Low rates of mother-to-child HIV transmission in a routine programmatic setting in Lilongwe, Malawi

Autor: Peter N. Kazembe, Elizabeth Y. Chiao, Thomas P. Giordano, Avni M. Bhalakia, Maria H. Kim, Debora Nanthuru, Mary E. Paul, Saeed Ahmed, Geoffrey A. Preidis, Elaine J. Abrams, Mina C. Hosseinipour
Rok vydání: 2012
Předmět:
Malawi
Non-Clinical Medicine
medicine.medical_treatment
Premedication
lcsh:Medicine
HIV Infections
Global Health
Pediatrics
law.invention
law
Pregnancy
Risk Factors
Young adult
lcsh:Science
Community Health Workers
education.field_of_study
Multidisciplinary
Obstetrics
Child and Adolescent Health Policy
Child Health
virus diseases
HIV diagnosis and management
Transmission (mechanics)
Medicine
Infectious diseases
Female
Health Services Research
Public Health
Infants
Research Article
Adult
medicine.medical_specialty
Anti-HIV Agents
Population
HIV prevention
Viral diseases
Microbiology
Young Adult
Virology
medicine
Humans
education
Biology
Retrospective Studies
Assisted reproductive technology
Health Care Policy
business.industry
Public health
lcsh:R
Infant
Newborn
Infant
HIV
Retrospective cohort study
medicine.disease
Infectious Disease Transmission
Vertical
CD4 Lymphocyte Count
Regimen
Immunology
lcsh:Q
business
Viral Transmission and Infection
Zdroj: PLoS ONE
PLoS ONE, Vol 8, Iss 5, p e64979 (2013)
ISSN: 1932-6203
Popis: Background The Tingathe program utilizes community health workers to improve prevention of mother-to-child transmission (PMTCT) service delivery. We evaluated the impact of antiretroviral (ARV) regimen and maternal CD4+ count on HIV transmission within the Tingathe program in Lilongwe, Malawi. Methods We reviewed clinical records of 1088 mother-infant pairs enrolled from March 2009 to March 2011 who completed follow-up to first DNA PCR. Eligibility for antiretroviral treatment (ART) was determined by CD4+ cell count (CD4+) for women not yet on ART. ART-eligible women initiated stavudine-lamivudine-nevirapine. Early ART was defined as ART for ≥14 weeks prior to delivery. For women ineligible for ART, optimal ARV prophylaxis was maternal AZT ≥6 weeks+sdNVP, and infant sdNVP+AZT for 1 week. HIV transmission rates were determined for ARV regimens, and factors associated with vertical transmission were identified using bivariate logistic regression. Results Transmission rate at first PCR was 4.1%. Pairs receiving suboptimal ARV prophylaxis were more likely to transmit HIV (10.3%, 95% CI, 5.5–18.1%). ART was associated with reduced transmission (1.4%, 95% CI, 0.6–3.0%), with early ART associated with decreased transmission (no transmission), compared to all other treatment groups (p = 0.001). No association was detected between transmission and CD4+ categories (p = 0.337), trimester of pregnancy at enrollment (p = 0.100), or maternal age (p = 0.164). Conclusion Low rates of MTCT of HIV are possible in resource-constrained settings under routine programmatic conditions. No transmissions were observed among women on ART for more than 14 weeks prior to delivery.
Databáze: OpenAIRE
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