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 |
Externí odkaz: |