Prevention of Mother-to-Child HIV Transmission in Nigeria: Six Years Experience from a Tertiary Institution

2021 ◽  
Vol 19 ◽  
Author(s):  
Rabiu Ibrahim Jalo ◽  
Taiwo Amole ◽  
Deepa Dongarwar ◽  
Hadiza Abdullahi ◽  
Fatima I. Tsiga-Ahmed ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Infection Rate ◽  
Hiv Transmission ◽  
Early Infant Diagnosis ◽  
Mixed Feeding ◽  
Hiv Exposed Infants ◽  
Early Infant ◽  
Antiretroviral Prophylaxis ◽  
Hiv Exposed ◽  
Mother To Child

Background: In line with global standards and progress made in Prevention of Mother-to-Child Transmission (PMTCT), an assessment of the outcome of Early Infant Diagnosis in northern Nigeria is necessary to evaluate progress towards a zero Human immunodeficiency Virus (HIV) infection rate among children. Objectives: This study assessed the infection rate and risk factors for mother-to-child HIV transmission among HIV-exposed children in Kano, northwest Nigeria. Method: Using a retrospective cohort design, pregnant HIV-positive women and their exposed infants were recruited over a period of six years (2010 to 2016). Participants were enrolled during pregnancy or at delivery from the PMTCT clinic of a tertiary health facility in Kano, Nigeria. The main observations of the study were Early infant diagnosis positivity for HIV at 6 weeks and the risk factors for positivity. Results: Of the 1,514 infants studied, Early Infant Diagnosis was positive for HIV among 13 infants (0.86%). Infants whose mothers did not have antiretroviral therapy (adjusted Prevalence Ratio aPR = 2.58, 95%CI [1.85- 3.57]); who had mixed feeding (aPR = 12.06, 95%CI [9.86- 14.70]) and those not on antiretroviral prophylaxis (aPR = 20.39, 95%CI [16.04- 25.71]) were more likely to be infected with HIV. HIV-exposed infants on nevirapine and zidovudine prophylaxis accounted for 95% and 74%, respectively, and were less likely to be infected with HIV. Conclusion: HIV infection rate remains high among HIV-exposed infants whose mothers did not receive PMTCT services. Scaling up proven interventions of early commencement of antiretroviral treatment for mothers, adherence to antiretroviral prophylaxis and avoidance of mixed feeding among HIV-exposed infants would protect future generations from HIV infection.

Factors associated with mother to child transmission of HIV despite overall low transmission rates in HIV-exposed infants in rural Kenya

2017 ◽  
Vol 28 (12) ◽  
pp. 1215-1223 ◽  
Author(s):  
Nicollate A Okoko ◽  
Kevin O Owuor ◽  
Jayne L Kulzer ◽  
George O Owino ◽  
Irene A Ogolla ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Hiv Transmission ◽  
Poor Adherence ◽  
Pmtct Service ◽  
Hiv Education ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Hiv Exposed Infants ◽  
Hiv Exposed ◽  
Mother To Child

Despite the availability of efficacious prevention of mother-to-child transmission (PMTCT) interventions and improved access to preventive services in many developing countries, vertical HIV transmission persists. A matched case–control study of HIV-exposed infants between January and June 2012 was conducted at 20 clinics in Kenya. Cases were HIV-infected infants and controls were exposed, uninfected infants. Conditional logistic regression analysis was conducted to determine characteristics associated with HIV infection. Forty-five cases and 45 controls were compared. Characteristics associated with HIV-infection included poor PMTCT service uptake such as late infant enrollment (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 2.6–16.7) and poor adherence to infant prophylaxis (OR: 8.3, 95%CI: 3.2–21.4). Maternal characteristics associated with MTCT included lack of awareness of HIV status (OR: 5.6, 95%CI: 2.2–14.5), failure to access antiretroviral prophylaxis (OR: 22.2, 95%CI: 5.8–84.6), and poor adherence (OR: 8.1, 95%CI: 3.7–17.8). Lack of clinic-based HIV education (OR: 7.7, 95%CI: 2.0–25.0) and counseling (OR: 8.3, 95%CI: 2.2–33.3) were reported by mothers of cases. Poor uptake of PMTCT services and a reported absence of HIV education and counseling at the clinic were associated with MTCT. More emphasis on high-quality, comprehensive PMTCT service provision are urgently needed to minimize HIV transmission to children.

scholarly journals Impact of a Maternal Prevention of Mother-to-child Transmission of HIV (PMTCT) Intervention on HIV-exposed Infants in Uganda

2020 ◽  
Vol 9 (3) ◽  
pp. 320-329
Author(s):  
Anays Murillo ◽  
Mary Bachman DeSilva ◽  
Lora L. Sabin ◽  
Nafisa Halim ◽  
Harriet Chemusto ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Global Health ◽  
Early Infant Diagnosis ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Hiv Exposed Infants ◽  
Early Infant ◽  
Hiv Test ◽  
Hiv Exposed ◽  
Mother To Child

Background: Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions. We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing. Methods: At two sites in Uganda, the Wise Infant Study (WIN) prospectively followed an infant cohort. Infants were born to women enrolled in an RCT testing the effect of real-time reminders delivered via EDM on maternal adherence to antiretroviral therapy. We assessed intrapartum and discharge receipt of NVP prophylaxis using pharmacy and infant HIV DNA testing laboratory data. Results: Of 121 women eligible for WIN, 97 (80%) consented and enrolled; 46 had been randomized to control and 51 to intervention. There were no differences in receipt of a six-week NVP supply (control 87%, intervention 82%, p = 0.53). Receipt of any NVP prophylaxis did not vary by delivery location (p = 0.35), and although 12% of infants were delivered at non-study health facilities, they were not less likely to receive NVP at discharge (p = 0.37). Among infants with a completed HIV test, there was no difference in mean time to first test (control 52 days (SD 18), intervention 51 days (SD 15), p = 0.86). Only one infant, in the control group, tested positive for HIV. Conclusion and Global Health Implications: We found no significant differences in adherence to infant PMTCT practices between intervention and control infants with relatively high rates of NVP receipt albeit with suboptimal adherence to six-week EID testing. Further work is needed to ensure improved access, uptake, and follow-up of HIV-exposed infants in the Option B+ era. Key words: • Prevention of maternal to child transmission of HIV • HIV • Nevirapine • Antiretroviral therapy prophylaxis • Early infant diagnosis • HIV-exposed infants   Copyright © 2020 Murillo et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals Early infant diagnosis and associated factors among HIV exposed infants in West Shoa Zone, Ethiopia: A mixed methods study

2020 ◽  
Author(s):  
Gurmesa Tura Debelew ◽  
Bontu Berhanu Fana ◽  
Mahilet Birhanu Habte
Keyword(s):  
Hiv Infection ◽  
Associated Factors ◽  
Qualitative Data ◽  
World Health ◽  
Early Infant Diagnosis ◽  
Hiv Exposed Infants ◽  
Early Infant ◽  
The World ◽  
The Status ◽  
Hiv Exposed

Abstract Background: The World Health Organization recommends testing of all HIV exposed infants at 4–6 weeks of age to optimize detection of intrauterine, intrapartum, and early postnatal HIV transmissions. However, the global coverage of early infant diagnosis remains low. With less than 25% national coverage, the progress of this early diagnosis in Ethiopia is one of the slowest in the World. Furthermore, local studies are limited to determine the status and identify the associated factors in many parts of the country in general and in West Shoa Zone in particular. Thus, this study aimed to fill this gap.Methods: A mixed method study by using retrospective record review of four years facility data of 342 mother-infant pairs supplemented by qualitative method was conducted in West Shoa Zone, Oromia Region, Ethiopia in 2018. The quantitative data related to maternal and HIV exposed infants’ cares were collected by using questionnaire. The qualitative data related to facility related barriers were collected by key-informants interview with selected mothers and service providers. Factors associated with early infant diagnosis of HIV infection were identified by using multivariable logistic regression analysis. The qualitative data were analyzed thematically and triangulated with the quantitative findings. Results: The status of early infant diagnosis was 58.5% (95%CI: 53.3%, 63.7%). Attending secondary education or above (AOR=2.41; 95%CI: 1.54, 3.28), having <4 living children (AOR=4.76, 95%CI: 02.56, 9.09), knowing HIV sero-status during or before pregnancy (AOR=6.24, 95%CI: 2.40, 10.08) and sero-status disclosure (AOR=8.30, 95%CI: 3.30, 20.60) were significantly associated with early infant diagnosis. Attending ANC visit (AOR=5.32; 95%CI: 2.53, 8.11), giving birth in health facility (AOR=62; 95%CI: 3.39, 11.85) and Neverapine provision at enrolment (AOR=6.05; 95%CI: 2.48, 14.73) were also significantly associated with early infant diagnosis of HIV infection.Conclusion: The status of early infant diagnosis in the study area is low to achieve the national target of 95% coverage by 2020. Maternal socio-demography, maternal behavior in knowing sero-status and disclosing and using services during pregnancy and delivery were among the determinants of early infant diagnosis. Promoting ANC and PMTCT cascade through behavioral interventions and fulfilling the essential equipments and supplies are required.

scholarly journals Assessment of PMTCT Success Rates Based on Antiretroviral Interventions and Feeding Options: A Prospective Cohort Study

2018 ◽  
Vol 7 (2) ◽  
pp. 226-234
Author(s):  
Kolawole A. Fasakin ◽  
Christopher T. Omisakin ◽  
Idowu O. Adebara ◽  
Wasiu A. Ajetunmobi ◽  
Adebayo A. Adeniyi ◽  
...  
Keyword(s):  
Pmtct Service ◽  
Early Infant Diagnosis ◽  
Mother To Child Transmission ◽  
Success Rates ◽  
Child Transmission ◽  
Hiv Exposed Infants ◽  
Early Infant ◽  
Hiv Exposed ◽  
Mother To Child ◽  
Hiv 1

Background: The success of any prevention of mother-to-child transmission (PMTCT) program is assessed by the proportion of HIV-exposed infants that sero-convert at the end of all risk exposures. Although adopting the best feeding option for HIV-exposed infants is one of the factors that impact PMTCT outcomes, there is limited data on the assessment of PMTCT success rates based on antiretroviral interventions and feeding options. This study assesses the success rate of PMTCT service based on antiretroviral interventions and feeding options. Methods: Eighty-five HIV-infected mothers previously in care were enrolled in a prospective cohort study. Folders and structured questionnaires were used to extract data on mother-infant pair and the first CD4, count of infected mothers on enrolment at PMTCT clinic. Dry blood spot samples were obtained from exposed infants for early infant diagnosis. Results were analyzed using the SPSS software. Results: The mean age of enrolled mothers was 31.3 ± 4.4 years, and an average CD4+ T-lymphocyte count of 368.6 ± 216.2 cells/µl. Seven (8.2%) of the HIV-exposed infants were positive for HIV-1 based on early infant diagnosis results. Overall PMTCT success rate (PMTCTSR) was 91.8%. HIV-1 prevalence of 5.0%, 0% and 21.1% was found among infants of patients who opted for breastfeeding, replacement feeding, and mixed feeding respectively thus yielding PMTCT success rates of 95%, 100% and 78.9%. Pediatric antiretroviral interventions success rates in HIV-exposed infants was 95.8%, 80.0% and 66.7% based on age groups ≤ 6 months, > 6 ≤ 12 months, and > 12 ≤ 18 months respectively. Conclusion and Global Health Implications: Quality PMTCT service is vital for successful prevention of mother-to-child transmission of HIV. Implementation of more dynamic approaches such as adherence to option B+ guidelines in PMTCT service in our settings can further reduce mother-to-child transmission of HIV and improve outcomes. Key words: Assessment, Antiretroviral Interventions, PMTCT, Success Rates, Feeding Options, Cohort  Copyright © 2018 Fasakin et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mother-to-child HIV-transmission prevention programs in a sub-Saharan African setting: The Gabonese experience

2017 ◽  
Vol 29 (3) ◽  
pp. 221-226 ◽  
Author(s):  
Armel Mintsa-Ndong ◽  
Corneille Ndong-Ella ◽  
Roselyne K Boussougou ◽  
Léatitia M Busugu ◽  
Alexandre Mba ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Antenatal Care ◽  
Hiv Transmission ◽  
Care Delivery ◽  
Hiv Positive ◽  
Hiv Exposed Infants ◽  
Hiv Positive Mothers ◽  
Sub Saharan ◽  
Hiv Exposed ◽  
Mother To Child

In many developing countries, mothers’ awareness remains a challenge despite the scaling up of antenatal care and programs preventing mother-to-child (MTC) HIV transmission. The present study was done in Libreville, Gabon where all antenatal care (delivery included) is free of charge. Here we assessed the timing of antenatal antiretroviral (ARV) prophylaxis initiation, HIV-exposed infants’ age at their first postnatal HIV check visit and investigated the association between mothers’ awareness or knowledge on their ARV therapy and infants’ HIV infection. We interviewed HIV-positive mothers on their first and subsequent laboratory visits to investigate infants’ HIV status and tested infants for HIV RNA and antibody between 2012 and 2014. We established that (1) of 718 HIV-positive mothers, only 6% were fully aware and knew what ARV treatment they were on during pregnancy; (2) half of the women (54%) start their antenatal ARV prophylaxis initiation during the second trimester of pregnancy; (3) 64% of HIV-exposed infants had their first HIV infection screening between birth and three months of age; (4) the overall prevalence of HIV infection in infants born from infected mothers was 8.9%; and (5) infants born from mothers uncertain about taking prophylactic ARV therapy were 13.3 times more likely to be infected by HIV than infants born from mothers certain about taking prophylactic ARV therapy. In conclusion, the study showed that despite free antenatal care, early access and adherence to components of MTC, HIV transmission preventive care remains unsatisfactory.

scholarly journals National-level effectiveness of ART to prevent early mother to child transmission of HIV in Namibia

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0233341
Author(s):  
Andrew Agabu ◽  
Andrew L. Baughman ◽  
Christa Fischer-Walker ◽  
Michael de Klerk ◽  
Nicholus Mutenda ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
National Level ◽  
Prevalence Ratio ◽  
Dried Blood Spots ◽  
Test Results ◽  
Hiv Diagnosis ◽  
Hiv Exposed Infants ◽  
Hiv Test ◽  
Hiv Exposed ◽  
Mother To Child

Background Namibia introduced the prevention of mother to child HIV transmission (MTCT) program in 2002 and lifelong antiretroviral therapy (ART) for pregnant women (option B-plus) in 2013. We sought to quantify MTCT measured at 4–12 weeks post-delivery. Methods During Aug 2014-Feb 2015, we recruited a nationally representative sample of 1040 pairs of mother and infant aged 4–12 weeks at routine immunizations in 60 public health clinics using two stage sampling approach. Of these, 864 HIV exposed infants had DNA-PCR HIV test results available. We defined an HIV exposed infant if born to an HIV-positive mother with documented status or diagnosed at enrollment using rapid HIV tests. Dried Blood Spots samples from HIV exposed infants were tested for HIV. Interview data and laboratory results were collected on smartphones and uploaded to a central database. We measured MTCT prevalence at 4–12 weeks post-delivery and evaluated associations between infant HIV infection and maternal and infant characteristics including maternal treatment and infant prophylaxis. All statistical analyses accounted for the survey design. Results Based on the 864 HIV exposed infants with test results available, nationally weighted early MTCT measured at 4–12 weeks post-delivery was 1.74% (95% confidence interval (CI): 1.00%-3.01%). Overall, 62% of mothers started ART pre-conception, 33.6% during pregnancy, 1.2% post-delivery and 3.2% never received ART. Mothers who started ART before pregnancy and during pregnancy had low MTCT prevalence, 0.78% (95% CI: 0.31%-1.96%) and 0.98% (95% CI: 0.33%-2.91%), respectively. MTCT rose to 4.13% (95% CI: 0.54%-25.68%) when the mother started ART after delivery and to 11.62% (95% CI: 4.07%-28.96%) when she never received ART. The lowest MTCT of 0.76% (95% CI: 0.36% - 1.61%) was achieved when mother received ART and ARV prophylaxis within 72hrs for infant and highest 22.32% (95%CI: 2.78% -74.25%) when neither mother nor infant received ARVs. After adjusting for mother’s age, maternal ART (Prevalence Ratio (PR) = 0.10, 95% CI: 0.03–0.29) and infant ARV prophylaxis (PR = 0.32, 95% CI: 0.10–0.998) remained strong predictors of HIV transmission. Conclusion As of 2015, Namibia achieved MTCT of 1.74%, measured at 4–12 weeks post-delivery. Women already on ART pre-conception had the lowest prevalence of MTCT emphasizing the importance of early HIV diagnosis and treatment initiation before pregnancy. Studies are needed to measure MTCT and maternal HIV seroconversion during breastfeeding.

scholarly journals Growth of HIV-exposed infants from birth to 6 months in the prevention of mother-to-child transmission program

2019 ◽  
Vol 59 (4) ◽  
pp. 183-7
Author(s):  
Maria Priskila ◽  
Ketut Dewi Kumarawati ◽  
Ni Putu Siadi Purniti
Keyword(s):  
Birth Weight ◽  
Hiv Infection ◽  
Distributed Data ◽  
Pmtct Program ◽  
Child Transmission ◽  
Post Hoc Analysis ◽  
Hiv Exposed Infants ◽  
Hiv Exposed ◽  
Post Hoc ◽  
Mother To Child

Background Human immunodeficiency virus (HIV) infection is a global health issue. Most cases of HIV infection in children are acquired through transmission from HIV-infected mothers. Maternal HIV infection affects infant  growth. Objective To evaluate the first six months of growth in HIV-exposed infants born to mothers in the prevention of mother-to-child transmission (PMTCT) program. Methods This prospective cohort study was done in 40 HIV-exposed infants born in Sanglah General Hospital, Bali. Subjects’ underwent weight and length measurements at birth and monthly for 6 months. Data analyses used were repeated ANOVA test with Bonferonni post-hoc analysis for normally distributed data and Friedman test with Wilcoxon post-hoc analysis for abnormally distributed data. Correlations between birth weight and length to weight and length at 6 months of age were analyzed with Spearman’s test. Results Subjects’ mean birth weight was 2,900 (SD 546) grams and median birth length was 48 (range 36-52) cm. Subjects’ body weight and length increased monthly throughout the measurement period (P<0.001). There was a strong negative correlation between birth weight and infant weight gain at 6 months of age (r=-0.678), and a moderate negative correlation between birth length and infant length gain at 6 months of age (r=-0.564). Conclusion HIV-exposed infants born to mothers in the PMTCT program have a significant body weight and body length growth in the first 6 months of life, and followed general WHO weight and length curves for age.

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