Reducing mother-to-child transmission of HIV: findings from an early infant diagnosis program in south-south region of Nigeria

FHI 360, Nigeria, Plot 1073 J,S Tarka Street, Area 3 Garki Abuja.
BMC Public Health (Impact Factor: 2.26). 03/2012; 12(1):184. DOI: 10.1186/1471-2458-12-184
Source: PubMed


Early diagnosis of HIV in infants provides a critical opportunity to strengthen follow-up of HIV-exposed children and assure early access to antiretroviral (ARV) treatment for infected children. This study describes findings from an Early Infant Diagnosis (EID) program and the effectiveness of a prevention of mother-to-child transmission (PMTCT) intervention in six health facilities in Cross-River and Akwa-Ibom states, south-south Nigeria.
This was a retrospective study. Records of 702 perinatally exposed babies aged six weeks to 18 months who had a DNA PCR test between November 2007 and July 2009 were reviewed. Details of the ARV regimen received to prevent mother-to-child transmission (MTCT), breastfeeding choices, HIV test results, turn around time (TAT) for results and post test ART enrolment status of the babies were analysed.
Two-thirds of mother-baby pairs received ARVs and 560 (80%) babies had ever been breastfed. Transmission rates for mother-baby pairs who received ARVs for PMTCT was 4.8% (CI 1.3, 8.3) at zero to six weeks of age compared to 19.5% (CI 3.0, 35.5) when neither baby nor mother received an intervention. Regardless of intervention, the transmission rates for babies aged six weeks to six months who had mixed feeding was 25.6% (CI 29.5, 47.1) whereas the transmission rates for those who were exclusively breastfed was 11.8% (CI 5.4, 18.1). Vertical transmission of HIV was eight times (AOR 7.8, CI: 4.52-13.19) more likely in the sub-group of mother-baby pairs who did not receive ARVS compared with mother-baby pairs that did receive ARVs. The median TAT for test results was 47 days (IQR: 35-58). A follow-up of 125 HIV positive babies found that 31 (25%) were enrolled into a paediatric ART program, nine (7%) were known to have died before the return of their DNA PCR results, and 85 (67%) could not be traced and were presumed to be lost-to-follow-up.
Reduction of MTCT of HIV is possible with effective PMTCT interventions, including improved access to ARVs for PMTCT and appropriate infant feeding practices. Loss to follow up of HIV exposed infants is a challenge and requires strategies to enhance retention.

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    • "This reflects the low usage of ANC service utilization hence only 234(54.9%) of them didn’t receive any PMTCT prophylaxis by the mother and those mother whose didn’t have ANC follow up were five times more likely to have HIV sero positivity infant than those mother who had ANC visits. Similar studies have shown that in Nigeria, seventy-three mother-baby pairs were not opportune to get ARV prophylaxis and 39 babies were PCR-positive (53.4%) [19] and patient attrition along with the lower ANC attendance rate of 58% observed in Nigeria, is likely to contribute to the suboptimal uptake of ARV prophylaxis for PMTCT [20]. In contrary to this, PMTCT ANC services are feasible in resource limited settings whereby 80% of ANC attendees accepted the HIV test and a majority of the HIV positive women commenced ARV prophylaxis [21,22]. "
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    ABSTRACT: Background: Preventing mother-to-child transmission (PMTCT) of human immunodeficiency virus infection (HIV) has been a fundamental advancement in the acquired immunodeficiency syndrome (AIDS) response for the past decade. Several countries have made great strides in the efforts to prevent HIV through mother-to-child transmission. The objective of this study is to assess the determinant and outcome of early diagnosis of HIV infection among HIV-exposed infants in southwest Ethiopia. Methods: An institutional based retrospective cohort study was conducted in a hospital. Medical records of HIV-exposed infants and their mothers enrolled into the program were reviewed. Data entry and analysis was carried out using SPSS version 20 for Windows. Results: A total of 426 HIV exposed infant-mother pairs where both mother and infants received a minimum ARV intervention for PMTCT were included in the study. Two hundred fifty-four (59.6%) of mothers had attended antenatal care (ANC). Of all participants, 234(54.9%) mothers did not receive any PMTCT prophylaxis during ANC, while only 104(24.4) received antiretroviral (ART) as PMTCT prophylaxis and 163(38.3%) claimed that did not observe any infant PMTCT interventions while 135(31.7%) of the infants received single-dose NVP + AZT. About 385(90.4%) infants were not infected at their final infection status. Those mothers who did not attended ANC follow-up, infants on mixed and complementary feeding and infants weaned off and mothers who were in WHO clinical stage III and IV were more likely to have HIV sero positive infant. Conclusion: This study showed that 385(90.4%) of the infants were not infected at their final infection status. Therefore, encouraging pregnant women to visit health facilities during their course of pregnancy, focusing on exclusive breast feeding counseling and promotion, and early initiation of antiretroviral treatment to HIV infected pregnant women are recommend.
    BMC Research Notes 05/2014; 7(309). DOI:10.1186/1756-0500-7-309
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    • "A sizable number of infected individuals do not get the treatment they need, including the 95% of HIV-positive pregnant women who do not receive prevention of mother-to-child transmission (PMTCT) services, the 73,000 children born infected annually, and the 750,000 individuals in need of antiretroviral therapy who do not receive it [6]. Further, the largest contributor to the global mother-to-child transmission of HIV burden is Nigeria [7]. "
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    ABSTRACT: More than three million people in Nigeria are living with HIV/AIDS. In order to reduce the HIV/AIDS burden in Nigeria, the US Government (USG) has dedicated significant resources to combating the epidemic through the President's Emergency Plan for AIDS Relief (PEPFAR). In-service training (IST) of health workers is one of the most commonly used strategies to improve the quality and coverage of HIV/AIDS services. At USAID/Nigeria's request, the USAID-funded CapacityPlus project conducted an assessment of PEPFAR-funded IST for all cadres of health workers in Nigeria. Using the IST Improvement Framework, developed by the USAID Applying Sciences to Strengthen and Improve Systems Project (ASSIST), as a guide, the authors developed a survey tool to assess the efficiency, effectiveness and sustainability of IST provided between January 2007 and July 2012 by PEPFAR-funded implementing partners in Nigeria. The instrument was adapted to the Nigerian context and refined through a stakeholder engagement process. It was then distributed via an online platform to more than 50 PEPFAR-funded implementing partners who provided IST in Nigeria. A total of 39 implementing partners completed the survey. Our survey found that PEPFAR implementing partners have been providing a wide range of IST to a diverse group of health workers in Nigeria since 2007. Most trainings are developed using national curricula, manuals and/or other standard operating procedures. Many of the partners are conducting TNAs to inform the planning, design and development of their training programs. However, the assessment also pointed to a number of recommendations to increase the efficiency, effectiveness and sustainability of PEPFAR-funded IST. These actions are as follows: improve collaboration and coordination among implementing partners; apply a more diverse and cost-effective set of training modalities; allocate funding specifically for the evaluation of the effectiveness of training; improve links between IST and both continuing professional development and pre-service education; require implementing partners to create sustainability plans to transition training from PEPFAR funding to other funding sources; and develop a training information management system to track key aspects of IST, such as the number and types of providers, courses, and participants of PEPFAR-funded IST.
    Human Resources for Health 04/2014; 12(1):20. DOI:10.1186/1478-4491-12-20 · 1.83 Impact Factor
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    • "suggesting that prolonged exposure to breastfeeding and particularly mixed feeding is likely to have affected HIV transmission rates for infants taking the DNA PCR test at a later date compared with those who had the test before 6 months. These findings are consistent with those of Illif et al. in Zimbabwe and Anoje et al. in Nigeria [27, 28]. Indeed, mixed feeding by HIV-infected mother, when compared to exclusive breastfeeding and replacement feeding has been shown to be associated with an increased risk of HIV transmission [29]. "
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    ABSTRACT: Early diagnosis of HIV is crucial to ensure early antiretroviral (ARV) treatment which is associated with lower mortality in HIV-infected children. This study reports the prevalence of HIV infection and the factors associated to mother-to-child transmission (MTCT) in an Early Infant Diagnosis (EID) program in Bertoua, Cameroon. We reviewed the records of 112 HIV-exposed infants aged six weeks to 18 months who had an HIV-1 DNA PCR test done in 2010. Data included socio-demographic characteristics, clinical manifestations of HIV, ARV prophylaxis, feeding options and results of the PCR tests. The median age at first HIV testing was 4 months (IQR, 2-7). Ninety-one point one percent of infants and 65.2% of mothers did not receive ARV prophylaxis. Fifty infants (44.6%) were exclusively breastfed, 37 (33%) received formula feeding and 25 (22.4%) received mixed feeding. The prevalence of HIV in the infants was 11.6%. MTCT of HIV was significantly associated with mixed feeding (adjusted odds ratio (aOR): 6.7, 95% CI 1.6-28.3; p=0.009) and an age at 1st PCR test greater than 6 months (aOR: 6.5, 95% CI 1.4-29.3; p=0.014). The mothers of 66.1% of the infants tested returned to collect the result. There is a high rate of MTCT of HIV in this setting, due to a poor implementation of the PMTCT program. There is a critical need to increase the use of ARV prophylaxis, and to improve rapid first testing and completion of the EID. The infant feeding practices also have to be improved.
    Pan African Medical Journal 06/2013; 15:65. DOI:10.11604/pamj.2013.15.65.2551
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